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Gazel D, Akdoğan H, Büyüktaş Manay A, Erinmez M, Zer Y. The potential of therapeutic hyperthermia to eradicate Staphylococcus aureus bacteria; an in vitro study. J Therm Biol 2024; 120:103812. [PMID: 38447276 DOI: 10.1016/j.jtherbio.2024.103812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 03/08/2024]
Abstract
Staphylococcus aureus is one of the most common infectious agents, causing morbidity and mortality worldwide. Most pathogenic bacteria are classified in the group of mesophilic bacteria and the optimal growth temperature of these bacteria changes between 33 and 41 °C. Increased temperature can inhibit bacterial growth and mobility, which in turn, can trigger autolysis and cause cell wall damage. Hyperthermia treatment is defined as a heat-mediated treatment method applied using temperatures higher than body temperature. Nowadays, this treatment method is used especially in the treatment of tumours. Hyperthermia treatment is divided into two groups: mild hyperthermia and ablative or high-temperature hyperthermia. Mild hyperthermia is a therapeutic technique in which tumour tissue is heated above body temperature to produce a physiological or biological effect but is often not aimed at directly causing significant cell death. The goal of this method is to achieve temperatures of 40-45 °C in human tissues for up to 2 h. Hyperthermia can be used in the treatment of infections caused by such bacterial pathogens. In addition, using hyperthermia in combination with antimicrobial drugs may result in synergistic effects and reduce resistance issues. In our study, we used two different temperature levels (37 °C and 45 °C). We assessed growth inhibition, some virulence factors, alteration colony morphologies, and antimicrobial susceptibility for several antibiotics with three methods (Kirby-Bauer, E-test and broth microdilution) under hyperthermia. In the study, we observed that hyperthermia affected the urease enzyme, antibiotic sensitivity levels showed synergy with hyperthermia, and changes occurred in colony diameters and affected bacterial growth. We hypothesise that hyperthermia might be a new therapeutic option for infectious diseases as a sole agent or in combination with different antimicrobials.
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Affiliation(s)
- Deniz Gazel
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey.
| | - Hüseyin Akdoğan
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
| | - Ayşe Büyüktaş Manay
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
| | - Mehmet Erinmez
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
| | - Yasemin Zer
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
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2
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Brandel MG, Kunwar N, Alattar AA, Kang KM, Forseth KJ, Rennert RC, Shih JJ, Ben-Haim S. A cost analysis of MR-guided laser interstitial thermal therapy for adult refractory epilepsy. Epilepsia 2023; 64:2286-2296. [PMID: 37350343 DOI: 10.1111/epi.17693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE MR-guided laser interstitial thermal therapy (LITT) is used increasingly for refractory epilepsy. The goal of this investigation is to directly compare cost and short-term adverse outcomes for adult refractory epilepsy treated with temporal lobectomy and LITT, as well as to identify risk factors for increased costs and adverse outcomes. METHODS The National Inpatient Sample (NIS) was queried for patients who received LITT between 2012 and 2019. Patients with adult refractory epilepsy were identified. Multivariable mixed-effects models were used to analyze predictors of cost, length of stay (LOS), and complications. RESULTS LITT was associated with reduced LOS and overall cost relative to temporal lobectomy, with a statistical trend toward lower incidence of postoperative complications. High-volume surgical epilepsy centers had lower LOS overall. Longer LOS was a significant driver of increased cost for LITT, and higher comorbidity was associated with non-routine discharge. SIGNIFICANCE LITT is an affordable alternative to temporal lobectomy for adult refractory epilepsy with an insignificant reduction in inpatient complications. Patients may benefit from expanded access to this treatment modality for both its reduced LOS and lower cost.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Nikhita Kunwar
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Ali A Alattar
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Keiko M Kang
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Kiefer J Forseth
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Jerry J Shih
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
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3
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Gd 2O 3-mesoporous silica/gold nanoshells: A potential dual T1/ T2 contrast agent for MRI-guided localized near-IR photothermal therapy. Proc Natl Acad Sci U S A 2022; 119:e2123527119. [PMID: 35858309 PMCID: PMC9303993 DOI: 10.1073/pnas.2123527119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
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.
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Zhu L, Lam D, Pacia CP, Gach HM, Partanen A, Talcott MR, Greco SC, Zoberi I, Hallahan DE, Chen H, Altman MB. Characterization of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-induced large-volume hyperthermia in deep and superficial targets in a porcine model. Int J Hyperthermia 2020; 37:1159-1173. [DOI: 10.1080/02656736.2020.1825836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lifei Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dao Lam
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christopher Pham Pacia
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - H. Michael Gach
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Ari Partanen
- Clinical Science, Profound Medical Inc, Mississauga, Ontario, Canada
| | - Michael R. Talcott
- Division of Comparative Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Suellen C. Greco
- Division of Comparative Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Dennis E. Hallahan
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Hong Chen
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Michael B. Altman
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
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Radical Laser Interstitial Thermal Therapy Ablation Volumes Increase Progression-Free Survival in Biopsy-Proven Radiation Necrosis. World Neurosurg 2020; 136:e646-e659. [DOI: 10.1016/j.wneu.2020.01.116] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/27/2022]
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Salem U, Kumar VA, Madewell JE, Schomer DF, de Almeida Bastos DC, Zinn PO, Weinberg JS, Rao G, Prabhu SS, Colen RR. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging 2019; 19:65. [PMID: 31615562 PMCID: PMC6792239 DOI: 10.1186/s40644-019-0250-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/30/2019] [Indexed: 02/02/2023] Open
Abstract
MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.
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Affiliation(s)
- Usama Salem
- Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA.
| | - Vinodh A Kumar
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - John E Madewell
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Donald F Schomer
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Pascal O Zinn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. .,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
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Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease. J Vasc Interv Radiol 2019; 30:401-409.e2. [DOI: 10.1016/j.jvir.2018.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022] Open
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8
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Tandon V, Lang M, Chandra PS, Sharan A, Garg A, Tripathi M. Is Edema a Matter of Concern After Laser Ablation of Epileptogenic Focus? World Neurosurg 2018; 113:366-372.e3. [DOI: 10.1016/j.wneu.2018.01.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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9
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Gazel D, Yılmaz M. Are infectious diseases and microbiology new fields for thermal therapy research? Int J Hyperthermia 2018; 34:918-924. [PMID: 29448846 DOI: 10.1080/02656736.2018.1440015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Antimicrobial chemotherapy and surgery are classical methods for treating infectious diseases. However, there is a need for alternative methods to cure infections caused by antibiotic-resistant pathogens, recurrent or chronic infections, and unreachable local infections in which the use of drugs or surgery is anatomically and physically restricted. Several micro-organisms are known to be sensitive to mild hyperthermia, and this sensitivity is one of the potential benefits proposed for the host during an episode of fever. Additionally, some immunological or biophysical changes occur during hyperthermia. These changes may be useful for eliminating thermo-susceptible microbial pathogens using local heat therapy. There are several experimental studies proposing the use of hyperthermia to treat local infections. The infected organs or tissues may be heated up to a temperature that can inhibit invading microorganisms. Here, it is hypothesised that local heat therapy may become an alternative or adjuvant method for curing local infections. Here, we highlight the potential for local hyperthermia in the treatment of bacterial infections caused by thermo-susceptible pathogens in a systematic plan. If the proposed thermal-microbiology concepts and local thermal therapies can be adapted to clinical microbiology and infectiology, new medical fields, such as thermo-microbiology and thermo-infectiology, may be created in the future.
