Magnetic resonance-guided focused ultrasound thalamotomy restored distinctive resting-state networks in patients with essential tremor
Magnetic resonance-guided focused ultrasound thalamotomy restored distinctive resting-state networks in patients with essential tremor
复制标题
DOI：
10.3171/2022.5.jns22411
复制
发表时间：
2022-02-01
影响因子：
4.1
通讯作者：
Sobue, Gen
中科院分区：
文献类型：
--
作者：
Kato, Sachiko;Maesawa, Satoshi;Sobue, Gen
目的 磁共振引导聚焦超声 (MRgFUS) 丘脑切开术可改善特发性震颤 (ET) 患者的症状。这种治疗如何影响典型的大脑网络尚未阐明。本研究的目的是通过分析静息态网络（RSN）来阐明 ET 患者 MRgFUS 丘脑切除术后大脑网络的变化。方法 本研究纳入 15 名 ET 患者。所有病例均进行左侧 MRgFUS 丘脑切除术，并在手术前后拍摄 MR 图像，包括静息态功能 MRI (rsfMRI)。 15 名年龄和性别匹配的健康对照 (HC) 的 MR 图像也用于分析。使用 rsfMRI 数据，通过执行双重回归分析提取典型 RSN，并比较 MRgFUS 前患者、MRgFUS 后患者和 HC 之间各自网络内的功能连接 (FC)。术前和术后使用震颤临床评定量表（CRST）评分评估震颤严重程度，并检查其与RSN的相关性。 结果术前，与HC相比，ET患者感觉运动网络（SMN）、初级视觉网络（VN）和视觉空间网络（VSN）的FC显着降低。 SMN 中 FC 的减少与震颤的严重程度相关。 MRgFUS 丘脑切除术后，ET 患者在 SMN 的小区域中仍表现出 FC 显着下降，但小脑网络 (CN) 有所增加。与 MRgFUS 治疗前和治疗后的患者相比，治疗后 SMN 和 VSN 中的 FC 显着增加。对这三组 FC 的定量评估显示，术后 SMN 和 VSN 增加，并呈现出向 HC 增加的趋势。结论 SMN 和 CN 被认为与小脑-丘脑-皮质环相关，在 MRgFUS 丘脑切除术后表现出连接性增加。此外，与 HC 相比，ET 患者的视觉网络 FC 有所下降，但术后趋于正常化。这可能与视觉反馈与 ET 患者震颤严重程度有关的假设有关。总体而言，rsfMRI 对 RSN 的分析反映了 ET 患者中 MRgFUS 丘脑切开术干预的病理生理学，并证明了成功治疗的生物标志物的可能性。 https://thejns.org/doi/abs/10.3171/2022.5.JNS22411
OBJECTIVE Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy ameliorates symptoms in patients with essential tremor (ET). How this treatment affects canonical brain networks has not been elucidated. The purpose of this study was to clarify changes of brain networks after MRgFUS thalamotomy in ET patients by analyzing resting-state networks (RSNs).METHODS Fifteen patients with ET were included in this study. Left MRgFUS thalamotomy was performed in all cases, and MR images, including resting-state functional MRI (rsfMRI), were taken before and after surgery. MR images of 15 age-and sex-matched healthy controls (HCs) were also used for analysis. Using rsfMRI data, canonical RSNs were extracted by performing dual regression analysis, and the functional connectivity (FC) within respective networks was compared among pre-MRgFUS patients, post-MRgFUS patients, and HCs. The severity of tremor was evaluated using the Clinical Rating Scale for Tremor (CRST) score pre-and postoperatively, and its correlation with RSNs was examined.RESULTS Preoperatively, ET patients showed a significant decrease in FC in the sensorimotor network (SMN), primary visual network (VN), and visuospatial network (VSN) compared with HCs. The decrease in FC in the SMN correlated with the severity of tremor. After MRgFUS thalamotomy, ET patients still exhibited a significant decrease in FC in a small area of the SMN, but they exhibited an increase in the cerebellar network (CN). In comparison between pre-and post-MRgFUS patients, the FC in the SMN and the VSN significantly increased after treatment. Quantitative evaluation of the FCs in these three groups showed that the SMN and VSN increased postoperatively and demonstrated a trend toward those of HCs.CONCLUSIONS The SMN and CN, which are considered to be associated with the cerebello-thalamo-cortical loop, exhibited increased connectivity after MRgFUS thalamotomy. In addition, the FC of the visual network, which declined in ET patients compared with HCs, tended to normalize postoperatively. This could be related to the hypothesis that visual feedback is involved in tremor severity in ET patients. Overall, the analysis of the RSNs by rsfMRI reflected the pathophysiology with the intervention of MRgFUS thalamotomy in ET patients and demonstrated a possibility of a biomarker for successful treatment. https://thejns.org/doi/abs/10.3171/2022.5.JNS22411