Mapping the Target for the MRgFUS Treatment of Tremor
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|ClinicalTrials.gov Identifier: NCT04661241|
Recruitment Status : Recruiting
First Posted : December 10, 2020
Last Update Posted : December 10, 2020
|Condition or disease||Intervention/treatment||Phase|
|Tremor, Essential Parkinson's Disease||Other: Automatic DRT/VIM target-recognition method using MR-SISET and ML approaches Other: Routine clinical MRI protocol||Not Applicable|
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.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||40 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||All patients in this study will be recruited from New York University Langone Health in cooperation with the NYU Neurosurgery and the Center for Neuromodulation. The Department of Neurosurgery will make initial contact with prospective patients who will undergo the MRgFUS tremor treatment. The patient's treating physician will determine suitability based on the subject's known clinical status and ability to be informed consent to participate in the study.|
|Masking:||Single (Care Provider)|
|Masking Description:||As a pilot study, the results of our method will be blinded to the clinician who will operate the MRgFUS tremor therapy in order to compare the locations of the proposed target, surgical lesion and stereotactic coordinates.|
|Official Title:||MRI-guided Personalized Targeting of the Ventral Intermediate Nucleus (VIM)/Dentato-rubro-thalamic Tract (DRT) for the MRgFUS Tremor Treatment|
|Actual Study Start Date :||September 10, 2020|
|Estimated Primary Completion Date :||June 30, 2021|
|Estimated Study Completion Date :||June 30, 2021|
Experimental: Investigational Scan
The proposed sequence (<15 minutes) will be added as a supplementary sequence only for the preoperative imaging if subjects agree to participate.
Other: Automatic DRT/VIM target-recognition method using MR-SISET and ML approaches
The proposed sequence (<15 minutes) will be added as a supplementary sequence only for the preoperative imaging for subjects who agree to participate: a 3D multi-echo GRE sequence will be performed during a preoperative MR imaging, using the following parameters: field of view = 220x170x75 mm3, matrix = 176x136x60, 1.25-mm isotropic resolution, flip angle = 22 degrees, TR = 92 ms, 20 TEs = 1.90 - 45.98 ms with echo spacing of 2.32 ms, bandwidth = 840 Hz/pixel.
Active Comparator: Current Clinical Practice
All patients will undergo a routine clinical preoperative MRI of the brain under general anesthesia to reduce movement artifacts.
Other: Routine clinical MRI protocol
MRI will be performed using 3T scanner (Skyra, Siemens, Erlangen, Germany). All patients will undergo preoperative MRI of the brain including routine clinical MRI protocol (T1-/T2-weighted and diffusion imaging) under general anesthesia to reduce movement artifacts.
- Tremor improvement [ Time Frame: 6 weeks ]A routine clinical follow-up will be performed to assess the severity of tremor after the treatment (~ 6 weeks) by the clinician. Patients will be categorized into three groups based on their outcome: a good clinical outcome (>65% tremor improvement), a moderate outcome (>33%, but <66% tremor improvement) and a poor outcome (<33% tremor improvement).
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04661241
|Contact: Sohae Chung, MDemail@example.com|
|Contact: Timothy Shepherd, MD||212-263-8487||Timothy.Shepherd@nyulangone.org|
|United States, New York|
|New York, New York, United States, 10016|
|Contact: Terlika Sood, PhD 212-731-5313 Terlika.firstname.lastname@example.org|
|Principal Investigator:||Sohae Chung, MD||NYU Langone|
|Principal Investigator:||Timothy Shepherd, MD||NYU Langone|