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Affiliation(s)
- Deniz Gazel
- a Department of Medical Microbiology, Faculty of Medicine , Gaziantep University , Gaziantep , Turkey
| | - Mehmet Yılmaz
- b Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Sanko University , Gaziantep , Turkey
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10
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Mitchell D, Fahrenholtz S, MacLellan C, Bastos D, Rao G, Prabhu S, Weinberg J, Hazle J, Stafford J, Fuentes D. A heterogeneous tissue model for treatment planning for magnetic resonance-guided laser interstitial thermal therapy. Int J Hyperthermia 2018; 34:943-952. [PMID: 29343140 DOI: 10.1080/02656736.2018.1429679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We evaluated a physics-based model for planning for magnetic resonance-guided laser interstitial thermal therapy for focal brain lesions. Linear superposition of analytical point source solutions to the steady-state Pennes bioheat transfer equation simulates laser-induced heating in brain tissue. The line integral of the photon attenuation from the laser source enables computation of the laser interaction with heterogeneous tissue. Magnetic resonance thermometry data sets (n = 31) were used to calibrate and retrospectively validate the model's thermal ablation prediction accuracy, which was quantified by the Dice similarity coefficient (DSC) between model-predicted and measured ablation regions (T > 57 °C). A Gaussian mixture model was used to identify independent tissue labels on pre-treatment anatomical magnetic resonance images. The tissue-dependent optical attenuation coefficients within these labels were calibrated using an interior point method that maximises DSC agreement with thermometry. The distribution of calibrated tissue properties formed a population model for our patient cohort. Model prediction accuracy was cross-validated using the population mean of the calibrated tissue properties. A homogeneous tissue model was used as a reference control. The median DSC values in cross-validation were 0.829 for the homogeneous model and 0.840 for the heterogeneous model. In cross-validation, the heterogeneous model produced a DSC higher than that produced by the homogeneous model in 23 of the 31 brain lesion ablations. Results of a paired, two-tailed Wilcoxon signed-rank test indicated that the performance improvement of the heterogeneous model over that of the homogeneous model was statistically significant (p < 0.01).
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Affiliation(s)
- Drew Mitchell
- a Department of Imaging Physics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Samuel Fahrenholtz
- a Department of Imaging Physics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Christopher MacLellan
- a Department of Imaging Physics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Dhiego Bastos
- b Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ganesh Rao
- b Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Sujit Prabhu
- b Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jeffrey Weinberg
- b Department of Neurosurgery , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - John Hazle
- a Department of Imaging Physics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jason Stafford
- a Department of Imaging Physics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - David Fuentes
- a Department of Imaging Physics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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11
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Silva D, Sharma M, Juthani R, Meola A, Barnett GH. Magnetic Resonance Thermometry and Laser Interstitial Thermal Therapy for Brain Tumors. Neurosurg Clin N Am 2017; 28:525-533. [PMID: 28917281 DOI: 10.1016/j.nec.2017.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent technological advancements in intraoperative imaging are shaping the way for a new era in brain tumor surgery. Magnetic resonance thermometry has provided intraoperative real-time imaging feedback for safe and effective application of laser interstitial thermal therapy (LITT) in neuro-oncology. Thermal ablation has also established itself as a surgical option in epilepsy surgery and is currently used in spine oncology with promising results. This article reviews the principles and rationale as well as the clinical application of LITT for brain tumors. It also discusses the technical nuances of the current commercially available systems.
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Affiliation(s)
- Danilo Silva
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mayur Sharma
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rupa Juthani
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Antonio Meola
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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12
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Fahrenholtz SJ, Madankan R, Danish S, Hazle JD, Stafford RJ, Fuentes D. Theoretical model for laser ablation outcome predictions in brain: calibration and validation on clinical MR thermometry images. Int J Hyperthermia 2017; 34:101-111. [PMID: 28540820 DOI: 10.1080/02656736.2017.1319974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Neurosurgical laser ablation is experiencing a renaissance. Computational tools for ablation planning aim to further improve the intervention. Here, global optimisation and inverse problems are demonstrated to train a model that predicts maximum laser ablation extent. METHODS A closed-form steady state model is trained on and then subsequently compared to N = 20 retrospective clinical MR thermometry datasets. Dice similarity coefficient (DSC) is calculated to provide a measure of region overlap between the 57 °C isotherms of the thermometry data and the model-predicted ablation regions; 57 °C is a tissue death surrogate at thermal steady state. A global optimisation scheme samples the dominant model parameter sensitivities, blood perfusion (ω) and optical parameter (μeff) values, throughout a parameter space totalling 11 440 value-pairs. This represents a lookup table of μeff-ω pairs with the corresponding DSC value for each patient dataset. The μeff-ω pair with the maximum DSC calibrates the model parameters, maximising predictive value for each patient. Finally, leave-one-out cross-validation with global optimisation information trains the model on the entire clinical dataset, and compares against the model naïvely using literature values for ω and μeff. RESULTS When using naïve literature values, the model's mean DSC is 0.67 whereas the calibrated model produces 0.82 during cross-validation, an improvement of 0.15 in overlap with the patient data. The 95% confidence interval of the mean difference is 0.083-0.23 (p < 0.001). CONCLUSIONS During cross-validation, the calibrated model is superior to the naïve model as measured by DSC, with +22% mean prediction accuracy. Calibration empowers a relatively simple model to become more predictive.
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Affiliation(s)
- Samuel John Fahrenholtz
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
| | - Reza Madankan
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Shabbar Danish
- c Section of Neurosurgery , Rutgers Cancer Institute of New Jersey , New Brunswick , NJ , USA
| | - John D Hazle
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
| | - R Jason Stafford
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
| | - David Fuentes
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
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LaRiviere MJ, Gross RE. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery. Front Surg 2016; 3:64. [PMID: 27995127 PMCID: PMC5136731 DOI: 10.3389/fsurg.2016.00064] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/21/2016] [Indexed: 12/02/2022] Open
Abstract
Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one-third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular, radiofrequency (RF) ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT), the development of which began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided RF ablation series for mesial temporal lobe epilepsy. The developments of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided LITT systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.
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Affiliation(s)
- Michael J. LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E. Gross
- Departments of Neurosurgery and Neurology, Emory University School of Medicine, Atlanta, GA, USA
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14
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Wicks RT, Jermakowicz WJ, Jagid JR, Couture DE, Willie JT, Laxton AW, Gross RE. Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy. Neurosurgery 2016; 79 Suppl 1:S83-S91. [DOI: 10.1227/neu.0000000000001439] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Approximately one-third of patients with epilepsy do not achieve adequate seizure control through medical management alone. Mesial temporal lobe epilepsy (MTLE) is one of the most common forms of medically refractory epilepsy referred for surgical management. Stereotactic laser amygdalohippocampotomy using magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is an important emerging therapy for MTLE. Initial published reports support MRg-LITT as a less invasive surgical option with a shorter hospital stay and fewer neurocognitive side effects compared with craniotomy for anterior temporal lobectomy with amygdalohippocampectomy and selective amygdalohippocampectomy. We provide a historical overview of laser interstitial thermal therapy development and the technological advancements that led to the currently available commercial systems. Current applications of MRg-LITT for MTLE, reported outcomes, and technical issues of the surgical procedure are reviewed. Although initial reports indicate that stereotactic laser amygdalohippocampotomy may be a safe and effective therapy for medically refractory MTLE, further research is required to establish its long-term effectiveness and its cost/benefit profile.
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Affiliation(s)
- Robert T. Wicks
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | - Daniel E. Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jon T. Willie
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Adrian W. Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Robert E. Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia
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15
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Tatsui CE, Lee SH, Amini B, Rao G, Suki D, Oro M, Brown PD, Ghia AJ, Bhavsar S, Popat K, Rhines LD, Stafford RJ, Li J. Spinal Laser Interstitial Thermal Therapy. Neurosurgery 2016; 79 Suppl 1:S73-S82. [DOI: 10.1227/neu.0000000000001444] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Although surgery followed by radiation effectively treats metastatic epidural compression, the ideal surgical approach should enable fast recovery and rapid institution of radiation and systemic therapy directed at the primary tumor.
OBJECTIVE:
To assess spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery monitored in real time by thermal magnetic resonance (MR) images.
METHODS:
Patients referred for spinal metastasis without motor deficits underwent MR-guided SLITT, followed by stereotactic radiosurgery. Clinical and radiological data were gathered prospectively, according to routine practice.
