"PICS": a novel patient-specific landmark for thalamic surgical interventions in the Posterior limb of the Internal Capsule Signal

Motivation: Difficulties in direct visualization of thalamic subnuclei have led to inconsistent neurosurgery patient outcomes. Goal(s): To study whether PICS, a "bright spot" in the posterior limb of the internal capsule (pLIC) in DiMANI images, could serve as a reliable landmark for directly targeting the Vim. Approach: Using 7T DWI, we parcellate the pLIC, correlate its location with intra- and post-operative clinical data, and explore the PICS visibility in other MRI sequences. Results: PICS is directly lateral to the Vim, comprises motor fibers associated with limbs and the trunk, and is visible on several MR contrasts. Impact: A new MRI landmark is now visible on DiMANI, enabling patient-specific direct targeting for DBS and MR-guided focused ultrasound procedures. This will provide immediate impact by enhancing accuracy, clinical workflow efficiency and ultimately improve patient outcomes.