Noninvasive MRI thermometry with the proton resonance frequency (PRF) method: in vivo results in human muscle

Noninvasive monitoring of brain temperature during mild hypothermia

The main purpose of this study was to verify the feasibility of brain temperature mapping with high-spatial- and reduced-spectral-resolution magnetic resonance spectroscopic imaging (MRSI). A secondary goal was to determine the temperature coefficient of water chemical shift in the brain with and without internal spectral reference. The accuracy of the proposed MRSI method was verified using a water and vegetable oil phantom. Selective decrease of the brain temperature of pigs was induced by intranasal cooling. Temperature reductions between 2 degrees C and 4 degrees C were achieved within 20 min. The relative changes in temperature during the cooling process were monitored using MRSI. The reference temperature was measured with MR-compatible fiber-optic probes. Single-voxel (1)H MRS was used for measurement of absolute brain temperature at baseline and at the end of cooling. The temperature coefficient of the water chemical shift of brain tissue measured by MRSI without internal reference was -0.0192+/-0.0019 ppm/degrees C. The temperature coefficients of the water chemical shift relative to N-acetylaspartate, choline-containing compounds and creatine were -0.0096+/-0.0009, -0.0083+/-0.0007 and -0.0091+/-0.0011 ppm/degrees C, respectively. The results of this study indicate that MRSI with high spatial and reduced spectral resolutions is a reliable tool for monitoring long-term temperature changes in the brain.

Focal reversible deactivation of cerebral metabolism affects water diffusion

The underlying biophysical mechanisms which affect cerebral diffusion contrast remain poorly understood. We hypothesized that cerebral metabolism may affect cerebral diffusion contrast. The purpose of this study was to develop the methodology to reversibly deactivate cerebral metabolism and measure the effect on the diffusion MRI signal. We developed an MRI-compatible cortical cooling system to reversibly deactivate cortical metabolism in rhesus monkey area V1 and used MR thermometry to calculate three-dimensional temperature maps of the brain to define the extent of deactivated brain in vivo. Significant changes in the apparent diffusion coefficient (ADC) were only observed during those experiments in which the cortex was cooled below the metabolic cutoff temperature of 20 degrees C. ADC decreases (12-20%) were observed during cortical cooling in regions where the temperature did not change. The normalized in vivo ADC as function of temperature was measured and found to be equivalent to the normalized ADC of free water at temperatures above 20 degrees C, but was significantly decreased below 20 degrees C (20-25% decrease). No changes in fractional anisotropy were observed. In future experiments, we will apply this methodology to quantify the effect of reversible deactivation on neural activity as measured by the hemodynamic response and compare water diffusion changes with hemodynamic changes.

Correlation between high field MR images and histopathological findings of rat transplanted cancer immediately after partial microwave coagulation

PURPOSE

To investigate the immediate effects of microwave coagulation on rat tumors in various magnetic resonance (MR) images at high magnetic field strength using histopathological examinations as reference.

MATERIALS AND METHODS

Tumors implanted in rat femurs were partially thermocoagulated by microwave. Immediately after, T1- and T2-weighted images, diffusion-weighted images (DWIs), and contrast-enhanced T1 weighted images (CE-T1WIs) were acquired with a 7-tesla MR scanner. After measurements, tumors were examined histopathologically with hematoxylin-eosin (HE) staining and histochemically for acid phosphatase activity.

RESULTS

Without contrast, boundaries of coagulated areas were unclear on MR images, including apparent diffusion coefficient (ADC) maps. CE-T1WIs clearly showed immediate contrast enhancement of untreated areas of tumor, and the area of enhancement gradually enlarged in 5 min. Quantitative analyses were conducted by classifying tumor areas by contrast enhancement results. Signal intensities of the areas in the MR images showed no significant differences, but at the periphery, ADC values were significantly higher in areas with delayed enhancement than those with immediate enhancement. Compared with histopathological findings, with microwave thermocoagulation, increased ADC value seemed to derive from collection of extracellular fluid in the outer zone, where acid phosphatase activity was attenuated.

CONCLUSION

ADC values in the areas with delayed enhancement of CE-T1WIs were higher than those in non-affected areas, but MR images could not show areas of coagulation within tumors. Clear detection of the boundaries of coagulated areas required contrast enhancement, even at magnetic field strength of 7T.

Brain temperature and pH measured by (1)H chemical shift imaging of a thulium agent

Temperature and pH are two of the most important physiological parameters and are believed to be tightly regulated because they are intricately related to energy metabolism in living organisms. Temperature and/or pH data in mammalian brain are scarce, however, mainly because of lack of precise and non-invasive methods. At 11.7 T, we demonstrate that a thulium-based macrocyclic complex infused through the bloodstream can be used to obtain temperature and pH maps of rat brain in vivo by (1)H chemical shift imaging (CSI) of the sensor itself in conjunction with a multi-parametric model that depends on several proton resonances of the sensor. Accuracies of temperature and pH determination with the thulium sensor - which has a predominantly extracellular presence - depend on stable signals during the course of the CSI experiment as well as redundancy for temperature and pH sensitivities contained within the observed signals. The thulium-based method compared well with other methods for temperature ((1)H MRS of N-acetylaspartate and water; copper-constantan thermocouple wire) and pH ((31)P MRS of inorganic phosphate and phosphocreatine) assessment, as established by in vitro and in vivo studies. In vitro studies in phantoms with two compartments of different pH value observed under different ambient temperature conditions generated precise temperature and pH distribution maps. In vivo studies in alpha-chloralose-anesthetized and renal-ligated rats revealed temperature (33-34 degrees C) and pH (7.3-7.4) distributions in the cerebral cortex that are in agreement with observations by other methods. These results show that the thulium sensor can be used to measure temperature and pH distributions in rat brain in vivo simultaneously and accurately using Biosensor Imaging of Redundant Deviation in Shifts (BIRDS).

Monitoring prostate thermal therapy with diffusion-weighted MRI

For MR-guided minimally invasive therapies, it is important to have a repeatable and reliable tissue viability evaluation method. The use of diffusion-weighted MRI (DWI) to evaluate tissue damage was assessed in 19 canine prostates with cryoablation or high-intensity ultrasound (HIU) ablation. The apparent diffusion coefficient (ADC) trace value was measured in the treated tissue immediately upon the procedure and on the posttreatment follow-up. For the acute lesions, the ADC value decreased to (1.05+/-0.25)x10(-3) mm2/s, as compared to (1.64+/-0.24)x10(-3) mm2/s before the treatment. There was no statistical difference between previously frozen or previously ultrasound-heated lesions in terms of the 36% ADC reduction (P=0.66). The ADC decrease occurred early during the course of the treatment, which appears to complicate DWI-based thermometry. Over time, the ADC value increased as the tissue recovered and regenerated. This study shows that DWI could be a promising method to monitor prostate thermal therapies and to provide insight on tissue damage and tissue remodeling after injury.