RESULTS:
MR imaging-guided SLITT was performed on 19 patients with metastatic epidural compression. No procedures were discontinued because of technical difficulties, and no permanent neurological injuries occurred. The median follow-up duration was 28 weeks (range 10-64 weeks). Systemic therapy was not interrupted to perform the procedures. The mean preoperative visual analog scale scores of 4.72 (SD ± 0.67) decreased to 2.56 (SD ± 0.71, P = .043) at 1 month and remained improved from baseline at 3.25 (SD ± 0.75, P = .021) 3 months after the procedure. The preoperative mean EQ-5D index for quality of life was 0.67 (SD ± 0.07) and remained without significant change at 1 month 0.79 (SD ± 0.06, P = .317) and improved at 3 months 0.83 (SD ± 0.06, P = .04) after SLITT. Follow-up MR imaging after 2 months revealed significant decompression of the neural component in 16 patients. However, 3 patients showed progression at follow-up, 1 was treated with surgical decompression and stabilization and 2 were treated with repeated SLITT.
CONCLUSION:
MR-guided SLITT can be both a feasible and safe alternative to separation surgery in carefully selected cases of spinal metastatic tumor epidural compression.
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Affiliation(s)
- Claudio E. Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Behrang Amini
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marilou Oro
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul D. Brown
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amol J. Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shreyas Bhavsar
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keyuri Popat
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laurence D. Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - R. Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Jin Y, Liang X, An Y, Dai Z. Microwave-Triggered Smart Drug Release from Liposomes Co-encapsulating Doxorubicin and Salt for Local Combined Hyperthermia and Chemotherapy of Cancer. Bioconjug Chem 2016; 27:2931-2942. [DOI: 10.1021/acs.bioconjchem.6b00603] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yushen Jin
- Department of Biomedical
Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Xiaolong Liang
- Department of Biomedical
Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Yunkun An
- Department of Biomedical
Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Zhifei Dai
- Department of Biomedical
Engineering, College of Engineering, Peking University, Beijing 100871, China
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17
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Tovar-Spinoza Z, Choi H. Magnetic resonance-guided laser interstitial thermal therapy: report of a series of pediatric brain tumors. J Neurosurg Pediatr 2016; 17:723-33. [PMID: 26849811 DOI: 10.3171/2015.11.peds15242] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment that has multiple advantages in pediatric use and broad applicability for different types of lesions. Here, the authors report the preliminary results of the first series of pediatric brain tumors treated with MRgLITT at Golisano Children's Hospital in Syracuse, New York. METHODS Pediatric brain tumors treated with MRgLITT between February 2012 and August 2014 at Golisano Children's Hospital were evaluated retrospectively. Medical records, radiological findings, surgical data, complications, and results of tumor volumetric analyses were reviewed. The Visualase thermal laser system (Medtronic) was used in all MRgLITT procedures. RESULTS This series included 11 patients with 12 tumors (pilocytic astrocytoma, ependymoma, medulloblastoma, choroid plexus xanthogranuloma, subependymal giant cell astrocytoma, and ganglioglioma). A single laser and multiple overlapping ablations were used for all procedures. The mean laser dose was 10.23 W, and the mean total ablation time was 68.95 seconds. The mean initial target volume was 6.79 cm(3), and the mean immediate post-ablation volume was 7.86 cm(3). The mean hospital stay was 3.25 days, and the mean follow-up time was 24.5 months. Tumor volume decreased in the first 3 months after surgery (n = 11; p = 0.007) and continued to decrease by the 4- to 6-month followup (n = 11; mean volume 2.61 cm(3); p = 0.009). Two patients experienced post-ablation complications: transient right leg weakness in one patient, and transient hemiparesis, akinetic mutism, and eye movement disorder in the other. CONCLUSIONS Magnetic resonance-guided laser interstitial thermal therapy is an effective first- or second-line treatment for select pediatric brain tumors. Larger multiinstitutional clinical trials are necessary to evaluate its use for different types of lesions to further standardize practices.
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Affiliation(s)
- Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Hoon Choi
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
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18
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Negussie AH, Partanen A, Mikhail AS, Xu S, Abi-Jaoudeh N, Maruvada S, Wood BJ. Thermochromic tissue-mimicking phantom for optimisation of thermal tumour ablation. Int J Hyperthermia 2016; 32:239-43. [PMID: 27099078 DOI: 10.3109/02656736.2016.1145745] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to (1) develop a novel tissue-mimicking thermochromic (TMTC) phantom that permanently changes colour from white to magenta upon heating above ablative temperatures, and (2) assess its utility for specific applications in evaluating thermal therapy devices. Materials and methods Polyacrylamide gel mixed with thermochromic ink was custom made to produce a TMTC phantom that changes its colour upon heating above biological ablative temperatures (> 60 °C). The thermal properties of the phantom were characterised, and compared to those of human tissue. In addition, utility of this phantom as a tool for the assessment of laser and microwave thermal ablation was examined. Results The mass density, thermal conductivity, and thermal diffusivity of the TMTC phantom were measured as 1033 ± 1.0 kg/m(3), 0.590 ± 0.015 W/m.K, and 0.145 ± 0.002 mm(2)/s, respectively, and found to be in agreement with reported values for human soft tissues. Heating the phantom with laser and microwave ablation devices produced clearly demarcated regions of permanent colour change geographically corresponding to regions with temperature elevations above 60 °C. Conclusion The TMTC phantom provides direct visualisation of ablation dynamics, including ablation volume and geometry as well as peak absolute temperatures within the treated region post-ablation. This phantom can be specifically tailored for different thermal therapy modalities, such as radiofrequency, laser, microwave, or therapeutic ultrasound ablation. Such modality-specific phantoms may enable better quality assurance, device characterisation, and ablation parameter optimisation, or optimise the study of dynamic heating parameters integral to drug device combination therapies relying upon heat.
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Affiliation(s)
- Ayele H Negussie
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Ari Partanen
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD ;,b Clinical Science MR Therapy, Philips , Andover , MA
| | - Andrew S Mikhail
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Sheng Xu
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Nadine Abi-Jaoudeh
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Subha Maruvada
- c US Food and Drug Administration , Silver Spring , MD , USA
| | - Bradford J Wood
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
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Patel P, Patel NV, Danish SF. Intracranial MR-guided laser-induced thermal therapy: single-center experience with the Visualase thermal therapy system. J Neurosurg 2016; 125:853-860. [PMID: 26722845 DOI: 10.3171/2015.7.jns15244] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE MR-guided laser-induced thermal therapy (MRgLITT) can be used to treat intracranial tumors, epilepsy, and chronic pain syndromes. Here, the authors report their single-center experience with 102 patients, the largest series to date in which the Visualase thermal therapy system was used. METHODS A retrospective analysis of all patients who underwent MRgLITT between 2010 and 2014 was performed. Pathologies included glioma, recurrent metastasis, radiation necrosis, chronic pain, and epilepsy. Laser catheters were placed stereotactically, and ablation was performed in the MRI suite. Demographics, operative parameters, length of hospital stay, and complications were recorded. Thirty-day readmission rates were calculated by using the standard method according to America's Health Insurance Plans Center for Policy and Research guidelines. RESULTS A total of 133 lasers were placed in 102 patients who required intervention for intracranial tumors (87 patients), chronic pain syndrome (cingulotomy, 5 patients), or epilepsy (10 patients). The procedure was completed in 98% (100) of these patients. Ninety-two patients (90.2%) had undergone previous treatment for their intracranial tumors. The average (± SD) total procedural time was 170.5 ± 34.4 minutes, and the mean laser-on time was 8.7 ± 6.8 minutes. The average intensive care unit (ICU) and hospital stays were 1.8 and 3.6 days, respectively, and the median length of stay for both the ICU and the hospital was 1 day. By postoperative Day 1, 54% of the patients (n = 55) were neurologically stable for discharge. There were 27 cases of morbidity, including new-onset neurological deficits, and 2 perioperative deaths. Fourteen patients (13.7%) developed new deficits after the MRgLITT procedure, and of those 14 patients, 64.3% (n = 9) had complete resolution of deficits within 1 month, 7.1% (n = 1) had partial resolution of symptoms within 1 month, 14.3% (n = 2) had not had resolution of symptoms at the most recent follow-up, and 14.3% (n = 2) died without resolution of symptoms. The 30-day readmission rate was 5.6% CONCLUSIONS MRgLITT, although minimally invasive, must be used with caution. Thermal damage to critical and eloquent structures can occur despite MRI guidance. Once the learning curve is overcome, the overall procedural complication rate is low, and most patients can be discharged within 24 hours, with a relatively low readmission rate. In cases in which they occurred, most neurological deficits were temporary. The therapeutic role of MRgLITT in various intracranial diseases will require larger and more rigorous studies.
