University of Basle, Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Petersgraben, Basle, Switzerland.
Stanford University Medical Center, Department of Radiology, Neuroradiology Division, Stanford, California, USA.
J Magn Reson Imaging. 2018 Jul;48(1):58-65. doi: 10.1002/jmri.25878. Epub 2017 Oct 27.
Transcranial MR-guided high-intensity focused ultrasound (tcMRgFUS) is a promising noninvasive method to treat medication-refractory essential tremor.
PURPOSE/HYPOTHESIS: To define the correlation between lesion size after ablation, thermal dose, and clinical outcome in tcMRgFUS treatment of essential tremor.
Retrospective.
POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL: Eight patients with medication-refractory essential tremor were treated using a tcMRgFUS system at 3T.
FIELD STRENGTH/SEQUENCE: T -weighted images were acquired immediately and at 1 year posttreatment at 3T.
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.
Statistical significance was assessed using the Wilcoxon two-tailed rank test.
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.
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.
1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2017.
经颅磁共振引导高强度聚焦超声（tcMRgFUS）是一种有前途的非侵入性方法，可用于治疗药物难治性原发性震颤。
目的/假设：确定消融后病变大小、热剂量与 tcMRgFUS 治疗原发性震颤的临床结果之间的相关性。
回顾性。
人群/受试者/体模/标本/动物模型：8 例药物难治性原发性震颤患者在 3T 下接受 tcMRgFUS 治疗。
磁场强度/序列：在 3T 下，分别于治疗后即刻和 1 年时采集 T1 加权图像。
将丘脑核图谱和剂量图变形到治疗后的图像上。热剂量、治疗后即刻的病变体积和 1 年的最终病变体积，以及限制在腹侧外侧后丘脑腹侧部（VLpv）内的体积，与治疗后 1 个月和 1 年的临床结果用 Pearson 系数进行相关性分析。从临床震颤评分改善的 1 年平均图中，在归一化空间中得出与最大临床结果相关的治疗空间区域。
采用 Wilcoxon 双尾秩检验评估统计学意义。
热剂量、治疗后即刻和 1 年的病变体积以及 1 年的结果之间存在良好的相关性（r=0.73、0.65、0.73），且略优于治疗后 1 个月时的相关性（r=0.57、0.49、0.65）。将测量值缩小到仅包括 VLpv 内的部分并不会显著改变相关性（P=0.09）。治疗空间区域的中心位于前联合-后联合平面，中线外侧 14.3mm，后联合上方 8.3mm。
在这项初步研究中，发现接受 VLpv 消融的原发性震颤患者的病变大小、热剂量与临床结果之间存在良好的相关性。
1 技术功效：第 4 阶段 J. 磁共振成像 2017。