Validation of fast MR thermometry at 1.5 T with gradient-echo echo planar imaging sequences: phantom and clinical feasibility studies

The purpose of this work was to validate in phantom studies and demonstrate the clinical feasibility of MR proton resonance frequency thermometry at 1.5 T with segmented gradient-echo echo planar imaging (GRE-EPI) sequences during liver tumour radiofrequency (RF) ablation. Classical GRE acquisitions and segmented GRE-EPI acquisitions were performed at 1.5 T during simultaneous RF heating with an MR-compatible RF electrode placed in an agar gel phantom. Temperature increments were calculated and compared with four optical temperature probe measurements using Bland- Altman analysis. In a preliminary clinical feasibility study, the rapid GRE-EPI sequence (echo train length = 13) was used for MR temperature monitoring of RF ablation of liver tumours in three patient procedures. For phantom experiments, the Bland-Altman mean of differences between MR and optical probe temperature measurements was <0.4 degrees C, and the 95% limits of agreement value was <1.4 degrees C. For the in vivo studies, respiratory-triggered GRE-EPI acquisitions yielded a temperature accuracy of 1.3 +/- 0.4 degrees C (acquisition time = 0.6 s/image, spatial coverage of three slices/respiratory cycle). MR proton resonance frequency thermometry at 1.5 T yields precise and accurate measurements of temperature increment with both classical GRE and rapid GRE-EPI sequences. Rapid GRE-EPI sequences minimize intra-scan motion effects and can be used for MR thermometry during RF ablation in moving organs.

Imaging with concave large-aperture therapeutic ultrasound arrays using conventional synthetic-aperture beamforming

Several dual-mode ultrasound array (DMUA) systems are being investigated for potential use in image- guided surgery. In therapeutic mode, DMUAs generate pulsed or continuous-wave (CW) high-intensity focused ultrasound (HIFU) beams capable of generating localized therapeutic effects within the focal volume. In imaging mode, pulse-echo data can be collected from the DMUA elements to obtain B-mode images or other forms of feedback on the state of the target tissue before, during, and after the application of the therapeutic HIFU beam. Therapeutic and technological constraints give rise to special characteristics of therapeutic arrays. Specifically, DMUAs have concave apertures with low f-number values and are typically coarsely sampled using directive elements. These characteristics necessitate pre- and post-beamforming signal processing of echo data to improve the spatial and contrast resolution and maximize the image uniformity within the imaging field of view (IxFOV). We have recently developed and experimentally validated beamforming algorithms for concave large-aperture DMUAs with directive elements. Experimental validation was performed using a 1 MHz, 64-element, concave spherical aperture with 100 mm radius of curvature. The aperture was sampled in the lateral direction using elongated elements 1-lambda x 33.3-lambda with 1.333-lambda center-to-center spacing (lambda is the wavelength). This resulted in f-number values of 0.8 and 2 in the azimuth and elevation directions, respectively. In this paper, we present a new DMUA design approach based on different sampling of the shared concave aperture to improve image quality while maintaining therapeutic performance. A pulse-wave (PW) simulation model using a modified version of the Field II program is used in this study. The model is used in generating pulse-echo data for synthetic-aperture (SA) beamforming for forming images of a variety of targets, e.g., wire arrays and speckle-generating cyst phantoms. To provide validation for the simulation model and illustrate the improvements in image quality, we show SA images of similar targets using pulse-echo data acquired experimentally using our existing 64-element prototype. The PW simulation model is used to investigate the effect of transducer bandwidth as well as finer sampling of the concave DMUA aperture on the image quality. The results show that modest increases in the sampling density and transducer bandwidth result in significant improvement in spatial and contrast resolutions in addition to extending the DMUA IxFOV.

Real-time Magnetic Resonance-guided Laser Thermal Therapy for Focal Metastatic Brain Tumors

Objective:

We report the initial results of a pilot clinical trial exploring the safety and feasibility of the first real-time magnetic resonance-guided laser-induced thermal therapy of treatment-resistant focal metastatic intracranial tumors.

Methods:

Patients with resistant metastatic intracranial tumors who had previously undergone chemotherapy, whole-brain radiation therapy, and radiosurgery and who were recused from surgery were eligible for this trial. Under local anesthesia, a Leksell stereotactic head frame was used to insert a water-cooled interstitial fiberoptic laser applicator inside the cranium. In the bore of a magnetic resonance imaging (MRI) scanner, laser energy was delivered to heat the tumor while continuous MRI was performed. A computer workstation extracted temperature-sensitive information to display images of laser heating and computed estimates of the thermal damage zone. Posttreatment MRI scans were used to confirm the zone of thermal necrosis, and follow-up was performed at 7, 15, 30, and 90 days after treatment.

Results:

In all cases, the procedure was well tolerated without secondary effect, and patients were discharged to home within 14 hours after the procedure. Follow-up imaging showed an acute increase in apparent lesion volume followed by a gradual and steady decrease. No tumor recurrence within thermal ablation zones was noted.

Conclusion:

In this ongoing trial, a total of four patients have had six metastatic tumors treated with laser thermal ablations. Magnetic resonance-guided laser-induced thermal therapy appears to provide a new, efficient treatment for recurrent focal metastatic brain disease. This therapy is a prelude to the future development of closed-head interventional MRI techniques in neurosurgery.

MR thermometry

Minimally invasive thermal therapy as local treatment of benign and malignant diseases has received increasing interest in recent years. Safety and efficacy of the treatment require accurate temperature measurement throughout the thermal procedure. Noninvasive temperature monitoring is feasible with magnetic resonance (MR) imaging based on temperature-sensitive MR parameters such as the proton resonance frequency (PRF), the diffusion coefficient (D), T1 and T2 relaxation times, magnetization transfer, the proton density, as well as temperature-sensitive contrast agents. In this article the principles of temperature measurements with these methods are reviewed and their usefulness for monitoring in vivo procedures is discussed. Whereas most measurements give a temperature change relative to a baseline condition, temperature-sensitive contrast agents and spectroscopic imaging can provide absolute temperature measurements. The excellent linearity and temperature dependence of the PRF and its near independence of tissue type have made PRF-based phase mapping methods the preferred choice for many in vivo applications. Accelerated MRI imaging techniques for real-time monitoring with the PRF method are discussed. Special attention is paid to acquisition and reconstruction methods for reducing temperature measurement artifacts introduced by tissue motion, which is often unavoidable during in vivo applications.

