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<meta name="DC.Title" content="Predicting Post-Operative Side Effects in VIM MRgFUS based on THalamus Optimized Multi Atlas Segmentation (THOMAS) on white-matter-nulled MRI: A Retrospective Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8448" />
<meta name="DC.Date" content="2024-08-09" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2024 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Precise and individualized targeting of the ventral intermediate thalamic nucleus for the MR-guided focused ultrasound is crucial for enhancing treatment efficacy and avoiding undesirable side effects. In this study, we tested the hypothesis that the spatial relationships between Thalamus Optimized Multi Atlas Segmentation derived segmentations and the post-focused ultrasound lesion can predict post-operative side effects in patients treated with MR-guided focused ultrasound.

MATERIALS AND METHODS: We retrospectively analyzed 30 patients (essential tremor, n = 26; tremor-dominant Parkinson’s disease, n = 4) who underwent unilateral ventral intermediate thalamic nucleus focused ultrasound treatment. We created ROIs of coordinate-based indirect treatment target, focused ultrasound-induced lesion, and thalamus and ventral intermediate thalamic nucleus segmentations. We extracted imaging features including 1) focused ultrasound-induced lesion volumes, 2) overlap between lesions and thalamus and ventral intermediate thalamic nucleus segmentations, 3) distance between lesions and ventral intermediate thalamic nucleus segmentation and 4) distance between lesions and the indirect standard target. These imaging features were compared between patients with and without post-operative gait/balance side effects using Wilcoxon rank-sum test. Multi-variate prediction models of side effects based on the imaging features were evaluated using the receiver operating characteristic analyses.

RESULTS: Patients with self-reported gait/balance side effects had a significantly larger extent of focused ultrasound-induced edema, a smaller fraction of the lesion within the ventral intermediate thalamic nucleus segmentation, a larger fraction of the off-target lesion outside the thalamus segmentation, a more inferior centroid of the lesion from the ventral intermediate thalamic nucleus segmentation, and a larger distance between the centroid of the lesion and ventral intermediate thalamic nucleus segmentation ( p &lt; 0.05). Similar results were found for exam-based side effects. Multi-variate regression models based on the imaging features achieved areas under the curve of 0.99 (95% CI: 0.88 to 1.00) and 0.96 (95% CI: 0.73 to 1.00) for predicting self-reported and exam-based side effects, respectively.

CONCLUSIONS: Thalamus Optimized Multi Atlas Segmentation-based patient-specific segmentation of the ventral intermediate thalamic nucleus can predict post-operative side effects, which has implications for aiding the direct targeting of MR-guided focused ultrasound and reducing side effects.

