Correlation between fractional anisotropy changes in the targeted ventral intermediate nucleus and clinical outcome after transcranial MR-guided focused ultrasound thalamotomy for essential tremor: results of a pilot study

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OBJECTIVE

This study evaluated changes of fractional anisotropy (FA) in the ventral intermediate nucleus (VIM) of the thalamus after transcranial MR-guided focused ultrasound (TcMRgFUS) thalamotomy and their associations with clinical outcome.

METHODS

Clinical and radiological data of 12 patients with medically refractory essential tremor (mean age 76.5 years) who underwent TcMRgFUS thalamotomy with VIM targeting were analyzed retrospectively. The Clinical Rating Scale for Tremor (CRST) score was calculated before and at 1 year after treatment. Measurements of the relative FA (rFA) values, defined as ratio of the FA value in the targeted VIM to the FA value in the contralateral VIM, were performed before thalamotomy, and 1 day and 1 year thereafter.

RESULTS

TcMRgFUS thalamotomy was well tolerated and no long-term complications were noted. At 1-year follow-up, 8 patients demonstrated relief of tremor (improvement group), whereas in 4 others persistent tremor was noted (recurrence group). In the entire cohort, mean rFA values in the targeted VIM before treatment, and at 1 day and 1 year after treatment, were 1.12 ± 0.15, 0.44 ± 0.13, and 0.82 ± 0.22, respectively (p < 0.001). rFA values were consistently higher in the recurrence group compared with the improvement group, and the difference reached statistical significance at 1 day (p < 0.05) and 1 year (p < 0.01) after treatment. There was a statistically significant (p < 0.01) positive correlation between rFA values in the targeted VIM at 1 day after thalamotomy and CRST score at 1 year after treatment. Receiver operating characteristic curve analysis revealed that the optimal cutoff value of rFA at 1 day after thalamotomy for prediction of symptomatic improvement at 1-year follow-up is 0.54.

CONCLUSIONS

TcMRgFUS thalamotomy results in significant decrease of rFA in the targeted VIM, at both 1 day and 1 year after treatment. Relative FA values at 1 day after treatment showed significant correlation with CRST score at 1-year follow-up. Therefore, FA may be considered a possible imaging biomarker for early prediction of clinical outcome after TcMRgFUS thalamotomy for essential tremor.

ABBREVIATIONS AC-PC = anterior commissure–posterior commissure; AUC = area under the curve; CRST = Clinical Rating Scale for Tremor; DTI = diffusion tensor imaging; FA = fractional anisotropy; FOV = field of view; rFA = relative FA; ROC = receiver operating characteristic; ROI = region of interest; SDR = skull density ratio; TcMRgFUS = transcranial MR-guided focused ultrasound; VIM = ventral intermediate nucleus.
Article Information

Contributor Notes

Correspondence Yoshihiro Muragaki: Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo, Japan. ymuragaki@twmu.ac.jp.INCLUDE WHEN CITING Published online February 15, 2019; DOI: 10.3171/2018.10.JNS18993.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Akram HDayal VMahlknecht PGeorgiev DHyam JFoltynie T: Connectivity derived thalamic segmentation in deep brain stimulation for tremor. Neuroimage Clin 18:1301422018

    • Search Google Scholar
    • Export Citation
  • 2

    Alexander ALLee JELazar MField AS: Diffusion tensor imaging of the brain. Neurotherapeutics 4:3163292007

  • 3

    Bland JMAltman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:3073101986

  • 4

    Bond AEElias WJ: Predicting lesion size during focused ultrasound thalamotomy: a review of 63 lesions over 3 clinical trials. Neurosurg Focus 44(2):E52018

    • Search Google Scholar
    • Export Citation
  • 5

    Chazen JLSarva HStieg PEMin RJBallon DJPryor KO: Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor. J Neurosurg 129:3153232018

    • Search Google Scholar
    • Export Citation
  • 6

    Coenen VAAllert NMädler B: A role of diffusion tensor imaging fiber tracking in deep brain stimulation surgery: DBS of the dentato-rubro-thalamic tract (drt) for the treatment of therapy-refractory tremor. Acta Neurochir (Wien) 153:157915852011

    • Search Google Scholar
    • Export Citation
  • 7

    Coenen VAJenkner CHoney CRMädler B: Electrophysiologic validation of diffusion tensor imaging tractography during deep brain stimulation surgery. AJNR Am J Neuroradiol 37:147014782016

    • Search Google Scholar
    • Export Citation
  • 8

    Elias WJHuss DVoss TLoomba JKhaled MZadicario E: A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med 369:6406482013

    • Search Google Scholar
    • Export Citation
  • 9

    Elias WJLipsman NOndo WGGhanouni PKim YGLee W: A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 375:7307392016

    • Search Google Scholar
    • Export Citation
  • 10

    Fahn STolosa EMarin C: Clinical rating scale for tremor in Jankovic JTolosa E (eds): Parkinson’s Disease and Movement Disordersed 2. Baltimore: Williams & Wilkins1993 pp 271280

    • Search Google Scholar
    • Export Citation
  • 11

    Federau CGoubran MRosenberg JHenderson JHalpern CHSantini V: 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. J Magn Reson Imaging 48:58652018

    • Search Google Scholar
    • Export Citation
  • 12

    Gallay MNJeanmonod DLiu JMorel A: Human pallidothalamic and cerebellothalamic tracts: anatomical basis for functional stereotactic neurosurgery. Brain Struct Funct 212:4434632008

