Ebani Edward J, Kaplitt Michael G, Wang Yi, Nguyen Thanh D, Askin Gulce, Chazen J Levi
Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
Clin Imaging. 2020 Dec;68:94-98. doi: 10.1016/j.clinimag.2020.06.017. Epub 2020 Jun 15.
Magnetic resonance guided focused ultrasound (MRgFUS) of the globus pallidus interna (GPi) has shown promise in the treatment of drug-resistant Parkinson's disease, though direct visualization of the GPi remains challenging with MRI. The purpose of this study was to compare various preoperative MR imaging techniques and to evaluate the utility of quantitative susceptibility imaging (QSM) in the depiction of the GPi prior to MRgFUS ablation.
Six patients with medication refractory advanced idiopathic Parkinson's disease were referred for preoperative MR imaging prior to MRgFUS pallidotomy. Axial T1WI and T2WI, Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR), and QSM sequences were acquired. DTI tractography was performed to delineate the corticospinal tracts. Qualitative visualization scores and contrast to noise ratios (CNR) were recorded and measured on all images.
QSM had significantly higher median qualitative visualization scores (3.00) compared with the T1WI (1.00), T2WI (1.50), and FGATIR sequences (1.50) (p < 0.05). QSM provided superior CNR for GPi depiction in each category (GPi-GPe and GPi-IC), respectively. For GPi-GPe, median CNR for T1WI, T2WI, FGATIR, and QSM was 1.13, 1.68, 0.79, and 10.78. For GPi-IC, median CNR for T1WI, T2WI, FGATIR, and QSM was 1.48, 4.63, 4.24, and 40.26, respectively (p < 0.05).
QSM offers improved visualization of the GPi compared with the traditional and currently recommended MR sequences prior to MRgFUS ablation in patients with Parkinson's disease. These results suggest that QSM should be considered as part of all preoperative imaging protocols prior to MRgFUS pallidotomy.
内侧苍白球（GPi）的磁共振引导聚焦超声（MRgFUS）在耐药性帕金森病的治疗中已显示出前景，尽管通过MRI直接可视化GPi仍然具有挑战性。本研究的目的是比较各种术前MR成像技术，并评估定量磁化率成像（QSM）在MRgFUS消融术前对GPi的描绘效用。
6例药物难治性晚期特发性帕金森病患者在进行MRgFUS苍白球切开术前被转诊进行术前MR成像。采集了轴位T1WI和T2WI、快速灰质采集T1反转恢复（FGATIR）和QSM序列。进行了DTI纤维束成像以描绘皮质脊髓束。在所有图像上记录并测量定性可视化评分和对比噪声比（CNR）。
与T1WI（1.00）、T2WI（1.50）和FGATIR序列（1.50）相比，QSM的中位数定性可视化评分显著更高（3.00）（p < 0.05）。QSM在每个类别（GPi - GPe和GPi - IC）中为GPi描绘提供了更高的CNR。对于GPi - GPe，T1WI、T2WI、FGATIR和QSM的中位数CNR分别为1.13、1.68、0.79和10.78。对于GPi - IC，T1WI、T2WI、FGATIR和QSM的中位数CNR分别为1.48、4.63、4.24和40.26（p < 0.05）。
与帕金森病患者MRgFUS消融术前的传统和当前推荐的MR序列相比，QSM能更好地可视化GPi。这些结果表明，在MRgFUS苍白球切开术前，QSM应被视为所有术前成像方案的一部分。
