{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T11:17:30Z","timestamp":1767611850389,"version":"build-2065373602"},"reference-count":63,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T00:00:00Z","timestamp":1728086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Magnetic resonance\u2010guided focused ultrasound (MRgFUS) targeting the thalamic ventral intermediate nucleus (VIM) is an innovative treatment for drug\u2010refractory essential tremor (ET). The relationship between lesion characteristics, dentate\u2010rubro\u2010thalamic\u2010tract (DRTT) involvement and clinical benefit remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate whether clinical outcome is related to lesion volume and\/or its overlap with the DRTT. To compare the reliability of probabilistic versus deterministic tractography in reconstructing the DRTT and improving VIM targeting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty ET patients who underwent MRgFUS thalamotomy between 2019 and 2022 were retrospectively analyzed. Clinical outcomes and adverse effects were recorded at 1\/6\/12\u2009months after the procedure. The DRTT was generated using deterministic and probabilistic tractography on preoperative diffusion\u2010tensor 3\u2009T\u2010images and location and volume of the lesion were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Probabilistic tractography identified both decussating (d\u2010DRTT) and non\u2010decussating (nd\u2010DRTT) components of the DRTT, whereas the deterministic approach only identified one component overlapping with the nd\u2010DRTT. Despite the lesions predominantly intersecting the medial portion of the d\u2010DRTT, with a significantly greater overlap in responder patients, we observed only a non\u2010significant correlation between tremor improvement and increased d\u2010DRTT\u2010lesion overlap (<jats:italic>r<\/jats:italic>\u2009=\u20090.22, <jats:italic>P<\/jats:italic>\u2009=\u20090.20). The lesion volume demonstrated a significant positive correlation with clinical improvement at 1\u2010day MRI (<jats:italic>r<\/jats:italic>\u2009=\u20090.42, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Variability in the reconstructed DRTT position relative to the lesion center of mass, even among good responders, suggests that this fiber bundle is unlikely to be considered the sole target for a successful MRgFUS thalamotomy in ET. Indirect individualized targeting allows for more precise and reproducible identification of actual treatment coordinates than the direct method.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.14219","type":"journal-article","created":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T03:29:46Z","timestamp":1728098986000},"page":"1516-1529","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Quantitative Tractography\u2010Based Evaluations in Essential Tremor Patients after <scp>MRgFUS<\/scp> Thalamotomy"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2183-5077","authenticated-orcid":false,"given":"Francesco","family":"Ghielmetti","sequence":"first","affiliation":[{"name":"Health Department Fondazione IRCCS Istituto Neurologico Carlo Besta  Milan 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