Objective: To assess the viability and accuracy of visual estimation in determining directional deep brain stimulation (DBS) lead orientation.

Background: Directional DBS leads show large deviations from their intended implantation orientation [1]. The postoperative determination of actual lead orientation has become an important prerequisite for imaging-guided DBS programming as well as research applications. The accuracy of visual estimation from postoperative CT scans has yet to be explored.

Method: Within two software frameworks (Lead-DBS (DiODe v2 [2]) and a commercial tool for visual DBS programming (GXT)) lead orientation angles of 150 directional DBS leads were determined based on postoperative CT scans by automatic detection and by visual estimation following a defined procedure focusing on the configuration of the lead marker artifacts.

Results: Automatic lead orientation detection with GXT was not possible in 16% of cases (24/150) and resulted in a symmetry related direction error (~180° deviation) in 1.6% of the remaining cases (2/126), while automatic lead orientation detection with DiODE was successful and without symmetry related errors in 100% of cases. The average absolute difference in the projected angle between automatic detection and visual estimates was 6.27 ± 6.46° (range: 0.03 – 36.31; Pearson’s R = 0.98, p < 0.001) for DiODe and 5.3 ± 6.09° (range: 0.04 – 39.83; Pearson’s R = 0.98, p < 0.001). The average difference between DiODe and GXT was 7.26 ± 6.83° (range: 0.002 – 38.06; Pearson’s R = 0.97, p < 0.001). The average difference between the automatic and visual approach did not differ between DiODe and GXT (t(272) = 1.27, p = 0.2).

Conclusion: Visual estimation can be considered a viable option for determining directional DBS lead orientation and might be helpful for quality control and as a salvage strategy for imaging-guided DBS programming and research applications.

References: [1] Dembek TA, Hoevels M, Hellerbach A, Horn A, Petry-Schmelzer JN, Borggrefe J, et al. Directional DBS leads show large deviations from their intended implantation orientation. Parkinsonism & Related Disorders 2019;67:117–21. https://doi.org/10.1016/j.parkreldis.2019.08.017.
[2] Dembek TA, Hellerbach A, Jergas H, Eichner M, Wirths J, Dafsari HS, et al. DiODe v2: Unambiguous and Fully-Automated Detection of Directional DBS Lead Orientation. Brain Sci 2021;11:1450. https://doi.org/10.3390/brainsci11111450.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/viability-and-accuracy-of-visual-estimation-in-determining-directional-deep-brain-stimulation-lead-orientation/