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

Focused Ultrasound: Noninvasive Image-Guided Therapy

ABSTRACT

Invasive open surgery used to be compulsory to access tumor mass to perform excision or resection. Development of minimally invasive laparoscopic procedures followed, as well as catheter-based approaches, such as stenting, endovascular surgery, chemoembolization, brachytherapy, which minimize side effects and reduce the risks to patients. Completely noninvasive procedures bring further benefits in terms of reducing risk, procedure time, recovery time, potential of infection, or other side effects. Focusing ultrasound waves from the outside of the body specifically at the disease site has proven to be a safe noninvasive approach to localized ablative hyperthermia, mechanical ablation, and targeted drug delivery. Focused ultrasound as a medical intervention was proposed decades ago, but it only became feasible to plan, guide, monitor, and control the treatment procedures with advanced radiological imaging capabilities. The purpose of this review is to describe the imaging capabilities and approaches to perform these tasks, with the emphasis on magnetic resonance imaging and ultrasound. Some procedures already are in clinical practice, with more at the clinical trial stage. Imaging is fully integrated in the workflow and includes the following: (1) planning, with definition of the target regions and adjacent organs at risk; (2) real-time treatment monitoring via thermometry imaging, cavitation feedback, and motion control, to assure targeting and safety to adjacent normal tissues; and (3) evaluation of treatment efficacy, via assessment of ablation and physiological parameters, such as blood supply. This review also focuses on sonosensitive microparticles and nanoparticles, such as microbubbles injected in the bloodstream. They enable ultrasound energy deposition down to the microvascular level, induce vascular inflammation and shutdown, accelerate clot dissolution, and perform targeted drug delivery interventions, including focal gene delivery. Especially exciting is the ability to perform noninvasive drug delivery via opening of the blood-brain barrier at the desired areas within the brain. Overall, focused ultrasound under image guidance is rapidly developing, to become a choice noninvasive interventional radiology tool to treat disease and cure patients.

Transcranial MRI-guided Histotripsy Targeting Using MR-thermometry and MR-ARFI

OBJECTIVE

Transcranial magnetic resonance imaging (MRI)-guided histotripsy has been demonstrated to treat various locations in in vivo swine brain through a human skull. To ensure that the histotripsy treatment is delivered to the intended target location, accurate pre-treatment targeting is necessary. In this work, we investigate the feasibility of MR-thermometry and MR-acoustic radiation force imaging (MR-ARFI) to perform pre-treatment targeting of histotripsy in ex vivo bovine brain through a human skull.

METHODS

A 700 kHz, 128-element MR-compatible histotripsy array was used to generate histotripsy and tone-burst sonications. The array's electronic drivers were modified to also generate low-amplitude tone-burst sonications to perform MR-thermometry and MR-ARFI-based targeting. Twelve ex vivo bovine brains were treated with histotripsy at 35 MPa, 75 MPa and through a skull at 36 MPa. Before treating the tissue, both MR-ARFI and MR-thermometry were used to estimate the lesion location. Finally, the location of the histotripsy lesion was compared with the focus estimated by MR-thermometry and MR-ARFI.

RESULTS

MR-thermometry and MR-ARFI were able to successfully perform pre-treatment targeting of histotripsy using the modified histotripsy array driver. Histotripsy focus was estimated with mean absolute errors along the transverse/longitudinal axis of 2.06/2.95 mm and 2.13/2.51 mm for MR-ARFI and MR-thermometry, respectively. The presence of the human skull reduced the pressure at the focal region, but it did not compromise the targeting accuracy of either of the two methods with a mean absolute error of 1.10/2.91 mm and 1.29/2.91 mm for MR-ARFI and MR-thermometry, respectively.

CONCLUSION

This study demonstrated that transcranial histotripsy pre-treatment targeting is feasible with MR-thermometry and MR-ARFI.

Automatic volumetric temperature regulation during in vivo MRI-guided laser-induced thermotherapy (MRg-LITT) with multiple laser probes

BACKGROUND

Clinical Laser-Induced Thermotherapy (LITT) currently lacks precise control of tissue temperature increase during the procedure. This study presents a new method to automatically regulate the maximum temperature increase in vivo at different positions by adjusting LITT power delivered by multiple laser probes using real-time volumetric MR-thermometry.

METHODS

The regulation algorithm was evaluated in vivo on a pig leg muscle. Temperature regulation was performed in volumes surrounding each laser probe tip. The power delivered to each laser probe was automatically adjusted every second using a feedback control algorithm by processing on-the-fly MR-thermometry images (10 slices/second) on a 1.5 T clinical scanner (1.56 mm × 1.56 mm x 3 mm resolution), using the proton-resonance frequency (PRF) shift technique. Several experimental conditions were tested with predefined temperature-time profiles corresponding to conditions of thermal ablation (+30 °C above body temperature) or moderate hyperthermia (+10 and + 15 °C). Control images were acquired after injection of Gadolinium at the end of experiment and were compared with the thermal dose images calculated from the thermometry images.

RESULTS

The mean difference and root mean squared error between target temperatures and measured ones remained below 0.5 °C and 2 °C respectively, for 5 min duration. Lesion sizes observed on thermal dose and on images acquired after gadolinium injection were in good agreement.

CONCLUSION

Automatic regulation of in vivo temperature increase during LITT procedures with multiple laser emitters control is feasible. The method provides an adaptative solution to improve the safety and efficacity of such clinical procedures.

Complex-valued image reconstruction for compressed sensing MRI using hierarchical constraint

In Magnetic Resonance Imaging (MRI), the sequential acquisition of raw complex-valued image data in Fourier space, also known as k-space, results in extended examination times. To speed up the MRI scans, k-space data are usually undersampled and processed using numerical techniques such as compressed sensing (CS). While the majority of CS-MRI algorithms primarily focus on magnitude images due to their significant diagnostic value, the phase components of complex-valued MRI images also hold substantial importance for clinical diagnosis, including neurodegenerative diseases. In this work, complex-valued MRI reconstruction is studied with a focus on the simultaneous reconstruction of both magnitude and phase images. The proposed algorithm is based on the nonsubsampled contourlet transform (NSCT) technique, which offers shift invariance in images. Instead of directly transforming the complex-valued image into the NSCT domain, we introduce a wavelet transform within the NSCT domain, reducing the size of the sparsity of coefficients. This two-level hierarchical constraint (HC) enforces sparse representation of complex-valued images for CS-MRI implementation. The proposed HC is seamlessly integrated into a proximal algorithm simultaneously. Additionally, to effectively minimize the artifacts caused by sub-sampling, thresholds related to different sub-bands in the HC are applied through an alternating optimization process. Experimental results show that the novel method outperforms existing CS-MRI techniques in phase-regularized complex-valued image reconstructions.

A probabilistic thermal dose model for the estimation of necrosis in MR-guided tumor ablations

BACKGROUND

Monitoring minimally invasive thermo ablation procedures using magnetic resonance (MR) thermometry allows therapy of tumors even close to critical anatomical structures. Unfortunately, intraoperative monitoring remains challenging due to the necessary accuracy and real-time capability. One reason for this is the statistical error introduced by MR measurement, which causes the prediction of ablation zones to become inaccurate.

PURPOSE

In this work, we derive a probabilistic model for the prediction of ablation zones during thermal ablation procedures based on the thermal damage model CEM43 . By integrating the statistical error caused by MR measurement into the conventional prediction, we hope to reduce the amount of falsely classified voxels.

METHODS

The probabilistic CEM43 model is empirically evaluated using a polyacrilamide gel phantom and three in-vivo pig livers.

RESULTS

The results show a higher accuracy in three out of four data sets, with a relative difference in Sørensen-Dice coefficient from- 3.04 % $-3.04\%$ to 3.97% compared to the conventional model. Furthermore, the ablation zones predicted by the probabilistic model show a false positive rate with a relative decrease of 11.89%-30.04% compared to the conventional model.

CONCLUSION

The presented probabilistic thermal dose model might help to prevent false classification of voxels within ablation zones. This could potentially result in an increased success rate for MR-guided thermal ablation procedures. Future work may address additional error sources and a follow-up study in a more realistic clinical context.

