Subthalamotomy using transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) is a novel and promising treatment for Parkinson’s Disease (PD). In this study, we investigate if baseline brain imaging features can be early predictors of tcMRgFUS-subthalamotomy efficacy, as well as which are the post-treatment brain changes associated with the clinical outcomes. Towards this aim, functional and structural neuroimaging and extensive clinical data from thirty-five PD patients enrolled in a double-blind tcMRgFUS-subthalamotomy clinical trial were analyzed. A multivariate cross-correlation analysis revealed that the baseline multimodal imaging data significantly explain (P < 0.005, FWE-corrected) the inter-individual variability in response to treatment. Most predictive features at baseline included neural fluctuations in distributed cortical regions and structural integrity in the putamen and parietal regions. Additionally, a similar multivariate analysis showed that the population variance in clinical improvements is significantly explained (P < 0.001, FWE-corrected) by a distributed network of concurrent functional and structural brain changes in frontotemporal, parietal, occipital, and cerebellar regions, as opposed to local changes in very specific brain regions. Overall, our findings reveal specific quantitative brain signatures highly predictive of tcMRgFUS-subthalamotomy responsiveness in PD. The unanticipated weight of a cortical-subcortical-cerebellar subnetwork in defining clinical outcome extends the current biological understanding of the mechanisms associated with clinical benefits.

使用经颅磁共振引导聚焦超声 (tcMRgFUS) 的丘脑下切开术是治疗帕金森病 (PD) 的一种新颖且有前途的治疗方法。在这项研究中，我们调查了基线大脑成像特征是否可以作为 tcMRgFUS 下丘脑切开术疗效的早期预测因子，以及哪些是与临床结果相关的治疗后大脑变化。为实现这一目标，对参加双盲 tcMRgFUS-subthalamotomy 临床试验的 35 名 PD 患者的功能和结构神经影像学以及广泛的临床数据进行了分析。多变量互相关分析表明，基线多模态成像数据显着解释了 ( P < 0.005，FWE 校正）个体间对治疗反应的变异性。大多数基线预测特征包括分布式皮层区域的神经波动和壳核和顶叶区域的结构完整性。此外，类似的多变量分析表明，临床改善的总体差异得到了显着解释（P < 0.001，FWE 校正）由额颞叶、顶叶、枕叶和小脑区域的并行功能和结构大脑变化的分布式网络，而不是非常特定的大脑区域的局部变化。总体而言，我们的研究结果揭示了高度预测 PD 中 tcMRgFUS-subthalamotomy 反应的特定定量大脑特征。皮质-皮质下-小脑子网络在定义临床结果中的意外权重扩展了当前对与临床益处相关的机制的生物学理解。