Spatio-temporal control of gene expression and cancer treatment using magnetic resonance imaging-guided focused ultrasound

Local temperature elevation may be used for tumor ablation, gene expression, drug activation, and gene and/or drug delivery. High-intensity focused ultrasound (HIFU) is the only clinically viable technology that can be used to achieve a local temperature increase deep inside the human body in a noninvasive way. Magnetic resonance imaging (MRI) guidance of the procedure allows in situ target definition and identification of nearby healthy tissue to be spared. In addition, MRI can be used to provide continuous temperature mapping during HIFU for spatial and temporal control of the heating procedure and prediction of the final lesion based on the received thermal dose. The primary purpose of the development of MRI-guided HIFU was to achieve safe noninvasive tissue ablation. The technique has been tested extensively in preclinical studies and is now accepted in the clinic for ablation of uterine fibroids. MRI-guided HIFU for ablation shows conceptual similarities with radiation therapy. However, thermal damage generally shows threshold-like behavior, with necrosis above the critical thermal dose and full recovery below. MRI-guided HIFU is being clinically evaluated in the cancer field. The technology also shows great promise for a variety of advanced therapeutic methods, such as gene therapy. MR-guided HIFU, together with the use of a temperature-sensitive promoter, provides local, physical, and spatio-temporal control of transgene expression. Specially designed contrast agents, together with the combined use of MRI and ultrasound, may be used for local gene and drug delivery.

Magnetic resonance-guided high-intensity ultrasound ablation of the prostate

OBJECTIVES

This paper describes our work in developing techniques and devices for magnetic resonance (MR)-guided high-intensity ultrasound ablation of the prostate and includes review of relevant literature.

METHODS

Catheter-based high-intensity ultrasound applicators, in interstitial and transurethral configurations, were developed to be used under MR guidance. Magnetic resonance thermometry and the relevant characteristics and artifacts were evaluated during in vivo thermal ablation of the prostate in 10 animals. Contrast-enhanced MR imaging (MRI) and diffusion-weighted MRI were used to assess tissue damage and compared with histology.

RESULTS

During evaluation of these applicators, MR thermometry was used to monitor the temperature distributions in the prostate in real time. Magnetic resonance-derived maximum temperature thresholds of 52 degrees C and thermal dose thresholds of 240 minutes were used to control the extent of treatment and qualitatively correlated well with posttreatment imaging studies and histology. The directional transurethral devices are selective in their ability to target well-defined regions of the prostate gland and can be rotated in discrete steps to conform treatment to prescribed boundaries. The curvilinear applicator is the most precise of these directional techniques. Multisectored transurethral applicators, with dynamic angular control of heating and no rotation requirements, offer a fast and less complex means of treatment with less selective contouring.

CONCLUSIONS

The catheter-based ultrasound devices can produce spatially selective regions of thermal destruction in prostate. The MR thermal imaging and thermal dose maps, obtained in multiple slices through the target volume, are useful for controlling therapy delivery (rotation, power levels, duration). Contrast-enhanced T1-weighted MRI and diffusion-weighted imaging are useful tools for assessing treatment.

MRI-temperature mapping during ultrasound prostate ablation using fat for phase estimation

Referenceless proton resonance frequency (PRF) shift thermometry provides a means to measure temperature changes during minimally invasive thermotherapy that is inherently robust to motion and tissue displacement. In this study, the method is expanded to allow background phase estimation from fatty tissue. A correction scheme for temperature map distortions caused by the ultrasound applicator is developed. The method is tested during thermal ablation of canine prostate using a directional transurethral ultrasound applicator.

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.

Referenceless MR thermometry for monitoring thermal ablation in the prostate

Referenceless proton resonance frequency (PRF) shift thermometry provides a means to measure temperature changes during minimally invasive thermotherapy that is inherently robust to motion and tissue displacement. However, if the referenceless method is used to determine temperature changes during prostate ablation, phase gaps between water and fat in image regions used to determine the background phase can confound the phase estimation. We demonstrate an extension to referenceless thermometry which eliminates this problem by allowing background phase estimation in the presence of phase discontinuities between aqueous and fatty tissue. In this method, images are acquired with a multiecho sequence and binary water and fat maps are generated from a Dixon reconstruction. For the background phase estimation, water and fat regions are treated separately and the phase offset between the two tissue types is determined. The method is demonstrated feasibile in phantoms and during in vivo thermal ablation of canine prostate.

MR thermometry for monitoring tumor ablation

Local thermal therapies are increasingly used in the clinic for tissue ablation. During energy deposition, the actual tissue temperature is difficult to estimate since physiological processes may modify local heat conduction and energy absorption. Blood flow may increase during temperature increase and thus change heat conduction. In order to improve the therapeutic efficiency and the safety of the intervention, mapping of temperature and thermal dose appear to offer the best strategy to optimize such interventions and to provide therapy endpoints. MRI can be used to monitor local temperature changes during thermal therapies. On-line availability of dynamic temperature mapping allows prediction of tissue death during the intervention based on semi-empirical thermal dose calculations. Much progress has been made recently in MR thermometry research, and some applications are appearing in the clinic. In this paper, the principles of MRI temperature mapping are described with special emphasis on methods employing the temperature dependency of the water proton resonance frequency. Then, the prospects and requirements for widespread applications of MR thermometry in the clinic are evaluated.

Conformal thermal therapy using planar ultrasound transducers and adaptive closed-loop MR temperature control: demonstration in gel phantoms andex vivotissues

MRI-guided transurethral ultrasound therapy offers a minimally invasive approach for the treatment of localized prostate cancer. Integrating a multi-element planar transducer with active MR temperature feedback can enable three-dimensional conformal thermal therapy of a target region within the prostate gland while sparing surrounding normal tissues. Continuous measurement of the temperature distribution in tissue enables dynamic compensation for unknown changes in blood flow and tissue properties during treatment. The main goal of this study was to evaluate the feasibility of using active temperature feedback on a clinical 1.5 T MR imager for conformal thermal therapy. MR thermometry was performed during heating in both gel phantoms and excised tissue with a transurethral heating applicator, and the rotation rate and power were varied based on the thermal measurements. The capability to produce a region of thermal damage that matched a target boundary was evaluated. The influence of a cooling gradient (to simulate cooling of the rectum or urethra) on the desired pattern of thermal damage was also investigated in gel phantoms. Results showed high correlation between the desired target boundary and the 55 degrees C isotherm generated during heating with an average distance error of 0.9 mm +/- 0.4 mm (n = 6) in turkey breasts, 1.4 mm +/- 0.6 mm (n = 4) in gel phantoms without rectal cooling and 1.4 mm +/- 0.6 mm (n = 3) in gel phantoms with rectal cooling. The results were obtained using a temporal update rate of 5 s, a spatial resolution of 3 x 3 x 10 mm for the control point, and a temperature uncertainty of approximately 1 degrees C. The performance of the control algorithm under these conditions was comparable to that of simulations conducted previously by our group. Overall, the feasibility of generating targeted regions of thermal damage with a transurethral heating applicator and active MR temperature feedback has been demonstrated experimentally. This method of treatment appears capable of accounting for unpredictable and varying tissue properties during the treatment.