MR Thermometry during Transcranial MR Imaging-Guided Focused Ultrasound Procedures: A Review

Interest in transcranial MR imaging-guided focused ultrasound procedures has recently grown. These incisionless procedures enable precise focal ablation of brain tissue using real-time monitoring by MR thermometry. This article will provide an updated review on clinically applicable technical underpinnings and considerations of proton resonance frequency MR thermometry, the most common clinically used MR thermometry sequence.

MR thermometry imaging for low intensity focused ultrasound modulation of spinal nervous tissue

OBJECTIVES

Previously in rodent and swine models, we have shown that external low intensity focused ultrasound (liFUS) can be used to modulate pain responses. To ensure no adverse heating events occur with liFUS modulation in a non-invasive manner, we perform initial work in swine to show that magnetic resonance thermometry imaging (MRTI) is capable of measuring <2.0 °C changes at the L5 DRG. Further, we show that our device can be constructed in an MR-compatible fashion to minimize artifact.

METHODS

Three MRTI techniques (referenceless, corrected proton resonance frequency shift (PRFS), and PRFS) were applied to assess accuracy of detecting thermal changes at the L5 DRG in unheated euthanized swine. A region of interest (ROI) that includes the L5 DRG was delineated, within which MRTI temperature changes were spatially averaged (ground truth 0 °C). In separate experiments with phantoms, B0 field-inhomogeneity, RF transmit (B1+) and fast gradient echo (fSPGR) magnitude images were acquired to downselect liFUS device materials that produce the least MRI artifacts.

RESULTS

Referenceless, corrected PRFS, and PRFS MRTI resulted in temperature measurements of 0.8 ± 1.1 °C, 1.1 ± 1.3 °C and 5.2 ± 5 °C, respectively. Both materials caused B0 perturbation but minimal B1+ and MRTI artifacts. The presence of imaging artifacts did not preclude thermal imaging of the region.

SIGNIFICANCE

We provide preliminary data suggesting that referenceless MRTI can adequately detect small thermal changes at the DRG that may occur with neuromodulation, which is one of the first steps in creating a table of safe parameters for liFUS therapy in humans.

Radiofrequency safety of high permittivity pads in MRI-Impact of insulation material

PURPOSE

High permittivity dielectric pads are known to be effective for tailoring the RF field and improving image quality in high field MRI. Despite a number of studies reporting benign specific absorption rate (SAR) effects, their "universal" safety remains an open concern. In this work, we evaluate the impact of the insulation material in between the pad and the body, using both RF simulations as well as phantom experiments.

METHODS

A 3T configuration with high permittivity material was simulated and characterized experimentally in terms of B₁ ⁺ fields and RF power absorption, both with and without electrical insulation in between the high permittivity material and the sample. Different insulation conditions were compared, and electromagnetic analyses on the induced current density were performed to elucidate the effect.

RESULTS

Increases in RF heating of up to 49% were observed experimentally in a tissue-mimicking phantom after removing the material insulation. The B₁ ⁺ magnitude and RF transceive phase were not affected. Simulations indicated that an insulation thickness of 0.5-2 mm should be accounted for in numerical models in order to ensure reliable results.

CONCLUSION

A reliable RF safety assessment of high permittivity dielectric pads requires accounting for the insulating properties of the plastic encasing. Ignoring the electrical insulation can lead to erroneous results with substantial increases in local SAR at the interface. Conversely, the material insulation does not need to be modeled to predict the B₁ ⁺ effects during the design of the pad geometry.

Magnetic Resonance Thermometry Targeting for Magnetic Resonance-Guided Histotripsy Treatments

OBJECTIVE

The potential of transcranial magnetic resonance (MR)-guided histotripsy for brain applications has been described in prior in vivo studies in the swine brain through an excised human skull. The safety and accuracy of transcranial MR-guided histotripsy (tcMRgHt) rely on pre-treatment targeting guidance. In the work described here, we investigated the feasibility and accuracy of using ultrasound-induced low-temperature heating and MR thermometry for histotripsy pre-treatment targeting in ex vivo bovine brain.

METHODS

A 15-element, 750-kHz MRI-compatible ultrasound transducer with modified drivers that can deliver both low-temperature heating and histotripsy acoustic pulses was used to treat seven bovine brain samples. The samples were first heated to an approximately 1.6°C temperature increase at the focus, and MR thermometry was used to localize the target. Once the targeting was confirmed, a histotripsy lesion was generated at the focus and visualized on post-histotripsy MR images.

DISCUSSION

The accuracy of MR thermometry targeting was evaluated with the mean/standard deviation of the difference between the locus of peak heating identified by MR thermometry and the center of mass of the post-treatment histotripsy lesion, which was 0.59/0.31 mm and 1.31/0.93 mm in the transverse and longitudinal directions, respectively.

CONCLUSION

This study determined that MR thermometry could provide reliable pre-treatment targeting for transcranial MR-guided histotripsy treatment.

Real-time automatic temperature regulation during in vivo MRI-guided laser-induced thermotherapy (MR-LITT)

Precise control of tissue temperature during Laser-Induced Thermotherapy (LITT) procedures has the potential to improve the clinical efficiency and safety of such minimally invasive therapies. We present a method to automatically regulate in vivo the temperature increase during LITT using real-time rapid volumetric Magnetic Resonance thermometry (8 slices acquired every second, with an in-plane resolution of 1.4 mmx1.4 mm and a slice thickness of 3 mm) using the proton-resonance frequency (PRF) shift technique. The laser output power is adjusted every second using a feedback control algorithm (proportional-integral-derivative controller) to force maximal tissue temperature in the targeted region to follow a predefined temperature-time profile. The root-mean-square of the difference between the target temperature and the measured temperature ranged between 0.5 °C and 1.4 °C, for temperature increases between + 5 °C to + 30 °C above body temperature and a long heating duration (up to 15 min), showing excellent accuracy and stability of the method. These results were obtained on a 1.5 T clinical MRI scanner, showing a potential immediate clinical application of such a temperature controller during MR-guided LITT.

Neurosurgical Ablation for Pain: A Technology Review

Neurosurgical ablative procedures for pain have dramatically transformed over the years. Compared to their precursors, present day techniques are less invasive and more precise as a result of advances in both device engineering and imaging technology. From a clinical perspective, understanding the strengths and drawbacks of modern techniques is necessary to optimize patient outcomes. In this review, we provide an overview of the major contemporary neuroablative modalities/technologies used for treating pain. We will compare and contrast these modalities from one another with respect to their intraoperative monitoring needs, invasiveness, range of access, and lesion generation. Finally, we will provide a brief commentary on the future of neuroablation given the advent of neuromodulation options for pain control.

Validation of a drift-corrected 3D MR temperature imaging sequence for breast MR-guided focused ultrasound treatments

Real-time temperature monitoring is critical to the success of thermally ablative therapies. This work validates a 3D thermometry sequence with k-space field drift correction designed for use in magnetic resonance-guided focused ultrasound treatments for breast cancer. Fiberoptic probes were embedded in tissue-mimicking phantoms, and temperature change measurements from the probes were compared with the magnetic resonance temperature imaging measurements following heating with focused ultrasound. Precision and accuracy of measurements were also evaluated in free-breathing healthy volunteers (N = 3) under a non-heating condition. MR temperature measurements agreed closely with those of fiberoptic probes, with a 95% confidence interval of measurement difference from -2.0 °C to 1.4 °C. Field drift-corrected measurements in vivo had a precision of 1.1 ± 0.7 °C and were accurate within 1.3 ± 0.9 °C across the three volunteers. The field drift correction method improved precision and accuracy by an average of 46 and 42%, respectively, when compared to the uncorrected data. This temperature imaging sequence can provide accurate measurements of temperature change in aqueous tissues in the breast and support the use of this sequence in clinical investigations of focused ultrasound treatments for breast cancer.

