Diffusion Tensor Imaging to Aid Subgenual Cingulum Target Selection for Deep Brain Stimulation in Depression

Background: The most investigated target for deep brain stimulation in depression is the subgenual cingulate gyrus (Cg25) which has been shown to be a critical hub for signalling in the condition. Diffusion tensor imaging (DTI) is a form of MR sequence that can visualise white matter connections and potentially aid target selection. Objectives: To assess whether targets selected using DTI to find the area of maximal tract crossover (maximal isotropy) underlying the subgenual cingulum differ significantly in location from those selected using standard T-2 sequences. Methods: Fifty-nine non-depressed adult volunteers underwent MR imaging using T-1, T-2 and DTI sequences of the brain. Each patient had targets selected for both hemispheres using both T-2 and DTI sequences. The significance of the differences in coordinates in all three dimensions was tested using the paired t test. Results: There was a significant difference in the mediolateral (x) and dorsoventral (z) coordinates of DTI targets when compared with T-2 targets (p < 0.001). Conclusions: Targets within Cg25 selected using DTI are significantly different in location from those selected using T 2 sequences and have the potential to enhance treatment outcome by reducing the impact of interindividual variability. Copyright (C) 2012 S. Karger AG, Basel