Microstructural, Morphological, and Metabolic Changes Following Magnetic Resonance–Guided Focused Ultrasound Capsulotomy

IF 4.9 2区医学 Q1 NEUROSCIENCES

Biological Psychiatry-Cognitive Neuroscience and Neuroimaging Pub Date : 2026-06-01 Epub Date: 2026-02-09 DOI:10.1016/j.bpsc.2026.01.011

Benjamin Davidson , Andrew Clappison , Karim Mithani , Leonardo Favi Bocca , Peter Giacobbe , Sean Nestor , Ying Meng , Julie Ottoy , Jennifer S. Rabin , Matthew Burke , Kamil Uludag , Clement Hamani , Nir Lipsman , Maged Goubran

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引用次数: 0

Abstract

Background

Magnetic resonance–guided focused ultrasound anterior capsulotomy (MRgFUS-AC) is an experimental, incisionless intervention for refractory obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Although its clinical efficacy has been demonstrated, the longitudinal structural and microstructural brain changes that it induces remain incompletely characterized.

Methods

A total of 33 patients with treatment-resistant OCD (n = 14) or MDD (n = 19) underwent MRgFUS-AC targeting the ventral anterior limb of the internal capsule. Diffusion and structural magnetic resonance imaging were acquired preoperatively and at follow-up. White matter integrity was evaluated using probabilistic tractography, and cortical and subcortical volumes were quantified using the FreeSurfer longitudinal pipeline. Longitudinal changes were assessed with linear mixed effects models.

Results

MRgFUS-AC produced small lesions (∼117 mm³) that regressed by over 80% within 3 months. Despite this, significant reductions in fractional anisotropy were observed along multiple corticothalamic and corticostriatal tracts. Volume loss was detected in both cortical (medial orbitofrontal, inferior temporal, fusiform) and subcortical (bilateral caudate) regions, with more widespread effects in OCD. A smaller preoperative volume of the left pars triangularis predicted greater clinical improvement.

Conclusions

MRgFUS-AC induces measurable white matter and gray matter changes within fronto-striatal-thalamic circuits, even with small, regressing lesions. Structural effects were more pronounced in OCD than in MDD. Preoperative imaging features may aid in stratifying response and optimizing individualized targeting strategies for psychiatric neurosurgery.

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磁共振引导聚焦超声包膜切开术后的显微结构、形态和代谢变化。

背景：磁共振引导聚焦超声包膜切开术（MRgFUS-AC）是一种实验性的无切口干预治疗顽固性强迫症（OCD）和重度抑郁症（MDD）的方法。虽然其临床疗效已得到证实，但其引起的脑纵向结构和微观结构变化仍不完全表征。方法：共33例难治性强迫症（OCD, n = 14）或重度抑郁症（MDD, n = 19）患者接受了靶向内囊腹前肢（ALIC）的MRgFUS-AC治疗。术前和随访时进行弥散和结构MRI检查。使用概率神经束造影评估白质完整性，使用FreeSurfer纵向管道量化皮质和皮质下体积。采用线性混合效应模型评估纵向变化。结果：MRgFUS-AC产生小病变（约117 mm3），在三个月内消退超过80%。尽管如此，沿多个皮质丘脑束和皮质纹状体束观察到分数各向异性的显著减少。在皮质（眶额内侧、颞下、梭状回）和皮质下（双侧尾状核）区域均检测到体积损失，在强迫症中影响更为广泛。术前左侧三角部体积较小预示临床改善较大。结论：MRgFUS-AC在额-纹状体-丘脑回路中诱导可测量的白质和灰质变化，即使是小的、退行性病变。结构效应在强迫症中比重度抑郁症更为明显。术前影像学特征可能有助于分层反应和优化精神神经外科个体化靶向策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Biological Psychiatry-Cognitive Neuroscience and Neuroimaging Neuroscience-Biological Psychiatry

CiteScore

10.40

自引率

1.70%

发文量

247

审稿时长

30 days

期刊介绍： Biological Psychiatry: Cognitive Neuroscience and Neuroimaging is an official journal of the Society for Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms, and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal focuses on studies using the tools and constructs of cognitive neuroscience, including the full range of non-invasive neuroimaging and human extra- and intracranial physiological recording methodologies. It publishes both basic and clinical studies, including those that incorporate genetic data, pharmacological challenges, and computational modeling approaches. The journal publishes novel results of original research which represent an important new lead or significant impact on the field. Reviews and commentaries that focus on topics of current research and interest are also encouraged.