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Affiliation(s)
- Purvee Patel
- Cancer Institute of New Jersey, Rutgers University.,Department of Neurological Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick; and
| | - Nitesh V Patel
- Department of Neurological Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick; and.,Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
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20
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Natarajan S, Raman S, Priester AM, Garritano J, Margolis DJA, Lieu P, Macairan ML, Huang J, Grundfest W, Marks LS. Focal Laser Ablation of Prostate Cancer: Phase I Clinical Trial. J Urol 2015; 196:68-75. [PMID: 26748164 DOI: 10.1016/j.juro.2015.12.083] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Focal laser ablation is an investigational technique to treat prostate cancer in a region confined manner via coagulative necrosis. This phase I trial primarily examines the safety of transrectal magnetic resonance imaging guided (in-bore) focal laser ablation in men with intermediate risk prostate cancer. An exploratory end point is cancer control after 6 months. MATERIALS AND METHODS In an institutional review board approved trial we studied focal laser ablation in 8 men with intermediate risk prostate cancer diagnosed using magnetic resonance-ultrasound fusion. Focal laser ablation was performed by inserting a cylindrically diffusing, water cooled laser fiber into magnetic resonance visible regions of interest, followed by interstitial heating at 10 to 15 W for up to 3 minutes. Secondary safety monitors (thermal probes) were inserted to assess the accuracy of magnetic resonance thermometry. Comprehensive magnetic resonance-ultrasound fusion biopsy was performed after 6 months. Adverse events and health related quality of life questionnaires were recorded. RESULTS Focal laser ablation was successfully performed in all 8 subjects. No grade 3 or greater adverse events occurred and no changes in International Prostate Symptom Score or International Index of Erectile Function 5 were observed. Ablation zones, as measured by posttreatment magnetic resonance imaging, had a median volume of 3 cc or 7.7% of prostate volume. Prostate specific antigen decreased in 7 men (p <0.01). At followup magnetic resonance-ultrasound fusion biopsy cancer was not detected in the ablation zone in 5 men but was present outside the treatment margin in 6 men. CONCLUSIONS Focal laser ablation of the prostate is feasible and safe in men with intermediate risk prostate cancer without serious adverse events or changes in urinary or sexual function at 6 months. Comprehensive biopsy followup indicates that larger treatment margins than previously thought necessary may be required for complete tumor ablation.
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Affiliation(s)
- Shyam Natarajan
- Department of Urology, University of California, Los Angeles, Los Angeles, California; Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - Steven Raman
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - James Garritano
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J A Margolis
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, University of California, Los Angeles, Los Angeles, California
| | - Maria L Macairan
- Department of Urology, University of California, Los Angeles, Los Angeles, California
| | - Jiaoti Huang
- Department of Pathology, University of California, Los Angeles, Los Angeles, California
| | - Warren Grundfest
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California.
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21
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Magnetic Resonance–Guided Thermal Therapy for Localized and Recurrent Prostate Cancer. Magn Reson Imaging Clin N Am 2015; 23:607-19. [DOI: 10.1016/j.mric.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Abstract
Although a surgical procedure is performed by visual inspection with histopathological assessment of the excised tumor and margins, percutaneous and noninvasive thermal ablation is performed strictly with the aid of imaging. Applicator guidance into the target zone, treatment monitoring and verification, and clinical follow-up rely on effective imaging. Detailed discussion of imaging is beyond the scope of this article, but the influence of imaging on the choice of thermal ablation or procedural approach will be discussed as needed. More information on imaging for interventional therapies can be found in other articles in this issue of IEEE Pulse.
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23
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Fahrenholtz SJ, Moon TY, Franco M, Medina D, Danish S, Gowda A, Shetty A, Maier F, Hazle JD, Stafford RJ, Warburton T, Fuentes D. A model evaluation study for treatment planning of laser-induced thermal therapy. Int J Hyperthermia 2015; 31:705-14. [PMID: 26368014 DOI: 10.3109/02656736.2015.1055831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A cross-validation analysis evaluating computer model prediction accuracy for a priori planning magnetic resonance-guided laser-induced thermal therapy (MRgLITT) procedures in treating focal diseased brain tissue is presented. Two mathematical models are considered. (1) A spectral element discretisation of the transient Pennes bioheat transfer equation is implemented to predict the laser-induced heating in perfused tissue. (2) A closed-form algorithm for predicting the steady-state heat transfer from a linear superposition of analytic point source heating functions is also considered. Prediction accuracy is retrospectively evaluated via leave-one-out cross-validation (LOOCV). Modelling predictions are quantitatively evaluated in terms of a Dice similarity coefficient (DSC) between the simulated thermal dose and thermal dose information contained within N = 22 MR thermometry datasets. During LOOCV analysis, the transient model's DSC mean and median are 0.7323 and 0.8001 respectively, with 15 of 22 DSC values exceeding the success criterion of DSC ≥ 0.7. The steady-state model's DSC mean and median are 0.6431 and 0.6770 respectively, with 10 of 22 passing. A one-sample, one-sided Wilcoxon signed-rank test indicates that the transient finite element method model achieves the prediction success criteria, DSC ≥ 0.7, at a statistically significant level.
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Affiliation(s)
- Samuel J Fahrenholtz
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
| | - Tim Y Moon
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - Michael Franco
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - David Medina
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - Shabbar Danish
- d Department of Neurosurgery , Robert Wood Johnson Hospital , New Brunswick, New Jersey , USA , and
| | | | | | - Florian Maier
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA
| | - John D Hazle
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
| | - Roger J Stafford
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
| | - Tim Warburton
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - David Fuentes
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
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Mikhail AS, Partanen A, Yarmolenko P, Venkatesan AM, Wood BJ. Magnetic Resonance-Guided Drug Delivery. Magn Reson Imaging Clin N Am 2015; 23:643-55. [PMID: 26499281 DOI: 10.1016/j.mric.2015.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The use of clinical imaging modalities for the guidance of targeted drug delivery systems, known as image-guided drug delivery (IGDD), has emerged as a promising strategy for enhancing antitumor efficacy. MR imaging is particularly well suited for IGDD applications because of its ability to acquire images and quantitative measurements with high spatiotemporal resolution. The goal of IGDD strategies is to improve treatment outcomes by facilitating planning, real-time guidance, and personalization of pharmacologic interventions. This article reviews basic principles of targeted drug delivery and highlights the current status, emerging applications, and future paradigms of MR-guided drug delivery.
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Affiliation(s)
- Andrew S Mikhail
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Ari Partanen
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA; Philips Healthcare, 3000 Minuteman Road, Andover, MA 01810, USA
| | - Pavel Yarmolenko
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Avenue, Washington, DC 20010, USA
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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Riordan M, Tovar-Spinoza Z. Laser induced thermal therapy (LITT) for pediatric brain tumors: case-based review. Transl Pediatr 2014; 3:229-35. [PMID: 26835340 PMCID: PMC4729851 DOI: 10.3978/j.issn.2224-4336.2014.07.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Integration of Laser induced thermal therapy (LITT) to magnetic resonance imaging (MRI) have created new options for treating surgically challenging tumors in locations that would otherwise have represented an intrinsic comorbidity by the approach itself. As new applications and variations of the use are discussed, we present a case-based review of the history, development, and subsequent updates of minimally invasive MRI-guided laser interstitial thermal therapy (MRgLITT) ablation in pediatric brain tumors.
