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Cammaroto S, Acri G, Hartwig V, Morabito R, Militi A, Smorto C, Ielo A, Bonanno L, Anfuso C, Quartarone A. Could the Anatomic Variants of the Superior Thalamic Vein (STV) Be Considered a Possible Landmark for Target Identification in Magnetic-Resonance-Guided Focused Ultrasound Procedures? A Pilot Study Using Susceptibility Weighted Imaging Sequences. Diagnostics (Basel) 2024; 14:1409. [PMID: 39001299 PMCID: PMC11240953 DOI: 10.3390/diagnostics14131409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
During magnetic-resonance-guided focused ultrasound ablation of the ventral intermediate thalamic nucleus (VIM) for essential tremor (ET) and Parkinson's disease (PD), targeting is generally performed using a standard atlas-based stereotactic approach. The purpose of our work is to evaluate the anatomic variations in the venous vasculature of the thalamus in patients treated with MRgFUS, as a possible landmark for targeting. We retrospectively evaluated the relationship between the obtained thalamotomy lesion and the ipsilateral superior thalamic vein (STV). A total of 36 patients (25 ET and 11 PD) who underwent MRgFUS treatment were evaluated, and the STV was studied with susceptibility weighted imaging (SWI) sequences. Based on the axial SWI images, the distance between the STV and the center of the lesion at the presumed site of the VIM was measured in follow-up MRI images one month after treatment. Statistical analysis shows that there is a correlation between the STV and the presumed site of the VIM. The STV visible in SWI could be used as an additional, real-time, and patient-specific anatomical landmark for VIM identification during MR examination and just before and during FUS treatment.
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Affiliation(s)
- Simona Cammaroto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Giuseppe Acri
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico “G. Martino”, 98125 Messina, Italy
| | - Valentina Hartwig
- Institute of Clinical Physiology, National Research Council—CNR, 56124 Pisa, Italy
| | - Rosa Morabito
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Annalisa Militi
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Chiara Smorto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Augusto Ielo
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Lilla Bonanno
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Carmelo Anfuso
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
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Bruno F, Badini P, Innocenzi A, Saporito G, Catalucci A, Sucapane P, Barile A, Cesare ED, Marini C, Pistoia F, Splendiani A. Early re-emerging tremor after MRgFUS thalamotomy: case-control analysis of procedural and imaging features. Front Neurol 2024; 15:1356613. [PMID: 38903176 PMCID: PMC11187326 DOI: 10.3389/fneur.2024.1356613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Purpose This study aimed to identify possible prognostic factors determining early tremor relapse after Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) thalamotomy in patients with essential tremor (ET) and Parkinson's disease (PD). Methods Nine patients (six ET and three PD) who underwent Vim MRgFUS thalamotomy in a single institution and developed early re-emergent tremor were analyzed. A control group of patients matched pairwise for sex, pathology, age, disease duration, and skull density ratio (SDR) was selected to compare the technical-procedural data and MR imaging evidence. MR imaging findings compared between groups included lesion shape and volume in multiparametric sequences, as well as Fractiona Anisotropy (FA) and Apparent Diffusion Coefficient (ADC) values derived from Diffusion Tensor Imaging Diffusion Weighted Imaging (DTI) and Diffusion Weighted Imaging (DWI) sequences. Results We did not find statistically significant differences in gender and age between the two groups. Technical and procedural parameters were also similar in both treatment groups. In MRI analysis, we found lesions of similar size but with greater caudal extension in the control group with stable outcomes compared to patients with tremor relapse. Conclusion In our analysis of early recurrences after thalamotomy with focused ultrasound, there were neither technical and procedural differences nor prognostic factors related to lesion size or ablation temperatures. Greater caudal extension of the lesion in patients without recurrence might suggest the importance of spatial consolidation during treatment.