ABBREVIATIONS: MRgFUS = MR-guided focused ultrasound; ET = essential tremor; PD = Parkinson’s disease; VIM = ventral intermediate nucleus; AC-PC = anterior commissure-posterior commissure; FGATIR = Fast Gray Matter Acquisition T1 Inversion Recovery; THOMAS = THalamus Optimized Multi Atlas Segmentation; TH = thalamus; FTM = Fahn-Tolosa-Marín Clinical Rating Scale for Tremor; AUC = areas under the curve." />
<meta name="DC.Contributor" content="Sonoko Oshima" />
<meta name="DC.Contributor" content="Asher Kim" />
<meta name="DC.Contributor" content="Xiaonan R. Sun" />
<meta name="DC.Contributor" content="Ziad Rifi" />
<meta name="DC.Contributor" content="Katy A. Cross" />
<meta name="DC.Contributor" content="Katherine A. Fu" />
<meta name="DC.Contributor" content="Noriko Salamon" />
<meta name="DC.Contributor" content="Benjamin M. Ellingson" />
<meta name="DC.Contributor" content="Ausaf A. Bari" />
<meta name="DC.Contributor" content="Jingwen Yao" />
<meta name="article:published_time" content="2024-08-09" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="Predicting Post-Operative Side Effects in VIM MRgFUS based on THalamus Optimized Multi Atlas Segmentation (THOMAS) on white-matter-nulled MRI: A Retrospective Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;ABSTRACT&lt;/h3&gt;
&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Precise and individualized targeting of the ventral intermediate thalamic nucleus for the MR-guided focused ultrasound is crucial for enhancing treatment efficacy and avoiding undesirable side effects. In this study, we tested the hypothesis that the spatial relationships between Thalamus Optimized Multi Atlas Segmentation derived segmentations and the post-focused ultrasound lesion can predict post-operative side effects in patients treated with MR-guided focused ultrasound.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively analyzed 30 patients (essential tremor, n = 26; tremor-dominant Parkinson’s disease, n = 4) who underwent unilateral ventral intermediate thalamic nucleus focused ultrasound treatment. We created ROIs of coordinate-based indirect treatment target, focused ultrasound-induced lesion, and thalamus and ventral intermediate thalamic nucleus segmentations. We extracted imaging features including 1) focused ultrasound-induced lesion volumes, 2) overlap between lesions and thalamus and ventral intermediate thalamic nucleus segmentations, 3) distance between lesions and ventral intermediate thalamic nucleus segmentation and 4) distance between lesions and the indirect standard target. These imaging features were compared between patients with and without post-operative gait/balance side effects using Wilcoxon rank-sum test. Multi-variate prediction models of side effects based on the imaging features were evaluated using the receiver operating characteristic analyses.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Patients with self-reported gait/balance side effects had a significantly larger extent of focused ultrasound-induced edema, a smaller fraction of the lesion within the ventral intermediate thalamic nucleus segmentation, a larger fraction of the off-target lesion outside the thalamus segmentation, a more inferior centroid of the lesion from the ventral intermediate thalamic nucleus segmentation, and a larger distance between the centroid of the lesion and ventral intermediate thalamic nucleus segmentation (&lt;i&gt;p&lt;/i&gt; &amp;lt; 0.05). Similar results were found for exam-based side effects. Multi-variate regression models based on the imaging features achieved areas under the curve of 0.99 (95% CI: 0.88 to 1.00) and 0.96 (95% CI: 0.73 to 1.00) for predicting self-reported and exam-based side effects, respectively.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Thalamus Optimized Multi Atlas Segmentation-based patient-specific segmentation of the ventral intermediate thalamic nucleus can predict post-operative side effects, which has implications for aiding the direct targeting of MR-guided focused ultrasound and reducing side effects.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: MRgFUS = MR-guided focused ultrasound; ET = essential tremor; PD = Parkinson’s disease; VIM = ventral intermediate nucleus; AC-PC = anterior commissure-posterior commissure; FGATIR = Fast Gray Matter Acquisition T1 Inversion Recovery; THOMAS = THalamus Optimized Multi Atlas Segmentation; TH = thalamus; FTM = Fahn-Tolosa-Marín Clinical Rating Scale for Tremor; AUC = areas under the curve.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/08/09" />
<meta name="citation_mjid" content="ajnr;ajnr.A8448v1" />
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<meta name="citation_section" content="ORIGINAL RESEARCH" />
<meta name="citation_author" content="Sonoko Oshima" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Asher Kim" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Xiaonan R. Sun" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Ziad Rifi" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Katy A. Cross" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Katherine A. Fu" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Noriko Salamon" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Benjamin M. Ellingson" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Ausaf A. Bari" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="citation_author" content="Jingwen Yao" />
<meta name="citation_author_institution" content="From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA." />
<meta name="twitter:title" content="Predicting Post-Operative Side Effects in VIM MRgFUS based on THalamus Optimized Multi Atlas Segmentation (THOMAS) on white-matter-nulled MRI: A Retrospective Study" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Precise and individualized targeting of the ventral intermediate thalamic nucleus for the MR-guided focused ultrasound is crucial for enhancing treatment efficacy and avoiding undesirable side effects. In this study, we tested the hypothesis that the spatial relationships between Thalamus Optimized Multi Atlas Segmentation derived segmentations and the post-focused ultrasound lesion can predict post-operative side effects in patients treated with MR-guided focused ultrasound.

