State-of-the-Art Imaging and Localization Assessment in Post-Operative Deep Brain Stimulation for Parkinson's Disease: A Review.

backgroundDeep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD), dependent on precise electrode placement relative to intended anatomical and functional targets. Post-operative imaging, primarily magnetic resonance imaging (MRI) and computed tomography (CT), is essential for verifying lead position, assessing surgical accuracy, and guiding stimulation programming. SUMMARY: Most centers perform imaging within the first week after surgery, typically using CT or MRI-CT fusion to confirm electrode location and detect complications. CT offers submillimeter resolution (slice thickness 0.5-1.25 mm; voxel ∼0.5 mm) for clear electrode visualization, while MRI (particularly T1-MPRAGE, T2-FLAIR, and GRE sequences) provides superior anatomical contrast and artifact characterization. KEY MESSAGES: Registration between pre- and post-operative scans remains the predominant localization technique, though automated pipelines such as Lead-DBS, Brainlab Elements™, SureTune4™ now achieve consistent precision within ±0.5-1.5 mm across platforms. This review summarizes current post-operative imaging strategies and quantitative localization techniques in DBS for PD. It discusses the advantages and limitations of each modality and outlines future directions in automation, multimodal integration, and personalized imaging pipelines for improving the accuracy, reproducibility, and clinical utility of post-operative DBS assessment.