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The standard initial targeting method uses an approximate, atlas\u2010based stereotactic approach. We developed a new patient\u2010specific targeting method to identify an individual's Vim and the optimal MRgFUS target region therein for suppression of tremor. In this retrospective study of 14 ET patients treated with MRgFUS, we investigated the ability of WMnMPRAGE, a highly sensitive and robust sequence for imaging gray matter\u2010white matter contrast, to identify the Vim, FUS ablation, and a clinically efficacious region within the Vim in individual patients. We found that WMnMPRAGE can directly visualize the Vim in ET patients, segmenting this nucleus using manual or automated segmentation capabilities developed by our group. WMnMPRAGE also delineated the ablation's core and penumbra, and showed that all patients' ablation cores lay primarily within their Vim segmentations. We found no significant correlations between standard ablation features (e.g., ablation volume, Vim\u2010ablation overlap) and 1\u2010month post\u2010treatment clinical outcome. We then defined a group\u2010based probabilistic target, which was nonlinearly warped to individual brains; this target was located within the Vim for all patients. The overlaps between this target and patient ablation cores correlated significantly with 1\u2010month clinical outcome (<jats:italic>r<\/jats:italic> = \u2212.57, <jats:italic>p<\/jats:italic> = .03), in contrast to the standard target (<jats:italic>r<\/jats:italic> = \u2212.23, <jats:italic>p<\/jats:italic> = .44). We conclude that WMnMPRAGE is a highly sensitive sequence for segmenting Vim and ablation boundaries in individual patients, allowing us to find a novel tremor\u2010associated center within Vim and potentially improving MRgFUS treatment for ET.<\/jats:p>","DOI":"10.1002\/hbm.25157","type":"journal-article","created":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T23:52:19Z","timestamp":1596757939000},"page":"4769-4788","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Improved Vim targeting for focused ultrasound ablation treatment of essential tremor: A probabilistic and patient\u2010specific approach"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5987-1108","authenticated-orcid":false,"given":"Jason H.","family":"Su","sequence":"first","affiliation":[{"name":"Department of Radiology Stanford University  Stanford California USA"},{"name":"Department of Electrical 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Arizona  Tucson Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey H.","family":"Halpern","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3276-2267","authenticated-orcid":false,"given":"Jaimie M.","family":"Henderson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6281-2771","authenticated-orcid":false,"given":"Kim Butts","family":"Pauly","sequence":"additional","affiliation":[{"name":"Department of Radiology Stanford University  Stanford California 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