PMID- 37948701
OWN - NLM
STAT- Publisher
LR  - 20231110
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
DP  - 2023 Nov 10
TI  - A novel high-precision fiber tractography for nuclear localization in 
      transcranial magnetic resonance-guided focused ultrasound surgery: a pilot study.
PG  - 1-11
LID - 10.3171/2023.8.JNS231459 [doi]
AB  - OBJECTIVE: In transcranial MR-guided focused ultrasound (TcMRgFUS), fiber 
      tractography using diffusion tensor imaging (DTI) has been proposed as a direct 
      method to identify the ventral intermediate nucleus (Vim), the ventral caudal 
      nucleus (Vc), and the pyramidal tract (PT). However, the limitations of the DTI 
      algorithm affect the accuracy of visualizing anatomical structures due to its 
      low-quality fiber tractography, whereas the application of the generalized 
      q-sampling imaging (GQI) algorithm enables the visualization of high-quality 
      fiber tracts, offering detailed insights into the spatial distribution of motor 
      cortex fibers. This retrospective study aimed to investigate the usefulness of 
      high-precision fiber tractography using the GQI algorithm as a planning image in 
      TcMRgFUS to achieve favorable clinical outcomes. METHODS: This study included 20 
      patients who underwent TcMRgFUS. The Clinical Rating Scale for Tremor (CRST) 
      scores and MR images were evaluated pretreatment and at 24 hours and 3-6 months 
      after treatment. Cases were classified based on the presence and adversity of 
      adverse events (AEs): no AEs, mild AEs without additional treatment, and severe 
      AEs requiring prolonged hospitalization. Fiber tractography of the Vim, Vc, and 
      PT was visualized using the DTI and GQI algorithm. The overlapping volume between 
      Vim fibers and the lesion was measured, and correlation analysis was performed. 
      The relationship between AEs and the overlapping volume of the Vc and PT fibers 
      within the lesions was examined. The cutoff value to achieve a favorable clinical 
      outcome and avoid AEs was determined using receiver operating characteristic 
      curve analysis. RESULTS: All patients showed improvement in tremors 24 hours 
      after treatment, with 3 patients experiencing mild AEs and 1 patient experiencing 
      severe AEs. At the 3- to 6-month follow-up, 5 patients experienced recurrence, 
      and 2 patients had persistent mild AEs. Although fiber visualization in the motor 
      cortex using the DTI algorithm was insufficient, the GQI algorithm enabled the 
      visualization of significantly higher-quality fibers. A strong correlation was 
      observed between the overlapping volume that intersects the lesion and Vim fibers 
      and the degree of tremor improvement (r = 0.72). Higher overlapping volumes of Vc 
      and PT within the lesion were associated with an increased likelihood of AEs (p < 
      0.05); the cutoff volume of Vim fibers within the lesion for a favorable clinical 
      outcome was 401 mm3, while the volume of Vc and PT within the lesion to avoid AEs 
      was 99 mm3. CONCLUSIONS: This pilot study suggests that incorporating the 
      high-precision GQI algorithm for fiber tractography as a planning imaging 
      technique for TcMRgFUS has the potential to enhance targeting precision and 
      achieve favorable clinical outcomes.
FAU - Hori, Hiroki
AU  - Hori H
FAU - Taira, Takaomi
AU  - Taira T
AD  - Department of FUS Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan.
FAU - Abe, Keiichi
AU  - Abe K
AD  - Department of FUS Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan.
FAU - Hori, Tomokatsu
AU  - Hori T
LA  - eng
PT  - Journal Article
DEP - 20231110
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
OTO - NOTNLM
OT  - diffusion tensor imaging
OT  - functional neurosurgery
OT  - generalized q-sampling imaging algorithm
OT  - targeting method
OT  - transcranial magnetic resonance-guided focused ultrasound
OT  - ventral intermediate nucleus
EDAT- 2023/11/10 18:43
MHDA- 2023/11/10 18:43
CRDT- 2023/11/10 16:53
PHST- 2023/06/26 00:00 [received]
PHST- 2023/08/31 00:00 [accepted]
PHST- 2023/11/10 18:43 [medline]
PHST- 2023/11/10 18:43 [pubmed]
PHST- 2023/11/10 16:53 [entrez]
AID - 10.3171/2023.8.JNS231459 [doi]
PST - aheadofprint
SO  - J Neurosurg. 2023 Nov 10:1-11. doi: 10.3171/2023.8.JNS231459.