Motion-robust, multi-slice, real-time MR thermometry for MR-guided thermal therapy in abdominal organs

PURPOSE

To develop an effective and practical reconstruction pipeline to achieve motion-robust, multi-slice, real-time MR thermometry for monitoring thermal therapy in abdominal organs.

METHODS

The application includes a fast spiral magnetic resonance imaging (MRI) pulse sequence and a real-time reconstruction pipeline based on multi-baseline proton resonance frequency shift (PRFS) method with visualization of temperature imaging. The pipeline supports multi-slice acquisition with minimal reconstruction lag. Simulations with a virtual motion phantom were performed to investigate the influence of the number of baselines and respiratory rate on the accuracy of temperature measurement. Phantom experiments with ultrasound heating were performed using a custom-made motion phantom to evaluate the performance of the pipeline. Lastly, experiments in healthy volunteers (N = 2) without heating were performed to evaluate the accuracy and stability of MR thermometry in abdominal organs (liver and kidney).

RESULTS

The multi-baseline approach with greater than 25 baselines resulted in minimal temperature errors in the simulation. Phantom experiments demonstrated a 713 ms update time for 3-slice acquisitions. Temperature maps with 30 baselines showed clear temperature distributions caused by ultrasound heating in the respiratory phantom. Finally, the pipeline was evaluated with physiologic motions in healthy volunteers without heating, which demonstrated the accuracy (root mean square error [RMSE]) of 1.23  ±   0.18 °C (liver) and 1.21  ±   0.17 °C (kidney) and precision of 1.13  ±   0.11 °C (liver) and 1.16  ±   0.15 °C (kidney) using 32 baselines.

CONCLUSIONS

The proposed real-time acquisition and reconstruction pipeline allows motion-robust, multi-slice, real-time temperature monitoring within the abdomen during free breathing.

A feasibility study of wireless inductively coupled surface coil for MR-guided high-intensity focused ultrasound ablation of rodents on clinical MRI systems

Recently, to conduct preclinical imaging research on clinical MRI systems has become an attractive alternative to researchers due to its wide availability, cost, and translational application to clinical human studies when compared to dedicated small animal, high-field preclinical MRI. However, insufficient signal-to-noise ratio (SNR) significantly degrades the applicability of those applications which require high SNR, e.g. magnetic resonance guided high-intensity focused ultrasound (MRgHIFU) treatment. This study introduces a wireless inductively coupled surface (WICS) coil design used on a clinical 3 T MRI system for MRgHIFU ablation. To evaluate the SNR improvement and temperature accuracy of WICS coil, the ex vivo experiments were performed on the pork tenderloins (n = 7) and the hind legs of deceased Sprague-Dawley rats (n = 5). To demonstrate the feasibility, the in vivo experiments were performed on the hind leg of Sprague-Dawley rat (n = 1). For all experiments, temperature measurements were performed before and during HIFU ablation. Temperature curves with and without WICS coil were compared to evaluate the temperature precision in ex vivo experiments. The use of WICS coil improves the temperature accuracy from 0.85 to 0.14 °C, demonstrating the feasibility of performing small animal MRgHIFU experiments using clinical 3 T MRI system with WICS coil.

Comparisons of healthy human brain temperature predicted from biophysical modeling and measured with whole brain MR thermometry

Brain temperature is an understudied parameter relevant to brain injury and ischemia. To advance our understanding of thermal dynamics in the human brain, combined with the challenges of routine experimental measurements, a biophysical modeling framework was developed to facilitate individualized brain temperature predictions. Model-predicted brain temperatures using our fully conserved model were compared with whole brain chemical shift thermometry acquired in 30 healthy human subjects (15 male and 15 female, age range 18-36 years old). Magnetic resonance (MR) thermometry, as well as structural imaging, angiography, and venography, were acquired prospectively on a Siemens Prisma whole body 3 T MR scanner. Bland-Altman plots demonstrate agreement between model-predicted and MR-measured brain temperatures at the voxel-level. Regional variations were similar between predicted and measured temperatures (< 0.55 °C for all 10 cortical and 12 subcortical regions of interest), and subcortical white matter temperatures were higher than cortical regions. We anticipate the advancement of brain temperature as a marker of health and injury will be facilitated by a well-validated computational model which can enable predictions when experiments are not feasible.

Thermal Damage Estimate Artifact Following Antecedent Biopsy: A Case Report

MR-guided laser interstitial therapy (MRgLITT) is becoming more commonly used for minimal access approaches to intracranial lesions of all etiologies. The short-term safety profile of MRgLITT is favorable compared with sweeping incisions and open craniotomies, especially for lesions located in deep, periventricular, and highly eloquent areas. The Visualase software (Medtronic Inc., Minneapolis, MN, USA) has multiple adaptations to assist with this safety margin, including the thermal damage estimate (TDE), which applies predictive mathematical modeling to a two-dimensional (2D) graphical representation. TDE has been shown to highly correlate with actual tissue destruction in a priori MRgLITT cases and to anecdotally be imprecise when MRgLITT is combined with biopsy. We present a case regarding a 17-year-old male patient with intractable focal epilepsy. He underwent stereotactic biopsy and then ablation where it was shown that TDE is ~35% larger in the coronal plane than in the actual ablation zone. Air may have caused this artifact in the biopsy cavity, which affected the proton resonance frequency (PRF) and caused TDE pigment deposition. We believe in the need for a more comprehensive understanding and investigation regarding this TDE artifact. Future prospective studies into MRgLITT should attend carefully in cases where it is combined with biopsy.

Gd2O3-mesoporous silica/gold nanoshells: A potential dual T1/T2 contrast agent for MRI-guided localized near-IR photothermal therapy

A promising clinical trial utilizing gold-silica core-shell nanostructures coated with polyethylene glycol (PEG) has been reported for near-infrared (NIR) photothermal therapy (PTT) of prostate cancer. The next critical step for PTT is the visualization of therapeutically relevant nanoshell (NS) concentrations at the tumor site. Here we report the synthesis of PEGylated Gd₂O₃-mesoporous silica/gold core/shell NSs (Gd₂O₃-MS NSs) with NIR photothermal properties that also supply sufficient MRI contrast to be visualized at therapeutic doses (≥10⁸ NSs per milliliter). The nanoparticles have r₁ relaxivities more than three times larger than those of conventional T₁ contrast agents, requiring less concentration of Gd³⁺ to observe an equivalent signal enhancement in T₁-weighted MR images. Furthermore, Gd₂O₃-MS NS nanoparticles have r₂ relaxivities comparable to those of existing T₂ contrast agents, observed in agarose phantoms. This highly unusual combination of simultaneous T₁ and T₂ contrast allows for MRI enhancement through different approaches. As a rudimentary example, we demonstrate T₁/T₂ ratio MR images with sixfold contrast signal enhancement relative to its T₁ MRI and induced temperature increases of 20 to 55 °C under clinical illumination conditions. These nanoparticles facilitate MRI-guided PTT while providing real-time temperature feedback through thermal MRI mapping.

POD-Kalman filtering for improving noninvasive 3D temperature monitoring in MR-guided hyperthermia

Background

During resonance frequency (RF) hyperthermia treatment, the temperature of the tumor tissue is elevated to the range of 39–44°C. Accurate temperature monitoring is essential to guide treatments and ensure precise heat delivery and treatment quality. Magnetic resonance (MR) thermometry is currently the only clinical method to measure temperature noninvasively in a volume during treatment. However, several studies have shown that this approach is not always sufficiently accurate for thermal dosimetry in areas with motion, such as the pelvic region. Model‐based temperature estimation is a promising approach to correct and supplement 3D online temperature estimation in regions where MR thermometry is unreliable or cannot be measured. However, complete 3D temperature modeling of the pelvic region is too complex for online usage.

Purpose

This study aimed to evaluate the use of proper orthogonal decomposition (POD) model reduction combined with Kalman filtering to improve temperature estimation using MR thermometry. Furthermore, we assessed the benefit of this method using data from hyperthermia treatment where there were limited and unreliable MR thermometry measurements.

