Noninvasive Magnetic Resonance Thermography of Recurrent Rectal Carcinoma in a 1.5 Tesla Hybrid System

Fluorescence microscopy in a microwave cavity

Optical microscopy is a well-established technique that has wide ranging applications for imaging molecular dynamics of biological systems. Typically, these applications rely on external temperature controllers to maintain or change reactions rates of these biological systems. With increasing interest in applying low power microwaves to drive biological and chemical reactions, we have combined optical and microwave based technologies and developed a fluorescence microscope in a microwave cavity. With this instrument, we have found a means to optically image biological systems inside microwave cavities during the application of microwave pulses.

Implications of clinical RF hyperthermia on protection limits in the RF range

The systemic temperature is meticulously regulated to 37-37.5 degrees C. Organ systems (skin, digestive system, muscles) have a considerable potential to regulate the perfusion for thermal regulation, physical activity, or digestion. While the regulation of the systemic temperature (37.5 degrees C) is quite strict, the tolerance and regulation potential with respect to local heat is more variable. Laboratory studies provided the relationship between thermal doses and cytotoxic effects. Tissue damage for short-term expositions (in the range of minutes) is only possible for temperatures above 50 degrees C. Radiofrequency radiation is utilized in cancer therapy, inducing local tissue temperatures in the range of 40-45 degrees C for 30-60 min. During local hyperthermia (with heated volumes <1 L) specific absorption rates (SARs) of 100-200 W kg, reactive perfusions of 20-40 mL/100 g/min, and tumor temperatures of 42-43 degrees C are achieved. Normally no side effects or damage in the normal tissue, such as muscle or skin, have been seen. During regional hyperthermia, SARs of 30-40 W kg are found in heated volumes of 10 L with temperatures of 41-42 degrees C in tumor-related measurement points. Then the reactive average perfusion is 6-9 mL/100 g/min (mean value 8 mL/100 g/min). Local temperatures even for higher SAR are regulated to values of not more than 40-42 degrees C. For these temperatures no damages in normal tissues have been found after regional hyperthermia in hundreds of patients. We conclude that the thermoregulatory potential for the whole body or large body regions is limited by the cardiac output, which can at least double the output from 5 to 10 L min. Even higher is the potential to compensate in smaller volumes. Here the perfusion in muscle can be increased from the basal value of 2-4 mL/100 g/min more than 5-10-fold.

Absolute Temperature Monitoring Using RF Radiometry in the MRI Scanner

Temperature detection using microwave radiometry has proven value for noninvasively measuring the absolute temperature of tissues inside the body. However, current clinical radiometers operate in the gigahertz range, which limits their depth of penetration. We have designed and built a noninvasive radiometer which operates at radio frequencies (64 MHz) with ∼100-kHz bandwidth, using an external RF loop coil as a thermal detector. The core of the radiometer is an accurate impedance measurement and automatic matching circuit of 0.05 Ω accuracy to compensate for any load variations. The radiometer permits temperature measurements with accuracy of ±0.1°K, over a tested physiological range of 28° C-40° C in saline phantoms whose electric properties match those of tissue. Because 1.5 T magnetic resonance imaging (MRI) scanners also operate at 64 MHz, we demonstrate the feasibility of integrating our radiometer with an MRI scanner to monitor RF power deposition and temperature dosimetry, obtaining coarse, spatially resolved, absolute thermal maps in the physiological range. We conclude that RF radiometry offers promise as a direct, noninvasive method of monitoring tissue heating during MRI studies and thereby providing an independent means of verifying patient-safe operation. Other potential applications include titration of hyper- and hypo-therapies.

Comparison of MR-thermography and planning calculations in phantoms

A systematic comparison of three-dimensional MR (magnetic resonance) thermography and planning calculations in phantoms for the hyperthermia (HT) SIGMA-Eye applicator. We performed 2 x 6 experiments in a homogeneous cylindrical and a heterogeneous elliptical phantom by adjusting 82 different patterns with different phase control inside an MR tomograph (Siemens Magnetom Symphony, 1.5 Tesla). For MR thermography, we employed the proton resonance frequency shift method with a drift correction based on silicon tubes. For the planning calculations, we used the finite-difference time-domain (FDTD) method and, in addition, modeled the antennas and the transforming network. We generated regions according to a segmentation of bones and tissue, and used an interpolation technique with a subgrid of 0.5 cm size at the interfaces. A Gauss-Newton solver has been developed to adapt phases and amplitudes. A qualitative agreement between the planning program and measurements was obtained, including a correct prediction of hot spot locations. The final deviation between planning and measurement is in the range of 2-3 W/kg, i.e., below 10%. Additional HT phase and amplitude adaptation, as well as position correction of the phantom in the SIGMA-Eye, further improve the results. HT phase corrections in the range of 30-40 degrees and HT amplitude corrections of +/- 20-30% are required for the best agreement. The deviation /MR-FDTD/, and the HT phase/amplitude corrections depend on the type of phantom, certain channel groups, pattern steering, and the positioning error. Appropriate agreement between three-dimensional specific absorption rate distributions measured by MR-thermography and planning calculations is achieved, if the correct position and adapted feed point parameters are considered. As long as feed-point parameters are uncertain (i.e., cannot be directly measured during therapy), a prospective planning will remain difficult. However, we can use the information of MR thermography to better predict the patterns in the future even without the knowledge of feed-point parameters.