MATERIALS AND METHODS: We retrospectively analyzed 30 patients (essential tremor, n = 26; tremor-dominant Parkinson’s disease, n = 4) who underwent unilateral ventral intermediate thalamic nucleus focused ultrasound treatment. We created ROIs of coordinate-based indirect treatment target, focused ultrasound-induced lesion, and thalamus and ventral intermediate thalamic nucleus segmentations. We extracted imaging features including 1) focused ultrasound-induced lesion volumes, 2) overlap between lesions and thalamus and ventral intermediate thalamic nucleus segmentations, 3) distance between lesions and ventral intermediate thalamic nucleus segmentation and 4) distance between lesions and the indirect standard target. These imaging features were compared between patients with and without post-operative gait/balance side effects using Wilcoxon rank-sum test. Multi-variate prediction models of side effects based on the imaging features were evaluated using the receiver operating characteristic analyses.

RESULTS: Patients with self-reported gait/balance side effects had a significantly larger extent of focused ultrasound-induced edema, a smaller fraction of the lesion within the ventral intermediate thalamic nucleus segmentation, a larger fraction of the off-target lesion outside the thalamus segmentation, a more inferior centroid of the lesion from the ventral intermediate thalamic nucleus segmentation, and a larger distance between the centroid of the lesion and ventral intermediate thalamic nucleus segmentation ( p &lt; 0.05). Similar results were found for exam-based side effects. Multi-variate regression models based on the imaging features achieved areas under the curve of 0.99 (95% CI: 0.88 to 1.00) and 0.96 (95% CI: 0.73 to 1.00) for predicting self-reported and exam-based side effects, respectively.

CONCLUSIONS: Thalamus Optimized Multi Atlas Segmentation-based patient-specific segmentation of the ventral intermediate thalamic nucleus can predict post-operative side effects, which has implications for aiding the direct targeting of MR-guided focused ultrasound and reducing side effects.

ABBREVIATIONS: MRgFUS = MR-guided focused ultrasound; ET = essential tremor; PD = Parkinson’s disease; VIM = ventral intermediate nucleus; AC-PC = anterior commissure-posterior commissure; FGATIR = Fast Gray Matter Acquisition T1 Inversion Recovery; THOMAS = THalamus Optimized Multi Atlas Segmentation; TH = thalamus; FTM = Fahn-Tolosa-Marín Clinical Rating Scale for Tremor; AUC = areas under the curve." />
<meta name="og-title" property="og:title" content="Predicting Post-Operative Side Effects in VIM MRgFUS based on THalamus Optimized Multi Atlas Segmentation (THOMAS) on white-matter-nulled MRI: A Retrospective Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/08/09/ajnr.A8448" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Precise and individualized targeting of the ventral intermediate thalamic nucleus for the MR-guided focused ultrasound is crucial for enhancing treatment efficacy and avoiding undesirable side effects. In this study, we tested the hypothesis that the spatial relationships between Thalamus Optimized Multi Atlas Segmentation derived segmentations and the post-focused ultrasound lesion can predict post-operative side effects in patients treated with MR-guided focused ultrasound.

MATERIALS AND METHODS: We retrospectively analyzed 30 patients (essential tremor, n = 26; tremor-dominant Parkinson’s disease, n = 4) who underwent unilateral ventral intermediate thalamic nucleus focused ultrasound treatment. We created ROIs of coordinate-based indirect treatment target, focused ultrasound-induced lesion, and thalamus and ventral intermediate thalamic nucleus segmentations. We extracted imaging features including 1) focused ultrasound-induced lesion volumes, 2) overlap between lesions and thalamus and ventral intermediate thalamic nucleus segmentations, 3) distance between lesions and ventral intermediate thalamic nucleus segmentation and 4) distance between lesions and the indirect standard target. These imaging features were compared between patients with and without post-operative gait/balance side effects using Wilcoxon rank-sum test. Multi-variate prediction models of side effects based on the imaging features were evaluated using the receiver operating characteristic analyses.

RESULTS: Patients with self-reported gait/balance side effects had a significantly larger extent of focused ultrasound-induced edema, a smaller fraction of the lesion within the ventral intermediate thalamic nucleus segmentation, a larger fraction of the off-target lesion outside the thalamus segmentation, a more inferior centroid of the lesion from the ventral intermediate thalamic nucleus segmentation, and a larger distance between the centroid of the lesion and ventral intermediate thalamic nucleus segmentation ( p &lt; 0.05). Similar results were found for exam-based side effects. Multi-variate regression models based on the imaging features achieved areas under the curve of 0.99 (95% CI: 0.88 to 1.00) and 0.96 (95% CI: 0.73 to 1.00) for predicting self-reported and exam-based side effects, respectively.