Methods

The performance of POD–Kalman filtering was evaluated in several heating experiments and for data from patients treated for locally advanced cervical cancer. For each method, we evaluated the mean absolute error (MAE) concerning the temperature measurements acquired by the thermal probes, and we assessed the reproducibility and consistency using the standard deviation of error (SDE). Furthermore, three patient groups were defined according to susceptibility artifacts caused by the level of intestinal gas motion to assess if the POD–Kalman filtering could compensate for missing and unreliable MR thermometry measurements.

Results

First, we showed that this method is beneficial and reproducible in phantom experiments. Second, we demonstrated that the combined method improved the match between temperature prediction and temperature acquired by intraluminal thermometry for patients treated for locally advanced cervical cancer. Considering all patients, the POD–Kalman filter improved MAE by 43% (filtered MR thermometry = 1.29°C, POD–Kalman filtered temperature = 0.74°C). Moreover, the SDE was improved by 47% (filtered MR thermometry = 1.16°C, POD–Kalman filtered temperature = 0.61°C). Specifically, the POD–Kalman filter reduced the MAE by approximately 60% in patients whose MR thermometry was unreliable because of the great amount of susceptibilities caused by the high level of intestinal gas motion.

Conclusions

We showed that the POD–Kalman filter significantly improved the accuracy of temperature monitoring compared to MR thermometry in heating experiments and hyperthermia treatments. The results demonstrated that POD–Kalman filtering can improve thermal dosimetry during RF hyperthermia treatment, especially when MR thermometry is inaccurate.

Laser ablation: Heating up the anti-tumor response in the intracranial compartment

Immunotherapies, such as immune checkpoint inhibition (ICI), have had limited success in treating intracranial malignancies. These failures are due partly to the restrictive blood-brain-barrier (BBB), the profound tumor-dependent induction of local and systemic immunosuppression, and immune evasion exhibited by these tumors. Therefore, novel approaches must be explored that aim to overcome these stringent barriers. LITT is an emerging treatment for brain tumors that utilizes thermal ablation to kill tumor cells. LITT provides an additional therapeutic benefit by synergizing with ICI and systemic chemotherapies to strengthen the anti-tumor immune response. This synergistic relationship involves transient disruption of the BBB and local augmentation of immune function, culminating in increased CNS drug penetrance and improved anti-tumor immunity. In this review, we will provide an overview of the challenges facing immunotherapy for brain tumors, and discuss how LITT may synergize with the endogenous anti-tumor response to improve the efficacy of ICI.

MRI Reconstruction with Separate Magnitude and Phase Priors Based on Dual-Tree Complex Wavelet Transform

The methods of compressed sensing magnetic resonance imaging (CS-MRI) can be divided into two categories roughly based on the number of target variables. One group devotes to estimating the complex-valued MRI image. And the other calculates the magnitude and phase parts of the complex-valued MRI image, respectively, by enforcing separate penalties on them. We propose a new CS-based method based on dual-tree complex wavelet (DT CWT) sparsity, which is under the frame of the second class of CS-MRI. Owing to the separate regularization frame, this method reduces the impact of the phase jumps (that means the jumps or discontinuities of phase values) on magnitude reconstruction. Moreover, by virtue of the excellent features of DT CWT, such as nonoscillating envelope of coefficients and multidirectional selectivity, the proposed method is capable of capturing more details in the magnitude and phase images. The experimental results show that the proposed method recovers the image contour and edges information well and can eliminate the artifacts in magnitude results caused by phase jumps.

Development of a Highly Responsive Organofluorine Temperature Sensor for 19F Magnetic Resonance Applications

Temperature can affect many biological and chemical processes within a body. During in vivo measurements, varied temperature can impact the accurate quantification of additional abiotic factors such as oxygen. During magnetic resonance imaging (MRI) measurements, the temperature of the sample can increase with the absorption of radiofrequency energy, which needs to be well-regulated for thermal therapies and long exposure. To address this potentially confounding effect, temperature can be probed intentionally using reporter molecules to determine the temperature in vivo. This work describes a combined experimental and computational approach for the design of fluorinated molecular temperature sensors with the potential to improve the accuracy and sensitivity of 19F MRI-based temperature monitoring. These fluorinated sensors are being developed to overcome the temperature sensitivity and tissue limitations of the proton resonance frequency (10 × 10-3 ppm °C-1), a standard parameter used for temperature mapping in MRI. Here, we develop (perfluoro-[1,1'-biphenyl]-4,4'-diyl)bis((heptadecafluorodecyl)sulfane), which has a nearly 2-fold increase in temperature responsiveness, compared to the proton resonance frequency and the 19F MRI temperature sensor perfluorotributylamine, when tested under identical NMR conditions. While 19F MRI is in the early stages of translation into clinical practice, development of alternative sensors with improved diagnostic abilities will help advance the development and incorporation of fluorine magnetic resonance techniques for clinical use.

Continuous cardiac thermometry via simultaneous catheter tracking and undersampled radial golden angle acquisition for radiofrequency ablation monitoring

The complexity of the MRI protocol is one of the factors limiting the clinical adoption of MR temperature mapping for real-time monitoring of cardiac ablation procedures and a push-button solution would ease its use. Continuous gradient echo golden angle radial acquisition combined with intra-scan motion correction and undersampled temperature determination could be a robust and more user-friendly alternative than the ultrafast GRE-EPI sequence which suffers from sensitivity to magnetic field susceptibility artifacts and requires ECG-gating. The goal of this proof-of-concept work is to establish the temperature uncertainty as well as the spatial and temporal resolutions achievable in an Agar-gel phantom and in vivo using this method. GRE radial golden angle acquisitions were used to monitor RF ablations in a phantom and in vivo in two sheep hearts with different slice orientations. In each case, 2D rigid motion correction based on catheter micro-coil signal, tracking its motion, was performed and its impact on the temperature imaging was assessed. The temperature uncertainty was determined for three spatial resolutions (1 × 1 × 3 mm³, 2 × 2 × 3 mm³, and 3 × 3 × 3 mm³) and three temporal resolutions (0.48, 0.72, and 0.97 s) with undersampling acceleration factors ranging from 2 to 17. The combination of radial golden angle GRE acquisition, simultaneous catheter tracking, intra-scan 2D motion correction, and undersampled thermometry enabled temperature monitoring in the myocardium in vivo during RF ablations with high temporal (< 1 s) and high spatial resolution. The temperature uncertainty ranged from 0.2 ± 0.1 to 1.8 ± 0.2 °C for the various temporal and spatial resolutions and, on average, remained superior to the uncertainty of an EPI acquisition while still allowing clinical monitoring of the RF ablation process. The proposed method is a robust and promising alternative to EPI acquisition to monitor in vivo RF cardiac ablations. Further studies remain required to improve the temperature uncertainty and establish its clinical applicability.

Perfluorocarbon emulsion enhances MR-ARFI displacement and temperature in vitro: Evaluating the response with MRI, NMR, and hydrophone

Sonosensitive perfluorocarbon F₈TAC₁₈-PFOB emulsion is under development to enhance heating, increase thermal contrast, and reduce treatment times during focused ultrasound tumor ablation of highly perfused tissue. The emulsion previously showed enhanced heating during ex vivo and in vitro studies. Experiments were designed to observe the response in additional scenarios by varying focused ultrasound conditions, emulsion concentrations, and surfactants. Most notably, changes in acoustic absorption were assessed with MR-ARFI. Phantoms were developed to have thermal, elastic, and relaxometry properties similar to those of ex vivo pig tissue. The phantoms were embedded with varying amounts of F₈TAC₁₈-PFOB emulsion or lecithin-PFOB emulsion, between about 0.0-0.3% v:w, in 0.05% v:w increments. MR-ARFI measurements were performed using a FLASH-ARFI-MRT sequence to obtain simultaneous displacement and temperature measurements. A Fabry-Perot hydrophone was utilized to observe the acoustic emissions. Susceptibility-weighted imaging and relaxometry mapping were performed to observe concentration-dependent effects. ¹⁹F diffusion-ordered spectroscopy NMR was used to measure the diffusion coefficient of perfluorocarbon droplets in a water emulsion. Increased displacement and temperature were observed with higher emulsion concentration. In semi-rigid MR-ARFI phantoms, a linear response was observed with low-duty cycle MR-ARFI sonications and a mono-exponential saturating response was observed with sustained sonications. The emulsifiers did not have a significant effect on acoustic absorption in semi-rigid gels. Stable cavitation might also contribute to enhanced heating.