Fluorescence Imaging of Heat-Stress Induced Mitochondrial Long-Term Depolarization in Breast Cancer Cells

Various thermotherapies are based on the induction of lethal heat in target tissues. Spatial and temporal instabilities of elevated temperatures induced in therapy targets require optimized treatment protocols and reliable temperature control methods during thermotherapies. Heat-stress induced effects on mitochondrial transmembrane potentials were analyzed in breast cancer cells, species MX1, using the potential sensor JC-1 (Molecular Probes, Invitrogen, Germany). Potential dependant labeling of heat-stressed cells was imaged and evaluated by fluorescence microscopy and compared with control cells. JC-1 stains mitochondria in cells with high mitochondrial potentials by forming orange-red fluorescent J-aggregates while in cells with depolarized or damaged mitochondria the sensor dye exists as green fluorescent monomers. In MX1 cells orange-red and green fluorescence intensities were correlated with each other after various heat-stress treatments and states of mitochondrial membrane potentials were deduced from the image data. With increasing stress temperatures the intensity of red fluorescent J-aggregates decreased while the green fluorescence intensity of JC-1 monomers increased. This heat-stress response happened in a nonlinear manner with increasing temperatures resulting in a nonlinear increase of red/green fluorescence ratios. These data indicated that mitochondria in MX1 cells were increasingly depolarized in response to increasing ambient temperatures.

Evidence for a specific microwave radiation effect on the green fluorescent protein

We have compared the effect of microwave irradiation and of conventional heating on the fluorescence of solution-based green fluorescent protein. A specialized near-field 8.5 GHz microwave applicator operating at 250 mW input microwave power was used. The solution temperature, the intensity, and the spectrum of the green fluorescent protein fluorescence 1), under microwave irradiation and 2), under conventional heating, were measured. In both cases the fluorescence intensity decreases and the spectrum becomes red-shifted. Although the microwave irradiation heats the solution, the microwave-induced changes in fluorescence cannot be explained by heating alone. Several possible scenarios are discussed.

Noninvasive magnetic resonance thermography of soft tissue sarcomas during regional hyperthermia

BACKGROUND

The objective of this study was to evaluate noninvasive magnetic resonance (MR) thermography for the monitoring of regional hyperthermia (RHT) in patients with soft tissue sarcomas of the lower extremities and pelvis.

METHODS

Noninvasive MR monitoring during RHT was performed in 9 patients who had high-risk soft tissue sarcomas of the lower extremities or pelvis during neoadjuvant chemotherapy plus RHT in the scope of the European Organization for Research and Treatment of Cancer 62961/European Society for Hyperthermic Oncology RHT-95 study. Anatomic and temperature-sensitive data sets were acquired every 10 minutes before and during RHT (using gradient-echo-sequences with variable echo times). MR temperature distributions were derived from the phase differences by using the proton-resonance frequency shift method. A phase convolution setting phase shifts to zero in the fat tissue was performed as a drift correction. The mean MR temperatures in the tumor and muscles and the index temperatures (e.g., T90, which covers 90% of the target volume) and thermal doses were determined and compared with pathohistologic responses and direct temperature measurements if available.

RESULTS

Thirty of 72 MR-thermography data sets (>40% of heat sessions) were evaluable. A significant correlation was observed between pathohistologic response (defined as a necrosis rate >or=90%) and standardized thermal parameters, such as thermal dose cumulative equivalent minutes at 43 degrees C to 90% of the target volume (T90) (P = .050), mean T90 (P = .048), or T50 (P = .050). The correlation of 13 conventional temperature measurements performed in selected patients and sessions invasively in the tumor or noninvasively in rectum and bladder revealed an excellent correlation with MR temperatures (R2 = .96).

CONCLUSIONS

Noninvasive MR thermography of soft tissue sarcoma was feasible and suitable for validating the quality of heating during RHT.