One-dimensional NMR thermal mapping of focused ultrasound surgery

[The use of transcranial focused ultrasound in CNS diseases]

Transcranial focused ultrasound is a modern medical technique, which provides non-invasive impact on the brain. Current development stage of this technique is no longer than 20 years and many possible applications of this technique are still at pre-clinical stage. The greatest progress has been made in the field of functional neurosurgery. Focused ultrasound enables non-invasive MRI-guided formation of small destruction foci in the relevant targets, providing therapeutic neuromodulating effects in patients with Parkinson's disease, essential tremor, pain syndromes, obsessive-compulsive disorders, and other diseases. So far, this treatment was carried out in more than 300 patients. Several cases of ultrasound thermal destruction of intracranial neoplasms were published. There are attempts to perform third ventriculostomy using ultrasound in animals. A separate area focuses on the enhancement of the permeability of the blood-brain barrier to various substances driven by focused ultrasound. The possibilities of enhancing the permeability to chemotherapeutic agents, immune drugs, and other substances are being investigated in laboratories. A large number of studies focus on treatment of Alzheimer's disease. clinical trials aimed at enhancing the permeability of the blood-brain barrier to chemotherapeutic agents have been initiated. Reversible neuromodulating, stimulating, and inhibiting effect of focused ultrasound on the nervous system structures is another non-destructive effect, which is currently being actively investigated in animals. Furthermore, laboratory studies demonstrated the ability of focused ultrasound to destroy blood clots and thrombi. Transcranial focused ultrasound provides numerous unique possibilities for scientific and practical medicine. Large-scale research is required prior to the widespread clinical implementation. Nevertheless, we can already state that implementation of this technique will significantly enhance diagnostic and therapeutic potential of neurosurgery and neurology.

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

MRI-guided focused ultrasound surgery (MRgFUS) is a minimally invasive treatment guided by the most sophisticated imaging tool available in today's clinical practice. Both the imaging and therapeutic sides of the equipment are based on non-ionizing energy. This technique is a very promising option as potential treatment for several pathologies, including musculoskeletal (MSK) disorders. Apart from clinical applications, MRgFUS technology is the result of long, heavy and cumulative efforts exploring the effects of ultrasound on biological tissues and function, the generation of focused ultrasound and treatment monitoring by MRI. The aim of this article is to give an updated overview on a "new" interventional technique and on its applications for MSK and allied sciences.

Treatment monitoring and thermometry for therapeutic focused ultrasound

Therapeutic ultrasound is currently enjoying increasingly widespread clinical use especially for the treatment of cancer of the prostate, liver, kidney, breast, pancreas and bone, as well as for the treatment of uterine fibroids. The optimum method of treatment delivery varies between anatomical sites, but in all cases monitoring of the treatment is crucial if extensive clinical acceptance is to be achieved. Monitoring not only provides the operating clinician with information relating to the effectiveness of treatment, but can also provide an early alert to the onset of adverse effects in normal tissue. This paper reviews invasive and non-invasive monitoring methods that have been applied to assess the extent of treatment during the delivery of therapeutic ultrasound in the laboratory and clinic (follow-up after treatment is not reviewed in detail). The monitoring of temperature and, importantly, the way in which this measurement can be used to estimate the delivered thermal dose, is dealt with as a separate special case. Already therapeutic ultrasound has reached a stage of development where it is possible to attempt real-time feedback during exposure in order to optimize each and every delivery of ultrasound energy. To date, data from MR imaging have shown better agreement with the size of regions of damage than those from diagnostic ultrasound, but novel ultrasonic techniques may redress this balance. Whilst MR currently offers the best method for non-invasive temperature measurement, the ultrasound techniques under development, which could potentially offer more rapid visualisation of results, are discussed.