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Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, L’Aquila, Italy
| | - Pierfrancesco Badini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Innocenzi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gennaro Saporito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessia Catalucci
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, L’Aquila, Italy
| | | | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Neurology, San Salvatore Hospital, L’Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, L’Aquila, Italy
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Kyle K, Peters J, Jonker B, Barnett Y, Maamary J, Barnett M, Maller J, Wang C, Tisch S. Magnetic Resonance-Guided Focused Ultrasound for Treatment of Essential Tremor: Ventral Intermediate Nucleus Ablation Alone or Additional Posterior Subthalamic Area Lesioning? Mov Disord Clin Pract 2024; 11:504-514. [PMID: 38469997 PMCID: PMC11078489 DOI: 10.1002/mdc3.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of essential tremor (ET) traditionally targets the ventral intermediate (Vim) nucleus. Recent strategies include a secondary lesion to the posterior subthalamic area (PSA). OBJECTIVE The aim was to compare lesion characteristics, tremor improvement, and adverse events (AE) between patients in whom satisfactory tremor suppression was achieved with lesioning of the Vim alone and patients who required additional lesioning of the PSA. METHODS Retrospective analysis of data collected from ET patients treated with MRgFUS at St Vincent's Hospital Sydney was performed. Clinical Rating Scale for Tremor (CRST), hand tremor score (HTS), and Quality of Life in Essential Tremor Questionnaire (QUEST) were collected pre- and posttreatment in addition to the prevalence of AEs. The lesion coordinates and overlap with the dentatorubrothalamic tract (DRTT) were evaluated using magnetic resonance imaging. RESULTS Twenty-one patients were treated in Vim only, and 14 were treated with dual Vim-PSA lesions. Clinical data were available for 29 of the 35 patients (19 single target and 10 dual target). At follow-up (mean: 18.80 months) HTS, CRST, and QUEST in single-target patients improved by 57.97% (P < 0.001), 36.71% (P < 0.001), and 58.26% (P < 0.001), whereas dual-target patients improved by 68.34% (P < 0.001), 35.37% (P < 0.003), and 46.97% (P < 0.005), respectively. The Vim lesion of dual-target patients was further anterior relative to the posterior commissure (PC) (7.84 mm), compared with single-target patients (6.92 mm), with less DRTT involvement (14.85% vs. 23.21%). Dual-target patients exhibited a greater proportion of patients with acute motor AEs (100% vs. 58%); however, motor AE prevalence was similar in both groups at long-term follow-up (33% vs. 38%). CONCLUSION Posterior placement of lesions targeting the Vim may confer greater tremor suppression. The addition of a PSA lesion, in patients with inadequate tremor control despite Vim lesioning, had a trend toward better long-term tremor suppression; however, this approach was associated with greater prevalence of gait disturbance in the short term.
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Affiliation(s)
- Kain Kyle
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
| | - James Peters
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Benjamin Jonker
- Department of NeurosurgerySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- Royal Prince Alfred Institute of Academic SurgeryUniversity of SydneyCamperdownNew South WalesAustralia
| | - Yael Barnett
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- Department of Medical ImagingSt Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Joel Maamary
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Michael Barnett
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | | | - Chenyu Wang
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
| | - Stephen Tisch
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Jameel A, Akgun S, Yousif N, Smith J, Jones B, Nandi D, Bain P, Gedroyc W. The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation. Front Neurol 2024; 15:1345873. [PMID: 38595847 PMCID: PMC11002122 DOI: 10.3389/fneur.2024.1345873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 04/11/2024] Open
Abstract
Background The ventral intermediate nucleus (VIM) is the premiere target in magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for tremor; however, there is no consensus on the optimal coordinates for ablation. This study aims to ascertain the various international VIM targeting approaches (VIM-TA) and any evolution in practice. Methods International MRgFUS centers were invited to share VIM-TAs in 2019 and 2021. Analyses of any modification in practice and of anatomical markers and/or tractography in use were carried out. Each VIM-TA was mapped in relation to the mid-commissural point onto a 3D thalamic nucleus model created from the Schaltenbrand-Wahren atlas. Results Of the 39 centers invited, 30 participated across the study period, providing VIM-TAs from 26 centers in 2019 and 23 in 2021. The results are reported as percentages of the number of participating centers in that year. In 2019 and 2021, respectively, 96.2% (n = 25) and 95.7% (n = 22) of centers based their targeting on anatomical landmarks rather than tractography. Increased adoption of tractography in clinical practice and/or for research was noted, changing from 34.6% to 78.3%. There was a statistically significant change in VIM-TAs in the superior-inferior plane across the study period; the percentage of VIM-TAs positioned 2 mm above the intercommissural line (ICL) increased from 16.0% in 2019 to 40.9% in 2021 (WRST, p < 0.05). This position is mapped at the center of VIM on the 3D thalamic model created based on the Schaltenbrand-Wahren atlas. In contrast, the VIM-TA medial-lateral and anterior-posterior positions remained stable. In 2022, 63.3% of participating centers provided the rationale for their VIM-TAs and key demographics. The centers were more likely to target 2 mm above the ICL if they had increased experience (more than 100 treatments) and/or if they were North American. Conclusion Across the study period, FUS centers have evolved their VIM targeting superiorly to target the center of the VIM (2 mm above the ICL) and increased the adoption of tractography to aid VIM localization. This phenomenon is observed across autonomous international centers, suggesting that it is a more optimal site for FUS thalamotomy in tremors.