Real-time adaptive methods for treatment of mobile organs by MRI-controlled high-intensity focused ultrasound

Focused ultrasound (US) is a unique and noninvasive technique for local deposition of thermal energy deep inside the body. MRI guidance offers the additional benefits of excellent target visualization and continuous temperature mapping. However, treating a moving target poses severe problems because 1) motion-related thermometry artifacts must be corrected, 2) the US focal point must be relocated according to the target displacement. In this paper a complete MRI-compatible, high-intensity focused US (HIFU) system is described together with adaptive methods that allow continuous MR thermometry and therapeutic US with real-time tracking of a moving target, online motion correction of the thermometry maps, and regional temperature control based on the proportional, integral, and derivative method. The hardware is based on a 256-element phased-array transducer with rapid electronic displacement of the focal point. The exact location of the target during US firing is anticipated using automatic analysis of periodic motions. The methods were tested with moving phantoms undergoing either rigid body or elastic periodical motions. The results show accurate tracking of the focal point. Focal and regional temperature control is demonstrated with a performance similar to that obtained with stationary phantoms.

MR-Encephalography: Fast multi-channel monitoring of brain physiology with magnetic resonance

A new approach to measure activation-related changes in the brain by magnetic resonance is described offering high temporal resolution of 10-100 measurements per second. This is achieved by simultaneous multi-channel reception where the spatial resolution during continuous observation is determined by the sensitive volume of each coil alone without any additional spatial encoding gradients. Experimental results demonstrate the very high sensitivity of this approach, which allows to directly measure and monitor the stimulus-dependent hemodynamic response as well as ECG- and breathing-related signal fluctuations. One-dimensional spatial encoding either parallel or orthogonal to the cortex demonstrates that vascular signals can be identified by the pronounced signal variation at the ECG-frequency. Noise analysis at different frequencies reveals regional signal fluctuations in the frequency range between 2 and 10 Hz. Furthermore, initial results show that frequency changes in the order of <0.03 Hz corresponding to <1 nano Tesla can be detected. In addition to its potential use in neuroscientific studies, this new method opens a wide range of applications for fast physiological monitoring and can be easily combined with conventional high-resolution imaging.

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.

1H-MRS internal thermometry in test-objects (phantoms) to within 0.1 K for quality assurance in long-term quantitative MR studies

Many magnetic resonance test-object properties are temperature-dependent, with typical temperature coefficients of approximately 2-3% K(-1). Therefore, to achieve consistent quality assurance measurements to within 1%, test object temperatures should ideally be known to within 0.3 K. Proton magnetic resonance spectroscopy has previously been used to estimate accurately absolute tissue temperature in vivo, based on the linear temperature dependence of the chemical shift difference between water and temperature-stable reference metabolites such as N-acetylaspartate. In this study, this method of 'internal thermometry' in quality assurance test-objects was investigated, and in particular the value of sodium 3-(trimethylsilyl)propane-1-sulfonate (DSS) as a chemical shift reference was demonstrated. The relationship between the DSS-water chemical shift difference (sigma, expressed in ppm) and temperature tau (in K) was shown to be tau = 764.55 (+/-5.05) - 97.72 (+/-1.05) sigma (286 <or= tau <or= 309 K). Internal thermometry in MRI test-objects is feasible and straightforward, using readily available (1)H-MRS pulse sequences and standard spectroscopy evaluation packages, with a minimum detectable temperature difference of 100 (+/-20) mK.

Investigation of proton density for measuring tissue temperature

PURPOSE

To examine the temperature dependence of the proton density (PD) in both adipose and muscle tissues, and the application of the PD as a thermometry parameter in breast tissues.

MATERIALS AND METHODS

Porcine fat samples and bovine muscle samples were successively heated to temperatures ranging from 30 degrees C to 76 degrees C and then cooled. They were then imaged with a dual-echo spin-echo sequence. T1 and T2 effects were carefully corrected from the images. The apparent PD (APD) in regions of interest (ROIs) and the sum of the APD in all pixels (Sum_APD) were measured and analyzed by linear regression.

RESULTS

APD in adipose tissue is linear and reversible, and changes with a 0.3%/ degrees C to 0.45%/ degrees C temperature variation. The temperature coefficient of Sum_APD in adipose tissue is approximately 0.29%/ degrees C, as predicted from the Boltzmann distribution. However, the results in muscle tissue are more variable. There is an offset in both APD and Sum_APD between heating and cooling phases, as well as different temperature coefficients between these two phases.

CONCLUSION

The Sum_APD in adipose tissue validates the 1/T dependence on temperature. The APD is a potentially useful parameter for fat thermometry; however, its application in muscle tissue requires further investigation.

MRI-guided focused ultrasound: methodology and applications

Focused ultrasound is very well suited for inducing noninvasive local hyperthermia. Since magnetic resonance imaging (MRI) may be employed to obtain real-time temperature maps noninvasively the combination of these two technologies offers great advantages specifically aimed toward oncological studies. Real-time identification of the target region and accurate control of the temperature evolution during the treatment has now become possible. Thermal ablation of pathological tissue, local drug delivery using thermosensitive micro-carriers and controlled transgene expression using thermosensitive promoters have recently been demonstrated with this unique technology. Based on these experiments combined focused ultrasound and MRI thermometry holds promise for future oncological diagnostics and treatment. In this paper, we review some of the recent methodological developments as well as experimental and first clinical studies using this approach.

k-space inherited parallel acquisition (KIPA): application on dynamic magnetic resonance imaging thermometry

In this study, a novel method for dynamic parallel image acquisition and reconstruction is presented. In this method, called k-space inherited parallel acquisition (KIPA), localized reconstruction coefficients are used to achieve higher reduction factors, and lower noise and artifact levels compared to that of generalized autocalibrating partially parallel acquisition (GRAPPA) reconstruction. In KIPA, the full k-space for the first frame and the partial k-space for later frames are required to reconstruct a whole series of images. Reconstruction coefficients calculated for different segments of k-space from the first frame data set are used to estimate missing k-space lines in corresponding k-space segments of other frames. The local determination of KIPA reconstruction coefficients is essential to adjusting them according to the local signal-to-noise ratio characteristics of k-space data. The proposed algorithm is applicable to dynamic imaging with arbitrary k-space sampling trajectories. Simulations of magnetic resonance thermometry using the KIPA method with a reduction factor of 6 and using dynamic imaging studies of human subjects with reduction factors of 4 and 6 have been performed to prove the feasibility of our method and to show apparent improvement in image quality in comparison with GRAPPA for dynamic imaging.

