{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:00:07Z","timestamp":1789592407538,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T00:00:00Z","timestamp":1696550400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Magnetic-resonance-guided focused ultrasound (MRgFUS) thalamotomy uses multiple converging high-energy ultrasonic beams to produce thermal lesions in the thalamus. Early postoperative MR imaging demonstrates the location and extent of the lesion, but there is no consensus on the utility or frequency of postoperative imaging. We aimed to evaluate the evolution of MRgFUS lesions and describe the incidence, predictors, and clinical effects of lesion persistence in a large patient cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 215 unilateral MRgFUS thalamotomy procedures for essential tremor (ET) by a single surgeon were retrospectively analyzed. All patients had MR imaging 1 day postoperatively; 106 had imaging at 3 months and 32 had imaging at 1 year. Thin cut (2 mm) axial and coronal T2-weighted MRIs at these timepoints were analyzed visually on a binary scale for lesion presence and when visible, lesion volumes were measured. SWI and DWI sequences were also analyzed when available. Clinical outcomes including tremor scores and side effects were recorded at these same time points. We analyzed if patient characteristics (age, skull density ratio), preoperative tremor score, and sonication parameters influenced lesion evolution and if imaging characteristics correlated with clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Visible lesions were present in all patients 1 day post- MRgFUS and measured 307.4 \u00b1 128.7 mm<jats:sup>3<\/jats:sup>. At 3 months, residual lesions (excluding patients where lesions were not visible) were 83.6% smaller and detectable in only 54.7% of patients (<jats:italic>n<\/jats:italic> = 58). At 1 year, residual lesions were detected in 50.0% of patients (<jats:italic>n<\/jats:italic> = 16) and were 90.7% smaller than 24 h and 46.5% smaller than 3 months. Lesions were more frequently visible on SWI (100%, <jats:italic>n<\/jats:italic> = 17), DWI (<jats:italic>n<\/jats:italic> = 38, 97.4%) and ADC (<jats:italic>n<\/jats:italic> = 36, 92.3%). At 3 months, fewer treatment sonications, higher maximum power, and greater distance between individual sonications led to larger lesion volumes. Volume at 24 h did not predict if a lesion was visible later. Lesion visibility at 3 months predicted sensory side effects but was not correlated with tremor outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Overall, lesions are visible on T2-weighted MRI in about half of patients at both 3 months and 1 year post-MRgFUS thalamotomy. Certain sonication parameters significantly predicted persistent volume, but residual lesions did not correlate with tremor outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1272425","type":"journal-article","created":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T09:49:04Z","timestamp":1696585744000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Longitudinal MR imaging after unilateral MR-guided focused ultrasound thalamotomy: clinical and radiological correlation"],"prefix":"10.3389","volume":"14","author":[{"given":"Sarah E.","family":"Blitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M. J.","family":"Chua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Segar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Jha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan J.","family":"McDannold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew N.","family":"DeSalvo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Rolston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Rees","family":"Cosgrove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.3171\/2022.6.JNS212483","article-title":"Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results","volume":"138","author":"Cosgrove","year":"2022","journal-title":"J Neurosurg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1001\/jama.2014.1397","article-title":"Tremor","volume":"311","author":"Elias","year":"2014","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"150","DOI":"10.2214\/AJR.14.13632","article-title":"Transcranial MR-guided focused ultrasound: a review of the technology and neuro applications","volume":"205","author":"Ghanouni","year":"2015","journal-title":"AJR Am J Roentgenol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"891","DOI":"10.3174\/ajnr.A3808","article-title":"Imaging findings in MR imaging-guided focused ultrasound treatment for patients with essential tremor","volume":"35","author":"Wintermark","year":"2014","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref5","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","year":"2013","journal-title":"N Engl J Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1007\/s00234-020-02433-9","article-title":"MRI follow-up after magnetic resonance-guided focused ultrasound for non-invasive thalamotomy: the neuroradiologist\u2019s perspective","volume":"62","author":"Keil","year":"2020","journal-title":"Neuroradiology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1136\/jnnp-2014-307642","article-title":"Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes","volume":"86","author":"Chang","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/2017.11.FOCUS17587","article-title":"Volumetric analysis of magnetic resonance-guided focused ultrasound thalamotomy lesions","volume":"44","author":"Harary","year":"2018","journal-title":"Neurosurg Focus"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"E5","DOI":"10.3171\/2017.11.FOCUS17623","article-title":"Predicting lesion size during focused ultrasound thalamotomy: a review of 63 lesions over 3 clinical trials","volume":"44","author":"Bond","year":"2018","journal-title":"Neurosurg Focus"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"4704","DOI":"10.1002\/mp.13126","article-title":"Predicting lesion size by accumulated thermal dose in MR-guided focused ultrasound for essential tremor","volume":"45","author":"Huang","year":"2018","journal-title":"Med Phys"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3089","DOI":"10.1093\/brain\/awab176","article-title":"Lesion location and lesion creation affect