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Affiliation(s)
- Margaret Riordan
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
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26
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Mohammadi AM, Hawasli AH, Rodriguez A, Schroeder JL, Laxton AW, Elson P, Tatter SB, Barnett GH, Leuthardt EC. The role of laser interstitial thermal therapy in enhancing progression-free survival of difficult-to-access high-grade gliomas: a multicenter study. Cancer Med 2014; 3:971-9. [PMID: 24810945 PMCID: PMC4303165 DOI: 10.1002/cam4.266] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 12/21/2022] Open
Abstract
Surgical extent-of-resection has been shown to have an impact on high-grade glioma (HGG) outcomes; however, complete resection is rarely achievable in difficult-to-access (DTA) tumors. Controlled thermal damage to the tumor may have the same impact in DTA-HGGs. We report our multicenter results of laser interstitial thermal therapy (LITT) in DTA-HGGs. We retrospectively reviewed 34 consecutive DTA-HGG patients (24 glioblastoma, 10 anaplastic) who underwent LITT at Cleveland Clinic, Washington University, and Wake Forest University (May 2011-December 2012) using the NeuroBlate(®) System. The extent of thermal damage was determined using thermal damage threshold (TDT) lines: yellow TDT line (43 °C for 2 min) and blue TDT line (43°C for 10 min). Volumetric analysis was performed to determine the extent-of-coverage of tumor volume by TDT lines. Patient outcomes were evaluated statistically. LITT was delivered as upfront in 19 and delivered as salvage in 16 cases. After 7.2 months of follow-up, 71% of cases demonstrated progression and 34% died. The median overall survival (OS) for the cohort was not reached; however, the 1-year estimate of OS was 68 ± 9%. Median progression-free survival (PFS) was 5.1 months. Thirteen cases who met the following two criteria-(1) <0.05 cm(3) tumor volume not covered by the yellow TDT line and (2) <1.5 cm(3) additional tumor volume not covered by the blue TDT line-had better PFS than the other 21 cases (9.7 vs. 4.6 months; P = 0.02). LITT can be used effectively for treatment of DTA-HGGs. More complete coverage of tumor by TDT lines improves PFS which can be translated as the extent of resection concept for surgery.
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Affiliation(s)
- Alireza M Mohammadi
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, 9500 Euclid Avenue, S70, Cleveland Clinic, Cleveland, Ohio, 44195
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Wu X, Zhang F, Chen R, Zheng W, Yang X. Recent advances in imaging-guided interventions for prostate cancers. Cancer Lett 2014; 349:114-9. [PMID: 24769076 DOI: 10.1016/j.canlet.2014.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The numbers of patients diagnosed with prostate cancers is increasing due to the widespread application of prostate-specific antigen screening and subsequent prostate biopsies. The methods of systemic administration of therapeutics are not target-specific and thus cannot efficiently destroy prostate tumour cells while simultaneously sparing the surrounding normal tissues and organs. Recent advances in imaging-guided minimally invasive therapeutic techniques offer considerable potential for the effective management of prostate cancers. An objective understanding of the feasibility, effectiveness, morbidity, and deficiencies of these interventional techniques is essential for both clinical practice and scientific progress. This review presents the recent advances in imaging-guided interventional techniques for the diagnosis and treatment of prostate cancers.
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Affiliation(s)
- Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Feng Zhang
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,3 East Qingchun Road, Hangzhou 310016, China.
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China.
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
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28
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Wilfong AA, Curry DJ. Hypothalamic hamartomas: optimal approach to clinical evaluation and diagnosis. Epilepsia 2014; 54 Suppl 9:109-14. [PMID: 24328883 DOI: 10.1111/epi.12454] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hypothalamic hamartomas (HHs) present a difficult medical problem, manifested by gelastic seizures, which are often medically intractable. Although existing techniques offer modest surgical outcomes with the potential for significant morbidity, the relatively novel technique of magnetic resonance imaging (MRI)-guided stereotactic laser ablation (SLA) offers a potentially safer, minimally invasive method with high efficacy for the HH treatment. We report here on 14 patients with medically refractory gelastic epilepsy who underwent stereotactic frame-based placement of an MR-compatible laser catheter (1.6 mm diameter) through a 3.2-mm twist drill hole. A U.S. Food and Drug Administration (FDA)-cleared laser surgery system (Visualase, Inc.) was utilized to ablate the HH, using real-time MRI thermometry. Seizure freedom was obtained in 12 (86%) of 14 cases, with mean follow-up of 9 months. There were no permanent surgical complications, neurologic deficits, or neuroendocrine disturbances. One patient had a minor subarachnoid hemorrhage that was asymptomatic. Most patients were discharged home within 1 day. SLA was demonstrated to be a safe and effective minimally invasive tool in the ablation of epileptogenic HH. Because use of SLA for HH is being adopted by other medical centers, further data will be acquired to help treat this difficult disorder.
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Affiliation(s)
- Angus A Wilfong
- Division of Pediatric Neurology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
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Mohammadi AM, Schroeder JL. Laser interstitial thermal therapy in treatment of brain tumors – the NeuroBlate System. Expert Rev Med Devices 2014; 11:109-19. [DOI: 10.1586/17434440.2014.882225] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rahmathulla G, Recinos PF, Kamian K, Mohammadi AM, Ahluwalia MS, Barnett GH. MRI-Guided Laser Interstitial Thermal Therapy in Neuro-Oncology: A Review of Its Current Clinical Applications. Oncology 2014; 87:67-82. [DOI: 10.1159/000362817] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/08/2014] [Indexed: 11/19/2022]
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Yeniaras E, Fuentes DT, Fahrenholtz SJ, Weinberg JS, Maier F, Hazle JD, Stafford RJ. Design and initial evaluation of a treatment planning software system for MRI-guided laser ablation in the brain. Int J Comput Assist Radiol Surg 2013; 9:659-67. [PMID: 24091853 DOI: 10.1007/s11548-013-0948-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/14/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE An open-source software system for planning magnetic resonance (MR)-guided laser-induced thermal therapy (MRgLITT) in brain is presented. The system was designed to provide a streamlined and operator-friendly graphical user interface (GUI) for simulating and visualizing potential outcomes of various treatment scenarios to aid in decisions on treatment approach or feasibility. METHODS A portable software module was developed on the 3D Slicer platform, an open-source medical imaging and visualization framework. The module introduces an interactive GUI for investigating different laser positions and power settings as well as the influence of patient-specific tissue properties for quickly creating and evaluating custom treatment options. It also provides a common treatment planning interface for use by both open-source and commercial finite element solvers. In this study, an open-source finite element solver for Pennes' bioheat equation is interfaced to the module to provide rapid 3D estimates of the steady-state temperature distribution and potential tissue damage in the presence of patient-specific tissue boundary conditions identified on segmented MR images. RESULTS The total time to initialize and simulate an MRgLITT procedure using the GUI was [Formula: see text]5 min. Each independent simulation took [Formula: see text]30 s, including the time to visualize the results fused with the planning MRI. For demonstration purposes, a simulated steady-state isotherm contour [Formula: see text] was correlated with MR temperature imaging (N = 5). The mean Hausdorff distance between simulated and actual contours was 2.0 mm [Formula: see text], whereas the mean Dice similarity coefficient was 0.93 [Formula: see text]. CONCLUSIONS We have designed, implemented, and conducted initial feasibility evaluations of a software tool for intuitive and rapid planning of MRgLITT in brain. The retrospective in vivo dataset presented herein illustrates the feasibility and potential of incorporating fast, image-based bioheat predictions into an interactive virtual planning environment for such procedures.
