■头骨密度比(SDR)是骨髓和皮质骨的平均Hounsfield单位之间的比率,影响通过头骨的能量传输。在磁共振引导聚焦超声(MRgFUS)丘脑切开术治疗药物难治性特发性震颤(ET)的主要试验中,低SDR已被用作排除标准。然而,一些研究表明,SDR低的患者可以安全地接受MRgFUS治疗,结果良好.在这个病例匹配的研究中,我们的目标是比较特征,超声处理参数,病变大小,低SDR患者的临床结局与接受单侧MRgFUS丘脑切开术治疗药物难治性ET的高SDR患者。
■在2016年3月至2023年4月之间,所有在单一机构接受单侧MRgFUS丘脑切开术治疗药物难治性ET的患者(n=270)均分为低SDR(<0.40)和高SDR(≥0.40)。前瞻性收集所有临床和放射学数据,并使用非病例匹配和1:1病例匹配的方法进行回顾性分析。
■31名患者的SDR较低,239例患者SDR较高。56例患者(每组28例)纳入1:1病例匹配分析。在非病例匹配和1:1病例匹配分析中,两组之间的基线特征没有显着差异。在这两种分析中,与SDR高的患者相比,SDR低的患者需要更高的最大超声处理功率,能源,和持续时间,并以较小的病变体积达到较低的最高温度。在非案例匹配和案例匹配分析中,在术后任何时间点,低SDR患者的震颤控制均未明显减少.然而,低SDR组手术失败的机率较高,3例患者未获得适当大小的病灶.在这两种分析中,在术后第1天和第3个月,高SDR患者的失衡更常见.
■SDR<0.40的ET患者可以使用MRgFUS安全有效地治疗,尽管治疗失败和术中不适的发生率可能更高。
UNASSIGNED: Skull density ratio (SDR) is the ratio between the mean Hounsfield units of marrow and cortical bone, impacting energy transmission through the skull. Low SDR has been used as an exclusion criterion in major trials of magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor (ET). However, some studies have suggested that patients with low SDR can safely undergo MRgFUS with favorable outcomes. In this
case-matched study, we aim to compare the characteristics, sonication parameters, lesion sizes, and clinical outcomes of patients with low SDR vs. patients with high SDR who underwent unilateral MRgFUS thalamotomy for medication-refractory ET.
UNASSIGNED: Between March 2016 and April 2023, all patients (n = 270) who underwent unilateral MRgFUS thalamotomy for medication-refractory ET at a single institution were classified as low SDR (<0.40) and high SDR (≥0.40). All clinical and radiological data was prospectively collected and retrospectively analyzed using non-case-matched and 1:1
case-matched methodology.
UNASSIGNED: Thirty-one patients had low SDR, and 239 patients had high SDR. Fifty-six patients (28 in each cohort) were included in 1:1
case-matched analysis. There were no significant differences in baseline characteristics between the two groups in both non-case-matched and 1:1
case-matched analyses. In both analyses, compared to patients with high SDR, patients with low SDR required a significantly higher maximum sonication power, energy, and duration, and reached a lower maximum temperature with smaller lesion volumes. In the non-
case-matched and
case-matched analyses, low SDR patients did not have significantly less tremor control at any postoperative timepoints. However, there was a higher chance of procedure failure in the low SDR group with three patients not obtaining an appropriately sized lesion. In both analyses, imbalance was observed more often in high SDR patients on postoperative day 1 and month 3.
UNASSIGNED: ET patients with SDR <0.40 can be safely and effectively treated with MRgFUS, though there may be higher rates of treatment failure and intraoperative discomfort.