Dual-mode ultrasound phased arrays for image-guided surgery

A 64-element, 1 MHz prototype dual-mode array (DMUA) with therapeutic and imaging capabilities is described. Simulation and experimental results for the characterization of the therapeutic operating field (ThxOF) and imaging field-of-view (IxFOV) for a DMUA are given. In addition, some of the special considerations for imaging with DMUAs are given and illustrated experimentally using wire-target arrays and commercial, quality-assurance phantoms. These results demonstrate what is potentially the most powerful advantage of the use of DMUAs in image-guided surgery; namely, inherent registration between the imaging and therapeutic coordinate systems. We also present imaging results before and after discrete and volumetric HIFU-induced lesions in freshly-excised tissues. DMUA images consistently show changes in echogenicity after lesion formation with shape and extent reflecting the actual shape of the lesion. While changes in echogenicity cannot be used as an indicator of irreversible HIFU-induced tissue damage, they provide important feedback on the location and extent of the expected lesion. Thus, together with the self-registration property of DMUAs, lesion images can be expected to provide immediate and spatially-accurate feedback on the tissue response to the therapeutic HIFU beams. Based on the results provided here, the imaging capabilities of DMUAs can add unique features to other forms of image guidance, e.g. MRI, CT and diagnostic ultrasound.

Non-invasive temperature imaging with thulium 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethyl-1,4,7,10-tetraacetic acid (TmDOTMA-)

Non-invasive thermometry using hyperfine-shifted MR signals from paramagnetic lanthanide complexes has attracted attention recently because the chemical shifts of these complexes are many times more sensitive to temperature than the water 1H signal. Among all the lanthanide complexes examined thus far, thulium tetramethyl-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate (TmDOTMA-) appears to be the most suitable for MR thermometry. In this paper, the feasibility of imaging the methyl 1H signal from TmDOTMA- using a frequency-selective radiofrequency excitation pulse and chemical shift-selective (CHESS) water suppression is demonstrated. A temperature imaging method using a phase-sensitive spin-echo imaging sequence was validated in phantom experiments. A comparison of regional temperature changes measured with fiber-optic probes and the temperatures calculated from the phase shift near each probe showed that the accuracy of imaging the temperature with TmDOTMA- is at least 0.1-0.2 degrees C. The feasibility of imaging temperature changes in an intact rat at 0.5-0.6 mmol/kg dose in only a few minutes is demonstrated. Similar to commonly used MRI contrast agents, the lanthanide complex does not cross the blood-brain barrier. TmDOTMA- may prove useful for temperature imaging in many biomedical applications but further studies relating to acceptable dose and signal-to-noise ratio are necessary before clinical applications.

Regional temperature changes in the brain during somatosensory stimulation

Time-dependent variations in the brain temperature (Tt) are likely to be caused by fluctuations of cerebral blood flow (CBF) and cerebral metabolic rate of oxidative consumption (CMRO2) both of which are seemingly coupled to alterations in neuronal activity. We combined magnetic resonance, optical imaging, temperature sensing, and electrophysiologic methods in alpha-chloralose anesthetized rats to obtain multimodal measurements during forepaw stimulation. Localized changes in neuronal activity were colocalized with regional increases in Tt (by approximately 0.2%), CBF (by approximately 95%), and CMRO2 (by approximately 73%). The time-to-peak for Tt (42+/-11 secs) was significantly longer than those for CBF and CMRO2 (5+/-2 and 18+/-4 secs, respectively) with a 2-min stimulation. Net heat in the region of interest (ROI) was modeled as being dependent on the sum of heats attributed to changes in CMRO2 (Qm) and CBF (Qf) as well as conductive heat loss from the ROI to neighboring regions (Qc) and to the environment (Qe). Although tissue cooling because of Qf and Qc can occur and are enhanced during activation, the net increase in Tt corresponded to a large rise in Qm, whereas effects of Qe can be ignored. The results show that Tt increases slowly (by approximately 0.1 degrees C) during physiologic stimulation in alpha-chloralose anesthetized rats. Because the potential cooling effect of CBF depends on the temperature of blood entering the brain, Tt is mainly affected by CMRO2 during functional challenges. Implications of these findings for functional studies in awake humans and temperature regulation are discussed.

Optimization of self-reference thermometry using complex field estimation

Referenceless, or self-reference, thermometry is a technique for mapping temperature differences in the region of interest (ROI) using the baseline phase estimated by extrapolating the field in the surrounding region for estimation (RFE) and subtracting the estimated baseline from the measured field. In the present work a self-reference technique based on complex field estimation using 2D polynomials comprising complex-valued coefficients was proposed and optimized. Numerical simulations with a Gaussian-profiled phase distribution demonstrated that the ROI radius had to be 2.3-2.5 times the standard deviation (SD) of the Gaussian function in order to keep the error below 8% of the peak phase change. The area ratio between the ROI and the RFE had to be larger than 2.0 to maintain the error level. Based on the simulations, and phantom and volunteer experiments, the complex-based method with independently optimized polynomial orders for the two spatial dimensions was compared with the phase-based method using the similar-order optimization strategy. The complex-based method appeared to be useful when phase unwrapping was not removed. Otherwise, the phase-based method yielded equivalent results with less polynomial orders.

In vivo porcine liver radiofrequency ablation with simultaneous MR temperature imaging

PURPOSE

To demonstrate in vivo MR-guided temperature mapping during radiofrequency (RF) ablation of the liver with a commercially available RF generator modified to allow simultaneous RF treatment and MRI.

MATERIALS AND METHODS

A commercial RF generator was modified using passive filtering to allow the continuous application of the treatment current during MRI studies. A total of six ablations were performed with the device in vivo in three porcine livers, and imaging was concurrently performed using one of two different temperature mapping strategies.

RESULTS

MR images acquired during RF ablation demonstrated no noticeable interference from the RF ablation device, which was operated at clinically relevant power levels. Temperature maps showed areas of heating that were consistent with the dimensions of the RF ablation probe, with some asymmetry (likely depending on the orientation of the probe and heat propagation effects), and some differences in heating-spot area stability depending on the specific temperature mapping strategy used. Lesions were visualized on post-ablation imaging and sectioning.

CONCLUSION

The feasibility of performing RF ablation with a modified commercial RF generator simultaneously with MRI was demonstrated. Interference-free MR temperature maps were produced with both variable respiratory motion and mechanical ventilation, and showed the extent of heating as the ablation progressed.