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Affiliation(s)
- E Yeniaras
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77054, USA,
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Partanen A, Tillander M, Yarmolenko PS, Wood BJ, Dreher MR, Kohler MO. Reduction of peak acoustic pressure and shaping of heated region by use of multifoci sonications in MR-guided high-intensity focused ultrasound mediated mild hyperthermia. Med Phys 2013; 40:013301. [PMID: 23298120 DOI: 10.1118/1.4769116] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Ablative hyperthermia (>55 °C) has been used as a definitive treatment for accessible solid tumors not amenable to surgery, whereas mild hyperthermia (40-45 °C) has been shown effective as an adjuvant for both radiotherapy and chemotherapy. An optimal mild hyperthermia treatment is spatially accurate, with precise and homogeneous heating limited to the target region while also limiting the likelihood of unwanted thermal or mechanical bioeffects (tissue damage, vascular shutoff). Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) can noninvasively heat solid tumors under image-guidance. In a mild hyperthermia setting, a sonication approach utilizing multiple concurrent foci may provide the benefit of reducing acoustic pressure in the focal region (leading to reduced or no mechanical effects), while providing better control over the heating. The objective of this study was to design, implement, and characterize a multifoci sonication approach in combination with a mild hyperthermia heating algorithm, and compare it to the more conventional method of electronically sweeping a single focus. METHODS Simulations (acoustic and thermal) and measurements (acoustic, with needle hydrophone) were performed. In addition, heating performance of multifoci and single focus sonications was compared using a clinical MR-HIFU platform in a phantom (target = 4-16 mm), in normal rabbit thigh muscle (target = 8 mm), and in a Vx2 tumor (target = 8 mm). A binary control algorithm was used for real-time mild hyperthermia feedback control (target range = 40.5-41 °C). Data were analyzed for peak acoustic pressure and intensity, heating energy efficiency, temperature accuracy (mean), homogeneity of heating (standard deviation [SD], T10 and T90), diameter and length of the heated region, and thermal dose (CEM(43)). RESULTS Compared to the single focus approach, multifoci sonications showed significantly lower (67% reduction) peak acoustic pressures in simulations and hydrophone measurements. In a rabbit Vx2 tumor, both single focus and multifoci heating approaches were accurate (mean = 40.82±0.12 °C [single] and 40.70±0.09 °C [multi]) and precise (standard deviation = 0.65±0.05 °C [single] and 0.64±0.04 °C [multi]), producing homogeneous heating (T(10-90) = 1.62 °C [single] and 1.41 °C [multi]). Heated regions were significantly shorter in the beam path direction (35% reduction, p < 0.05, Tukey) for multifoci sonications, i.e., resulting in an aspect ratio closer to one. Energy efficiency was lower for the multifoci approach. Similar results were achieved in phantom and rabbit muscle heating experiments. CONCLUSIONS A multifoci sonication approach was combined with a mild hyperthermia heating algorithm, and implemented on a clinical MR-HIFU platform. This approach resulted in accurate and precise heating within the targeted region with significantly lower acoustic pressures and spatially more confined heating in the beam path direction compared to the single focus sonication method.The reduction in acoustic pressure and improvement in spatial control suggest that multifoci heating is a useful tool in mild hyperthermia applications for clinical oncology.
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Affiliation(s)
- Ari Partanen
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Torres-Reveron J, Tomasiewicz HC, Shetty A, Amankulor NM, Chiang VL. Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. J Neurooncol 2013; 113:495-503. [PMID: 23677747 DOI: 10.1007/s11060-013-1142-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 04/27/2013] [Indexed: 11/28/2022]
Abstract
Since the inception of radiosurgery, the management of brain metastases has become a common problem for neurosurgeons. Although the use of stereotactic radiosurgery and/or whole brain radiation therapy serves to control the majority of disease burden, patients who survive longer than 6-8 months sometimes face the problem of symptomatic radiographically regrowing lesions with few treatment options. Here we investigate the feasibility of use of MRI-guided stereotactic laser induced thermotherapy (LITT) as a novel treatment option for these lesions. Six patients who had previously undergone gamma knife stereotactic radiosurgery for brain metastases were selected. All patients had an initial favorable response to radiosurgery but subsequently developed regrowth of at least one lesion associated with recurrent edema and progressive neurological symptoms requiring ongoing steroids for symptom control. All lesions were evaluated for craniotomy, but were deemed unresectable due to deep location or patient's comorbidities. Stereotactic biopsies were performed prior to the thermotherapy procedure in all cases. LITT was performed using the Visualase system and follow-up MRI imaging was used to determine treatment response. In all six patients biopsy results were negative for tumor and consistent with adverse radiation effects also known as radiation necrosis. Patients tolerated the procedure well and were discharged from the hospital within 48 h of the procedure. In 4/6 cases there was durable improvement of neurological symptoms until death. In all cases steroids were weaned off within 2 months. One patient died from systemic causes related to his cancer a month after the procedure. One patient had regrowth of the lesion 3 months after the procedure and required re-initiation of steroids and standard craniotomy for surgical resection. There were no complications directly related to the thermocoagulation procedure. Stereotactic laser induced thermotherapy is a feasible alternative for the treatment of symptomatic regrowing metastatic lesions after radiosurgery. The procedure carries minimal morbidity and, in this small series, shows some effectiveness in the symptomatic relief of edema and neurological symptoms paralleled by radiographic lesional control. Further studies are necessary to elucidate the safety of this technology.
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Affiliation(s)
- Juan Torres-Reveron
- Department of Neurosurgery, Yale University School of Medicine, PO Box 208082, New Haven, CT 06520-8082, USA
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de Smet M, Langereis S, van den Bosch S, Bitter K, Hijnen NM, Heijman E, Grüll H. SPECT/CT imaging of temperature-sensitive liposomes for MR-image guided drug delivery with high intensity focused ultrasound. J Control Release 2013; 169:82-90. [PMID: 23598044 DOI: 10.1016/j.jconrel.2013.04.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/01/2013] [Accepted: 04/04/2013] [Indexed: 01/30/2023]
Abstract
The goal of this study was to investigate the blood kinetics and biodistribution of temperature-sensitive liposomes (TSLs) for MR image-guided drug delivery. The co-encapsulated doxorubicin and [Gd(HPDO3A)(H₂O)] as well as the ¹¹¹In-labeled liposomal carrier were quantified in blood and organs of tumor bearing rats. After TSL injection, mild hyperthermia (T=42 °C) was induced in the tumor using high intensity focused ultrasound under MR image-guidance (MR-HIFU). The biodistribution of the radiolabeled TSLs was investigated using SPECT/CT imaging, where the highest uptake of ¹¹¹In-labeled TSLs was observed in the spleen and liver. The MR-HIFU-treated tumors showed 4.4 times higher liposome uptake after 48 h in comparison with controls, while the doxorubicin concentration was increased by a factor of 7.9. These effects of HIFU-treatment are promising for applications in liposomal drug delivery to tumors.
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Affiliation(s)
- Mariska de Smet
- Department of Biomedical Engineering, Biomedical NMR, Eindhoven University of Technology, Eindhoven, The Netherlands
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Partanen A, Yarmolenko PS, Viitala A, Appanaboyina S, Haemmerich D, Ranjan A, Jacobs G, Woods D, Enholm J, Wood BJ, Dreher MR. Mild hyperthermia with magnetic resonance-guided high-intensity focused ultrasound for applications in drug delivery. Int J Hyperthermia 2012; 28:320-36. [PMID: 22621734 DOI: 10.3109/02656736.2012.680173] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Mild hyperthermia (40-45 °C) is a proven adjuvant for radiotherapy and chemotherapy. Magnetic resonance guided high intensity focused ultrasound (MR-HIFU) can non-invasively heat solid tumours under image guidance. Low temperature-sensitive liposomes (LTSLs) release their drug cargo in response to heat (>40 °C) and may improve drug delivery to solid tumours when combined with mild hyperthermia. The objective of this study was to develop and implement a clinically relevant MR-HIFU mild hyperthermia heating algorithm for combination with LTSLs. MATERIALS AND METHODS Sonications were performed with a clinical MR-HIFU platform in a phantom and rabbits bearing VX2 tumours (target = 4-16 mm). A binary control algorithm was used for real-time mild hyperthermia feedback control (target = 40-41 °C). Drug delivery with LTSLs was measured with HPLC. Data were compared to simulation results and analysed for spatial targeting accuracy (offset), temperature accuracy (mean), homogeneity of heating (standard deviation (SD), T10 and T90), and thermal dose (CEM43). RESULTS Sonications in a phantom resulted in better temperature control than in vivo. Sonications in VX2 tumours resulted in mean temperatures between 40.4 °C and 41.3 °C with a SD of 1.0-1.5 °C (T10 = 41.7-43.7 °C, T90 = 39.0-39.6 °C), in agreement with simulations. 3D spatial offset was 0.1-3.2 mm in vitro and 0.6-4.8 mm in vivo. Combination of MR-HIFU hyperthermia and LTSLs demonstrated heterogeneous delivery to a partially heated VX2 tumour, as expected. CONCLUSIONS An MR-HIFU mild hyperthermia heating algorithm was developed, resulting in accurate and homogeneous heating within the targeted region in vitro and in vivo, which is suitable for applications in drug delivery.