CONCLUSIONS: Thalamus Optimized Multi Atlas Segmentation-based patient-specific segmentation of the ventral intermediate thalamic nucleus can predict post-operative side effects, which has implications for aiding the direct targeting of MR-guided focused ultrasound and reducing side effects.

ABBREVIATIONS: MRgFUS = MR-guided focused ultrasound; ET = essential tremor; PD = Parkinson’s disease; VIM = ventral intermediate nucleus; AC-PC = anterior commissure-posterior commissure; FGATIR = Fast Gray Matter Acquisition T1 Inversion Recovery; THOMAS = THalamus Optimized Multi Atlas Segmentation; TH = thalamus; FTM = Fahn-Tolosa-Marín Clinical Rating Scale for Tremor; AUC = areas under the curve." />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node109707--5" data-node-nid="109707" id="top-node-109707--62094179604" data-pisa="ajnr;ajnr.A8448v1" data-pisa-master="ajnr;ajnr.A8448" data-apath="/ajnr/early/2024/08/09/ajnr.A8448.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ORIGINAL RESEARCH</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Predicting Post-Operative Side Effects in VIM MRgFUS based on THalamus Optimized Multi Atlas Segmentation (THOMAS) on white-matter-nulled MRI: A Retrospective Study</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Sonoko Oshima</span>, <span class="highwire-citation-author" data-delta="1">Asher Kim</span>, <span class="highwire-citation-author" data-delta="2">Xiaonan R. Sun</span>, <span class="highwire-citation-author" data-delta="3">Ziad Rifi</span>, <span class="highwire-citation-author" data-delta="4">Katy A. Cross</span>, <span class="highwire-citation-author" data-delta="5">Katherine A. Fu</span>, <span class="highwire-citation-author" data-delta="6">Noriko Salamon</span>, <span class="highwire-citation-author" data-delta="7">Benjamin M. Ellingson</span>, <span class="highwire-citation-author" data-delta="8">Ausaf A. Bari</span> and <span class="highwire-citation-author" data-delta="9">Jingwen Yao</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8448; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8448 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-109707--62094179604" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Sonoko Oshima </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Sonoko%2BOshima%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Oshima%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ASonoko%2BOshima%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Asher Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Asher%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAsher%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Xiaonan R. Sun </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Xiaonan%2BR.%2BSun%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sun%20XR&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AXiaonan%2BR.%2BSun%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Ziad Rifi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Ziad%2BRifi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rifi%20Z&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AZiad%2BRifi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Katy A. Cross </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Katy%2BA.%2BCross%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cross%20KA&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKaty%2BA.%2BCross%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Katherine A. Fu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Katherine%2BA.%2BFu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fu%20KA&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKatherine%2BA.%2BFu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Noriko Salamon </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Noriko%2BSalamon%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Salamon%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ANoriko%2BSalamon%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Benjamin M. Ellingson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Benjamin%2BM.%2BEllingson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ellingson%20BM&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ABenjamin%2BM.%2BEllingson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Ausaf A. Bari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Ausaf%2BA.%2BBari%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bari%20AA&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAusaf%2BA.