{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:42:52Z","timestamp":1792806172434,"version":"4.5.0"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n \n Sufficient thermal increase capable of generating thermocoagulation is indispensable for an effective clinical outcome in patients undergoing magnetic resonance\u2013guided focused ultrasound (MRgFUS). The skull density ratio (SDR) is one of the most dominant predictors of thermal increase prior to treatment. However, users currently rely only on the average SDR value (SDR\n mean<\/jats:sub>\n ) as a screening criterion, although some patients with low SDR\n mean<\/jats:sub>\n values can achieve sufficient thermal increase. The present study aimed to examine the numerical distribution of SDR values across 1024 elements to identify more precise predictors of thermal increase during MRgFUS.\n <\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively analyzed the correlations between the skull parameters and the maximum temperature achieved during unilateral ventral intermediate nucleus thalamotomy with MRgFUS in a cohort of 55 patients. In addition, the numerical distribution of SDR values was quantified across 1024 elements by using the skewness, kurtosis, entropy, and uniformity of the SDR histogram. Next, the authors evaluated the correlation between the aforementioned indices and a peak temperature > 55\u00b0C by using univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis was performed to compare the predictive ability of the indices. The diagnostic performance of significant factors was also assessed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The SDR skewness (SDR\n skewness<\/jats:sub>\n ) was identified as a significant predictor of thermal increase in the univariate and multivariate logistic regression analyses (p < 0.001, p = 0.013). Moreover, the receiver operating characteristic curve analysis indicated that the SDR\n skewness<\/jats:sub>\n exhibited a better predictive ability than the SDR\n mean<\/jats:sub>\n , with area under the curve values of 0.847 and 0.784, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n \n The SDR\n skewness<\/jats:sub>\n is a more accurate predictor of thermal increase than the conventional SDR\n mean<\/jats:sub>\n . The authors suggest setting the SDR\n skewness<\/jats:sub>\n cutoff value to 0.68. SDR\n skewness<\/jats:sub>\n may allow for the inclusion of treatable patients with essential tremor who would have been screened out based on the SDR\n mean<\/jats:sub>\n exclusion criterion.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2021.5.jns21669","type":"journal-article","created":{"date-parts":[[2021,10,15]],"date-time":"2021-10-15T04:48:43Z","timestamp":1634273323000},"page":"1381-1386","source":"Crossref","is-referenced-by-count":7,"title":["Predictors of thermal increase in magnetic resonance\u2013guided focused ultrasound treatment for essential tremor: histogram analysis of skull density ratio values for 1024 elements"],"prefix":"10.3171","volume":"136","author":[{"given":"Ken","family":"Iijima","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Yokota","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshio","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Research Institute for Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Ouchi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Futaba","family":"Maki","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahito","family":"Takasaki","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Hori","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Iwamuro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinichi","family":"Sasanuma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Uno","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Ther Ultrasound","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s40349-016-0049-8","article-title":"Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy","volume":"4","author":"Gallay MN","year":"2016","unstructured":"Gallay MN, Moser D, Rossi F, Pourtehrani P, Magara AE, Kowalski M, Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy. J Ther Ultrasound. 2016;4(1):5.10.1186\/s40349-016-0049-826877873"},{"issue":"5","key":"b2","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1016\/S1474-4422(13)70048-6","article-title":"MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study","volume":"12","author":"Lipsman N","year":"2013","unstructured":"Lipsman N, Schwartz ML, Huang Y, Lee L, Sankar T, Chapman M, MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study. Lancet Neurol. 2013;12(5):462\u2013468.10.1016\/S1474-4422(13)70048-623523144"},{"issue":"6","key":"b3","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1002\/ana.21801","article-title":"High-intensity focused ultrasound for noninvasive functional neurosurgery","volume":"66","author":"Martin E","year":"2009","unstructured":"Martin E, Jeanmonod D, Morel A, Zadicario E, Werner B. High-intensity focused ultrasound for noninvasive functional neurosurgery. Ann Neurol. 