Rapid MR elastography using selective excitations

Rapid MR elastography (MRE) techniques using spatially-selective excitations to reduce acquisition times to a few seconds or less were devised and tested. The techniques included reduced field of view (rFOV) MRE and 1D MRE (beam MRE) using 2D spatially selective RF excitations for gradient-echo (GRE) applications and intersecting 90 degrees and 180 degrees slice-selective excitations for spin-echo (SE) applications. It was shown that scan times could be reduced by a factor of 8 using rFOV MRE, and by 64 using beam MRE, while still obtaining stiffness estimates comparable to full-FOV MRE. Results were shown in gel phantom experiments as well as in the case of a preserved postmortem breast tissue specimen with a stiff lesion. These methods can be used to more rapidly interrogate regions of interest (ROIs) in tissue to quickly obtain information about the viscoelastic properties of that tissue.

A quality control program for MR-guided focused ultrasound ablation therapy

In this study, we propose a quality control program for MR-guided focused ultrasound (FUS) ablation treatment to assess FUS beam positioning accuracy, FUS power delivery accuracy, MR imaging quality, and FUS ablation system safety. A total of 353 sonication points in Lucite cards were measured, the average placement errors were -0.06 mm in the SI direction and -0.04 mm in the LR direction. Temperature elevation was calculated from MR phase difference images and the measured water proton chemical shift (WPCS) temperature coefficient. WPCS temperature calibration for phantoms yielded a temperature coefficient of 0.011 ppm/degree C. Sixteen experiments were conducted using six different phantoms to test the reliability of FUS power delivery. SNR and RF power calculated from phantom images were analyzed and stored at the MR console. A computer program was developed to integrate the system power delivery and the MR image quality control into one automated process. In the clinical trial at our institution, we expect this quality control program to be carried out before each patient treatment. If measured quality control values exceeds or below the preset values, a system service and retest should be conducted before the treatment.

Simultaneous measurements of temperature and pH in vivo using NMR in conjunction with TmDOTP5-

NMR techniques for temperature and pH measurements have attracted increasing interest in recent years, motivated in part by the growing importance of medical hyperthermia for the treatment of cancer. The chemical shifts of thulium 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetrakis(methylene phosphonate) (TmDOTP5-) have been studied as a function of temperature and pH. The results demonstrate that TmDOTP5- resonance shifts are highly sensitive to temperature (approximately 1.0 ppm/degrees C) and pH (approximately 3.2 ppm/pH unit) at clinically relevant field strengths. A new method is presented which utilizes two magnetically non-equivalent protons in TmDOTP5- for simultaneous NMR measurements of both temperature and pH. The difference in the chemical shift values of pairs of 1H resonances provides a temperature sensitivity of about 1.6 ppm/ degrees C. The technique is demonstrated in live rats undergoing ultrasound-induced hyperthermia therapy.

MR imaging of shear waves generated by focused ultrasound

This study has shown that magnetic resonance elastography (MRE) can detect shear waves excited by focused ultrasound (FUS) in both gel phantoms and ex vivo muscle. Good agreement was shown between the shear modulus measured from MRE images generated using FUS and that using previously reported MRE techniques. The shear wave displacement amplitude at the FUS focus was studied and found to be proportional with both FUS ultrasonic pulse intensity and the FUS modulation pulse period over the range tested.

Reliability of water proton chemical shift temperature calibration for focused ultrasound ablation therapy

Our purpose in this work was to assess the reliability of the calibration coefficient for magnetic resonance water proton chemical shift temperature mapping. Over a six month period, the calibration coefficient was measured 15 times in several different phantoms. A highly linear relationship between water proton chemical shift and temperature change was found. The average temperature calibration coefficient determined from all studies was 0.009+/-0.001 ppm/degrees C. Four of the 15 studies were conducted on the same day using the same phantom. The average temperature calibration coefficient of these four studies was 0.0096+/-0.0001 ppm/degrees C.

Thermal dosimetry of a focused ultrasound beam in vivo by magnetic resonance imaging