Magnetic resonance temperature imaging

Continuous, real-time, 3D temperature mapping during a hyperthermic procedure may provide (i) enhanced safety by visualizing temperature maps in and around the treated region, (ii) improved efficiency by adapting local energy deposition with feedback coupling algorithms and (iii) therapy end-points based on the accumulated thermal dose. Non-invasive mapping of temperature changes can be achieved with MRI and may be based on temperature dependent MRI parameters. The excellent linearity of the temperature dependency of the proton resonance frequency (PRF) and its near-independence with respect to tissue type make the PRF-based methods the preferred choice for many applications, in particular at mid- to-high field strength (> or =0.5 T). The PRF methods employ RF-spoiled gradient echo imaging methods and incorporate fat suppression techniques for most organs. A standard deviation of less than 1 degrees C, for a temporal resolution below 1 s and a spatial resolution of approximately 2 mm is feasible for immobile tissues. Special attention is paid to methods for reducing artifacts in MR temperature mapping caused by intra-scan and inter-scan motion and motion and temperature-induced susceptibility effects in mobile tissues. Real-time image processing and visualization techniques, together with accelerated MRI acquisition techniques, are described because of their potential for therapy guidance.

Methods and potentials of magnetic resonance imaging for monitoring radiofrequency hyperthermia in a hybrid system

INTRODUCTION

Non-invasive thermometry (NIT) is a valuable and probably indispensable tool for further development of radiofrequency (RF) hyperthermia. A hybridization of an MRI scanner with a hyperthermia system is necessary for a real-time NIT. The selection of the best thermographic method is difficult, because many parameters and attributes have to be considered.

METHODS

In the hybrid system (Siemens Symphony/BSD-2000-3D) the standard methods for NIT were tested such as T1, diffusion (ADC: apparent diffusion coefficient) and proton-resonance-frequency shift (PFS) method. A series of three-dimensional datasets was acquired with different gradient-echo sequences, diffusion-weighted EPI spin-echo sequences and calculated MR-temperatures in the software platform AMIRA-HyperPlan. In particular for the PFS-method, corrective methods were developed and tested with respect to drift and other disturbances. Experiments were performed in phantoms and the results compared with direct temperature measurements. Then the procedures were transferred to clinical applications in patients with larger tumours of the lower extremity or the pelvis.

RESULTS

Heating experiments and MR-thermography in a homogeneous cylindrical phantom give an excellent survey over the potentials of the methods. Under clinical conditions all these methods have difficulties due to motion, physiological changes, inhomogeneous composition and susceptibility variations in human tissues. The PFS-method is most stable in patients yielding reasonable MR temperature distributions and time curves for pelvic and lower extremity tumours over realistic treatment times of 60-90 min. Pooled data exist for rectal tumour recurrencies and soft tissue sarcomas. The fat tissue can be used for drift correction in these patients. T1 and diffusion-dependent methods appear less suitable for these patients. The standard methods have different sensitivities with respect to the various error sources. The advantages and pitfalls of every method are discussed with respect to the literature and illustrated by the phantom and patient measurements.

CONCLUSIONS

MR-controlled RF hyperthermia in a hybrid system is well established in phantoms and already feasible for patients in the pelvic and lower extremity region. Under optimal conditions the temperature accuracy might be in the range of 0.5 degrees C. However a variety of developments, especially sequences and post-processing modules, are still required for the clinical routine.

Noninvasive thermometry using hyperfine-shifted MR signals from paramagnetic lanthanide complexes

MR thermometry techniques based on the strong water 1H signal provide high spatial and temporal resolution and have shown promise for applications such as laser surgery and RF ablation. However, these techniques have low temperature sensitivity for hyperthermia applications and are greatly influenced by local motion and susceptibility variations. 1H NMR signals from paramagnetic lanthanide complexes of Pr3+, Yb3+ and Tm3+ show up to 300-fold stronger temperature dependence compared to the water 1H signal. In addition, 1H chemical shifts of many of these complexes are insensitive to other factors such as the concentration of the paramagnetic complex, pH, [Ca2+], and the presence of plasma macro-molecules and ions. Applications of lanthanide complexes for temperature measurement in intact animals and the feasibility of mapping temperatures in phantoms have been demonstrated. Among all the lanthanide complexes examined so far, thulium 1, 4, 7, 10-tetramethyl-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetate (TmDOTMA-) appears to be the most attractive for in vivo MR thermometry. The 1H signal from the methyl groups on this complex is relatively intense because of 12 equivalent protons and provides high temperature sensitivity because of the large paramagnetic shifts induced by thulium. The possibility of imaging TmDOTMA2--in intact animals at physiologically safe concentrations has recently been demonstrated. Overall, MR thermometry methods based on hyperfine-shifted MR signals from paramagnetic lanthanide complexes appear promising for animal applications, but further studies relating to acceptable dose and signal-to-noise ratio are necessary before clinical use.

Magnetic susceptibility effects on the accuracy of MR temperature monitoring by the proton resonance frequency method

PURPOSE

To evaluate the error of MR temperature assessment based on the temperature-dependent Larmor frequency shift of water protons, which can result from susceptibility effects caused by the radiofrequency (RF) applicator.

MATERIALS AND METHODS

Local frequency shifts due to RF applicator displacements were simulated numerically by means of a three-dimensional elementary dipole model. Experimental examinations using a water tank phantom equipped with a high-precision screw thread were applied to examine temperature and movement effects for five commercially available, MR-compatible RF applicators. Measurements were performed at 1.5 Tesla.

RESULTS

For single-needle electrodes perpendicular to the external field, a distortion of 0.1 ppm and 0.2 ppm was recorded at a distance of 17.5 mm and 12.5 mm, respectively, to the needle shaft. Cluster applicators and umbrella-shaped applicators caused distortions of 0.1 ppm up to distances of 36 mm. Sinusoidal dependence on applicator orientation was found with the highest values for perpendicular orientation and the lowest values for orientation parallel to the magnetic field. With a single electrode oriented perpendicular to the field at a distance of 1.5 cm and 2.0 cm, a needle displacement of 5 mm led to an error in temperature measurement of 16.3 degrees C and 7.5 degrees C, respectively.

CONCLUSION

In MR temperature measurement, displacement of the RF applicator by patient movement or breathing leads to significant errors that have to be taken into account when PRF temperature maps are used to monitor tumor ablation in the presence of paramagnetic applicators.

A review of technical advances in interventional magnetic resonance imaging

Initial research in the development of interventional magnetic resonance (MR) imaging in the late 1980s and early to mid-1990s focused on pulse sequences, devices, and clinical applications. This focus was largely a result of the limited number of areas in which the academic research community leading the development could provide innovation on the MR systems of the time. However, during the past decade, computational power, higher bandwidth graphical displays, faster computer networks, improved pulse sequence architectures, and improved technical specifications have accelerated the pace of development on modern MR systems. Today, it is the combination of multiple system factors that are enabling the future of interventional MR. These developments, their impact on the field, and newly emerging applications are described.

