1. The Role of Treatment-Related Parameters and Brain Morphology in the Lesion Volume of Magnetic-Resonance-Guided Focused Ultrasound Thalamotomy in Patients with Tremor-Dominant Neurological Conditions.
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Morabito, Rosa, Cammaroto, Simona, Militi, Annalisa, Smorto, Chiara, Anfuso, Carmelo, Lavano, Angelo, Tomasello, Francesco, Di Lorenzo, Giuseppe, Brigandì, Amelia, Sorbera, Chiara, Bonanno, Lilla, Ielo, Augusto, Vatrano, Martina, Marino, Silvia, Cacciola, Alberto, Cerasa, Antonio, and Quartarone, Angelo
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NEUROLOGICAL disorders , *BRAIN damage , *HIGH-intensity focused ultrasound , *MULTIPLE regression analysis , *SIZE of brain , *PARKINSON'S disease , *CEREBROSPINAL fluid examination - Abstract
Purpose: To determine the best predictor of lesion volume induced by magnetic resonance (MR)-guided focused ultrasound (MRgFUS) thalamotomy in patients with tremor-dominant symptoms in Parkinson's disease (PD) and essential tremor (ET) patients. Methods: Thirty-six neurological patients with medication-refractory tremor (n°19 PD; n°17 ET) were treated using a commercial MRgFUS brain system (Exablate Neuro 4000, Insightec) integrated with a 1.5 T MRI unit (Sigma HDxt; GE Medical System). Linear regression analysis was used to determine how the demographic, clinical, radiological (Fazekas scale), volumetric (total GM/WM/CSF volume, cortical thickness), and MRgFUS-related parameters [Skull Density Ratio (SDR), n° of transducer elements, n° of sonications, skull area, maximal energy delivered (watt), maximal power delivered (joule), maximal sonication time delivered, maximal mean temperature reached (T°C_max), accumulated thermal dose (ATD)] impact on ventral intermediate (VIM)-thalamotomy-related 3D volumetric lesions of necrosis and edema. Results: The VIM thalamotomy was clinically efficacious in improving the tremor symptoms of all the patients as measured at 1 week after treatment. Multiple regression analysis revealed that T°C_max and n° of transducer elements were the best predictors of the necrosis and edema volumes. Moreover, total WM volume also predicted the size of necrosis. Conclusions: Our study provides new insights into the clinical MRgFUS procedures that can be used to forecast brain lesion size and improve treatment outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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