M Wintermark1, J Druzgal2, D S Huss3, M A Khaled3, S Monteith3, P Raghavan2, T Huerta2, L C Schweickert2, B Burkholder2, J J Loomba3, E Zadicario4, Y Qiao2, B Shah5, J Snell6, M Eames6, R Frysinger3, N Kassell3, W J Elias3. 1. From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.) Max.Wintermark@virginia.edu. 2. From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.). 3. Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.). 4. Insightec Ltd (E.Z.), Haifa, Israel. 5. Neurology (B.S.), University of Virginia, Charlottesville, Virginia. 6. Focused Ultrasound Surgery Foundation (J.S., M.E.), Charlottesville, Virginia.
Abstract
BACKGROUND AND PURPOSE: MR imaging-guided focused sonography surgery is a new stereotactic technique that uses high-intensity focused sonography to heat and ablate tissue. The goal of this study was to describe MR imaging findings pre- and post-ventralis intermedius nucleus lesioning by MR imaging-guided focused sonography as a treatment for essential tremor and to determine whether there was an association between these imaging features and the clinical response to MR imaging-guided focused sonography. MATERIALS AND METHODS: Fifteen patients with medication-refractory essential tremor prospectively gave consent; were enrolled in a single-site, FDA-approved pilot clinical trial; and were treated with transcranial MR imaging-guided focused sonography. MR imaging studies were obtained on a 3T scanner before the procedure and 24 hours, 1 week, 1 month, and 3 months following the procedure. RESULTS: On T2-weighted imaging, 3 time-dependent concentric zones were seen at the site of the focal spot. The inner 2 zones showed reduced ADC values at 24 hours in all patients except one. Diffusion had pseudonormalized by 1 month in all patients, when the cavity collapsed. Very mild postcontrast enhancement was seen at 24 hours and again at 1 month after MR imaging-guided focused sonography. The total lesion size and clinical response evolved inversely compared with each other (coefficient of correlation = 0.29, P value = .02). CONCLUSIONS: MR imaging-guided focused sonography can accurately ablate a precisely delineated target, with typical imaging findings seen in the days, weeks, and months following the treatment. Tremor control was optimal early when the lesion size and perilesional edema were maximal and was less later when the perilesional edema had resolved.
BACKGROUND AND PURPOSE: MR imaging-guided focused sonography surgery is a new stereotactic technique that uses high-intensity focused sonography to heat and ablate tissue. The goal of this study was to describe MR imaging findings pre- and post-ventralis intermedius nucleus lesioning by MR imaging-guided focused sonography as a treatment for essential tremor and to determine whether there was an association between these imaging features and the clinical response to MR imaging-guided focused sonography. MATERIALS AND METHODS: Fifteen patients with medication-refractory essential tremor prospectively gave consent; were enrolled in a single-site, FDA-approved pilot clinical trial; and were treated with transcranial MR imaging-guided focused sonography. MR imaging studies were obtained on a 3T scanner before the procedure and 24 hours, 1 week, 1 month, and 3 months following the procedure. RESULTS: On T2-weighted imaging, 3 time-dependent concentric zones were seen at the site of the focal spot. The inner 2 zones showed reduced ADC values at 24 hours in all patients except one. Diffusion had pseudonormalized by 1 month in all patients, when the cavity collapsed. Very mild postcontrast enhancement was seen at 24 hours and again at 1 month after MR imaging-guided focused sonography. The total lesion size and clinical response evolved inversely compared with each other (coefficient of correlation = 0.29, P value = .02). CONCLUSIONS: MR imaging-guided focused sonography can accurately ablate a precisely delineated target, with typical imaging findings seen in the days, weeks, and months following the treatment. Tremor control was optimal early when the lesion size and perilesional edema were maximal and was less later when the perilesional edema had resolved.
Authors: F A Jolesz; G J Moore; R V Mulkern; A R Bleier; R G Gonzales; J L Bowers; K R Metz; N Higuchi; V M Colucci Journal: Invest Radiol Date: 1989-12 Impact factor: 6.016
Authors: Steven Paul Woods; J Cobb Scott; Julie A Fields; Amelia Poquette; Alexander I Tröster Journal: Cogn Behav Neurol Date: 2008-03 Impact factor: 1.600
Authors: Jose A Pineda-Pardo; Raul Martínez-Fernández; Rafael Rodríguez-Rojas; Marta Del-Alamo; Frida Hernández; Guglielmo Foffani; Michele Dileone; Jorge U Máñez-Miró; Esther De Luis-Pastor; Lydia Vela; José A Obeso Journal: Hum Brain Mapp Date: 2019-03-13 Impact factor: 5.038
Authors: Yuexi Huang; Nir Lipsman; Michael L Schwartz; Vibhor Krishna; Francesco Sammartino; Andres M Lozano; Kullervo Hynynen Journal: Med Phys Date: 2018-08-31 Impact factor: 4.071
Authors: Pejman Ghanouni; Kim Butts Pauly; W Jeff Elias; Jaimie Henderson; Jason Sheehan; Stephen Monteith; Max Wintermark Journal: AJR Am J Roentgenol Date: 2015-07 Impact factor: 3.959
Authors: Chenchen Bing; Robert M Staruch; Matti Tillander; Max O Köhler; Charles Mougenot; Mika Ylihautala; Theodore W Laetsch; Rajiv Chopra Journal: Int J Hyperthermia Date: 2016-05-22 Impact factor: 3.914