Biological thermometer based on the temperature sensitivity of magnetic nanoparticle paraSHIFT

In the paper, the temperature dependence of magnetic nanoparticle (MNP) paramagnetic chemical shift (paraSHIFT) was studied by magnetic resonance (MR) spectroscopy. Based on it, iron oxide MNPs are considered as MR shifting probes for determining the temperature in liquids. With the increase in measurement temperature of the MNP reagent with MNPs, the decrease of MNP magnetization would make the peak of spectroscopy shift to the higher chemical shift area. The peak shift is related to the magnetic susceptibility of MNPs, which can be determined by MR frequency as a function of temperature and particle size. Experiments on temperature-dependent chemical shifts are performed for MNP samples with different core sizes and the estimated temperature accuracy can achieve 0.1 K. Combined with the contrast effect of magnetic nanoparticles in magnetic resonance imaging at 3 T, this technology can realize temperature imaging.

A nine-channel transmit/receive array for spine imaging at 10.5 T: Introduction to a nonuniform dielectric substrate antenna

PURPOSE

The purpose of this study is to introduce a new antenna element with improved transmit performance, named the nonuniform dielectric substrate (NODES) antenna, for building transmit arrays at ultrahigh-field.

METHODS

We optimized a dipole antenna at 10.5 Tesla by maximizing the B 1 + -SAR efficiency in a phantom for a human spine target. The optimization parameters included permittivity variation in the substrate, substrate thickness, antenna length, and conductor geometry. We conducted electromagnetic simulations as well as phantom experiments to compare the transmit/receive performance of the proposed NODES antenna design with existing coil elements from the literature.

RESULTS

Single NODES element showed up to 18% and 30% higher B 1 + -SAR efficiency than the fractionated dipole and loop elements, respectively. The new element is substantially shorter than a commonly used dipole, which enables z-stacked array formation; it is additionally capable of providing a relatively uniform current distribution along its conductors. The nine-channel transmit/receive NODES array achieved 7.5% higher B 1 + homogeneity than a loop array with the same number of elements. Excitation with the NODES array resulted in 33% lower peak 10g-averaged SAR and required 34% lower input power than the loop array for the target anatomy of the spine.

CONCLUSION

In this study, we introduced a new RF coil element: the NODES antenna. NODES antenna outperformed the widely used loop and dipole elements and may provide improved transmit/receive performance for future ultrahigh field MRI applications.

Lanthanide complexes with polyaminopolycarboxylates as prospective NMR/MRI diagnostic probes: peculiarities of molecular structure, dynamics and paramagnetic properties

The paramagnetic lanthanide complexes with polyaminopolycarboxylate (PAPC) ligands attract considerable attention from the standpoint of potential applications thereof as relaxation agents used in medical magnetic resonance imaging (MRI) and in luminescent materials, as well as owing to promising use thereof as paramagnetic labels for studying the properties of biopolymers since they exhibit thermodynamic stability, good solubility in aqueous media and moderate toxicity. For the last decades, the NMR methods have been used to determine the physical and chemical properties of paramagnetic Ln compounds. The studies concerning paramagnetic NMR lanthanide-induced shifts (LISs) in dissolved Ln complexes, as well as the analysis of band shape as a function of temperature make it possible to obtain valuable information on the structure, intra- and intermolecular dynamics and paramagnetic properties thereof. This review is devoted solely to the following features: firstly, the processes of intramolecular dynamics of lanthanide complexes with polyamino-polycarboxylate ligands such as DOTA, EDTA and DTPA and their derivatives studied by NMR; secondly, the LISs of lanthanide complexes with EDTA, DOTA, DTPA and some of their derivatives depending on temperature and pH. Moreover, in this review, for the first time, the dependence of the activation energy of molecular dynamics in complexes with polydentate ligands on the atomic number of the lanthanide cation is analyzed and a monotonic change in energy is detected, which is due to the effect of lanthanide contraction. It should be noted that this phenomenon is quite general and may also appear in the future in many other series of lanthanide complexes with both other multidentate ligands and with bidentate and monodentate ligands. In the future, it is possible to predict the dependence of the properties of certain lanthanide complexes on the ionic radius of the lanthanide cation based on the approaches presented in the review. In this review, we have also presented the dynamic NMR as the main research method widely used to analyze the processes of molecular dynamics, and the structural studies based on the NMR relaxation spectroscopy and LIS analysis.

Experimental Validation of the MRcollar: An MR Compatible Applicator for Deep Heating in the Head and Neck Region

Clinical effectiveness of hyperthermia treatments, in which tumor tissue is artificially heated to 40-44 °C for 60-90 min, can be hampered by a lack of accurate temperature monitoring. The need for noninvasive temperature monitoring in the head and neck region (H&N) and the potential of MR thermometry prompt us to design an MR compatible hyperthermia applicator: the MRcollar. In this work, we validate the design, numerical model, and MR performance of the MRcollar. The MRcollar antennas have low reflection coefficients (<-15 dB) and the intended low interaction between the individual antenna modules (<-32 dB). A 10 °C increase in 3 min was reached in a muscle-equivalent phantom, such that the specifications from the European Society for Hyperthermic Oncology were easily reached. The MRcollar had a minimal effect on MR image quality and a five-fold improvement in SNR was achieved using the integrated coils of the MRcollar, compared to the body coil. The feasibility of using the MRcollar in an MR environment was shown by a synchronous heating experiment. The match between the predicted SAR and measured SAR using MR thermometry satisfied the gamma criteria [distance-to-agreement = 5 mm, dose-difference = 7%]. All experiments combined show that the MRcollar delivers on the needs for MR-hyperthermia in the H&N and is ready for in vivo investigation.

Responsive Nanoparticles to Enable a Focused Ultrasound-Stimulated Magnetic Resonance Imaging Spotlight

Magnetic resonance imaging (MRI)-guided high-intensity focused ultrasound (HIFU) has been applied as a therapeutic tool in the clinic, and enhanced MRI contrast for depiction of target tissues will improve the precision and applicability of HIFU therapy. This work presents a "spotlight MRI" contrast enhancement technique, which combines four essential components: periodic HIFU stimulation, strong modulation of T₁ caused by HIFU, rapid MRI signal collection, and spotlight MRI spectral signal processing. The T₁ modulation is enabled by a HIFU-responsive nanomaterial based on mesoporous silica nanoparticles with Pluronic polymers (Poloxamers) and MRI contrast agents attached. With periodic HIFU stimulation in a precisely defined region containing the nanomaterial, strong periodic MRI T₁-weighted signal changes are generated. Rapid MRI signal collection of the periodic signal changes is realized by a rapid dynamic 3D MRI technique, and spotlight MRI spectral signal processing creates modulation enhancement maps (MEM) that suppress background signal and spotlight the spatial location with nanomaterials experiencing HIFU stimulation. In particular, a framework is presented to analyze the trade-offs between different parameter choices for the signal processing method. The optimal parameter choices under a specific experimental setting achieved MRI contrast enhancement of more than 2 orders of magnitude at the HIFU focal point, compared to controls.

Measurement of sub-zero temperatures in MRI using T1 temperature sensitive soft silicone materials: Applications for MRI-guided cryosurgery

PURPOSE

One standard method, proton resonance frequency shift, for measuring temperature using magnetic resonance imaging (MRI), in MRI-guided surgeries, fails completely below the freezing point of water. Because of this, we have developed a new methodology for monitoring temperature with MRI below freezing. The purpose of this paper is to show that a strong temperature dependence of the nuclear relaxation time T₁ in soft silicone polymers can lead to temperature-dependent changes of MRI intensity acquired with T₁ weighting. We propose the use of silicone filaments inserted in tissue for measuring temperature during MRI-guided cryoablations.

