Cargando…

The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor

Magnetic Resonance-guided Focused UltraSound (MRgFUS) offers an incisionless approach to treat essential tremor (ET). Due to lack of evident internal anatomy on traditional structural imaging, indirect targeting must still be used to localize the lesion. Here, we investigate the potential predictive...

Descripción completa

Detalles Bibliográficos
Autores principales: Tsolaki, Evangelia, Downes, Angela, Speier, William, Elias, W. Jeff, Pouratian, Nader
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842733/
https://www.ncbi.nlm.nih.gov/pubmed/29527503
http://dx.doi.org/10.1016/j.nicl.2017.12.018
_version_ 1783304956791488512
author Tsolaki, Evangelia
Downes, Angela
Speier, William
Elias, W. Jeff
Pouratian, Nader
author_facet Tsolaki, Evangelia
Downes, Angela
Speier, William
Elias, W. Jeff
Pouratian, Nader
author_sort Tsolaki, Evangelia
collection PubMed
description Magnetic Resonance-guided Focused UltraSound (MRgFUS) offers an incisionless approach to treat essential tremor (ET). Due to lack of evident internal anatomy on traditional structural imaging, indirect targeting must still be used to localize the lesion. Here, we investigate the potential predictive value of probabilistic tractography guided thalamic targeting by defining how tractography-defined targets, lesion size and location, and clinical outcomes interrelate. MR imaging and clinical outcomes from 12 ET patients that underwent MRgFUS thalamotomy in a pilot study at the University of Virginia were evaluated in this analysis. FSL was used to evaluate each patient's voxel-wise thalamic connectivity with FreeSurfer generated pre- and post-central gyrus targets, to generate thalamic target maps. Using Receiver Operating Characteristic curves, the overlap between these thalamic target maps and the MRgFUS lesion was systematically evaluated relative to clinical outcome. To further define the connectivity characteristics of effective MRgFUS thalamotomy lesions, we evaluated whole brain probabilistic tractography of lesions (using post-treatment imaging to define the lesion pre-treatment diffusion tensor MRI). The structural connectivity difference was explored between subjects with the best clinical outcome relative to all others. Ten of twelve patients presented high percentage of overlapping between connectivity-based thalamic segmentation maps and lesion area. The improvement of clinical score was predicted (AUC: 0.80) using the volume of intersection between the thalamic target (precentral gyrus) map and MRgFUS induced lesion as feature. The main structural differences between those with different magnitudes of response were observed in connectivity to the pre- and post-central gyri and brainstem/cerebellum. MRgFUS thalamotomy lesions characterized by strong structural connectivity to precentral gyrus demonstrated better responses in a cohort of patients treated with MRgFUS for ET. The intersection between lesion and thalamic-connectivity maps to motor - sensory targets proved to be effective in predicting the response to the therapy. These imaging techniques can be used to increase the efficacy and consistency of outcomes with MRgFUS and potentially shorten treatment times by identifying optimal targets in advance of treatment.
format Online
Article
Text
id pubmed-5842733
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-58427332018-03-09 The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor Tsolaki, Evangelia Downes, Angela Speier, William Elias, W. Jeff Pouratian, Nader Neuroimage Clin Regular Article Magnetic Resonance-guided Focused UltraSound (MRgFUS) offers an incisionless approach to treat essential tremor (ET). Due to lack of evident internal anatomy on traditional structural imaging, indirect targeting must still be used to localize the lesion. Here, we investigate the potential predictive value of probabilistic tractography guided thalamic targeting by defining how tractography-defined targets, lesion size and location, and clinical outcomes interrelate. MR imaging and clinical outcomes from 12 ET patients that underwent MRgFUS thalamotomy in a pilot study at the University of Virginia were evaluated in this analysis. FSL was used to evaluate each patient's voxel-wise thalamic connectivity with FreeSurfer generated pre- and post-central gyrus targets, to generate thalamic target maps. Using Receiver Operating Characteristic curves, the overlap between these thalamic target maps and the MRgFUS lesion was systematically evaluated relative to clinical outcome. To further define the connectivity characteristics of effective MRgFUS thalamotomy lesions, we evaluated whole brain probabilistic tractography of lesions (using post-treatment imaging to define the lesion pre-treatment diffusion tensor MRI). The structural connectivity difference was explored between subjects with the best clinical outcome relative to all others. Ten of twelve patients presented high percentage of overlapping between connectivity-based thalamic segmentation maps and lesion area. The improvement of clinical score was predicted (AUC: 0.80) using the volume of intersection between the thalamic target (precentral gyrus) map and MRgFUS induced lesion as feature. The main structural differences between those with different magnitudes of response were observed in connectivity to the pre- and post-central gyri and brainstem/cerebellum. MRgFUS thalamotomy lesions characterized by strong structural connectivity to precentral gyrus demonstrated better responses in a cohort of patients treated with MRgFUS for ET. The intersection between lesion and thalamic-connectivity maps to motor - sensory targets proved to be effective in predicting the response to the therapy. These imaging techniques can be used to increase the efficacy and consistency of outcomes with MRgFUS and potentially shorten treatment times by identifying optimal targets in advance of treatment. Elsevier 2017-12-12 /pmc/articles/PMC5842733/ /pubmed/29527503 http://dx.doi.org/10.1016/j.nicl.2017.12.018 Text en © 2017 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Regular Article
Tsolaki, Evangelia
Downes, Angela
Speier, William
Elias, W. Jeff
Pouratian, Nader
The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor
title The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor
title_full The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor
title_fullStr The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor
title_full_unstemmed The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor
title_short The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor
title_sort potential value of probabilistic tractography-based for mr-guided focused ultrasound thalamotomy for essential tremor
topic Regular Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842733/
https://www.ncbi.nlm.nih.gov/pubmed/29527503
http://dx.doi.org/10.1016/j.nicl.2017.12.018
work_keys_str_mv AT tsolakievangelia thepotentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT downesangela thepotentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT speierwilliam thepotentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT eliaswjeff thepotentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT pouratiannader thepotentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT tsolakievangelia potentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT downesangela potentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT speierwilliam potentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT eliaswjeff potentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor
AT pouratiannader potentialvalueofprobabilistictractographybasedformrguidedfocusedultrasoundthalamotomyforessentialtremor