The Distribution of Skull Score and Skull Density Ratio in Tremor Patients for MR-Guided Focused Ultrasound Thalamotomy

Kevin Wen Kai Tsai, Jui Cheng Chen, Hui Chin Lai, Wei Chieh Chang, Takaomi Taira, Jin Woo Chang, Cheng Yu Wei

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objective: Magnetic resonance-guided focused ultrasound (MRgFUS) is a minimum-invasive surgical approach to non-incisionally cause the thermos-coagulation inside the human brain. The skull score (SS) has already been approved as one of the most dominant factors related to a successful MRgFUS treatment. In this study, we first reveal the SS distribution of the tremor patients, and correlate the SS with the image feature from customized skull density ratio (cSDR). This correlation might give a direction to future clinical studies for improving the SS. Methods: Two hundred and forty-six patients received a computed tomography (CT) scan of the brain, and a bone-enhanced filter was applied and reconstructed to a high spatial resolution CT images. The SS of all patients would be estimated by the MRgFUS system after importing the reconstructed CT images into the MRgFUS system. The histogram and the cumulative distribution of the SS from all the patients were calculated to show the percentage of the patients whose SS lower than 0.3 and 0.4. The same CT images of all patients were utilized to calculated the cSDR by first segmented the trabecular bone and the cortical bone from the CT images and divided the average trabecular bone intensity (aTBI) by the average cortical bone intensity (aCBI). The Pearson’s correlations between the SS and the cSDR, aTBI, and the aCBI were calculated, respectively. Results: There were 19.19 and 50% of the patient who had the SS lower than the empirical threshold 0.3 and 0.4, respectively. The Pearson’s correlation between the SS and the cSDR, aCBI, and the aTBI were R = 0.8145, 0.5723, and 0.8842. Conclusion: Half of the patients were eligible for the MRgFUS thalamotomy based on the SS, and nearly 20% of patients were empirically difficult to achieve a therapeutic temperature during MRgFUS. The SS and our cSDR are highly correlated, and the SS had a higher correlation with aTBI than with aCBI. This is the first report to explicitly reveal the SS population and indicate a potential way to increase the chance to achieve a therapeutic temperature for those who originally have low SS.

Original languageEnglish
Article number612940
JournalFrontiers in Neuroscience
Publication statusPublished - 2021 May 17

Bibliographical note

Funding Information:
KW-KT and H-CL received a grant (RA18001) from the Chang Bing Show Chwan Memorial Hospital. J-CC was supported by the Ministry of Science and Technology, Taiwan (MOST 107-2221-E-008-091; MOST107-2314-B-039-040-; MOST109-2314-B-039-027-; and MOST 109-2314-B-039-002-), China Medical University Hospital (DMR-110-100), and China Medical University Hsinchu Hospital (CMUHCH-DMR-110-012 and CMUHCH-DMR-110-001).

Funding Information:
We wish to thank the research funding from the Chang Bing Show Chwan Memorial Hospital (RA18001), and the technical support from InSightec Ltd. We also are thankful for the valuable help of Ming-Tsung Lee from the Research Assistant Center, Chang Bing Show Chwan Memorial Hospital.

Publisher Copyright:
© Copyright © 2021 Tsai, Chen, Lai, Chang, Taira, Chang and Wei.

All Science Journal Classification (ASJC) codes

  • Neuroscience(all)


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