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

To implement noninvasive thermometry, we installed a hybrid system consisting of a radiofrequency multiantenna applicator (SIGMA-Eye) for deep hyperthermia (BSD-2000/3D) integrated into the gantry of a 1.5 Tesla magnetic resonance (MR) tomograph Symphony. This system can record MR data during radiofrequency heating and is suitable for application and evaluation of methods for MR thermography. In 15 patients with preirradiated pelvic rectal recurrences, we acquired phase data sets (25 slices) every 10 to 15 minutes over the treatment time (60-90 minutes) using gradient echo sequences (echo time = 20 ms), transformed the phase differences to MR temperatures, and fused the color-coded MR-temperature distributions with anatomic T1-weighted MR data sets. We could generate one complete series of MR data sets per patient with satisfactory quality for further analysis. In fat, muscle, water bolus, prostate, bladder, and tumor, we delineated regions of interest (ROI), used the fat ROI for drift correction by transforming these regions to a phase shift zero, and evaluated the MR-temperature frequency distributions. Mean MR temperatures (T(MR)), maximum T(MR), full width half maximum (FWHM), and other descriptors of tumors and normal tissues were noninvasively derived and their dependencies outlined. In 8 of 15 patients, direct temperature measurements in reference points were available. We correlated the tumor MR temperatures with direct measurements, clinical response, and tumor features (volume and location), and found reasonable trends and correlations. Therefore, the mean T(MR) of the tumor might be useful as a variable to evaluate the quality and effectivity of heat treatments, and consequently as optimization variable. Feasibility of noninvasive MR thermography for regional hyperthermia has been shown and should be further investigated.

Open-configuration MR-guided microwave thermocoagulation therapy for metastatic liver tumors from breast cancer

BACKGROUND

Liver metastases from breast cancer are associated with a poor prognosis, however, local control with microwave thermocoagulation therapy has been used in certain subgroups of these patients in the past decade. In this study, open-configuration magnetic resonance (MR) -guided microwave thermocoagulation therapy was used for metastatic liver tumors from breast cancer, and the efficacy of this treatment was assessed.

METHODS

Between June 2000 and April 2004, we used MR-guided microwave thermocoagulation therapy on 11 nodules in 8 patients with metastatic liver tumors from breast cancer. The procedure was carried out under general anesthesia. A 0.5 T open-configuration MR system and a microwave coagulator were used. Near-real-time MR images and real-time temperature images were collected and displayed on the monitor. The MR-compatible thoracoscope was used and combined with MR imaging guidance. Navigation software, a 3D Slicer, was installed and customized.

RESULTS

The customized navigation software displayed near-real-time MR images. The percutaneous puncture into the tumors was successful in all cases. No mortality or major complications occurred as a result of the procedures. Five of the 8 patients are alive with new metastatic foci with a mean observation period of 25.9 months.

CONCLUSIONS

We developed several devices to allow safe, easy, and accurate MR-guided microwave thermocoagulation therapy of liver tumors. Open-configuration MR-guided microwave thermocoagulation therapy appears to be a feasible method for tumor ablation of metastatic liver tumors from breast cancer.

MRI guided and monitored focused ultrasound thermal ablation methods: a review of progress

This paper reviews the current status in using magnetic resonance imaging (MRI) to guide and monitor thermal coagulation of tumours using focused ultrasound. The patient treatment procedure with a second generation phased array system will be described. Several clinical trials have found that patient treatments are feasible and that MRI thermometry allows noninvasive monitoring of clinical treatments. Overall, this emerging modality holds significant potential for non-invasive tumour treatment of both benign and malignant tumours.

A Clinical Water-Coated Antenna Applicator for MR-Controlled Deep-Body Hyperthermia: A Comparison of Calculated and Measured 3-D Temperature Data Sets

A magnetic resonance (MR)-compatible three-dimensional (3-D) hyperthermia applicator was developed and evaluated in the magnetic resonance (MR) tomograph Siemens MAGNETOM Symphony 1.5 T. Radiating elements of this applicator are 12 so-called water coated antenna (WACOA) modules, which are designed as specially shaped and adjustable dipole structures in hermetically closed cassettes that are filled by deionized water. The WACOA modules are arranged in the applicator frame in two transversal antenna subarrays, six antennas per subarray. As a standard load for the applicator an inhomogeneous phantom was fabricated. Details of applicator's realization are presented and a 3-D comparison of calculated and measured temperature data sets is made. A fair agreement is achieved that demonstrates the numerically supported applicator's ability of phase-defined 3-D pattern steering. Further refinement of numerical models and measuring methods is necessary. The applicator's design and the E-field calculations were performed using the finite-difference time-domain (FDTD) method. The calculation and optimization of temperature patterns was obtained using the finite element method (FEM). For MR temperature measurements the proton resonance frequency (PRF) method was used.

A practical approach to thermography in a hyperthermia/magnetic resonance hybrid system: Validation in a heterogeneous phantom

PURPOSE

This study investigates the feasibility and accuracy of noninvasive magnetic resonance (MR) monitoring for a system that includes a multiantenna applicator for part-body hyperthermia (SIGMA-Eye applicator, BSD-2000/3D) and a 1.5 Tesla MR tomograph (Siemens Magnetom Symphony).

METHODS

A careful electrical decoupling enabled simultaneous operation of both systems, the hyperthermia system (100 MHz, up to 1600 W) and the MR tomograph (63.9 MHz). We used the phase data sets of a gradient echo sequence (long echo time TE = 20 ms) according to the proton frequency shift (PFS) method to determine MR temperature changes. Data postprocessing and visualization was conducted in the software platform AMIRA-HyperPlan. Heating was evaluated in an elliptical Lucite cylinder of 50 cm length filled with tissue-equivalent agarose and a skeleton made from low-dielectric material to simulate the heterogeneity of a real patient. Multiple catheters were included longitudinally for direct thermometry (using Bowman high-impedance thermistors). The phantom was positioned in the 24-antenna applicator SIGMA-Eye employing the integrated water bolus (filled with deionized water) both for coupling the radiated power into the lossy medium and to enable a correction procedure based on direct temperature measurements.

RESULTS

In eight phantom experiments we monitored the heating in the applicator not only by repetitive acquisition of three-dimensional MR datasets, but also by measuring temperature-time curves directly at selected spatial positions. For the correction, we specified regions in the bolus. Direct bolus temperatures at fixed positions were taken to aim at best possible agreement between MR temperatures and these direct temperature-time curves. Then we compared additional direct temperature-position scans (thermal maps) for each experiment with the MR temperatures along these probes, which agreed satisfactorily (averaged accuracy of +/- 0.4-0.5 degrees C). The deviations decreased with decreasing observation time, temperature increase, and thermal load to the surroundings (corresponding to bolus heating)-estimating a resolution of, at best, +/- 0.2-0.3 degrees C. The acquired MR temperature distributions give also insight into limitations and control possibilities of regional hyperthermia (annular phased array technology) for various tumor sites.

