Ces radiol. 2025, 79(3):188-195 | DOI: 10.55095/CesRadiol2025/026

Imaging Techniques in Deep Brain Stimulation: A Review of Preoperative, Intraoperative, and Postoperative Applications

Šimon Janovič¹, Samuel Hollý^{3, 4}, Alice Kušnírová¹, Michal Kľoc², Tomáš Harag², Marek Chmelík^{3, 5}, Zuzana Košutzká¹

¹ 2nd Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia

² nd Department of Neurology, Faculty of Medicine Comenius University and University Hospital Bratislava

³ JESSENIUS Diagnostic Center, Nitra, Slovakia

⁴ Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic

⁵ Department of Medical-Technical Disciplines, Faculty of Health Care, University of Prešov, Prešov, Slovakia Corresponding adrress:

Deep brain stimulation (DBS) has over the years established as an effective and safe treatment for various neurological and psychiatric disorders, such as Parkinson’s disease, essential tremor, dystonia, etc. With the advancement of this therapy, imaging techniques have gained crucial importance in all phases of treatment – from patient selection and surgical planning, through intraoperative electrode placement, to postoperative monitoring and stimulation programming. In the preoperative phase, magnetic resonance imaging (MRI) plays a fundamental role in visualizing brain structures, identifying contraindications, and planning the procedure. Advanced MRI techniques, such as diffusion imaging and tractography, enable assessment of brain structural connectivity and allow treatment to be tailored to individual symptoms. These approaches support a new perspective on neurological disorders – not as diseases of isolated structures, but of neural circuits. During DBS electrode implantation, imaging ensures precise placement – either through direct anatomical targeting with MRI or via position verification using CT or X-ray. Postoperatively, CT scanning is crucial in assessing electrode placement accuracy and identifying complications such as ischemia, hemorrhage, or pneumocephalus. Advances in information technology have enabled the development of software tools for imaging data analysis in DBS. Among the most widely used are the open-source tool Lead-DBS, and certified platforms such as SureTune™ (Medtronic) and GUIDE™ XT (Boston Scientific). These systems allow for reconstruction of electrode placement, calculation of the volume of activated tissue, and visualization of stimulation fields. Some also enable connectome and brain network analysis, supporting personalized, network-oriented stimulation settings and thereby significantly improving DBS therapy precision and effectiveness.

Keywords: deep brain stimulation, neuroimaging, Parkinson disease.

Accepted: August 31, 2025; Published: December 1, 2025  Show citation