Magnetic resonance imaging (MRI) thermometry has been utilized for in vivo evaluation of thermal exposure induced by a focused ultrasound beam. A simulation study of the focused ultrasound beam was conducted to select imaging parameters for reducing the error due to the spatial and temporal averaging of MRI. Temperature imaging based on the proton resonance frequency shift was utilized to obtain the temperature distribution during sonication in the skeletal muscle of eight rabbits. MRI-derived temperature information was then used to calculate the thermal dose distribution induced by the sonication and to estimate the coagulated tissue volume. The tissue changes were also evaluated directly by taking the T2-weighted and the contrast agent enhanced T1-weighted MR images. Errors in the temperature and thermal dose measurements were found to be minimal using the following parameters: slice thickness = 3 mm, voxel dimension = 0.6 mm, and scan time per image = 3.4 s. The estimated dimensions of the coagulated tissue volume were in good agreement with the tissue damages seen on the contrast agent enhanced T1-weighted images. The tissue damage seen on the histology was closely matched to the ones seen on the T2-weighted images. This study showed that MRI thermometry has significant potential for both monitoring the thermal exposure and evaluating the tissue damage. This would allow real-time control of the sonication parameters to optimize clinical treatments.

A multi-gate time-of-flight technique for estimation of temperature distribution in heated tissue: theory and computer simulation

Non-invasive determination of temperature distribution in biological media is important in many heating-related studies, such as thermal treatment. In this paper, we present an in vitro ultrasound technique for estimation of temperature distribution in heated tissue. Our technique consists of two major steps: (1) using multiple time gates to track echo signals scattered from tissue regions at different depths; (2) estimating temperature distribution based on heating-induced changes of arrival times of echo signals scattered from the targeted tissue regions. We use the conventional cross-correlation approach to track echoes. For temperature estimation, we have developed an iterative method that takes into account the influences of thermal expansion and heating-induced change in the speed of sound on the time of flight. We have introduced a concept of thermal sensitivity of the time of flight and used it to derive a theoretical formula that relates the achievable accuracy on the estimation of tissue temperature to seven parameters. The seven parameters are tissue thermal sensitivity of the time of flight, signal-to-noise ratio, bandwidth and center frequency of the signal, degree of signal decorrelation induced by changes in tissue physical properties during tissue heating, and widths and spacing of the time gates. We tested our technique by computer simulation, using a random discrete scatterer model and temperature distribution data acquired in our laser heating experiments on prostate tissue of live dog. Simulation results showed that our technique could accurately estimate the temperature distribution in the heated tissue. Our technique is fast in terms of computation and could be used as a research tool for in vitro real-time monitoring of temperature distribution in tissue under hyperthermal heating.

Automatic ultrasound determination of thermal coagulation front during laser tissue heating

Thermal therapies using laser, microwaves, radio frequency radiation, and high intensity focused ultrasound have shown great promise for minimally invasive treatment of benign and malignant lesions. To treat tissue effectively and safely, techniques that could monitor the advancement of coagulation front during treatment are highly desirable. This paper presents a noninvasive ultrasound technique for automatically determining the propagation of coagulation damage front during laser tissue heating. The basic assumption underlying this technique is that when coagulation is taking place in a tissue, owing to thermally induced structure changes in tissue, the waveform of echo signal scattered from that treated region should be changing accordingly. We first track echoes scattered from many small tissue regions during heating using a cross-correlation echo-tracking technique. We then use the waveform-change information to determine the position of coagulation front via an automatic calculation procedure. To test our technique, we carried out 35 experiments in which we irradiated fresh canine liver samples with a Nd:YAG laser (1064-nm wavelength) at various light fluence (62 to 167 W/cm(2)) and exposure time (20 to 350 s). A 13-mm diameter 10-MHz broadband single-element spherical focused ultrasound transducer was used to detect the thermal coagulation front. The root mean square difference between ultrasonically and visually determined coagulation depths was 0.77 mm. This good agreement between visually inspected and ultrasonically determined coagulation depths shows the potential of our technique for monitoring coagulative tissue damage during thermal therapy.

NMR temperature measurements using a paramagnetic lanthanide complex

NMR thermometry has previously suffered from poor thermal resolution owing to the relatively weak dependence of chemical shift on temperature in diamagnetic molecules. In contrast, the shifts of nuclear spins near a paramagnetic center exhibit strong temperature dependencies. The chemical shifts of the thulium 1,4,7, 10-tetraazacyclododecane-1,4,7,10-tetrakis(methylene phosphonate) complex (TmDOTP5-) have been studied as a function of temperature, pH, and Ca2+ concentration over ranges which may be encountered in vivo. The results demonstrate that the 1H and 31P shifts in TmDOTP5- are highly sensitive to temperature and may be used for NMR thermometry with excellent accuracy and resolution. A new technique is also described which permits simultaneous measurements of temperature and pH changes from the shifts of multiple TmDOTP5- spectral lines.