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Affiliation(s)
- Ayesha Jameel
- Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sena Akgun
- Sapienza University of Rome, Rome, Italy
| | - Nada Yousif
- University of Hertfordshire, Hatfield, United Kingdom
| | - Joely Smith
- Imperial College London, London, United Kingdom
| | - Brynmor Jones
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dipankar Nandi
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Peter Bain
- Imperial College London, London, United Kingdom
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Yearley AG, Goedmakers CMW, Panahi A, Doucette J, Rana A, Ranganathan K, Smith TR. FDA-approved machine learning algorithms in neuroradiology: A systematic review of the current evidence for approval. Artif Intell Med 2023; 143:102607. [PMID: 37673576 DOI: 10.1016/j.artmed.2023.102607] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 09/08/2023]
Abstract
Over the past decade, machine learning (ML) and artificial intelligence (AI) have become increasingly prevalent in the medical field. In the United States, the Food and Drug Administration (FDA) is responsible for regulating AI algorithms as "medical devices" to ensure patient safety. However, recent work has shown that the FDA approval process may be deficient. In this study, we evaluate the evidence supporting FDA-approved neuroalgorithms, the subset of machine learning algorithms with applications in the central nervous system (CNS), through a systematic review of the primary literature. Articles covering the 53 FDA-approved algorithms with applications in the CNS published in PubMed, EMBASE, Google Scholar and Scopus between database inception and January 25, 2022 were queried. Initial searches identified 1505 studies, of which 92 articles met the criteria for extraction and inclusion. Studies were identified for 26 of the 53 neuroalgorithms, of which 10 algorithms had only a single peer-reviewed publication. Performance metrics were available for 15 algorithms, external validation studies were available for 24 algorithms, and studies exploring the use of algorithms in clinical practice were available for 7 algorithms. Papers studying the clinical utility of these algorithms focused on three domains: workflow efficiency, cost savings, and clinical outcomes. Our analysis suggests that there is a meaningful gap between the FDA approval of machine learning algorithms and their clinical utilization. There appears to be room for process improvement by implementation of the following recommendations: the provision of compelling evidence that algorithms perform as intended, mandating minimum sample sizes, reporting of a predefined set of performance metrics for all algorithms and clinical application of algorithms prior to widespread use. This work will serve as a baseline for future research into the ideal regulatory framework for AI applications worldwide.
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Affiliation(s)
- Alexander G Yearley
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| | - Caroline M W Goedmakers
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Armon Panahi
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, USA
| | - Joanne Doucette
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; School of Pharmacy, MCPHS University, 179 Longwood Ave, Boston, MA 02115, USA
| | - Aakanksha Rana
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA
| | - Kavitha Ranganathan
- Division of Plastic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Timothy R Smith
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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Baek H, Chen J, Lockwood D, Obusez E, Poturalski M, Nagel SJ, Jones SE. Feasibility of Magnetic Resonance-Compatible Accelerometers to Monitor Tremor Fluctuations During Magnetic Resonance-Guided Focused Ultrasound Thalamotomy: Technical Note. Oper Neurosurg (Hagerstown) 2023; 24:641-650. [PMID: 36827201 DOI: 10.1227/ons.0000000000000638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/30/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is used to treat essential tremor and tremor-dominant Parkinson disease. Feedback is collected throughout the procedure to verify the location of the target and completeness of response; however, variability in clinical judgments may underestimate or overestimate treatment response. OBJECTIVE To objectively quantify joint motion after each sonication using accelerometers secured to the contralateral upper extremity in an effort to optimize MRgFUS treatment. METHODS Before the procedure, 3 accelerometers were secured to the patient's arm, forearm, and index finger. Throughout the procedure, tremor motion was regularly recorded during postural and kinetic tremor testing and individual joint angle measures were modeled. The joint angle from each accelerometer was compared with baseline measurements to assess changes in angles. Subsequent adjustments to the target location and sonication energy were made at the discretion of the neurosurgeon and neuroradiologist. RESULTS Intraoperative accelerometer measurements of hand tremor from 18 patients provided quantified data regarding joint angle reduction: 87.3%, 94.2%, and 86.7% for signature writing, spiral drawing, and line drawing tests, respectively. Target adjustment based on accelerometer monitoring of the angle at each joint added substantial value toward achieving optimal tremor reduction. CONCLUSION Real-time accelerometer recordings collected during MRgFUS thalamotomy offered objective quantification of changes in joint angle after each sonication, and these findings were consistent with clinical judgments of tremor response. These results suggest that this technique could be used for fine adjustment of the location of sonication energy and number of sonications to consistently achieve optimal tremor reduction.