    • Search Google Scholar
    • Export Citation
  • 13

    Gallay MNMoser DRossi FPourtehrani PMagara AEKowalski M: Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy. J Ther Ultrasound 4:52016

    • Search Google Scholar
    • Export Citation
  • 14

    Jia LJia-Lin SQin DQing LYan Z: A diffusion tensor imaging study in essential tremor. J Neuroimaging 21:3703742011

  • 15

    Kiss ZHWilkinson MKrcek JSuchowersky OHu BMurphy WF: Is the target for thalamic deep brain stimulation the same as for thalamotomy? Mov Disord 18:116911752003

    • Search Google Scholar
    • Export Citation
  • 16

    Klein JCLorenz BKang JSBaudrexel SSeifried Cvan de Loo S: Diffusion tensor imaging of white matter involvement in essential tremor. Hum Brain Mapp 32:8969042011

    • Search Google Scholar
    • Export Citation
  • 17

    Krishna VSammartino FAgrawal PChangizi BKBourekas EKnopp MV: Prospective tractography-based targeting for improved safety of focused ultrasound thalamotomy. Neurosurgery 84:1601682019

    • Search Google Scholar
    • Export Citation
  • 18

    Lefranc MCarron RRegis J: Prelemniscal radiations: a new reliable landmark of the thalamic nucleus ventralis intermedius location. Stereotact Funct Neurosurg 93:4004062015

    • Search Google Scholar
    • Export Citation
  • 19

    Lipsman NSchwartz MLHuang YLee LSankar TChapman M: MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study. Lancet Neurol 12:4624682013

    • Search Google Scholar
    • Export Citation
  • 20

    Maeda T: Lateral coordinates of nucleus ventralis intermedius target for tremor alleviation. Stereotact Funct Neurosurg 52:1911991989

    • Search Google Scholar
    • Export Citation
  • 21

    Martin EJeanmonod DMorel AZadicario EWerner B: High-intensity focused ultrasound for noninvasive functional neurosurgery. Ann Neurol 66:8588612009

    • Search Google Scholar
    • Export Citation
  • 22

    Mori SCrain BJChacko VPvan Zijl PC: Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 45:2652691999

    • Search Google Scholar
    • Export Citation
  • 23

    Mori SZhang J: Principles of diffusion tensor imaging and its applications to basic neuroscience research. Neuron 51:5275392006

  • 24

    Ohye C: From selective thalamotomy with microrecording to gamma thalamotomy for movement disorders. Stereotact Funct Neurosurg 84:1551612006

    • Search Google Scholar
    • Export Citation
  • 25

    Ohye CHiguchi YShibazaki THashimoto TKoyama THirai T: Gamma knife thalamotomy for Parkinson disease and essential tremor: a prospective multicenter study. Neurosurgery 70:5265362012

    • Search Google Scholar
    • Export Citation
  • 26

    Rezai ARMachado AGDeogaonkar MAzmi HKubu CBoulis NM: Surgery for movement disorders. Neurosurgery 62 (2 Suppl 2):8098392008

    • Search Google Scholar
    • Export Citation
  • 27

    Saini JBagepally BSBhatt MDChandran VBharath RDPrasad C: Diffusion tensor imaging: tract based spatial statistics study in essential tremor. Parkinsonism Relat Disord 18:4774822012

    • Search Google Scholar
    • Export Citation
  • 28

    Sammartino FKrishna VKing NKLozano AMSchwartz MLHuang Y: Tractography-based ventral intermediate nucleus targeting: novel methodology and intraoperative validation. Mov Disord 31:121712252016

    • Search Google Scholar
    • Export Citation
  • 29

    Sato SOhye CShibazaki TZama ACai X: Neurophysiological evaluation of the optimum target in gamma thalamotomy: indirect evidence. Stereotact Funct Neurosurg 83:1081142005

    • Search Google Scholar
    • Export Citation
  • 30

    Shin DHHan BSKim HSLee PH: Diffusion tensor imaging in patients with essential tremor. AJNR Am J Neuroradiol 29:1511532008

  • 31

    Stacy MAElble RJOndo WGWu SCHulihan J: Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor. Mov Disord 22:8338382007

    • Search Google Scholar
    • Export Citation
  • 32

    Wintermark MHuss DSShah BBTustison NDruzgal TJKassell N: Thalamic connectivity in patients with essential tremor treated with MR imaging-guided focused ultrasound: in vivo fiber tracking by using diffusion-tensor MR imaging. Radiology 272:2022092014

    • Search Google Scholar
    • Export Citation
  • 33

    Yagishita ANakano IOda MHirano A: Location of the corticospinal tract in the internal capsule at MR imaging. Radiology 191:4554601994

    • Search Google Scholar
    • Export Citation
  • 34

    Yamada KAkazawa KYuen SGoto MMatsushima STakahata A: MR imaging of ventral thalamic nuclei. AJNR Am J Neuroradiol 31:7327352010

    • Search Google Scholar
    • Export Citation
  • 35

    Yamada KKizu OKubota TIto HMatsushima SOouchi H: The pyramidal tract has a predictable course through the centrum semiovale: a diffusion-tensor based tractography study. J Magn Reson Imaging 26:5195242007

    • Search Google Scholar
    • Export Citation
  • 36

    Zarei MJohansen-Berg HJenkinson MCiccarelli OThompson AJMatthews PM: Two-dimensional population map of cortical connections in the human internal capsule. J Magn Reson Imaging 25:48542007

    • Search Google Scholar
    • Export Citation
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