%2BBari%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">Jingwen Yao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers (S.O., A.K., B.M.E., J.Y.), Department of Bioengineering, Henry Samueli School of Engineering and Applied Science (A.K., B.M.E., J.Y.), University of California Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences (S.O., N.S., B.M.E., J.Y.), Department of Neurosurgery (X.R.S, Z.R., B.M.E., A.A.B.), Department of Neurology (K.A.C., K.A.F.), and Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Jingwen%2BYao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yao%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJingwen%2BYao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="item-list"><ul class="tabs inline panels-ajax-tab"><li class="first"><a href="/content/early/2024/08/09/ajnr.A8448" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:109707" data-trigger="" data-url-enabled="1">Article</a><a href="/panels_ajax_tab/jnl_ajnr_tab_art/node:109707/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/early/2024/08/09/ajnr.A8448/tab-supplemental" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_supp" data-target-id="highwire_article_tabs" data-entity-context="node:109707" data-trigger="tab-supplemental" data-url-enabled="1">Supplemental</a><a href="/panels_ajax_tab/jnl_ajnr_tab_supp/node:109707/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/early/2024/08/09/ajnr.A8448/tab-article-info" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_info" data-target-id="highwire_article_tabs" data-entity-context="node:109707" data-trigger="tab-article-info" data-url-enabled="1">Info &amp; Metrics</a><a href="/panels_ajax_tab/jnl_ajnr_tab_info/node:109707/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li class="last"><a href="/content/ajnr/early/2024/08/09/ajnr.A8448.full.pdf" class="panels-ajax-tab-tab" data-panel-name="jnl_ajnr_tab_pdf" data-target-id="highwire_article_tabs" data-entity-context="node:109707" data-trigger="tab-pdf" data-url-enabled="1"><i class="icon-file-alt"></i> PDF</a><a href="/panels_ajax_tab/jnl_ajnr_tab_pdf/node:109707/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li></ul></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">ABSTRACT</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> Precise and individualized targeting of the ventral intermediate thalamic nucleus for the MR-guided focused ultrasound is crucial for enhancing treatment efficacy and avoiding undesirable side effects. In this study, we tested the hypothesis that the spatial relationships between Thalamus Optimized Multi Atlas Segmentation derived segmentations and the post-focused ultrasound lesion can predict post-operative side effects in patients treated with MR-guided focused ultrasound.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> We retrospectively analyzed 30 patients (essential tremor, n = 26; tremor-dominant Parkinson’s disease, n = 4) who underwent unilateral ventral intermediate thalamic nucleus focused ultrasound treatment. We created ROIs of coordinate-based indirect treatment target, focused ultrasound-induced lesion, and thalamus and ventral intermediate thalamic nucleus segmentations. We extracted imaging features including 1) focused ultrasound-induced lesion volumes, 2) overlap between lesions and thalamus and ventral intermediate thalamic nucleus segmentations, 3) distance between lesions and ventral intermediate thalamic nucleus segmentation and 4) distance between lesions and the indirect standard target. These imaging features were compared between patients with and without post-operative gait/balance side effects using Wilcoxon rank-sum test. Multi-variate prediction models of side effects based on the imaging features were evaluated using the receiver operating characteristic analyses.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> Patients with self-reported gait/balance side effects had a significantly larger extent of focused ultrasound-induced edema, a smaller fraction of the lesion within the ventral intermediate thalamic nucleus segmentation, a larger fraction of the off-target lesion outside the thalamus segmentation, a more inferior centroid of the lesion from the ventral intermediate thalamic nucleus segmentation, and a larger distance between the centroid of the lesion and ventral intermediate thalamic nucleus segmentation (<em>p</em> &lt; 0.05). Similar results were found for exam-based side effects. Multi-variate regression models based on the imaging features achieved areas under the curve of 0.99 (95% CI: 0.88 to 1.00) and 0.96 (95% CI: 0.73 to 1.00) for predicting self-reported and exam-based side effects, respectively.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> Thalamus Optimized Multi Atlas Segmentation-based patient-specific segmentation of the ventral intermediate thalamic nucleus can predict post-operative side effects, which has implications for aiding the direct targeting of MR-guided focused ultrasound and reducing side effects.</p><p id="p-6">ABBREVIATIONS: MRgFUS = MR-guided focused ultrasound; ET = essential tremor; PD = Parkinson’s disease; VIM = ventral intermediate nucleus; AC-PC = anterior commissure-posterior commissure; FGATIR = Fast Gray Matter Acquisition T1 Inversion Recovery; THOMAS = THalamus Optimized Multi Atlas Segmentation; TH = thalamus; FTM = Fahn-Tolosa-Marín Clinical Rating Scale for Tremor; AUC = areas under the curve.</p></div></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-conflict" id="fn-1"><p id="p-1">The authors declare no conflicts of interest related to the content of this article.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2024 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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