TY  - JOUR
AU  - Upadhyay, Neeraj
AU  - Daamen, Marcel
AU  - Purrer, Veronika
AU  - Borger, Valeri
AU  - Schmeel, Carsten
AU  - Krauss, Jonas
AU  - Maurer, Angelika
AU  - Radbruch, Alexander
AU  - Wüllner, Ullrich
AU  - Boecker, Henning
TI  - Longitudinal evolution of diffusion metrices within the Cerebello-Thalamo-cortical tract after MRgFUS thalamotomy for essential tremor.
JO  - Journal of the neurological sciences
VL  - 476
SN  - 0022-510X
CY  - Amsterdam [u.a.]
PB  - Elsevier Science
M1  - DZNE-2025-00994
SP  - 123604
PY  - 2025
AB  - Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy in essential tremor (ET) targets ventral intermediate nucleus hub region within cerebello-thalamo-cortical tract (CTCT). Understanding the microstructural changes in CTCT over time and their link to tremor improvement is crucial from a tremor-network perspective. We retrospectively analyzed tremor scores, lesion characteristics, and diffusion MRI-derived CTCT microstructural measures in 27 ET patient's pre-treatment (T0), at 1 month (T2), and 6 months (T3) post-MRgFUS. Using probabilistic tractography, we created an average CTCT mask at T0 for assessing fractional anisotropy (FA), axial (AD), mean (MD), and radial diffusivity (RD) measures across time points. Significant tremor reduction was observed at T2 and T3. The Linear mixed effect analyses showed significant time effects for FA, MD, and AD. Relative to baseline, post-hoc comparisons showed a significant decrease of FA and AD at lesion site only for T2. Instead, there was a significant increase in AD and MD at T3 compared to T2 at lesion site, and remotely near the motor cortex. Lesion size and FA changes in the CTCT at T2 showed only trend-level correlations with tremor outcome. Stronger associations were observed for the thalamic lesion-tract overlap at T2, which were even more robust at T3. Dynamic microstructural changes suggest early axonal disruption at the lesion site and subsequent reorganization, with remote CTCT changes potentially indicating chronic degeneration. Meanwhile, microstructural measures show limited predictive value for tremor outcome at 6 months compared with macroanatomical lesion-CTCT overlap. Yet, advanced diffusion imaging protocol could increase the sensitivity to predict MRgFUS clinical outcome.
KW  - Humans
KW  - Essential Tremor: surgery
KW  - Essential Tremor: diagnostic imaging
KW  - Male
KW  - Thalamus: surgery
KW  - Thalamus: diagnostic imaging
KW  - Female
KW  - Aged
KW  - Middle Aged
KW  - Retrospective Studies
KW  - Diffusion Tensor Imaging
KW  - Cerebellum: diagnostic imaging
KW  - Cerebellum: surgery
KW  - Cerebral Cortex: diagnostic imaging
KW  - Cerebral Cortex: surgery
KW  - Longitudinal Studies
KW  - Neural Pathways: diagnostic imaging
KW  - Neural Pathways: surgery
KW  - Diffusion Magnetic Resonance Imaging
KW  - Axial diffusivity (Other)
KW  - Cerebello-thalamo-cortical tract (Other)
KW  - Essential tremor (Other)
KW  - Fractional anisotropy (Other)
KW  - MRgFUS (Other)
KW  - Mean diffusivity (Other)
KW  - Outcome (Other)
LB  - PUB:(DE-HGF)16
C6  - pmid:40651055
DO  - DOI:10.1016/j.jns.2025.123604
UR  - https://pub.dzne.de/record/280911
ER  -