Predicting lesion size during focused ultrasound thalamotomy: a review of 63 lesions over 3 clinical trials

OBJECTIVE The goal of this study was to improve the predictability of lesion size during focused ultrasound (FUS) thalamotomy procedures. METHODS Treatment profiles and T2-weighted MRI (T2 MRI) studies obtained in 63 patients who participated in 3 clinical trials of FUS thalamotomy from February 2011 to March 2015 were reviewed retrospectively. Four damage estimate models were compared with lesion sizes measured on postprocedural T2 MRI. Models were based on 54 degrees C x 3 seconds, 240 cumulative equivalent minutes at 43 degrees C, and simple thermal threshold analysis, which recorded the maximum diameter that reached a temperature of at least 51 degrees C and 54 degrees C. Energy requirements per degrees C thermal rise above 37 degrees C were also recorded. RESULTS Lesion diameters from T2 MRI correlated poorly from the day of the procedure to day 1 postprocedure (mean increase 78% [SD 79%]). There was more predictability of lesion size from day 1 to day 30, with a mean reduction in lesion diameter of 11% (SD 24%). Of the 4 models tested, the most correlative model to day 1 findings on T2 MRI was a 51 degrees C threshold. The authors observed an increase in the energy requirement for each subsequent treatment sonication, with the largest percentage increase from treatment sonication 1 to treatment sonication 2 (mean increase 20% in energy required per degrees C increase in temperature above 37 degrees C). CONCLUSIONS At the margins, 51 degrees C temperature threshold diameters correlated best to lesion diameters measured at day 1 with T2 MRI. The lesion size from T2 MRI decreases from day 1 to day 30 in a predictable manner, much more so than from the day of the procedure to day 1 postprocedure. Energy requirements per degrees C rise above 37 degrees C continuously increase with each successive sonication.