METHODS

The temperature dependence of T₁ in bio-compatible soft silicone polymers was measured using nuclear magnetic resonance spectroscopy and MRI. Phantoms, made of bulk silicone materials and put in an MRI-compatible thermal container with dry ice, allowed temperature measurements ranging from -60°C to + 20°C. T₁ -weighted gradient echo images of the phantoms were acquired at spatially uniform temperatures and with a gradient in temperature to determine the efficacy of using these materials as temperature indicators in MRI. Ex vivo experiments on silicone rods, 4 mm in diameter, inserted in animal tissue were conducted to assess the practical feasibility of the method.

RESULTS

Measurements of nuclear relaxation times of protons in soft silicone polymers show a monotonic, nearly linear, change with temperature (R²  > 0.98) and have a significant correlation with temperature (Pearson's r > 0.99, p < 0.01). Similarly, the intensity of the MR images in these materials, taken with a gradient echo sequence, are also temperature dependent. There is again a monotonic change in MRI intensity that correlates well with the measured temperature (Pearson's r < -0.98 and p < 0.01). The MRI experiments show that a temperature change of 3°C can be resolved in a distance of about 2.5 mm. Based on MRI images and external sensor calibrations for a sample with a gradient in temperature, temperature maps with 3°C isotherms are created for a bulk phantom. Experiments demonstrate that these changes in MRI intensity with temperature can also be seen in 4 mm silicone rods embedded in ex vivo animal tissue.

CONCLUSIONS

We have developed a new method for measuring temperature in MRI that potentially could be used during MRI-guided cryoablation operations, reducing both procedure time and cost, and making these surgeries safer.

Proton resonance frequency-based thermometry for aqueous and adipose tissues

PURPOSE

The proton resonance frequency (PRF)-based thermometry uses heating-induced phase variations to reconstruct magnetic resonance (MR) temperature maps. However, the measurements of the phase differences may be corrupted by the presence of fat due to its phase being insensitive to heat. The work aims to reconstruct the PRF-based temperature maps for tissues containing fat.

METHODS

This work proposes a PRF-based method that eliminates the fat's phase contribution by estimating the temperature-insensitive fat vector. A vector in a complex domain represents a given voxel's magnetization from an acquired, complex MR image. In this method, a circle was fit to a time series of vectors acquired from a heated region during a heating experiment. The circle center served as the fat vector, which was then subtracted from the acquired vectors, leaving only the temperature-sensitive vectors for thermal mapping. This work was verified with the gel phantoms of 10%, 15%, and 20% fat content and the ex vivo phantom of porcine abdomen tissue during water-bath heating. It was also tested with an ex vivo porcine tissue during focused ultrasound (FUS) heating.

RESULTS

A good agreement was found between the temperature measurements obtained from the proposed method and the optical fiber temperature probe in the verification experiments. In the gel phantoms, the linear regression provided a slope of 0.992 and an R² of 0.994. The Bland-Altman analysis gave a bias of 0.49°C and a 95% confidence interval of ±1.60°C. In the ex vivo tissue, the results of the linear regression and Bland-Altman methods provided a slope of 0.979, an intercept of 0.353, an R² of 0.947, and a 95% confidence interval of ±3.26°C with a bias of -0.14°C. In FUS tests, a temperature discrepancy of up to 28% was observed between the proposed and conventional PRF methods in ex vivo tissues containing fat.

CONCLUSIONS

The proposed PRF-based method can improve the accuracy of the temperature measurements in tissues with fat, such as breast, abdomen, prostate, and bone marrow.

Anatomical Phase Extraction (APE) Method: A Novel Method to Correct Detrimental Effects of Tissue-Inhomogeneity in Referenceless MR Thermometry-Preliminary Ex Vivo Investigation

Purpose

We present a novel background tissue phase removing method, called anatomical phase extraction (APE), and to investigate the accuracy of temperature estimation and capability of reducing background artifacts compared with the conventional referenceless methods.

Methods

Susceptibility variance was acquired by subtracting pretreatment baseline images taken at different locations (nine pretreatment baselines are acquired and called φ₁ to φ₉). The susceptibility phase data φ_S was obtained using the Wiener deconvolution algorithm. The background phase data φ_T was isolated by subtracting φ_S from the whole phase data. Finally, φ_T was subtracted from the whole phase data before applying the referenceless method. As a proof of concept, the proposed APE method was performed on ex vivo pork tenderloin and compared with other two referenceless temperature estimation approaches, including reweighted ℓ1 referenceless (RW- ℓ1) and ℓ2 referenceless methods. The proposed APE method was performed with four different baselines combination, namely, (φ₁, φ₅, φ₂, φ₄), (φ₃, φ₅, φ₂, φ₆), (φ₇, φ₅, φ₈, φ₄), and (φ₉, φ₅, φ₈, φ₆), and called APE experiment 1 to 4, respectively. The multibaseline method was used as a standard reference. The mean absolute error (MAE) and two-sample t-test analysis in temperature estimation of three regions of interest (ROI) between the multibaseline method and the other three methods, i.e., APE, RW- ℓ1, and ℓ2, were calculated and compared.

Results

Our results show that the mean temperature errors of the APE method-experiment 1, APE method-experiment 2, APE method-experiment 3, APE method-experiment 4, and RW- ℓ1 and ℓ2 referenceless method are 1.02°C, 1.04°C, 1.00°C, 1.00°C, 4.75°C, and 13.65°C, respectively. The MAEs of the RW- ℓ1 and ℓ2 referenceless methods were higher than that of APE method. The APE method showed no significant difference (p > 0.05), compared with the multibaseline method.

Conclusion

The present work demonstrates the use of the APE method on referenceless MR thermometry to improve the accuracy of temperature estimation during MRI guided high-intensity focused ultrasound for ablation treatment.

A novel matrix-array-based MR-conditional ultrasound system for local hyperthermia of small animals

OBJECTIVE

The goal of this work was to develop a novel modular focused ultrasound hyperthermia (FUS-HT) system for preclinical applications with the following characteristics: MR-compatible, compact probe for integration into a PET/MR small animal scanner, 3D-beam steering capabilities, high resolution focusing for generation of spatially confined FUS-HT effects.

METHODS

For 3D-beam steering capabilities, a matrix array approach with 11 11 elements was chosen. For reaching the required level of integration, the array was mounted with a conductive backing directly on the interconnection PCB. The array is driven by a modified version of our 128 channel ultrasound research platform DiPhAS. The system was characterized using sound field measurements and validated using tissue-mimicking phantoms. Preliminary MR-compatibility tests were performed using a 7T Bruker MRI scanner.

RESULTS

Four 11 11 arrays between 0.5 and 2 MHz were developed and characterized with respect to sound field properties and HT generation. Focus sizes between 1 and 4 mm were reached depending on depth and frequency. We showed heating by 4C within 60 s in phantoms. The integration concept allows a probe thickness of less than 12 mm.

CONCLUSION

We demonstrated FUS-HT capabilities of our modular system based on matrix arrays and a 128 channel electronics system within a 3D-steering range of up to 30. The suitability for integration into a small animal MR could be demonstrated in basic MR-compatibility tests.

SIGNIFICANCE

The developed system presents a new generation of FUS-HT for preclinical and translational work providing safe, reversible, localized, and controlled HT.

Visualization of thermal washout due to spatiotemporally heterogenous perfusion in the application of a model-based control algorithm for MR-HIFU mediated hyperthermia

PURPOSE

This article will report results from the in-vivo application of a previously published model-predictive control algorithm for MR-HIFU hyperthermia. The purpose of the investigation was to test the controller's in-vivo performance and behavior in the presence of heterogeneous perfusion.

MATERIALS AND METHODS

Hyperthermia at 42°C was induced and maintained for up to 30 min in a circular section of a thermometry slice in the biceps femoris of German landrace pigs (n=5) using a commercial MR-HIFU system and a recently developed MPC algorithm. The heating power allocation was correlated with heat sink maps and contrast-enhanced MRI images. The temporal change in perfusion was estimated based on the power required to maintain hyperthermia.