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Affiliation(s)
- Hongchae Baek
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | | | | | - Sean J Nagel
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Holcomb JM, Chopra R, Feltrin FS, Elkurd M, El-Nazer R, McKenzie L, O’Suilleabhain P, Maldjian JA, Dauer W, Shah BR. Improving tremor response to focused ultrasound thalamotomy. Brain Commun 2023; 5:fcad165. [PMID: 37533544 PMCID: PMC10390385 DOI: 10.1093/braincomms/fcad165] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/18/2023] [Accepted: 05/19/2023] [Indexed: 08/04/2023] Open
Abstract
MRI-guided high-intensity focused ultrasound thalamotomy is an incisionless therapy for essential tremor. To reduce adverse effects, the field has migrated to treating at 2 mm above the anterior commissure-posterior commissure plane. We perform MRI-guided high-intensity focused ultrasound with an advanced imaging targeting technique, four-tract tractography. Four-tract tractography uses diffusion tensor imaging to identify the critical white matter targets for tremor control, the decussating and non-decussating dentatorubrothalamic tracts, while the corticospinal tract and medial lemniscus are identified to be avoided. In some patients, four-tract tractography identified a risk of damaging the medial lemniscus or corticospinal tract if treated at 2 mm superior to the anterior commissure-posterior commissure plane. In these patients, we chose to target 1.2-1.5 mm superior to the anterior commissure-posterior commissure plane. In these patients, post-operative imaging revealed that the focused ultrasound lesion extended into the posterior subthalamic area. This study sought to determine if patients with focused ultrasound lesions that extend into the posterior subthalamic area have a differnce in tremor improvement than those without. Twenty essential tremor patients underwent MRI-guided high-intensity focused ultrasound and were retrospectively classified into two groups. Group 1 included patients with an extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. Group 2 included patients without extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. For each patient, the percent change in postural tremor, kinetic tremor and Archimedes spiral scores were calculated between baseline and a 3-month follow-up. Two-tailed Wilcoxon rank-sum tests were used to compare the improvement in tremor scores, the total number of sonications, thermal dose to achieve initial tremor response, and skull density ratio between groups. Group 1 had significantly greater postural, kinetic, and Archimedes spiral score percent improvement than Group 2 (P values: 5.41 × 10-5, 4.87 × 10-4, and 5.41 × 10-5, respectively). Group 1 also required significantly fewer total sonications to control the tremor and a significantly lower thermal dose to achieve tremor response (P values: 6.60 × 10-4 and 1.08 × 10-5, respectively). No significant group differences in skull density ratio were observed (P = 1.0). We do not advocate directly targeting the posterior subthalamic area with MRI-guided high-intensity focused ultrasound because the shape of the focused ultrasound lesion can result in a high risk of adverse effects. However, when focused ultrasound lesions naturally extend from the thalamus into the posterior subthalamic area, they provide greater tremor control than those that only involve the thalamus.
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Affiliation(s)
- James M Holcomb
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Rajiv Chopra
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Fabricio S Feltrin
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Mazen Elkurd
- Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Rasheda El-Nazer
- Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Lauren McKenzie
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | | | - Joseph A Maldjian
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - William Dauer
- Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
- O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA
| | - Bhavya R Shah
- Correspondence to: Bhavya R. Shah Department of Radiology, UTSW Medical Center, 1801 Inwood Rd Dallas, TX 75235, USA E-mail:
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Kyle K, Maller J, Barnett Y, Jonker B, Barnett M, D’Souza A, Calamante F, Maamary J, Peters J, Wang C, Tisch S. Tremor suppression following treatment with MRgFUS: skull density ratio consistency and degree of posterior dentatorubrothalamic tract lesioning predicts long-term clinical outcomes in essential tremor. Front Neurol 2023; 14:1129430. [PMID: 37181561 PMCID: PMC10166854 DOI: 10.3389/fneur.2023.1129430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives Magnetic resonance-guided focussed ultrasound (MRgFUS) is an incisionless ablative procedure, widely used for treatment of Parkinsonian and Essential Tremor (ET). Enhanced understanding of the patient- and treatment-specific factors that influence sustained long-term tremor suppression could help clinicians achieve superior outcomes via improved patient screening and treatment strategy. Methods We retrospectively analysed data from 31 subjects with ET, treated with MRgFUS at a single centre. Tremor severity was assessed with parts A, B and C of the Clinical Rating Scale for Tremor (CRST) as well as the combined CRST. Tremor in the dominant and non-dominant hand was assessed with Hand Tremor Scores (HTS), derived from the CRST. Pre- and post-treatment imaging data were analysed to determine ablation volume overlap with automated thalamic segmentations, and the dentatorubrothalamic tract (DRTT) and compared with percentage change in CRST and HTS following treatment. Results Tremor symptoms were significantly reduced following treatment. Combined pre-treatment CRST (mean: 60.7 ± 17.3) and HTS (mean: 19.2 ± 5.7) improved by an average of 45.5 and 62.6%, respectively. Percentage change in CRST was found to be significantly negatively associated with age (β = -0.375, p = 0.015), and SDR standard deviation (SDRSD; β = -0.324, p = 0.006), and positively associated with ablation overlap with the posterior DRTT (β = 0.535, p < 0.001). Percentage HTS improvement in the dominant hand decreased significantly with older age (β = -0.576, p < 0.01). Conclusion Our results suggest that increased lesioning of the posterior region of the DRTT could result in greater improvements in combined CRST and non-dominant hand HTS, and that subjects with lower SDR standard deviation tended to experience greater improvement in combined CRST.
