Abstract
PURPOSE: Template-based segmentation techniques have been developed to facilitate the accurate targeting of deep brain structures in patients with movement disorders. Three template-based brain MRI segmentation techniques were compared to determine the best strategy for segmenting the deep brain structures of patients with Parkinson's disease. METHODS: T1-weighted and T2-weighted magnetic resonance (MR) image templates were created by averaging MR images of 57 patients with Parkinson's disease. Twenty-four deep brain structures were manually segmented on the templates. To validate the template-based segmentation, 14 of the 24 deep brain structures from the templates were manually segmented on 10 MR scans of Parkinson's patients as a gold standard. We compared the manual segmentations with three methods of automated segmentation: two registration-based approaches, automatic nonlinear image matching and anatomical labeling (ANIMAL) and symmetric image normalization (SyN), and one patch-label fusion technique. The automated labels were then compared with the manual labels using a Dice-kappa metric and center of gravity. A Friedman test was used to compare the Dice-kappa values and paired t tests for the center of gravity. RESULTS: The Friedman test showed a significant difference between the three methods for both thalami (p < 0.05) and not for the subthalamic nuclei. Registration with ANIMAL was better than with SyN for the left thalamus and was better than the patch-based method for the right thalamus. CONCLUSION: Although template-based approaches are the most used techniques to segment basal ganglia by warping onto MR images, we found that the patch-based method provided similar results and was less time-consuming. Patch-based method may be preferable for the subthalamic nucleus segmentation in patients with Parkinson's disease.