RESULTS

The controller performed well throughout the treatments with an absolute average tracking error of 0.27 ± 0.15 °C and an average difference of 1.25 ± 0.22 °C between T10 and T90. The MPC algorithm allocates additional heating power to sub-volumes with elevated heat sink effects, which are colocalized with blood vessels visible on contrast-enhanced MRI. The perfusion appeared to have increased by at least a factor of ∼1.86 on average.

CONCLUSIONS

The MPC controller generates temperature distributions with a narrow spectrum of voxel temperatures inside the target ROI despite the presence of spatiotemporally heterogeneous perfusion due to the rapid thermometry feedback available with MR-HIFU and the flexible allocation of heating power. The visualization of spatiotemporally heterogeneous perfusion presents new research opportunities for the investigation of stimulated perfusion in hypoxic tumor regions.

MR Thermometry Accuracy and Prospective Imaging-Based Patient Selection in MR-Guided Hyperthermia Treatment for Locally Advanced Cervical Cancer

The efficacy of a hyperthermia treatment depends on the delivery of well-controlled heating; hence, accurate temperature monitoring is essential for ensuring effective treatment. For deep pelvic hyperthermia, there are no comprehensive and systematic reports on MR thermometry. Moreover, data inclusion generally lacks objective selection criteria leading to a high probability of bias when comparing results. Herein, we studied whether imaging-based data inclusion predicts accuracy and could serve as a tool for prospective patient selection. The accuracy of the MR thermometry in patients with locally advanced cervical cancer was benchmarked against intraluminal temperature. We found that gastrointestinal air motion at the start of the treatment, quantified by the Jaccard similarity coefficient, was a good predictor for MR thermometry accuracy. The results for the group that was selected for low gastrointestinal air motion improved compared to the results for all patients by 50% (accuracy), 26% (precision), and 80% (bias). We found an average MR thermometry accuracy of 2.0 °C when all patients were considered and 1.0 °C for the selected group. These results serve as the basis for comprehensive benchmarking of novel technologies. The Jaccard similarity coefficient also has good potential to prospectively determine in which patients the MR thermometry will be valuable.

Prolonged survival after laser interstitial thermal therapy in glioblastoma

Background:

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Management includes surgical resection followed by chemoradiation, and prognosis remains poor. Surgical resection is not possible for some deep-seated or eloquent tumors. Laser interstitial thermal therapy (LITT) has emerged as a new, minimally invasive surgical option for deep-seated GBM.

Case Description:

We report a case of newly diagnosed thalamic GBM managed with LITT followed by radiation and chemotherapy.

Conclusion:

The patient remains well at 50-month post-LITT, indicating a potentially unique durability of LITT treatment in GBM.

Predicting ablation zones with multislice volumetric 2-D magnetic resonance thermal imaging

BACKGROUND

High-intensity focused ultrasound (HIFU) serves as a noninvasive stereotactic system for the ablation of brain metastases; however, treatments are limited to simple geometries and energy delivery is limited by the high acoustic attenuation of the calvarium. Minimally-invasive magnetic resonance-guided robotically-assisted (MRgRA) needle-based therapeutic ultrasound (NBTU) using multislice volumetric 2-D magnetic resonance thermal imaging (MRTI) overcomes these limitations and has potential to produce less collateral tissue damage than current methods.

OBJECTIVE

To correlate multislice volumetric 2-D MRTI volumes with histologically confirmed regions of tissue damage in MRgRA NBTU.

METHODS

Seven swine underwent a total of 8 frontal MRgRA NBTU lesions. MRTI ablation volumes were compared to histologic tissue damage on brain sections stained with 2,3,5-triphenyltetrazolium chloride (TTC). Bland-Altman analyses and correlation trends were used to compare MRTI and TTC ablation volumes.

RESULTS

Data from the initial and third swine's ablations were excluded due to sub-optimal tissue staining. For the remaining ablations (n = 6), the limits of agreement between the MRTI and histologic volumes ranged from -0.149 cm³ to 0.252 cm³ with a mean difference of 0.052 ± 0.042 cm³ (11.1%). There was a high correlation between the MRTI and histology volumes (r² = 0.831) with a strong linear relationship (r = 0.868).

CONCLUSION

We used a volumetric MRTI technique to accurately track thermal changes during MRgRA NBTU in preparation for human trials. Improved volumetric coverage with MRTI enhanced our delivery of therapy and has far-reaching implications for focused ultrasound in the broader clinical setting.

AAPM Task Group 241: A medical physicist's guide to MRI-guided focused ultrasound body systems

Magnetic resonance-guided focused ultrasound (MRgFUS) is a completely non-invasive technology that has been approved by FDA to treat several diseases. This report, prepared by the American Association of Physicist in Medicine (AAPM) Task Group 241, provides background on MRgFUS technology with a focus on clinical body MRgFUS systems. The report addresses the issues of interest to the medical physics community, specific to the body MRgFUS system configuration, and provides recommendations on how to successfully implement and maintain a clinical MRgFUS program. The following sections describe the key features of typical MRgFUS systems and clinical workflow and provide key points and best practices for the medical physicist. Commonly used terms, metrics and physics are defined and sources of uncertainty that affect MRgFUS procedures are described. Finally, safety and quality assurance procedures are explained, the recommended role of the medical physicist in MRgFUS procedures is described, and regulatory requirements for planning clinical trials are detailed. Although this report is limited in scope to clinical body MRgFUS systems that are approved or currently undergoing clinical trials in the United States, much of the material presented is also applicable to systems designed for other applications.

Modeling of Interstitial Ultrasound Ablation for Continuous Applicator Rotation With MR Validation

The primary objective of cancer intervention is the selective removal of malignant cells while conserving surrounding healthy tissues. However, the accessibility, size and shape of the cancer can make achieving appropriate margins a challenge. One minimally invasive treatment option for these clinical cases is interstitial needle based therapeutic ultrasound (NBTU). In this work, we develop a finite element model (FEM) capable of simulating continuous rotation of a directional NBTU applicator. The developed model was used to simulate the thermal deposition for different rotation trajectories. The actual thermal deposition patterns for the simulated trajectories were then evaluated using magnetic resonance thermal imaging (MRTI) in a porcine skin gelatin phantom. An MRI-compatible robot was used to control the rotation motion profile of the physical NBTU applicator to match the simulated trajectory. The model showed agreement when compared to experimental measurements with Pearson correlation coefficients greater than 0.839 when comparing temperature fields within an area of 12.6 mm radius from the ultrasound applicator. The average temperature error along a 6.3 mm radius profile from the applicator was 1.27 °C. The model was able to compute 1 s of thermal deposition by the applicator in 0.2 s on average with a 0.1 mm spatial resolution and 0.5 s time steps. The developed simulation demonstrates performance suitable for real-time control which may enable robotically-actuated closed-loop conformal tumor ablation.

The effect of thermal therapy on the blood-brain barrier and blood-tumor barrier

The blood-brain and blood-tumor barriers represent highly specialized structures responsible for tight regulation of molecular transit into the central nervous system. Under normal circumstances, the relative impermeability of the blood-brain barrier (BBB) protects the brain from circulating toxins and contributes to a brain microenvironment necessary for optimal neuronal function. However, in the context of tumors and other diseases of central nervous system, the BBB and the more recently appreciated blood-tumor barrier (BTB) represent barriers that prevent effective drug delivery. Overcoming both barriers to optimize treatment of central nervous system diseases remains the subject of intense scientific investigation. Although many newer technologies have been developed to overcome these barriers, thermal therapy, which dates back to the 1890 s, has been known to disrupt the BBB since at least the early 1980s. Recently, as a result of several technological advances, laser interstitial thermal therapy (LITT), a method of delivering targeted thermal therapy, has gained widespread use as a surgical technique to ablate brain tumors. In addition, accumulating evidence indicates that laser ablation may also increase local BBB/BTB permeability after treatment. We herein review the structure and function of the BBB and BTB and the impact of thermal injury, including LITT, on barrier function.