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Affiliation(s)
- Kain Kyle
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
| | | | - Yael Barnett
- Department of Medical Imaging, and Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - Benjamin Jonker
- Department of Neurosurgery, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- Royal Prince Alfred Institute of Academic Surgery, University of Sydney, Camperdown, NSW, Australia
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Arkiev D’Souza
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fernando Calamante
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia
- Sydney Imaging, The University of Sydney, Sydney, NSW, Australia
| | - Joel Maamary
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Peters
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - Chenyu Wang
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
| | - Stephen Tisch
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
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9
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Lu H, Wang X, Lou X. Current applications for magnetic resonance-guided focused ultrasound in the treatment of Parkinson's disease. Chin Med J (Engl) 2023; 136:780-787. [PMID: 36914938 PMCID: PMC10150909 DOI: 10.1097/cm9.0000000000002319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 03/16/2023] Open
Abstract
ABSTRACT Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel and minimally invasive technology. Since the US Food and Drug Administration approved unilateral ventral intermediate nucleus-MRgFUS for medication-refractory essential tremor in 2016, studies on new indications, such as Parkinson's disease (PD), psychiatric diseases, and brain tumors, have been on the rise, and MRgFUS has become a promising method to treat such neurological diseases. Currently, as the second most common degenerative disease, PD is a research hotspot in the field of MRgFUS. The actions of MRgFUS on the brain range from thermoablation, blood-brain barrier (BBB) opening, to neuromodulation. Intensity is a key determinant of ultrasound actions. Generally, high intensity can be used to precisely thermoablate brain targets, whereas low intensity can be used as molecular therapies to modulate neuronal activity and open the BBB in conjunction with injected microbubbles. Here, we aimed to summarize advances in the application of MRgFUS for the treatment of PD, with a focus on thermal ablation, BBB opening, and neuromodulation, in the hope of informing clinicians of current applications.
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Affiliation(s)
- Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
| | - Xiaoyu Wang
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
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10
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Bruno F, Tommasino E, Catalucci A, Pastorelli C, Borea F, Caldarelli G, Bellini M, Badini P, Mancini S, Santobuono C, Martino S, Pagliei V, Manco G, Cerone D, Pistoia F, Palumbo P, Arrigoni F, Di Cesare E, Marini C, Barile A, Splendiani A, Masciocchi C. Evaluation of Cerebral Volume Changes in Patients with Tremor Treated by MRgFUS Thalamotomy. Life (Basel) 2022; 13:life13010016. [PMID: 36675970 PMCID: PMC9865014 DOI: 10.3390/life13010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of the study is to quantify volumetric variations of cortical and subcortical brain structures after Vim ablation using MRgFUS, and correlate them with the patients’ clinical features and treatment outcomes. For this pilot retrospective study we enrolled 31 patients with a mean age of 70.86 years who were eligible for unilateral Vim thalamotomy. Clinical evaluation included tremor severity assessment using the FTM scale and cognitive assessment using the MoCA score. MRI data were acquired with a 3T scanner, using a dedicated 32-channel coil and acquiring a volumetric sequence of T1 3D IR FSPGR (BRAVO), before treatment and one year after MRgFUS thalamotomy. Image processing and volume data extraction were conducted with dedicated software. A volumetric analysis showed a significant reduction (p < 0.05) of the left thalamus 1 year after the treatment in patients with ET. Other significant results were found on the same side in the other nuclei of the basal ganglia and in the cerebellar cortex. In confronting the two groups (ET, PD), no significant differences were found in terms of age, FTM, MoCA scores, or brain volumes. Similarly, no significant correlations were found between the FTM and MoCA scores and the brain volumes before the treatment.
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Affiliation(s)
- Federico Bruno
- Emergency Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy
- Italian Society of Medical and Intervention Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Correspondence: or ; Tel.: +39-3313240926
| | - Emanuele Tommasino
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessia Catalucci
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Cristina Pastorelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Francesco Borea
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giulia Caldarelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Mattia Bellini
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Pierfrancesco Badini
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sara Mancini
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Chiara Santobuono
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Saverio Martino
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Valeria Pagliei
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | | | - Davide Cerone
- Neurology, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Intervention Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
| | | | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Carmine Marini
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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11
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Feltrin FS, Chopra R, Pouratian N, Elkurd M, El-Nazer R, Lanford L, Dauer W, Shah BR. Focused ultrasound using a novel targeting method four-tract tractography for magnetic resonance-guided high-intensity focused ultrasound targeting. Brain Commun 2022; 4:fcac273. [PMID: 36751499 PMCID: PMC9897190 DOI: 10.1093/braincomms/fcac273] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/03/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance-guided high-intensity focused ultrasound thalamotomy is a Food and Drug Administration-approved treatment for essential tremor. The target, the ventral intermediate nucleus of the thalamus, is not visualized on standard, anatomic MRI sequences. Several recent reports have used diffusion tensor imaging to target the dentato-rubro-thalamic-tract. There is considerable variability in fibre tracking algorithms and what fibres are tracked. Targeting discrete white matter tracts with magnetic resonance-guided high-intensity focused ultrasound is an emerging precision medicine technique that has the promise to improve patient outcomes and reduce treatment times. We provide a technical overview and clinical benefits of our novel, easily implemented advanced tractography method: four-tract tractography. Our method is novel because it targets both the decussating and non-decussating dentato-rubro-thalamic-tracts while avoiding the medial lemniscus and corticospinal tracts. Our method utilizes Food and Drug Administration-approved software and is easily implementable into existing workflows. Initial experience using this approach suggests that it improves patient outcomes by reducing the incidence of adverse effects.