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Affiliation(s)
- Ari Partanen
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Fuentes D, Elliott A, Weinberg JS, Shetty A, Hazle JD, Stafford RJ. An inverse problem approach to recovery of in vivo nanoparticle concentrations from thermal image monitoring of MR-guided laser induced thermal therapy. Ann Biomed Eng 2012; 41:100-11. [PMID: 22918665 DOI: 10.1007/s10439-012-0638-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/04/2012] [Indexed: 12/15/2022]
Abstract
Quantification of local variations in the optical properties of tumor tissue introduced by the presence of gold-silica nanoparticles (NP) presents significant opportunities in monitoring and control of NP-mediated laser induced thermal therapy (LITT) procedures. Finite element methods of inverse parameter recovery constrained by a Pennes bioheat transfer model were applied to estimate the optical parameters. Magnetic resonance temperature imaging (MRTI) acquired during a NP-mediated LITT of a canine transmissible venereal tumor in brain was used in the presented statistical inverse problem formulation. The maximum likelihood (ML) value of the optical parameters illustrated a marked change in the periphery of the tumor corresponding with the expected location of NP and area of selective heating observed on MRTI. Parameter recovery information became increasingly difficult to infer in distal regions of tissue where photon fluence had been significantly attenuated. Finite element temperature predictions using the ML parameter values obtained from the solution of the inverse problem are able to reproduce the NP selective heating within 5 °C of measured MRTI estimations along selected temperature profiles. Results indicate the ML solution found is able to sufficiently reproduce the selectivity of the NP mediated laser induced heating and therefore the ML solution is likely to return useful optical parameters within the region of significant laser fluence.
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Affiliation(s)
- D Fuentes
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Carpentier A, Chauvet D, Reina V, Beccaria K, Leclerq D, McNichols RJ, Gowda A, Cornu P, Delattre JY. MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas. Lasers Surg Med 2012; 44:361-8. [DOI: 10.1002/lsm.22025] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2012] [Indexed: 11/10/2022]
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Carpentier A, McNichols RJ, Stafford RJ, Guichard JP, Reizine D, Delaloge S, Vicaut E, Payen D, Gowda A, George B. Laser thermal therapy: Real-time MRI-guided and computer-controlled procedures for metastatic brain tumors. Lasers Surg Med 2011; 43:943-50. [DOI: 10.1002/lsm.21138] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2011] [Indexed: 11/11/2022]
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Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance-guided laser-induced thermal therapy. J Neurosurg Pediatr 2011; 8:468-75. [PMID: 22044371 DOI: 10.3171/2011.8.peds11148] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supratentorial primitive neuroectodermal tumors (PNETs) are rare tumors that carry a poorer prognosis than those arising from the infratentorial compartment (such as medulloblastoma). The overall prognosis for these patients depends on several factors including the extent of resection, age at diagnosis, CSF dissemination, and site in the supratentorial space. The authors present the first case of a patient with a newly diagnosed supratentorial PNET in which cytoreduction was achieved with MR-guided laser-induced thermal therapy. A 10-year-old girl presented with left-sided facial weakness and a large right thalamic mass extending into the right midbrain. The diagnosis of supratentorial PNET was made after stereotactic biopsy. Therapeutic options for this lesion were limited because of the risks of postoperative neurological deficits with resection. The patient underwent MR-guided laser-induced thermal ablation of her tumor. Under real-time MR thermometry, thermal energy was delivered to the tumor at a core temperature of 90°C for a total of 960 seconds. The patient underwent follow-up MR imaging at regular intervals to evaluate the tumor response to the thermal ablation procedure. Initial postoperative scans showed an increase in the size of the lesion as well as the amount of the associated edema. Both the size of the lesion and the edema stabilized by 1 week and then decreased below preablation levels at the 3-month postsurgical follow-up. There was a slight increase in the size of the lesion and associated edema at the 6-month follow-up scan, presumably due to concomitant radiation she received as part of her postoperative care. The patient tolerated the procedure well and has had resolution of her symptoms since surgery. Further study is needed to assess the role of laser-induced thermal therapy for the treatment of intracranial tumors. As such, it is a promising tool in the neurosurgical armamentarium. Postoperative imaging has shown no evidence of definitive recurrence at the 6-month follow-up period, but longer-term follow-up is required to assess for late recurrence.
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Affiliation(s)
- Pinakin R Jethwa
- Department of Neurosurgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA
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FUENTES D, WALKER C, ELLIOTT A, SHETTY A, HAZLE J, STAFFORD R. Magnetic resonance temperature imaging validation of a bioheat transfer model for laser-induced thermal therapy. Int J Hyperthermia 2011; 27:453-64. [PMID: 21756043 PMCID: PMC3930085 DOI: 10.3109/02656736.2011.557028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Magnetic resonance-guided laser-induced thermal therapy (MRgLITT) is currently undergoing initial safety and feasibility clinical studies for the treatment of intracranial lesions in humans. As studies progress towards evaluation of treatment efficacy, predictive computational models may play an important role for prospective 3D treatment planning. The current work critically evaluates a computational model of laser induced bioheat transfer against retrospective multiplanar MR thermal imaging (MRTI) in a canine model of the MRgLITT procedure in the brain. METHODS A 3D finite element model of the bioheat transfer that couples Pennes equation to a diffusion theory approximation of light transport in tissue is used. The laser source is modelled conformal with the applicator geometry. Dirichlet boundary conditions are used to model the temperature of the actively cooled catheter. The MRgLITT procedure was performed on n = 4 canines using a 1-cm diffusing tip 15-W diode laser (980 nm). A weighted L₂norm is used as the metric of comparison between the spatiotemporal MR-derived temperature estimates and model prediction. RESULTS The normalised error history between the computational models and MRTI was within 1-4 standard deviations of MRTI noise. Active cooling models indicate that the applicator temperature has a strong effect on the maximum temperature reached, but does not significantly decrease the tissue temperature away from the active tip. CONCLUSIONS Results demonstrate the computational model of the bioheat transfer may provide a reasonable approximation of the laser-tissue interaction, which could be useful for treatment planning, but cannot readily replace MR temperature imaging in a complex environment such as the brain.
