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Peer-reviewedCC BY-NC-ND 4.0NeuroImage: Clinical

Lesion characterization in magnetic resonance-guided focused ultrasound for essential tremor using quantitative susceptibility mapping

  • Mélanie Didier1
  • Nadya Pyatigorskaya1,2,3
  • Mathieu Santin1
  • Eric Bardinet1
  • Pierre Pouget3
  • Marie Vidailhet4,3
  • Stéphane Lehéricy1,2,3
  • David Grabli4,5
  • Jean-François Aubry6
  • Carine Karachi7,8
  • Cécile Galléa1,3
  • Elodie Hainque4,3
8 affiliations
  1. 1Institut du Cerveau, ICM, Centre de NeuroImagerie de Recherche (CENIR), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France
  2. 2Neuroradiology Department, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
  3. 3Institut du Cerveau, ICM, Movement Investigations and Therapeutics (MOV'IT), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013 Paris, France
  4. 4Neurology Department, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
  5. 5Institut du Cerveau, ICM, Molecular Physiopathology of Parkinson's Disease (MPP+), Inserm U 1127, CNRS UMR 7225, Sorbonne Universite, F-75013 Paris, France
  6. 6Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR8063, PSL University, Paris, France
  7. 7Neurosurgery Department, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
  8. 8Institut du Cerveau, ICM, Experimental Neurosurgery (NEURXP), Inserm U 1127, CNRS UMR 7225, Sorbonne Universite, F-75013 Paris, France
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Abstract

Background: Focused ultrasound (FUS) thalamotomy targeting the ventral intermediate nucleus (VIM) is an increasingly adopted treatment for essential tremor. Although conventional T1/T2-weighted imaging is routinely used for post-treatment lesion segmentation shortly after the intervention, these modalities can be confounded by transient edema. Consequently, alternative sequences may offer refined tissue-level specificity regarding cytotoxic necrosis.

Objectives: We investigated the use of quantitative susceptibility mapping (QSM) as a tool to characterize the thermal lesion and explored the association between QSM-derived measures and clinical outcomes.

Methods: Fifteen essential tremor patients had clinical evaluation, T1, T2-FLAIR, QSM and diffusion images acquisition one week before and three months after FUS-thalamotomy. We assessed clinical improvement using the Clinical Rating Scale for Tremor, alongside sensory and cerebellar adverse effects. Lesions were segmented on individual QSM maps to extract volume and mean magnetic susceptibility. Using automatic region segmentation of the VIM and probabilistic tractography, we reconstructed the dentato-rubro-thalamo-cortical tract and the medial lemniscus, quantifying their spatial overlaps and adverse effect risks.

Results: QSM revealed lesions in 100% of cases, compared to 47% and 60% for T1- and T2-weighted images respectively. Mean magnetic susceptibility correlated with clinical improvement. Sensory adverse effect was related to lesion overlap with medial lemniscus, whereas cerebellar symptoms mapped to regions receiving cerebello-thalamic fibers.

Conclusions: QSM is a reliable method for lesion segmentation. Magnetic susceptibility reflects the microstructural changes and tissue damage produced by FUS thalamotomy, serving as an important determinant of therapeutic efficacy.

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Cite

BibTeXRIS
BibTeX
@article{didier2026lesion,
  title = {{Lesion characterization in magnetic resonance-guided focused ultrasound for essential tremor using quantitative susceptibility mapping}},
  author = {Mélanie Didier and Nadya Pyatigorskaya and Mathieu Santin and Eric Bardinet and Pierre Pouget and Marie Vidailhet and Stéphane Lehéricy and David Grabli and Jean-François Aubry and Carine Karachi and Cécile Galléa and Elodie Hainque},
  journal = {NeuroImage: Clinical},
  year = {2026},
  month = oct,
  doi = {10.1016/j.nicl.2026.104083},
  url = {https://doi.org/10.1016/j.nicl.2026.104083},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Lesion characterization in magnetic resonance-guided focused ultrasound for essential tremor using quantitative susceptibility mapping
AU  - Mélanie Didier
AU  - Nadya Pyatigorskaya
AU  - Mathieu Santin
AU  - Eric Bardinet
AU  - Pierre Pouget
AU  - Marie Vidailhet
AU  - Stéphane Lehéricy
AU  - David Grabli
AU  - Jean-François Aubry
AU  - Carine Karachi
AU  - Cécile Galléa
AU  - Elodie Hainque
PY  - 2026
DA  - 2026/10/26
JO  - NeuroImage: Clinical
DO  - 10.1016/j.nicl.2026.104083
UR  - https://doi.org/10.1016/j.nicl.2026.104083
AB  - Background: Focused ultrasound (FUS) thalamotomy targeting the ventral intermediate nucleus (VIM) is an increasingly adopted treatment for essential tremor. Although conventional T1/T2-weighted imaging is routinely used for post-treatment lesion segmentation shortly after the intervention, these modalities can be confounded by transient edema. Consequently, alternative sequences may offer refined tissue-level specificity regarding cytotoxic necrosis.  Objectives: We investigated the use of quantitative susceptibility mapping (QSM) as a tool to characterize the thermal lesion and explored the association between QSM-derived measures and clinical outcomes.  Methods: Fifteen essential tremor patients had clinical evaluation, T1, T2-FLAIR, QSM and diffusion images acquisition one week before and three months after FUS-thalamotomy. We assessed clinical improvement using the Clinical Rating Scale for Tremor, alongside sensory and cerebellar adverse effects. Lesions were segmented on individual QSM maps to extract volume and mean magnetic susceptibility. Using automatic region segmentation of the VIM and probabilistic tractography, we reconstructed the dentato-rubro-thalamo-cortical tract and the medial lemniscus, quantifying their spatial overlaps and adverse effect risks.  Results: QSM revealed lesions in 100% of cases, compared to 47% and 60% for T1- and T2-weighted images respectively. Mean magnetic susceptibility correlated with clinical improvement. Sensory adverse effect was related to lesion overlap with medial lemniscus, whereas cerebellar symptoms mapped to regions receiving cerebello-thalamic fibers.  Conclusions: QSM is a reliable method for lesion segmentation. Magnetic susceptibility reflects the microstructural changes and tissue damage produced by FUS thalamotomy, serving as an important determinant of therapeutic efficacy.
SN  - 2213-1582
ER  -