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Affiliation(s)
- Fabricio S Feltrin
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Rajiv Chopra
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UTSW Medical Center, Dallas, TX 75235, USA,O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA
| | - Mazen Elkurd
- O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA,Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Rasheda El-Nazer
- O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA,Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Lauren Lanford
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - William Dauer
- O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA,Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Bhavya R Shah
- Correspondence to: Bhavya R. Shah UTSW Medical Center 1801 Inwood Rd, Dallas, TX 75235, USA E-mail:
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12
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Yin C, Zong R, Song G, Zhou J, Pan L, Li X. Comparison of Motor Scores between OFF and ON States in Tremor-Dominant Parkinson's Disease after MRgFUS Treatment. J Clin Med 2022; 11:jcm11154502. [PMID: 35956119 PMCID: PMC9369361 DOI: 10.3390/jcm11154502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: To compare the motor function improvements in ON and OFF states in tremor-dominant Parkinson’s disease (TDPD) patients within one year of follow-up after ablation of the unilateral ventral intermediate nucleus of the thalamus (Vim) by magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS). Methods: A total of nine consecutive patients confirmed with TDPD who underwent unilateral Vim ablation by MRgFUS between April 2019 and September 2019 were included. The Movement Disorder Society Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRSIII) and Clinical Rating Scale for Tremor (CRST) were performed in the ON and OFF stages to distinguish the surgical effects from drug therapy effects. The adverse events and adjustment of drug doses were also recorded. Results: The preoperative MDS-UPDRSIII score in OFF and ON states was 55.0 (48.0, 65.5) and 26.0 (17.0, 27.0), while the CRST score was 46.0 (39.5, 53.5) and 20.0 (13.0, 23.5), respectively; the Levodopa equivalent dose was 600 (456, 600) mg/d. At 1 year after operation, the total MDS-UPDRSIII score and CRST score were 40.0 (30.0, 60.5) and 16.0 (10.0, 29.5) in the OFF state, and 21.0 (17.5, 27.0) and 2.0 (1.5, 7.0) in the ON state, respectively. Compared with the preoperative levels, follow-up at the two-time points (three months and one year after operation) showed the total MDS-UPDRSIII score, as well as MDS-UPDRSIII tremor, bradykinesia, and rigidity scores of contralateral limbs all significantly improved in OFF state. However, in the ON state, only the total MDS-UPDRSIII score and tremor score of contralateral limbs significantly improved. The total CRST score and the CRST (A + B) score of contralateral limbs significantly improved at three months and one year after the operation compared with before the operation in both ON and OFF states. The Levodopa equivalent dose at one and three months were not significantly different from the preoperative dose (p > 0.05). No serious adverse responses were observed. Conclusion: Treating TDPD with unilateral Vim ablation by MRgFUS could improve the symptoms of limb tremor and the other core symptoms, such as bradykinesia and rigidity, as well as some non-motor symptoms and the symptoms of ipsilateral limbs.
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Affiliation(s)
- Chunyu Yin
- Department of Cadres’ Outpatient, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China;
| | - Rui Zong
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; (R.Z.); (J.Z.)
| | - Ge Song
- Department of Health Care, 305 Hospital of Chinese PLA, Beijing 100017, China;
| | - Jiayou Zhou
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; (R.Z.); (J.Z.)
| | - Longsheng Pan
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; (R.Z.); (J.Z.)
- Correspondence: (L.P.); (X.L.)
| | - Xuemei Li
- Department of Cadres’ Outpatient, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China;
- Correspondence: (L.P.); (X.L.)
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13
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Update in the clinical application of focused ultrasound. Curr Opin Neurol 2022; 35:525-535. [PMID: 35788096 DOI: 10.1097/wco.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the most recent evidence about the clinical applicability of transcranial MRI-guided focused ultrasound (MRgFUS), including clinical evidence and indications, recent technical developments for its use and future prospects. RECENT FINDINGS Unilateral MRgFUS thalamotomy for both essential and parkinsonian tremors is an approved and well established therapy. Recent studies have focused on its long-term safety and efficacy as well as technical advances for refining the approach. Moreover, ultrasound has expanded its application in Parkinson's disease, with clinical trials successfully targeting other brain regions like the subthalamic nucleus, the globus pallidus and the pallidothalamic tract, providing benefits for features that thalamotomy neglects. New indications, such as focal dystonia or neuropsychiatric conditions (namely obsessive-compulsive disorder and depression) have also been explored, with encouraging preliminary results. Finally, the application of ultrasound in low-intensity modality allows other approaches like focal blood-brain barrier opening and neuromodulation, which promise to be highly relevant in translational research. SUMMARY MRgFUS is a growing emergent technique. Its application in clinical routine is becoming widely accepted as a therapeutic option. Novel approaches and new potential applications are anticipated.
