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- Title
Transcranial MRI-guided high-intensity focused ultrasound for treatment of essential tremor: A pilot study on the correlation between lesion size, lesion location, thermal dose, and clinical outcome.
- Authors
Federau, Christian; Goubran, Maged; Rosenberg, Jarrett; Henderson, Jaimie; Halpern, Casey H.; Santini, Veronica; Wintermark, Max; Butts Pauly, Kim; Ghanouni, Pejman
- Abstract
<bold>Background: </bold>Transcranial MR-guided high-intensity focused ultrasound (tcMRgFUS) is a promising noninvasive method to treat medication-refractory essential tremor.<bold>Purpose/hypothesis: </bold>To define the correlation between lesion size after ablation, thermal dose, and clinical outcome in tcMRgFUS treatment of essential tremor.<bold>Study Type: </bold>Retrospective.<bold>Population/subjects/phantom/specimen/animal Model: </bold>Eight patients with medication-refractory essential tremor were treated using a tcMRgFUS system at 3T.<bold>Field Strength/sequence: </bold>T2 -weighted images were acquired immediately and at 1 year posttreatment at 3T.<bold>Assessment: </bold>An atlas of the thalamic nuclei and dose maps were warped to the posttreatment images. The thermal dose, the immediate posttreatment lesion volume and 1-year final lesion volume, and the volumes confined inside the ventral division of the ventral lateral posterior thalamic nucleus (VLpv) were correlated to clinical outcome at 1 month and 1 year using Pearson's coefficient. The spatial region of treatment correlating with maximal clinical outcome was derived in a normalized space from average maps of clinical tremor score improvement at 1 year.<bold>Statistical Tests: </bold>Statistical significance was assessed using the Wilcoxon two-tailed rank test.<bold>Results: </bold>The correlations between thermal dose, lesion volume posttreatment and at 1 year, and outcome at 1 year were good (r = 0.73, 0.65, 0.73, respectively), and were slightly better than at 1 month (r = 0.57, 0.49, 0.65). Reducing the measurement to include only the portion within the VLpv did not significantly modify the correlations (P = 0.09). The center of the spatial region of treatment was found in the anterior commissure - posterior commissure plane, 14.3 mm lateral from the midline, and 8.3 mm rostral to the posterior commissure.<bold>Data Conclusion: </bold>In this pilot study a good correlation was found between the size of the lesion, the thermal dose, and the clinical outcome in patients treated for essential tremor with ablation of the VLpv with tcMRgFUS.<bold>Level Of Evidence: </bold>1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2017.
- Publication
Journal of Magnetic Resonance Imaging, 2018, Vol 48, Issue 1, p58
- ISSN
1053-1807
- Publication type
journal article
- DOI
10.1002/jmri.25878