Accurate localization of deep brain stimulation electrode contacts using extended Hounsfield unit computed tomography.

Naomi I Kremer, Arjen L J van Hulzen, Katalin Tamasi, D L Marinus Oterdoom, Gea Drost, Teus van Laar, J Marc C van Dijk

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Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Naomi I KremerDepartment of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. n.i.kremer@umcg.nl.ORCID http://orcid.org/0000-0002-7818-0318

Arjen L J van HulzenDepartment of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Katalin TamasiDepartment of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

D L Marinus OterdoomDepartment of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Gea DrostDepartment of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Teus van LaarDepartment of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

J Marc C van DijkDepartment of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Funding

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6 · The paper itself

Abstract

objectivesAccurate localization of deep brain stimulation (DBS) electrodes is critical for effective therapy. Conventional CT is widely used postoperatively but fails to delineate individual electrode contacts due to metallic artifacts. This study aimed to evaluate extended Hounsfield unit (EHU) CT - using an expanded scale up to 40,000 HU- for accurate localization of individual DBS electrode contacts. MATERIALS AND

methodsThis retrospective study included 29 patients (58 DBS electrodes) who underwent DBS implantation. Postoperative imaging comprised both conventional CT and EHU-CT reconstructions. Two independent raters localized electrode contacts using a standardized protocol. Inter-method and inter-rater agreement were quantified using intraclass correlation coefficients (ICCs) and Euclidean distances. Qualitative assessments of contact visibility were also performed.

resultsQuantitative analysis showed near-perfect agreement between EHU-CT and conventional CT (ICC ≈ 1), with high inter-rater consistency. However, qualitative evaluation revealed superior contact visualization with EHU-CT: all contacts were clearly identifiable in 100% of cases, while conventional CT consistently failed to distinguish individual contacts due to blooming artifacts. Conventional CT localizations were also sensitive to window-level adjustments, particularly along the z-axis.

conclusionEHU-CT enables consistent and direct visualization of individual DBS contacts and provides a robust alternative to conventional CT. Its reduced sensitivity to display settings and improved interpretability may enhance intra-operative decision-making and postoperative programming, supporting more reliable DBS workflows. KEY POINTS: Question Accurate deep brain stimulation (DBS) electrode localization is crucial for optimal intra-operative adjustments and outcomes, yet conventional CT is hindered by metallic artifacts limiting individual contact visualization. Findings Extended Hounsfield unit (EHU)-CT and conventional CT showed near-perfect agreement in electrode localization, but EHU-CT provided clearly superior visualization of individual electrode contacts. Clinical relevance By enabling direct visualization of individual contacts through an extended Hounsfield scale, EHU-CT can improve intra-operative decision-making and postoperative programming, potentially enhancing DBS localization accuracy and patient outcomes.

Indexed as

BrainDeep Brain StimulationElectrodes, ImplantedTomography, X-Ray ComputedAdultAgedArtifactsFemaleHumansMaleMiddle AgedRetrospective StudiesArtifactsDeep brain stimulationMovement disordersTomography (x-ray computed)

Identifiers

PMID41420706

DOI10.1007/s00330-025-12179-8

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