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使用功能磁共振成像和机器学习预测帕金森病的最佳深部脑刺激参数。

Predicting optimal deep brain stimulation parameters for Parkinson's disease using functional MRI and machine learning.

机构信息

Joint Department of Medical Imaging, University of Toronto, Toronto, Canada.

Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada.

出版信息

Nat Commun. 2021 May 24;12(1):3043. doi: 10.1038/s41467-021-23311-9.

Abstract

Commonly used for Parkinson's disease (PD), deep brain stimulation (DBS) produces marked clinical benefits when optimized. However, assessing the large number of possible stimulation settings (i.e., programming) requires numerous clinic visits. Here, we examine whether functional magnetic resonance imaging (fMRI) can be used to predict optimal stimulation settings for individual patients. We analyze 3 T fMRI data prospectively acquired as part of an observational trial in 67 PD patients using optimal and non-optimal stimulation settings. Clinically optimal stimulation produces a characteristic fMRI brain response pattern marked by preferential engagement of the motor circuit. Then, we build a machine learning model predicting optimal vs. non-optimal settings using the fMRI patterns of 39 PD patients with a priori clinically optimized DBS (88% accuracy). The model predicts optimal stimulation settings in unseen datasets: a priori clinically optimized and stimulation-naïve PD patients. We propose that fMRI brain responses to DBS stimulation in PD patients could represent an objective biomarker of clinical response. Upon further validation with additional studies, these findings may open the door to functional imaging-assisted DBS programming.

摘要

常用于帕金森病(PD)的深部脑刺激(DBS)在优化后会产生显著的临床获益。然而,评估大量可能的刺激设置(即编程)需要多次就诊。在这里,我们研究了功能磁共振成像(fMRI)是否可用于预测个体患者的最佳刺激设置。我们前瞻性地分析了 67 名 PD 患者的 3T fMRI 数据,这些数据是在一项观察性试验中使用最佳和非最佳刺激设置获得的。临床最佳刺激会产生特征性的 fMRI 大脑反应模式,表现为运动回路的优先参与。然后,我们使用 39 名具有事先临床优化 DBS 的 PD 患者的 fMRI 模式构建了一个预测最佳与非最佳设置的机器学习模型(准确率为 88%)。该模型可预测在未见到的数据集(事先临床优化和刺激-naive PD 患者)中最佳刺激设置。我们提出,PD 患者对 DBS 刺激的 fMRI 反应可以代表临床反应的客观生物标志物。通过与其他研究进一步验证,这些发现可能为功能成像辅助 DBS 编程开辟道路。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47ec/8144408/ea65e3150a64/41467_2021_23311_Fig1_HTML.jpg

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