Investigation of Artifacts and Optimization in Proton Resonance Frequency Thermometry Towards Heating Risk Monitoring of Implantable Medical Devices in Magnetic Resonance Imaging

OBJECTIVE

Artifacts limit the application of proton resonance frequency (PRF) thermometry for on-site, individualized heating evaluations of implantable medical devices such as deep brain stimulation (DBS) for use in magnetic resonance imaging (MRI). Its properties are unclear and the research on how to choose an unaffected measurement region is insufficient.

METHODS

The properties of PRF signals around the metallic DBS electrode were investigated through simulations and phantom experiments considering electromagnetic interferences from material susceptibility and the radio frequency (RF) interactions. A threshold method on phase difference Δϕ was used to define a measurement area to estimate heating at the electrode surface. Its performance was compared to that of the Bayesian magnitude method and probe measurements.

RESULTS

The B₀ magnetic field inhomogeneity due to the electrode susceptibility was the main influencing factor on PRF compared to the RF artifact. Δϕ around the electrode followed normal distribution but was distorted. Underestimation occurred at places with high temperature rises. The noise was increased and could be well estimated from magnitude images using a modified NEMA method. The Δϕ-threshold method based on this knowledge outperformed the Bayesian magnitude method by more than 42% in estimation error of the electrode heating.

CONCLUSION

The findings favor the use of PRF with the proposed approach as a reliable method for electrode heating estimation.

SIGNIFICANCE

This study clarified the influence of device artifacts and could improve the performance of PRF thermometry for individualized heating assessments of patients with implants under MRI.

Phase unwrapping with a rapid opensource minimum spanning tree algorithm (ROMEO)

PURPOSE

To develop a rapid and accurate MRI phase-unwrapping technique for challenging phase topographies encountered at high magnetic fields, around metal implants, or postoperative cavities, which is sufficiently fast to be applied to large-group studies including Quantitative Susceptibility Mapping and functional MRI (with phase-based distortion correction).

METHODS

The proposed path-following phase-unwrapping algorithm, ROMEO, estimates the coherence of the signal both in space-using MRI magnitude and phase information-and over time, assuming approximately linear temporal phase evolution. This information is combined to form a quality map that guides the unwrapping along a 3D path through the object using a computationally efficient minimum spanning tree algorithm. ROMEO was tested against the two most commonly used exact phase-unwrapping methods, PRELUDE and BEST PATH, in simulated topographies and at several field strengths: in 3T and 7T in vivo human head images and 9.4T ex vivo rat head images.

RESULTS

ROMEO was more reliable than PRELUDE and BEST PATH, yielding unwrapping results with excellent temporal stability for multi-echo or multi-time-point data. It does not require image masking and delivers results within seconds, even in large, highly wrapped multi-echo data sets (eg, 9 seconds for a 7T head data set with 31 echoes and a 208 × 208 × 96 matrix size).

CONCLUSION

Overall, ROMEO was both faster and more accurate than PRELUDE and BEST PATH, delivering exact results within seconds, which is well below typical image acquisition times, enabling potential on-console application.

A Breast-Specific MR Guided Focused Ultrasound Platform and Treatment Protocol: First-in-Human Technical Evaluation

OBJECTIVE

This paper presents and evaluates a breast-specific magnetic resonance guided focused ultrasound (MRgFUS) system. A first-in-human evaluation demonstrates the novel hardware, a sophisticated tumor targeting algorithm and a volumetric magnetic resonance imaging (MRI) protocol.

METHODS

At the time of submission, N = 10 patients with non-palpable T0 stage breast cancer have been treated with the breast MRgFUS system. The described tumor targeting algorithm is evaluated both with a phantom test and in vivo during the breast MRgFUS treatments. Treatments were planned and monitored using volumetric MR-acoustic radiation force imaging (MR-ARFI) and temperature imaging (MRTI).

RESULTS

Successful technical treatments were achieved in 80 % of the patients. All patients underwent the treatment with no sedation and 60 % of participants had analgesic support. The total MR treatment time ranged from 73 to 114 minutes. Mean error between desired and achieved targeting in a phantom was 2.9 ±1.8 mm while 6.2 ±1.9 mm was achieved in patient studies, assessed either with MRTI or MR-ARFI measurements. MRTI and MR-ARFI were successful in 60 % and 70 % of patients, respectively.

CONCLUSION

The targeting accuracy allows the accurate placement of the focal spot using electronic steering capabilities of the transducer. The use of both volumetric MRTI and MR-ARFI provides complementary treatment planning and monitoring information during the treatment, allowing the treatment of all breast anatomies, including homogeneously fatty breasts.

Multi-Channel RF Supervision Module for Thermal Magnetic Resonance Based Cancer Therapy

Glioblastoma multiforme (GBM) is the most lethal and common brain tumor. Combining hyperthermia with chemotherapy and/or radiotherapy improves the survival of GBM patients. Thermal magnetic resonance (ThermalMR) is a hyperthermia variant that exploits radio frequency (RF)-induced heating to examine the role of temperature in biological systems and disease. The RF signals' power and phase need to be supervised to manage the formation of the energy focal point, accurate thermal dose control, and safety. Patient position during treatment also needs to be monitored to ensure the efficacy of the treatment and avoid damages to healthy tissue. This work reports on a multi-channel RF signal supervision module that is capable of monitoring and regulating RF signals and detecting patient motion. System characterization was performed for a broad range of frequencies. Monte-Carlo simulations were performed to examine the impact of power and phase errors on hyperthermia performance. The supervision module's utility was demonstrated in characterizing RF power amplifiers and being a key part of a feedback control loop regulating RF signals in heating experiments. Electromagnetic field simulations were conducted to calculate the impact of patient displacement during treatment. The supervision module was experimentally tested for detecting patient motion to a submillimeter level. To conclude, this work presents a cost-effective RF supervision module that is a key component for a hyperthermia hardware system and forms a technological basis for future ThermalMR applications.

Techniques for Temperature Monitoring of Myocardial Tissue Undergoing Radiofrequency Ablation Treatments: An Overview

Cardiac radiofrequency ablation (RFA) has received substantial attention for the treatment of multiple arrhythmias. In this scenario, there is an ever-growing demand for monitoring the temperature trend inside the tissue as it may allow an accurate control of the treatment effects, with a consequent improvement of the clinical outcomes. There are many methods for monitoring temperature in tissues undergoing RFA, which can be divided into invasive and non-invasive. This paper aims to provide an overview of the currently available techniques for temperature detection in this clinical scenario. Firstly, we describe the heat generation during RFA, then we report the principle of work of the most popular thermometric techniques and their features. Finally, we introduce their main applications in the field of cardiac RFA to explore the applicability in clinical settings of each method.

Precise Tumor Photothermal Therapy Guided and Monitored by Magnetic Resonance/Photoacoustic Imaging using A Safe and pH-Responsive Fe(III) Complex

Photothermal agents with strong near infrared (NIR) optical absorbance and excellent biocompatibility and traceability are highly desired for precise photothermal therapy. This study reports the development of a dual-functional Fe³⁺ complex (Fe-ZDS) for imaging-guided, precise photothermal therapy of tumors. The complex has stable structure and obvious zwitterionic features, resulting in excellent biocompatibility and efficient renal clearance. The iron-dopa core structure renders the complex capable of generating magnetic resonance imaging (MRI) contrast, while synergistically exhibiting optical absorption in the red and NIR regions. Interestingly, the optical absorption of the complex is pH-sensitive, with significantly higher absorption intensity in a weakly acidic environment than in a neutral environment. Thus the complex can respond to acidic tumor stimuli and confine the energy of the laser to the tumor tissue. The MRI contrast and photoacoustic signal of the complex is taken advantage of to monitor the probe injection process and optimize the injection position and dosage for maximally covering the tumor tissue and assessing the activation of the complex in tumor tissues. The evolution of temperature inside the tissue during the laser irradiation is also monitored. Using Fe-ZDS as the theranostic probe, satisfactory treatment outcomes are achieved for photothermal therapy of tumors.