Imaging of the centromedian thalamic nucleus using 3D fast gray matter acquisition T1 inversion recovery sequence in 3T MRI in epilepsy

Tunchanok  Paprad; Thanyachat  Yutthakasaemsan; Supada  Prakkamakul

Authors

Tunchanok Paprad Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Thanyachat Yutthakasaemsan Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Supada Prakkamakul Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Keywords:

Centromedian thalamic nucleus, epilepsy, fast gray matter acquisition T1 inversion recovery, magnetic resonance imaging, thalamus

Abstract

Background: The centromedian thalamic nucleus (CM) is an emerging deep brain stimulation (DBS) target for neurological disorders, including drug-resistant epilepsy. Traditional DBS localization relies on predefined stereotactic coordinates, which may be imprecise. Innovative magnetic resonance imaging (MRI) sequences enhance gray–white matter contrast, potentially allowing direct CM visualization and improving accuracy in DBS planning and targeting.

Objective: This study evaluated the 3D fast gray matter acquisition T1 inversion recovery (FGATIR) MRI sequence for visualizing the CM in patients with epilepsy.

Methods: This prospective IRB-approved descriptive study included adult patients with epilepsy who underwent a 3D FGATIR MRI sequence at 3 Tesla. Two neuroradiologists independently assessed CM visualization using qualitative grading and quantitative measurements of signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) of the CM and three neighboring nuclei. These nuclei included the mediodorsal (MD), medial pulvinar (PuM), and ventrolateral (VL) nuclei in each thalamus. Interobserver agreement for quantitative assessment was evaluated with the intraclass correlation coefficient (ICC).

Results:A total of 16 patients with epilepsy (mean age 42.8 ± 21.3 years, 44.0% male) were included. Qualitative assessment revealed good CM visualization in 84.0% and poor CM visualization in 16.0% of cases. Mean signal intensities and SNRs differed significantly between the CM and other neighboring thalamic nuclei (P < 0.001). CNRs of the CM relative to the MD, PuM, and VL varied across the thalami. Interobserver agreement was excellent, with ICC > 0.96 for all measurements.

Conclusion: The 3D FGATIR MRI sequence is a practical tool to visualize the CM. Its adoption in clinical practice could potentially improve DBS planning.

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