Improved Vim targeting for focused ultrasound ablation treatment of essential tremor: A probabilistic and patient-specific approach.
Improved Vim targeting for focused ultrasound ablation treatment of essential tremor: A probabilistic and patient-specific approach.
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DOI：
10.1002/hbm.25157
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发表时间：
2020-12
影响因子：
4.8
通讯作者：
Rutt BK
中科院分区：
文献类型：
--
作者：
Su JH;Choi EY;Tourdias T;Saranathan M;Halpern CH;Henderson JM;Pauly KB;Ghanouni P;Rutt BK
Magnetic resonance‐guided focused ultrasound (MRgFUS) ablation of the ventral intermediate (Vim) thalamic nucleus is an incisionless treatment for essential tremor (ET). The standard initial targeting method uses an approximate, atlas‐based stereotactic approach. We developed a new patient‐specific targeting method to identify an individual's Vim and the optimal MRgFUS target region therein for suppression of tremor. In this retrospective study of 14 ET patients treated with MRgFUS, we investigated the ability of WMnMPRAGE, a highly sensitive and robust sequence for imaging gray matter‐white matter contrast, to identify the Vim, FUS ablation, and a clinically efficacious region within the Vim in individual patients. We found that WMnMPRAGE can directly visualize the Vim in ET patients, segmenting this nucleus using manual or automated segmentation capabilities developed by our group. WMnMPRAGE also delineated the ablation's core and penumbra, and showed that all patients' ablation cores lay primarily within their Vim segmentations. We found no significant correlations between standard ablation features (e.g., ablation volume, Vim‐ablation overlap) and 1‐month post‐treatment clinical outcome. We then defined a group‐based probabilistic target, which was nonlinearly warped to individual brains; this target was located within the Vim for all patients. The overlaps between this target and patient ablation cores correlated significantly with 1‐month clinical outcome (r = −.57, p = .03), in contrast to the standard target (r = −.23, p = .44). We conclude that WMnMPRAGE is a highly sensitive sequence for segmenting Vim and ablation boundaries in individual patients, allowing us to find a novel tremor‐associated center within Vim and potentially improving MRgFUS treatment for ET. Magnetic resonance‐guided focused ultrasound (MRgFUS) ablation of the ventral intermediate (Vim) thalamic nucleus is an incisionless treatment for essential tremor (ET); a patient‐specific mapping of the upper extremity tremor‐associated center within Vim is an unmet need in present‐day MRgFUS treatment for ET. Using high quality preoperative and postoperative WMnMPRAGE imaging, state‐of‐the‐art nonlinear registration, segmentation of thalamic nuclei and FUS ablation characteristics, and probabilistic lesion calculations using a cohort of ET patients, we discovered a novel location within the Vim that is associated with upper extremity tremor reduction. This is a powerful example of human brain mapping that cannot be achieved in healthy subjects, yet still involves entirely noninvasive imaging and therapeutic modalities.
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