Mapping the Target for the MRgFUS Treatment of Tremor
Mapping the Target for the MRgFUS Treatment of Tremor
The purpose of this investigation is to determine the optimal DRT/VIM target location and its
 safety margins based on MR-SISET imaging features by comparing with postoperative lesions and
 clinical outcomes in patients with tremor who will undergo the MRgFUS tremor therapy.
Magnetic susceptibility is an important source of contrast in MRI, which arises from the
 subtle field perturbations generated by inter-molecular interaction in response to an
 external magnetic field. The DRT tract consists mainly of axon fibers covered by myelin
 sheaths that cause magnetic susceptibility variations. In addition, magnetic susceptibility
 of fiber bundle is in fact anisotropic. Such distinctive features of the DRT can generate a
 unique type of susceptibility contrast with respect to its neighboring thalamic tissues, yet
 clinically practical protocols are lacking. This study will utilize a novel MR
 susceptibility-based method, termed 'MR Susceptibility Imaging with Short Echo Time
 (MR-SISET)' which leverages short echo times to realize high contrast for direct and
 individualized DRT targeting. Combined with machine learning (ML) approaches, an automatic,
 operator-independent DRT-recognition will be achieved. This could provide a valid support to
 operators in the surgical planning and significantly improve the current operative
 methodology.

 MR imaging will be done on a 3T MRI Magnet at the NYU Langone Health. All patients will
 undergo a routine clinical preoperative MRI of the brain under general anesthesia to reduce
 movement artifacts. The proposed sequence (<15 minutes) will be added as a supplementary
 sequence only for the preoperative imaging for subjects who agree to participate. The
 operator/clinician will be blinded to the results of this study for the MRgFUS treatment. A
 routine clinical postoperative MRI will be performed prior to discharge by the clinician,
 typically the following day of the MRgFUS treatment. The severity of tremor will be assessed
 before and after the treatment (~6 weeks). Postoperative clinical data will be retrieved to
 get a surgical target lesion and clinical outcome after treatment in order to confirm our
 method.
Inclusion Criteria:

 -  Male or female

 -  18 years of age or older

 -  Any ethnic background

 -  History of a primary diagnosis of essential tremor or Parkinson's disease

 -  Present for the MRgFUS tremor treatment

 -  Ability to understand and agree to informed consent as determined by referring
 physician

 Exclusion Criteria:

 -  Inability to give informed consent

 -  Contraindications for MRI, including

 1. Intracranial clips

 2. Metal implants

 3. External metallic devices/objects/clips within 10 mm of the head

 4. Suspected or confirmed metal in eyes (history of welding or similar activity)

 5. Cardiac pacemaker

 6. Pregnant or potentially pregnant - pregnancy tests will be offered to women of
 childbearing age at no cost to the patient. (A SOC pregnancy test (Urine test)
 will be done for women of child bearing age if requested/required at the time of
 check-in at Tisch.This will be billed to the research study). The result of the
 test (if performed) will be added to the patient's chart in EPIC.

 7. No vulnerable populations will be enrolled.