Precision of Post-operative Localization of Deep Brain Stimulation Electrodes - Comparative Software Accuracy Assessment

Aug 25, 2026

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Study evaluates the precision of post-operative localization tools for deep brain stimulation (DBS) electrodes in Parkinson’s disease. Pre- and post-implant T1-weighted MRI scans from 105 patients were processed with Lead-DBS, SureTune4, and Brainlab pipelines. Euclidean distances between active contacts, repeated across operators, were computed, and Dice coefficients assessed overlap of volume of tissue activated (VTA) in Lead-DBS. Inter-software medians were 1.5–2 mm, while within-software intra- and interrater distances were 0.6–1 mm and 1–1.7 mm. VTA Dice medians were 0.78 and 0.75, respectively, and clinical use requires careful output review.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Precision of post-operative localization of DBS electrodes

Comparative methods across software packages

Euclidean distance and VTA overlap results

Clinical implications and review requirement

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Precision of post-operative localization of deep brain stimulation electrodes Andrej Lasica1, Pavel Filip1,2, Kristína Burdová1, Josef Mana1, Filip Růžička1, Dušan Urgošík3, Karsten Mueller1,4, Dimitra Kiakou1,4 & Robert Jech1􀀍 Tools for post-operative localization of deep brain stimulation (DBS) electrodes may be of major benefit in the evaluation of the stimulation area. However, little is known about their precision. This study compares 3 different software packages used for DBS electrode localization. T1-weighted MRI images before and after the implantation of the electrodes into the subthalamic nucleus for DBS in 105 Parkinson’s disease patients were processed using the pipelines implemented in Lead-DBS, SureTune4, and Brainlab. Euclidean distance between active contacts determined by individual software packages and in repeated processing by the same and by a different operator was calculated. Furthermore, Dice coefficient for overlap of volume of tissue activated (VTA) was determined for Lead-DBS. Medians of Euclidean distances between estimated active contact locations in inter-software package comparison ranged between 1.5 mm and 2 mm. Euclidean distances in within-software package intra-and interrater assessments were 0.6–1 mm and 1–1.7 mm, respectively. Median intra-and inter-rater Dice coefficients for VTAs were 0.78 and 0.75, respectively. Since the median distances are close to the size of the target nucleus, any clinical use should be preceded by careful review of the outputs. Keywords Deep brain stimulation, Parkinson’s disease, Neuroimaging, Magnetic resonance imaging, Subthalamic nucleus, Electrode localization, Software comparison Abbreviations DBS Deep brain stimulation STN Subthalamic nucleus T1w T1-weighted T2w T2-weighted MRI Magnetic resonance imaging VTA volume of tissue activated ANTs Advanced normalization tools AC-PC Anterior commissure–posterior commissure MCP Mid commissural point LDBS Lead-DBS Deep brain stimulation (DBS) is an established treatment of various neuropsychiatric disorders, most commonly Parkinson’s disease, dystonia, and essential tremor. Various DBS targets are utilized depending on the diagnosis. For Parkinson’s disease, DBS is implanted in the subthalamic nucleus (STN); the globus pallidus internus is utilized in dystonia, and the ventral intermediate nucleus of the thalamus in essential tremor1. The correct final position of the implanted electrode is essential for successful therapy. Extensive preoperative preparation is therefore required, including the acquisition of various structural Magnetic Resonance Imaging (MRI) images to precisely locate the target structure and insertion trajectory. Despite the many difficulties associated with planning and the surgical procedure itself, a mere “hit” of the target structure may not be fully sufficient toelicit the coveted clinical effects. Different parts of the nuclei can be associated with a different profile of adverse effects, efficacy, and therapeutic window2–4. Consequently, multiple tools were developed for post-operative localization of the DBS leads and the estimation of the volume of tissue activated (VTA) based on the stimulation position and settings. Currently, 1Department of Neurology, First Faculty of Medicine, General University Hospital in Prague, Charles University, Kateřinská 30, 120 00 Prague, Czech Republic. 2Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA. 3Department of Radiology, Na Homolce Hospital, Prague, Czech Republic. 4Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. 􀀍 [email: jech@cesnet.cz](email: jech@cesnet.cz) [www. nature.com/scientificreports/](www. nature.com/scientificreports/) | | | Count | | --- | --- | --- | | Age (years) | 58.5 [8 .25] | 105 | | Disease duration (years) | 14.68 [5 .9] | 98 | | Sex (coun

FAQs

How was electrode localization precision evaluated in this study?

T1-weighted MRI scans before and after DBS implantation were processed with three software packages, then Euclidean distances between estimated active contacts and Dice coefficients for VTA overlap were calculated.

What were the main distance results across software packages?

Inter-software median Euclidean distances between active contact locations ranged from 1.5 mm to 2 mm.

How did operator variability affect the measurements?

Within the same software package, intra-rater and inter-rater Euclidean distances were 0.6–1 mm and 1–1.7 mm, respectively, with VTA Dice medians of 0.78 and 0.75.

Aug 25, 2026

Upload by Quinn