2009;66(6):858\u2013861.10.1002\/ana.2180120033983"},{"issue":"8","key":"b4","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1056\/NEJMoa1600159","article-title":"A randomized trial of focused ultrasound thalamotomy for essential tremor","volume":"375","author":"Elias WJ","year":"2016","unstructured":"Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2016;375(8):730\u2013739.10.1056\/NEJMoa160015927557301"},{"issue":"2","key":"b5","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"411","DOI":"10.3171\/2015.3.JNS142592","article-title":"Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull","volume":"124","author":"Chang WS","year":"2016","unstructured":"Chang WS, Jung HH, Zadicario E, Rachmilevitch I, Tlusty T, Vitek S, Chang JW. Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull. J Neurosurg. 2016;124(2):411\u2013416.10.3171\/2015.3.JNS14259226361280"},{"issue":"5","key":"b6","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1392","DOI":"10.3171\/2019.2.JNS183517","article-title":"Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor","volume":"132","author":"D\u2019Souza M","year":"2019","unstructured":"D\u2019Souza M, Chen KS, Rosenberg J, Elias WJ, Eisenberg HM, Gwinn R, Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor. J Neurosurg. 2019;132(5):1392\u20131397.10.3171\/2019.2.JNS18351731026836"},{"issue":"6","key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.3171\/2019.2.JNS182995","article-title":"Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures","volume":"132","author":"Jones RM","year":"2019","unstructured":"Jones RM, Kamps S, Huang Y, Scantlebury N, Lipsman N, Schwartz ML, Hynynen K. Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures. J Neurosurg. 2019;132(6):1802\u20131809.10.3171\/2019.2.JNS18299531075781"},{"issue":"7","key":"b8","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1056\/NEJMoa1300962","article-title":"A pilot study of focused ultrasound thalamotomy for essential tremor","volume":"369","author":"Elias WJ","year":"2013","unstructured":"Elias WJ, Huss D, Voss T, Loomba J, Khaled M, Zadicario E, A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2013;369(7):640\u2013648.10.1056\/NEJMoa130096223944301"},{"issue":"24","key":"b9","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"e2284","DOI":"10.1212\/WNL.0000000000008561","article-title":"Three-year follow-up of prospective trial of focused ultrasound thalamotomy for essential tremor","volume":"93","author":"Halpern CH","year":"2019","unstructured":"Halpern CH, Santini V, Lipsman N, Lozano AM, Schwartz ML, Shah BB, Three-year follow-up of prospective trial of focused ultrasound thalamotomy for essential tremor. Neurology. 2019;93(24):e2284\u2013e2293.3174825010.1212\/WNL.0000000000008561"},{"issue":"2","key":"b10","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"417","DOI":"10.3171\/2019.3.JNS19466","article-title":"Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: a 5-year single-center experience","volume":"133","author":"Sinai A","year":"2020","unstructured":"Sinai A, Nassar M, Eran A, Constantinescu M, Zaaroor M, Sprecher E, Schlesinger I. Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: a 5-year single-center experience. J Neurosurg. 2020;133(2):417\u2013424.10.3171\/2019.3.JNS19466"},{"issue":"6","key":"b11","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.3171\/2019.2.JNS182571","article-title":"The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound","volume":"132","author":"Boutet A","year":"2019","unstructured":"Boutet A, Gwun D, Gramer R, Ranjan M, Elias GJB, Tilden D, The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound. J Neurosurg. 2019;132(6):1785\u20131791.10.3171\/2019.2.JNS18257131051458"},{"key":"b12","article-title":"Summary of Safety and Effectiveness Data (SSED), Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS)","author":"Food and Drug Administration","unstructured":"Food and Drug Administration. Summary of Safety and Effectiveness Data (SSED), Magnetic Resonance Guided Focused Ultrasound Surgery System (MRgFUS).Accessed July 22, 2021. https:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf15\/P150038S006B.pdf"},{"issue":"8","key":"b13","series-title":"Yonsei Med J","doi-asserted-by":"publisher","first-page":"768","DOI":"10.3349\/ymj.2019.60.8.768","article-title":"Skull factors affecting outcomes of magnetic resonance-guided focused ultrasound for patients with essential tremor","volume":"60","author":"Chang KW","year":"2019","unstructured":"Chang KW, Park YS, Chang JW. Skull factors affecting outcomes of magnetic resonance-guided focused ultrasound for patients with essential tremor. Yonsei Med J. 2019;60(8):768\u2013773.10.3349\/ymj.2019.60.8.76831347332"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/136\/5\/article-p1381.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/136\/5\/article-p1381.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/136\/5\/article-p1381.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:08:07Z","timestamp":1792804087000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/136\/5\/article-p1381.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,1]]},"references-count":13,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2021.5.jns21669","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,1]]}}}