Determination of laser-induced temperature distributions using echo-shifted TurboFLASH

An echo-shifted TurboFLASH sequence implemented on a clinical whole body MR scanner was used to determine thermal changes in tissue. With this snapshot-like data acquisition, temperature-related phase shifts were measured with a temporal resolution of 1.3 s. For different types of tissue (postmortem porcine brain, liver, and muscle) the temperature coefficients of the proton chemical shift were recorded during uniform heating of the specimen in a water bath. The specific temperature-dependent frequency shifts appeared similar to the proton chemical shift of free water (-0.01 ppm/degrees C). With this method, laser-induced ablation in postmortem porcine brain was monitored by temperature mapping. Comparison of the induced temperature profiles measured with NiCrNi-thermocouples with the MR calculated profiles demonstrated excellent temperature sensitivity and accuracy for this method of MR thermometry, with a maximum deviation of the determined temperatures of only 1.8 degrees C. This investigation was designed as a feasibility study for this rapid version of the phase mapping method, and no in vivo studies were performed.

TmDOTP5-: a substance for NMR temperature measurements in vivo

The chemical shifts of 31P and 1H in thulium 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetrakis(methylene phosphonate) (TmDOTP5-) are approximately two orders of magnitude more sensitive to temperature than are water proton and 19F shifts. In the physiologically relevant pH range, the 31P and 1H chemical shifts of TmDOTP5- are linear functions of temperature between 25 and 47 degrees C. The results indicate that using TmDOTP5- can provide measurements of temperature in vivo that are significantly more accurate than methods based on water and fluorocarbon chemical shifts.

Optimization of spoiled gradient-echo phase imaging for in vivo localization of a focused ultrasound beam

The parameters of a spoiled gradient-echo (SPGR) pulse sequence have been optimized for in vivo localization of a focused ultrasound beam. Temperature elevation was measured by using the proton resonance frequency shift technique, and the phase difference signal-to-noise ratio (SNR delta phi) was estimated in skeletal muscle and kidney cortex in 10 rabbits. Optimized parameters included the echo time equivalent to T2* of the tissue, the longest repetition time possible with a 20-s sonication, and the flip angle equivalent to the Ernst angle. Optimal SPGR phase imaging can detect a sonication beam with a peak phase difference of 0.55 radian, which corresponds to a temperature elevation of 7.3 degrees C. The sonication beam can be localized within one voxel (0.6 x 0.6 x 5 mm3) at power levels that are below the threshold for thermal damage of the tissue.

Line scan diffusion imaging

A novel line scan diffusion imaging sequence (LSDI) is introduced. LSDI is inherently insensitive to motion artifacts and high quality diffusion maps of the brain can be obtained rapidly without the use of head restraints or cardiac gating. Results from a stroke study and abdominal diffusion images are presented. The results indicate that it is feasible to use the LSDI technique for clinical evaluation of acute ischemic stroke. In contrast to echo-planar diffusion imaging, LSDI does not require modified gradient hardware and can be implemented on conventional scanners. Thus, LSDI should dramatically increase the general availability of robust clinical diffusion imaging.

Simultaneous magnetic resonance phase and magnitude temperature maps in muscle

Noninvasive magnetic resonance temperature maps that are used to monitor thermal ablation of tissue are described. In magnetic resonance images, thermally induced proton nuclear magnetic resonance frequency shifts, and changes in the longitudinal relaxation time produce both phase and magnitude changes in the MR signal. Temperature maps with improved sensitivity are derived from the complex-difference nuclear magnetic resonance signal. Bovine muscle specimens were heated with focused ultrasound to model thermal surgery and create a known thermal distribution to test the method. Resulting MR images acquired in 2 s produce temperature maps with 1 min resolution and 2 degrees C temperature sensitivity. The temperature sensitivity was increased by extending the acquisition to 5 s, by decreasing the receiver bandwidth, and increasing the echo time.