outcomes after focused ultrasound thalamotomy","volume":"144","author":"Segar","year":"2021","journal-title":"Brain J Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1002\/jmri.25878","article-title":"Transcranial MRI-guided high-intensity focused ultrasound for treatment of essential tremor: a pilot study on the correlation between lesion size, lesion location, thermal dose, and clinical outcome","volume":"48","author":"Federau","year":"2018","journal-title":"J Magn Reson Imaging"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1093\/neuros\/nyz395","article-title":"Transcranial magnetic resonance-guided focused ultrasound Thalamotomy in essential tremor: a comprehensive lesion characterization","volume":"87","author":"Pineda-Pardo","year":"2020","journal-title":"Neurosurgery"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.3171\/2020.11.JNS202580","article-title":"Technical and operative factors affecting magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: experience from 250 treatments","volume":"135","author":"Kim","year":"2021","journal-title":"J Neurosurg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1093\/neuros\/nyz417","article-title":"Predictors of outcomes after focused ultrasound Thalamotomy","volume":"87","author":"Krishna","year":"2020","journal-title":"Neurosurgery"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3821","DOI":"10.1109\/TMI.2020.3005631","article-title":"Using phase data from MR temperature imaging to visualize anatomy during MRI-guided focused ultrasound neurosurgery","volume":"39","author":"McDannold","year":"2020","journal-title":"IEEE Trans Med Imaging"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"6588","DOI":"10.1002\/mp.15239","article-title":"Patient-specific effects on sonication heating efficiency during magnetic resonance-guided focused ultrasound thalamotomy","volume":"48","author":"Yang","year":"2021","journal-title":"Med Phys"},{"key":"ref18","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","year":"2019","journal-title":"J Neurosurg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3171\/2022.5.JNS22350","article-title":"Comparison of the impact of skull density ratio with alternative skull metrics on magnetic resonance-guided focused ultrasound thalamotomy for tremor","volume":"138","author":"Yuen","year":"2023","journal-title":"J Neurosurg"},{"key":"ref20","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","year":"2019","journal-title":"J Neurosurg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2925","DOI":"10.1002\/mp.12975","article-title":"The reduction in treatment efficiency at high acoustic powers during MR-guided transcranial focused ultrasound thalamotomy for essential tremor","volume":"45","author":"Hughes","year":"2018","journal-title":"Med Phys"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"3405","DOI":"10.1093\/brain\/awy278","article-title":"Focused ultrasound thalamotomy location determines clinical benefits in patients with essential tremor","volume":"141","author":"Boutet","year":"2018","journal-title":"Brain"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"101754","DOI":"10.1016\/j.nicl.2019.101754","article-title":"Longitudinal analysis of structural changes following unilateral focused ultrasound thalamotomy","volume":"22","author":"Sammartino","year":"2019","journal-title":"NeuroImage Clin"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"318","DOI":"10.3171\/2022.5.JNS22324","article-title":"Differences in intrinsic functional networks in patients with essential tremor who had good and poor long-term responses after thalamotomy performed using MR-guided ultrasound","volume":"138","author":"Pae","year":"2022","journal-title":"J Neurosurg"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1148\/radiol.14132112","article-title":"Thalamic connectivity in patients with essential tremor treated with MR imaging-guided focused ultrasound: in vivo fiber tracking by using diffusion-tensor MR imaging","volume":"272","author":"Wintermark","year":"2014","journal-title":"Radiology"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1016\/j.nicl.2017.12.018","article-title":"The potential value of probabilistic tractography-based for MR-guided focused ultrasound thalamotomy for essential tremor","volume":"17","author":"Tsolaki","year":"2017","journal-title":"NeuroImage Clin"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/j.nicl.2018.05.010","article-title":"Diffusion MRI tractography for improved transcranial MRI-guided focused ultrasound thalamotomy targeting for essential tremor","volume":"19","author":"Tian","year":"2018","journal-title":"NeuroImage Clin."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2933","DOI":"10.1002\/hbm.24569","article-title":"Microstructural changes of the dentato-rubro-thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor","volume":"40","author":"Pineda-Pardo","year":"2019","journal-title":"Hum Brain Mapp"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1136\/jnnp-2020-322745","article-title":"Multimodal MRI for MRgFUS in essential tremor: post-treatment radiological markers of clinical outcome","volume":"91","author":"Kapadia","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.parkreldis.2021.09.013","article-title":"Lesions of the cerebello-thalamic tract rather than the ventral intermediate nucleus determine the outcome of focused ultrasound therapy in essential tremor: a 3T and 7T MRI-study","volume":"91","author":"Purrer","year":"2021","journal-title":"Parkinsonism Relat Disord"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1089\/brain.2021.0157","article-title":"Changes in the Cerebello-Thalamo-cortical network after magnetic resonance-guided focused ultrasound Thalamotomy","volume":"13","author":"Thaler","year":"2022","journal-title":"Brain Conn"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1272425\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T09:49:07Z","timestamp":1696585747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1272425\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,6]]},"references-count":31,"alternative-id":["10.3389\/fneur.2023.1272425"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2023.1272425","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,6]]},"article-number":"1272425"}}