Transcranial MRI-guided high-intensity focused ultrasound for treatment of essential tremor: A pilot study on the correlation between lesion size, lesion location, thermal dose, and clinical outcome

2017 ◽  
Vol 48 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Christian Federau ◽  
Maged Goubran ◽  
Jarrett Rosenberg ◽  
Jaimie Henderson ◽  
Casey H. Halpern ◽  
...  
Keyword(s):  
Pilot Study ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
High Intensity ◽  
Focused Ultrasound ◽  
Lesion Size ◽  
High Intensity Focused Ultrasound ◽  
Thermal Dose ◽  
Lesion Location ◽  
Mri Guided

scholarly journals Non-Invasive Targeted Peripheral Nerve Ablation Using 3D MR Neurography and MRI-Guided High-Intensity Focused Ultrasound (MR-HIFU): Pilot Study in a Swine Model

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0144742 ◽  
Author(s):  
Merel Huisman ◽  
Robert M. Staruch ◽  
Michelle Ladouceur-Wodzak ◽  
Maurice A. van den Bosch ◽  
Dennis K. Burns ◽  
...  
Keyword(s):  
Pilot Study ◽  
Peripheral Nerve ◽  
High Intensity ◽  
Focused Ultrasound ◽  
High Intensity Focused Ultrasound ◽  
Swine Model ◽  
Mr Neurography ◽  
Non Invasive ◽  
Mri Guided

scholarly journals Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures

2020 ◽  
Vol 132 (6) ◽  
pp. 1802-1809 ◽  
Author(s):  
Ryan M. Jones ◽  
Shona Kamps ◽  
Yuexi Huang ◽  
Nadia Scantlebury ◽  
Nir Lipsman ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Focused Ultrasound ◽  
Rating Scale ◽  
Lesion Size ◽  
Thermal Dose ◽  
Mr Thermometry ◽  
Dose Accumulation ◽  
Regression Slope ◽  
Tremor Suppression ◽  
Mri Guided

OBJECTIVEThe object of this study was to correlate lesion size with accumulated thermal dose (ATD) in transcranial MRI-guided focused ultrasound (MRgFUS) treatments of essential tremor with focal temperatures limited to 50°C–54°C.METHODSSeventy-five patients with medically refractory essential tremor underwent MRgFUS thalamotomy at the authors’ institution. Intraoperative MR thermometry was performed to measure the induced temperature and thermal dose distributions (proton resonance frequency shift coefficient = −0.00909 ppm/°C). In 19 patients, it was not possible to raise the focal temperature above 54°C because of unfavorable skull characteristics and/or the pain associated with cranial heating. In this patient subset, sonications with focal temperatures between 50°C and 54°C were repeated (5.1 ± 1.5, mean ± standard deviation) to accumulate a sufficient thermal dose for lesion formation. The ATD profile sizes (17, 40, 100, 200, and 240 cumulative equivalent minutes at 43°C [CEM43]) calculated by combining axial MR thermometry data from individual sonications were correlated with the corresponding lesion sizes measured on axial T1-weighted (T1w) and T2-weighted (T2w) MR images acquired 1 day posttreatment. Manual corrections were applied to the MR thermometry data prior to thermal dose accumulation to compensate for off-resonance–induced spatial-shifting artifacts.RESULTSMean lesion sizes measured on T2w MRI (5.0 ± 1.4 mm) were, on average, 28% larger than those measured on T1w MRI (3.9 ± 1.4 mm). The ATD thresholds found to provide the best correlation with lesion sizes measured on T2w and T1w MRI were 100 CEM43 (regression slope = 0.97, R2 = 0.66) and 200 CEM43 (regression slope = 0.98, R2 = 0.89), respectively, consistent with data from a previous study of MRgFUS thalamotomy via repeated sonications at higher focal temperatures (≥ 55°C). Two-way linear mixed-effects analysis revealed that dominant tremor subscores on the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (CRST) were statistically different from baseline at 3 months and 1 year posttreatment in both low-temperature (50°C–54°C) and high-temperature (≥ 55°C) patient cohorts. No significant fixed effect on the dominant tremor scores was found for the temperature cohort factor.CONCLUSIONSIn transcranial MRgFUS thalamotomy for essential tremor, repeated sonications with focal temperatures between 50°C and 54°C can accumulate a sufficient thermal dose to generate lesions for clinically relevant tremor suppression up to 1 year posttreatment, and the ATD can be used to predict the size of the resulting ablation zones measured on MRI. These data will serve to guide future clinical MRgFUS brain procedures, particularly those in which focal temperatures are limited to below 55°C.

