Creation and clinical utility of a 3D atlas-based model for visualising brain nuclei targeted by MR-guided focused ultrasound thalamotomy for tremor.

Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy is an established treatment for tremor. MRgFUS utilises ultrasound to non-invasively thermally ablate or 'lesion' tremorgenic tissue. The success of treatment is contingent on accurate lesioning as assessed by tremor improvement and minimisation of adverse effects. However, coordinate planning and post-procedure lesion visualisation are difficult as the key targets, cannot be seen on standard clinical imaging. Thus, a computational tool is needed to aid target visualisation. A 3D atlas-based model was created using the Schaltenbrand-Wahren atlas. Key nuclei were manually delineated, interpolated and smoothed in 3D Slicer to create the model. Evaluation of targeting approaches across a seven-year period and patient-specific analyses of tremor treatments were performed. The anatomical position of MRgFUS lesions in the model were compared against varying clinical outcomes. The model provides an anatomical visualisation of how the change in targeting approach led to improved tremor suppression and a reduction in adverse effects for patients. This study demonstrates the successful development of a 3D atlas-based computational model of the brain target nuclei in MRgFUS thalamotomy and its clinical utility for tremor treatment analysis.