CONCLUSIONS

On-line MR monitoring of regional hyperthermia by using the PFS method is feasible in a phantom setup and can be further developed for clinical applications.

Noninvasive MR thermometry using paramagnetic lanthanide complexes of 1,4,7,10-tetraazacyclodoecane-?,??,??,??-tetramethyl-1,4,7,10-tetraacetic acid (DOTMA4-)

Noninvasive techniques to monitor temperature have numerous useful biomedical applications. However, MR thermometry techniques based on the chemical shift, relaxation rates, and molecular diffusion rate of the water 1H signal suffer from poor thermal resolution. The feasibility of MR thermometry based on the strong temperature dependence of the hyperfine-shifted 1H signal from the paramagnetic lanthanide complex thulium-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate (TmDOTA-) was recently demonstrated. The use of paramagnetic lanthanide complexes for MR thermometry can be further enhanced by improving the signal-to-noise ratio (SNR) of the observed signal. In this study, the use of lanthanide complexes of a methyl-substituted analog of DOTA4-, 1,4,7,10-tetramethyl 1,4,7,10-tetra azacyclodoecane-1,4,7,10-tetraacetic acetate (DOTMA4-) was evaluated. DOTMA4- complexes have 12 magnetically equivalent methyl protons, which provide an intense and sharper resonance compared to the corresponding DOTA- complexes. Experiments with paramagnetic Pr3+, Yb3+, Tb3+, Dy3+, and Tm3+ complexes of DOTMA4- showed that the Tm3+ complex is most favorable for MR thermometery because of the high temperature dependence of its chemical shift and its relatively narrow linewidth. The chemical shift of the methyl 1H signal from TmDOTMA- was approximately 60 times more sensitive to temperature than the water 1H shift and was insensitive to changes in concentration, pH, [Ca2+], or the presence of other ions and macromolecules. The application of TmDOTMA- for measuring temperature in a subcutaneously implanted tumor model was demonstrated. Lastly, the feasibility of obtaining 3D images from the methyl 1H resonance of TmDOTMA- was demonstrated in phantom and live animal experiments. Overall, TmDOTMA- appears to be a promising probe for MR thermometry in vivo.

Simultaneous monitoring of temperature and T1: Methods and preliminary results of application to drug delivery using thermosensitive liposomes

A method is presented to obtain temperature and longitudinal relaxivity measurements simultaneously and in near real-time. Quantitative relaxivity values are obtained from the signal magnitude from fast Look-Locker EPI data, whereas phase information from all signal samples on the recovery curve is combined to provide temperature values using the proton resonance frequency method. The utility of this technique is illustrated in an in vitro experiment with thermosensitive liposomes, which are studied as potential micro vehicles for local drug delivery. The method allowed measuring the evolution of relaxivity during RF-heating of liposomes containing a paramagnetic contrast agent, demonstrating increase of liposome permeability near the phase transition temperature. Potential applications are monitoring of local drug delivery using thermosensitive liposomes, and confirmation of reaching the liposomes' threshold temperature during thermal therapy.

Alternate Biplanar MR Navigation for Microwave Ablation of Liver Tumors

Real-time MR (magnetic resonance) images in two perpendicular planes, both of which included the path of the needle, were utilized for MR-guided microwave ablation of liver tumors. The two image planes were automatically and alternately switched by new MR scanner control software installed on an external PC. This technique is possible only with MRI (magnetic resonance imaging) units with multiplanar and multisection capabilities. Reformatted images in the corresponding two planes were also constructed from preoperative three-dimensional volume data. These four images (two real-time and two reformatted) were continuously visible to the surgeons. These images enabled the needle position in the three-dimensional space to be accurately and clearly recognized, in contrast to the difficulty encountered with two-dimensional MR images in a single image plane. This technique was also applied to MR temperature mapping during microwave ablation, as it allowed monitoring of the spread of the heat in a three-dimensional space. This type of computer-integrated image navigation was demonstrated to be feasible for MR-guided microwave ablation of liver tumors.

Noninvasive measurement of temperature and fractional dissociation of imidazole in human lower leg muscles using 1H-nuclear magnetic resonance spectroscopy

The temperature change of the fractional dissociation of imidazole (α-imidazole) in resting human lower leg muscles was measured noninvasively using 1H-nuclear magnetic resonance spectroscopy at 3.0 and 1.5 T on five normal male volunteers aged 30.6 ± 10.4 yr (mean ± SD). Using 1H-nuclear magnetic resonance spectroscopy, water, carnosine, and creatine in the muscles could be simultaneously analyzed. Carnosine contains imidazole protons. The chemical shifts of water and carnosine imidazole protons relative to creatine could be used for estimating temperatures and α-imidazole, respectively. Using the chemical shift, the values of temperature in gastrocnemius (Gast) and soleus muscles at ambient temperature (21–25°C) were estimated to be 35.5 ± 0.5 and 37.4 ± 0.6°C (means ± SE), respectively (significantly different; P < 0.01). The estimated values of α-imidazole in these muscles were 0.620 ± 0.007 and 0.630 ± 0.013 (means ± SE), respectively (not significant). Alternation of the surface temperature of the lower leg from 40 to 10°C significantly changed the temperature in Gast ( P < 0.0001) from 38.1 ± 0.5 to 28.0 ± 1.2°C, and the α-imidazole in Gast decreased from 0.631 ± 0.003 to 0.580 ± 0.011 ( P < 0.05). However, the values of α-imidazole and the temperature in soleus muscles were not significantly affected by this maneuver. These results indicate that the α-imidazole in Gast changed significantly with alternation in muscle temperature ( r = 0.877, P < 0.00001), and its change was estimated to be 0.0058/°C.

MR-guided ablation of head and neck tumors

Interstitial laser-induced thermotherapy (LITT) is a minimally invasive technique for lo-caltumor destruction within solid organs using optical fibers to deliver a high-energylaser to the target lesion. MR imaging is used both for placement of the laser in the tumorand for monitoring progress of thermocoagulation caused by the laser. The success ofLITT is dependent on the delivery of the optical fibers to the target area, real-time mon-itoringof the effects of the treatment, and subsequent evaluation of the extent of thermaldamage. The key to achieving these objectives is the imaging methods used. The thermo-sensitivityof certain MR sequences is the key to real-time monitoring, allowing accurateestimation of the extent of thermal damage.