Xiong Yongqin, Lin Jiaji, Pan Longsheng, Zong Rui, Bian Xiangbing, Duan Caohui, Zhang Dekang, Lou Xin
1Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China; and.
2Department of Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China.
J Neurosurg. 2022 Feb 18;137(4):1135-1144. doi: 10.3171/2022.1.JNS212449. Print 2022 Oct 1.
Tractography-based direct targeting of the ventral intermediate nucleus (T-VIM) is a novel method that provides patient-specific VIM coordinates. This study aimed to explore the accuracy and predictive value of using T-VIM in combination with tractography and resting-state functional connectivity techniques to perform magnetic resonance imaging-guided focused ultrasound (MRgFUS) thalamotomy as a treatment of Parkinson's disease (PD).
PD patients underwent MRgFUS thalamotomy and were recruited for functional MRI scanning. A subscore of the Clinical Rating Scale for Tremor was used to evaluate tremor improvement. T-VIM and surgical VIM (S-VIM) were defined on preoperative diffusion tensor MRI and 24-hour postoperative T1-weighted imaging, respectively. The overlapping volume and center distance between S-VIM and T-VIM were measured to determine their correlations with 12-month postoperative tremor improvement. Moreover, pretherapeutic functional connectivity of T-VIM or S-VIM, based on region-of-interest connectivity and whole-brain seed-to-voxel connectivity, was measured with the resting-state functional connectivity technique to investigate their correlations with tremor improvement.
All patients had excellent tremor improvement (mean [range] tremor improvement 74.82% [50.00%-94.44%]). The authors found that both overlapping volume and center distance between T-VIM and S-VIM were significantly correlated with tremor improvement (r = 0.788 and p = 0.012 for overlapping volume; r = -0.696 and p = 0.037 for center distance). Pretherapeutic functional connectivity of T-VIM with the ipsilateral sensorimotor cortex (r = 0.876 and p = 0.002), subthalamic nucleus (r = 0.700 and p = 0.036), and visual area (r = 0.911 and p = 0.001) was significantly and positively correlated with tremor improvement.
T-VIM may improve the clinical application of MRgFUS thalamotomy as a treatment of PD. Pretherapeutic functional connectivity of T-VIM with the ipsilateral sensorimotor cortex, subthalamic nucleus, and visual area may predict PD tremor responses after MRgFUS thalamotomy.
基于纤维束成像的腹中间核直接靶向定位（T-VIM）是一种可提供患者特异性腹中间核坐标的新方法。本研究旨在探讨将T-VIM与纤维束成像及静息态功能连接技术相结合，用于磁共振成像引导聚焦超声（MRgFUS）丘脑切开术治疗帕金森病（PD）的准确性和预测价值。
PD患者接受MRgFUS丘脑切开术，并进行功能磁共振成像扫描。采用震颤临床评分量表的子评分评估震颤改善情况。分别在术前扩散张量磁共振成像和术后24小时T1加权成像上定义T-VIM和手术腹中间核（S-VIM）。测量S-VIM与T-VIM之间的重叠体积和中心距离，以确定它们与术后12个月震颤改善情况的相关性。此外，采用静息态功能连接技术，基于感兴趣区连接和全脑种子点到体素连接，测量T-VIM或S-VIM的治疗前功能连接，以研究它们与震颤改善情况的相关性。
所有患者的震颤均有显著改善（平均[范围]震颤改善率74.82%[50.00%-94.44%]）。作者发现，T-VIM与S-VIM之间的重叠体积和中心距离均与震颤改善情况显著相关（重叠体积：r = 0.788，p = 0.012；中心距离：r = -0.696，p = 0.037）。T-VIM与同侧感觉运动皮层（r = 0.876，p = 0.002）、丘脑底核（r = 0.700，p = 0.036）和视觉区（r = 0.911，p = 0.001）的治疗前功能连接与震颤改善情况显著正相关。
T-VIM可能会改善MRgFUS丘脑切开术治疗PD的临床应用。T-VIM与同侧感觉运动皮层、丘脑底核和视觉区的治疗前功能连接可能预测MRgFUS丘脑切开术后的PD震颤反应。