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14
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Pujol S, Cabeen RP, Yelnik J, François C, Fernandez Vidal S, Karachi C, Bardinet E, Cosgrove GR, Kikinis R. Somatotopic Organization of Hyperdirect Pathway Projections From the Primary Motor Cortex in the Human Brain. Front Neurol 2022; 13:791092. [PMID: 35547388 PMCID: PMC9081715 DOI: 10.3389/fneur.2022.791092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background The subthalamic nucleus (STN) is an effective neurosurgical target to improve motor symptoms in Parkinson's Disease (PD) patients. MR-guided Focused Ultrasound (MRgFUS) subthalamotomy is being explored as a therapeutic alternative to Deep Brain Stimulation (DBS) of the STN. The hyperdirect pathway provides a direct connection between the cortex and the STN and is likely to play a key role in the therapeutic effects of MRgFUS intervention in PD patients. Objective This study aims to investigate the topography and somatotopy of hyperdirect pathway projections from the primary motor cortex (M1). Methods We used advanced multi-fiber tractography and high-resolution diffusion MRI data acquired on five subjects of the Human Connectome Project (HCP) to reconstruct hyperdirect pathway projections from M1. Two neuroanatomy experts reviewed the anatomical accuracy of the tracts. We extracted the fascicles arising from the trunk, arm, hand, face and tongue area from the reconstructed pathways. We assessed the variability among subjects based on the fractional anisotropy (FA) and mean diffusivity (MD) of the fibers. We evaluated the spatial arrangement of the different fascicles using the Dice Similarity Coefficient (DSC) of spatial overlap and the centroids of the bundles. Results We successfully reconstructed hyperdirect pathway projections from M1 in all five subjects. The tracts were in agreement with the expected anatomy. We identified hyperdirect pathway fascicles projecting from the trunk, arm, hand, face and tongue area in all subjects. Tract-derived measurements showed low variability among subjects, and similar distributions of FA and MD values among the fascicles projecting from different M1 areas. We found an anterolateral somatotopic arrangement of the fascicles in the corona radiata, and an average overlap of 0.63 in the internal capsule and 0.65 in the zona incerta. Conclusion Multi-fiber tractography combined with high-resolution diffusion MRI data enables the identification of the somatotopic organization of the hyperdirect pathway. Our preliminary results suggest that the subdivisions of the hyperdirect pathway projecting from the trunk, arm, hand, face, and tongue motor area are intermixed at the level of the zona incerta and posterior limb of the internal capsule, with a predominantly overlapping topographical organization in both regions. Subject-specific knowledge of the hyperdirect pathway somatotopy could help optimize target definition in MRgFUS intervention.
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Affiliation(s)
- Sonia Pujol
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ryan P Cabeen
- Laboratory of Neuro Imaging, Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine of the USC, University of Southern California, Los Angeles, CA, United States
| | - Jérôme Yelnik
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Chantal François
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Sara Fernandez Vidal
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - Carine Karachi
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France.,Department of Neurosurgery, APHP, Hôpitaux Universitaires Pitié-Salpêtriére/Charles Foix, Paris, France
| | - Eric Bardinet
- Sorbonne Université, CNRS, INSERM, APHP GH Pitié-Salpêtriére, Paris Brain Institute - Institut du Cerveau (ICM), Paris, France.,CENIR Platform, Institut du Cerveau (ICM), Paris, France
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ron Kikinis
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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15
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Stefani A, Pierantozzi M, Cardarelli S, Stefani L, Cerroni R, Conti M, Garasto E, Mercuri NB, Marini C, Sucapane P. Neurotrophins as Therapeutic Agents for Parkinson’s Disease; New Chances From Focused Ultrasound? Front Neurosci 2022; 16:846681. [PMID: 35401084 PMCID: PMC8990810 DOI: 10.3389/fnins.2022.846681] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 01/02/2023] Open
Abstract
Magnetic Resonance–guided Focused Ultrasound (MRgFUS) represents an effective micro-lesioning approach to target pharmaco-resistant tremor, mostly in patients afflicted by essential tremor (ET) and/or Parkinson’s disease (PD). So far, experimental protocols are verifying the clinical extension to other facets of the movement disorder galaxy (i.e., internal pallidus for disabling dyskinesias). Aside from those neurosurgical options, one of the most intriguing opportunities of this technique relies on its capability to remedy the impermeability of blood–brain barrier (BBB). Temporary BBB opening through low-intensity focused ultrasound turned out to be safe and feasible in patients with PD, Alzheimer’s disease, and amyotrophic lateral sclerosis. As a mere consequence of the procedures, some groups described even reversible but significant mild cognitive amelioration, up to hippocampal neurogenesis partially associated to the increased of endogenous brain-derived neurotrophic factor (BDNF). A further development elevates MRgFUS to the status of therapeutic tool for drug delivery of putative neurorestorative therapies. Since 2012, FUS-assisted intravenous administration of BDNF or neurturin allowed hippocampal or striatal delivery. Experimental studies emphasized synergistic modalities. In a rodent model for Huntington’s disease, engineered liposomes can carry glial cell line–derived neurotrophic factor (GDNF) plasmid DNA (GDNFp) to form a GDNFp-liposome (GDNFp-LPs) complex through pulsed FUS exposures with microbubbles; in a subacute MPTP-PD model, the combination of intravenous administration of neurotrophic factors (either through protein or gene delivery) plus FUS did curb nigrostriatal degeneration. Here, we explore these arguments, focusing on the current, translational application of neurotrophins in neurodegenerative diseases.