Multimodal MRI for MRgFUS in essential tremor: post-treatment radiological markers of clinical outcome

2020 ◽  
Vol 91 (9) ◽  
pp. 921-927
Author(s):  
Anish N Kapadia ◽  
Gavin J B Elias ◽  
Alexandre Boutet ◽  
Jürgen Germann ◽  
Aditiya Pancholi ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
Focused Ultrasound ◽  
Lesion Size ◽  
Post Treatment ◽  
Medial Lemniscus ◽  
Invasive Treatment ◽  
Tremor Suppression ◽  
Registration Number

BackgroundMRI-guided focused ultrasound (MRgFUS) thalamotomy is a promising non-invasive treatment option for medication-resistant essential tremor. However, it has been associated with variable efficacy and a relatively high incidence of adverse effects.ObjectivesTo assess the evolution of radiological findings after MRgFUS thalamotomy and to evaluate their significance for clinical outcomes.MethodsNinety-four patients who underwent MRgFUS between 2012 and 2017 were retrospectively evaluated. Lesion characteristics were assessed on routine MRI sequences, as well as with tractography. Relationships between imaging appearance, extent of white matter tract lesioning (59/94, on a 4-point scale) and clinical outcome were investigated. Recurrence was defined as >33% loss of tremor suppression at 3 months relative to day 7.ResultsAcute lesions demonstrated blood products, surrounding oedema and peripheral diffusion restriction. The extent of dentatorubrothalamic tract (DRTT) lesioning was significantly associated with clinical improvement at 1 year (t=4.32, p=0.001). Lesion size decreased over time (180.8±91.5 mm3 at day 1 vs 19.5±19.3 mm3 at 1-year post-treatment). Higher post-treatment oedema (t=3.59, p<0.001) was associated with larger lesions at 3 months. Patients with larger lesions at day 1 demonstrated reduced rates of tremor recurrence (t=2.67, p=0.019); however, lesions over 170 mm3 trended towards greater incidence of adverse effects (sensitivity=0.60, specificity=0.63). Lesion encroachment on the medial lemniscus (Sn=1.00, Sp=0.32) and pyramidal tract (Sn=1.00, Sp=0.12) were also associated with increased adverse effects incidence.ConclusionLesion size at day 1 predicts symptom recurrence, with fewer recurrences seen with larger lesions. Greater DRTT lesioning is associated with treatment efficacy. These findings may have implications for lesion targeting and extent.Trial registration numberNCT02252380.

A study of efficacy and safety of high‐intensity focused ultrasound for the treatment of melasma in Asians: A single‐blinded, randomized, split‐face, pilot study

2019 ◽  
Vol 19 (2) ◽  
pp. 375-381 ◽  
Author(s):  
Vasanop Vachiramon ◽  
Wimolsiri Iamsumang ◽  
Nongsak Chanasumon ◽  
Kunlawat Thadanipon ◽  
Korn Triyangkulsri
Keyword(s):  
Pilot Study ◽  
High Intensity ◽  
Focused Ultrasound ◽  
High Intensity Focused Ultrasound ◽  
Efficacy And Safety ◽  
Split Face

scholarly journals MRI-Guided High-Intensity Focused Ultrasound as an Emerging Therapy for Stroke: A Review

2018 ◽  
Vol 29 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Atif Zafar ◽  
Syed A. Quadri ◽  
Mudassir Farooqui ◽  
Santiago Ortega-Gutiérrez ◽  
Omid R. Hariri ◽  
...  
Keyword(s):  
High Intensity ◽  
Focused Ultrasound ◽  
High Intensity Focused Ultrasound ◽  
Mri Guided ◽  
Emerging Therapy
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