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Affiliation(s)
- D. FUENTES
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, Houston
| | - C. WALKER
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, Houston
| | - A. ELLIOTT
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, Houston
| | | | - J.D. HAZLE
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, Houston
| | - R.J. STAFFORD
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, Houston
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Woodrum DA, Gorny KR, Mynderse LA, Amrami KK, Felmlee JP, Bjarnason H, Garcia-Medina OI, McNichols RJ, Atwell TD, Callstrom MR. Feasibility of 3.0T Magnetic Resonance Imaging-guided Laser Ablation of a Cadaveric Prostate. Urology 2010; 75:1514.e1-6. [DOI: 10.1016/j.urology.2010.01.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 11/25/2022]
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Schwartz JA, Shetty AM, Price RE, Stafford RJ, Wang JC, Uthamanthil RK, Pham K, McNichols RJ, Coleman CL, Payne JD. Feasibility study of particle-assisted laser ablation of brain tumors in orthotopic canine model. Cancer Res 2009; 69:1659-67. [PMID: 19208847 DOI: 10.1158/0008-5472.can-08-2535] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report on a pilot study showing a proof of concept for the passive delivery of nanoshells to an orthotopic tumor where they induce a local, confined therapeutic response distinct from that of normal brain resulting in the photothermal ablation of canine transmissible venereal tumor (cTVT) in a canine brain model. cTVT fragments grown in severe combined immunodeficient mice were successfully inoculated in the parietal lobe of immunosuppressed, mixed-breed hound dogs. A single dose of near-IR (NIR)-absorbing, 150-nm nanoshells was infused i.v. and allowed time to passively accumulate in the intracranial tumors, which served as a proxy for an orthotopic brain metastasis. The nanoshells accumulated within the intracranial cTVT, suggesting that its neovasculature represented an interruption of the normal blood-brain barrier. Tumors were thermally ablated by percutaneous, optical fiber-delivered, NIR radiation using a 3.5-W average, 3-minute laser dose at 808 nm that selectively elevated the temperature of tumor tissue to 65.8 +/- 4.1 degrees C. Identical laser doses applied to normal white and gray matter on the contralateral side of the brain yielded sublethal temperatures of 48.6 +/- 1.1 degrees C. The laser dose was designed to minimize thermal damage to normal brain tissue in the absence of nanoshells and compensate for variability in the accumulation of nanoshells in tumor. Postmortem histopathology of treated brain sections showed the effectiveness and selectivity of the nanoshell-assisted thermal ablation.
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Carpentier A, McNichols RJ, Stafford RJ, Itzcovitz J, Guichard JP, Reizine D, Delaloge S, Vicaut E, Payen D, Gowda A, George B. Real-time Magnetic Resonance-guided Laser Thermal Therapy for Focal Metastatic Brain Tumors. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000311254.63848.72] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
- Alexandre Carpentier
- Department of Neurosurgery, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
| | | | - R. Jason Stafford
- Department of Imaging Physics, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Julian Itzcovitz
- Department of Neurosurgery, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
| | - Jean-Pierre Guichard
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
| | - Daniel Reizine
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
| | - Suzette Delaloge
- Breast Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Eric Vicaut
- Clinical Research Monitoring Department, Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
| | - Didier Payen
- Department of Neurosurgery, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
| | | | - Bernard George
- Department of Neurosurgery, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
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Viard R, Piron B, Steiner A, Wassmer B, Rousseau J, Mordon S. Non-invasive 3d magnetic resonance thermal mapping: determination of the lesion size during laser-therapy in ex vivo tissues. Int J Comput Assist Radiol Surg 2008. [DOI: 10.1007/s11548-007-0141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Breen MS, Breen M, Butts K, Chen L, Saidel GM, Wilson DL. MRI-guided Thermal Ablation Therapy: Model and Parameter Estimates to Predict Cell Death from MR Thermometry Images. Ann Biomed Eng 2007; 35:1391-403. [PMID: 17436111 DOI: 10.1007/s10439-007-9300-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2006] [Accepted: 03/23/2007] [Indexed: 11/27/2022]
Abstract
Solid tumors and other pathologies can be treated using laser thermal ablation under interventional magnetic resonance imaging (iMRI) guidance. A model was developed to predict cell death from magnetic resonance (MR) thermometry measurements based on the temperature-time history, and validated using in vivo rabbit brain data. To align post-ablation T2-weighted spin-echo MR lesion images to gradient-echo MR images, from which temperature is derived, a registration method was used that aligned fiducials placed near the thermal lesion. The outer boundary of the hyperintense rim in the post-ablation MR lesion image was used as the boundary for cell death, as verified from histology. Model parameters were simultaneously estimated using an iterative optimization algorithm applied to every interesting voxel in 328 images from multiple experiments having various temperature histories. For a necrotic region of 766 voxels across all lesions, the model provided a voxel specificity and sensitivity of 98.1 and 78.5%, respectively. Mislabeled voxels were typically within one voxel from the segmented necrotic boundary with median distances of 0.77 and 0.22 mm for false positives (FP) and false negatives (FN), respectively. As compared to the critical temperature cell death model and the generalized Arrhenius model, our model typically predicted fewer FP and FN. This is good evidence that iMRI temperature maps can be used with our model to predict therapeutic regions in real-time during treatment.
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Affiliation(s)
- Michael S Breen
- Department of Biomedical Engineering, Case Western Reserve University, Wickenden Building, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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Sun L, Collins CM, Schiano JL, Smith MB, Smith NB. Adaptive Real-Time Closed-Loop Temperature Control for Ultrasound Hyperthermia Using Magnetic Resonance Thermometry. CONCEPTS IN MAGNETIC RESONANCE. PART B, MAGNETIC RESONANCE ENGINEERING 2005; 27B:51-63. [PMID: 22723751 PMCID: PMC3377976 DOI: 10.1002/cmr.b.20046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Previous researchers have successfully demonstrated the application of temperature feedback control for thermal treatment of disease using MR thermometry. Using the temperature-dependent proton resonance frequency (PRF) shift, ultrasound heating for hyperthermia to a target organ (such as the prostate) can be tightly controlled. However, using fixed gain controllers, the response of the target to ultrasound heating varies with type, size, location, shape, stage of growth, and proximity to other vulnerable organs. To adjust for clinical variables, feedback self-tuning regulator (STR) and model reference adaptive control (MRAC) methods have been designed and implemented using real-time, online MR thermometry by adjusting the output power to an ultrasound array to quickly reach the hyperthermia target temperatures. The use of fast adaptive controllers in this application is advantageous because adaptive controllers do not require a priori knowledge of the initial tissue properties and blood perfusion and can quickly reach the steady-state target temperature in the presence of dynamic tissue properties (e.g., thermal conductivity, blood perfusion). This research was conducted to rapidly achieve and manage therapeutic temperatures from an ultrasound array using novel MRI-guided adaptive closed-loop controllers both in ex vivo and in vivo experiments. The ex vivo phantom experiments with bovine muscle (n = 5) show that within 6 ± 0.2 minutes, the tissue temperature increased by 8 ± 1.37°C. Using rabbits' (n = 5) thigh muscle, the in vivo experiments demonstrated the target temperature reached 44.5°C ± 1.2°C in 8.0 ± 0.5 minutes. The preliminary in vivo experiment with canine prostate hyperthermia achieved 43 ± 2°C in 6.5 ± 0.5 minutes. These results demonstrate that the adaptive controllers with MR thermometry are able to effectively track the target temperature with dynamic tissue properties.
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Affiliation(s)
- L Sun
- Department of Bioengineering, College of Engineering, The Pennsylvania State University, University Park, PA 16802
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Bankson JA, Stafford RJ, Hazle JD. Partially parallel imaging with phase-sensitive data: Increased temporal resolution for magnetic resonance temperature imaging. Magn Reson Med 2005; 53:658-65. [PMID: 15723414 DOI: 10.1002/mrm.20378] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Magnetic resonance temperature imaging can be used to monitor the progress of thermal ablation therapies, increasing treatment efficacy and improving patient safety. High temporal resolution is important when therapies rapidly heat tissue, but many approaches to faster image acquisition compromise image resolution, slice coverage, or phase sensitivity. Partially parallel imaging techniques offer the potential for improved temporal resolution without forcing such concessions. Although these techniques perturb image phase, relative phase changes between dynamically acquired phase-sensitive images, such as those acquired for MR temperature imaging, can be reliably measured through partially parallel imaging techniques using reconstruction filters that remain constant across the series. Partially parallel and non-accelerated phase-difference-sensitive data can be obtained through arrays of surface coils using this method. Average phase differences measured through partially parallel and fully Fourier encoded images are virtually identical, while phase noise increases with g(sqrt)L as in standard partially parallel image acquisitions..
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Affiliation(s)
- James A Bankson
- Department of Imaging Physics, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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