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Affiliation(s)
- Alessandro Stefani
- Department of System Medicine, Parkinson Center, University Tor Vergata, Rome, Italy
- *Correspondence: Alessandro Stefani,
| | | | - Silvia Cardarelli
- Department of System Medicine, Parkinson Center, University Tor Vergata, Rome, Italy
| | - Lucrezia Stefani
- Department of System Medicine, Parkinson Center, University Tor Vergata, Rome, Italy
| | - Rocco Cerroni
- Department of System Medicine, Parkinson Center, University Tor Vergata, Rome, Italy
| | - Matteo Conti
- Department of System Medicine, UOC Neurology, University Tor Vergata, Rome, Italy
| | - Elena Garasto
- Department of System Medicine, UOC Neurology, University Tor Vergata, Rome, Italy
| | - Nicola B. Mercuri
- Department of System Medicine, UOC Neurology, University Tor Vergata, Rome, Italy
| | - Carmine Marini
- UOC Neurology and Stroke Unit, University of L’Aquila, L’Aquila, Italy
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16
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Binder DK, Shah BB, Elias WJ. Focused ultrasound and other lesioning in the treatment of tremor. J Neurol Sci 2022; 435:120193. [DOI: 10.1016/j.jns.2022.120193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
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17
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Bruno F, Catalucci A, Arrigoni F, Gagliardi A, Campanozzi E, Corridore A, Tommasino E, Pagliei V, Pertici L, Palumbo P, Sucapane P, Cerone D, Pistoia F, Di Cesare E, Barile A, Ricci A, Marini C, Splendiani A, Masciocchi C. Comprehensive Evaluation of Factors Affecting Tremor Relapse after MRgFUS Thalamotomy: A Case-Control Study. Brain Sci 2021; 11:brainsci11091183. [PMID: 34573204 PMCID: PMC8472207 DOI: 10.3390/brainsci11091183] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To identify possible relevant factors contributing to tremor relapse after MRgFUS thalamotomy in patients with essential tremor (ET) and Parkinson's disease (PD). METHODS We identified patients with tremor relapse from a series of 79 treatments in a single institution. The demographic and clinical characteristics of the study group patients were compared to those of patients who did not relapse in the same follow-up period. Imaging and procedural factors were compared using a control group matched for clinical and demographic characteristics. RESULTS Concerning clinical and demographic characteristics, we did not find statistically significant differences in gender and age. Seventy-three percent of patients with tremor relapse were Parkinson's disease patients. Using MRI, we found larger thalamotomy lesions at the 1-year follow-up in the control group with stable outcomes, compared to patients with tremor relapse. In the tractography evaluation, we found a more frequent eccentric position of the DRTt in patients with tremor relapse. CONCLUSIONS The most relevant determining factors for tremor relapse after MRgFUS thalamotomy appear to be tremor from Parkinson's disease and inaccurate thalamic targeting. Size of the thalamotomy lesion can also influence the outcome of treatment.
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Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy;
- Correspondence:
| | - Alessia Catalucci
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (E.D.C.)
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Alessio Gagliardi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Elena Campanozzi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Antonella Corridore
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Emanuele Tommasino
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Valeria Pagliei
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Leonardo Pertici
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy;
| | - Patrizia Sucapane
- Neurology, San Salvatore Hospital, 67100 L’Aquila, Italy; (P.S.); (D.C.)
| | - Davide Cerone
- Neurology, San Salvatore Hospital, 67100 L’Aquila, Italy; (P.S.); (D.C.)
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Ernesto Di Cesare
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (E.D.C.)
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | | | - Carmine Marini
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.A.); (A.G.); (E.C.); (A.C.); (E.T.); (V.P.); (L.P.); (F.P.); (A.B.); (C.M.); (A.S.); (C.M.)
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