Model predictive filtering MR thermometry: Effects of model inaccuracies, k-space reduction factor, and temperature increase rate

PURPOSE

Evaluate effects of model parameter inaccuracies (thermal conductivity, k, and ultrasound power deposition density, Q), k-space reduction factor (R), and rate of temperature increase ( T˙) in a thermal model-based reconstruction for MR-thermometry during focused-ultrasound heating.

METHODS

Simulations and ex vivo experiments were performed to investigate the accuracy of the thermal model and the model predictive filtering (MPF) algorithm for varying R and T˙, and their sensitivity to errors in k and Q. Ex vivo data was acquired with a segmented EPI pulse sequence to achieve large field-of-view (192 × 162 × 96 mm) four-dimensional temperature maps with high spatiotemporal resolution (1.5 × 1.5 × 2.0 mm, 1.7 s).

RESULTS

In the simulations, 50% errors in k and Q resulted in maximum temperature root mean square errors (RMSE) of 6 °C for model only and 3 °C for MPF. Using recently developed methods, estimates of k and Q were accurate to within 3%. The RMSE between MPF and true temperature increased with R and T˙. In the ex vivo study the RMSE remained below 0.7 °C for R ranging from 4 to 12 and T˙ of 0.28-0.75 °C/s.

CONCLUSION

Errors in MPF temperatures occur due to errors in k and Q. These MPF temperature errors increase with increase in R and T˙, but are smaller than those obtained using the thermal model alone.

Treatment envelope evaluation in transcranial magnetic resonance-guided focused ultrasound utilizing 3D MR thermometry

BACKGROUND

Current clinical targets for transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) are all located close to the geometric center of the skull convexity, which minimizes challenges related to focusing the ultrasound through the skull bone. Non-central targets will have to be reached to treat a wider variety of neurological disorders and solid tumors. Treatment envelope studies utilizing two-dimensional (2D) magnetic resonance (MR) thermometry have previously been performed to determine the regions in which therapeutic levels of FUS can currently be delivered. Since 2D MR thermometry was used, very limited information about unintended heating in near-field tissue/bone interfaces could be deduced.

METHODS

In this paper, we present a proof-of-concept treatment envelope study with three-dimensional (3D) MR thermometry monitoring of FUS heatings performed in a phantom and a lamb model. While the moderate-sized transducer used was not designed for transcranial geometries, the 3D temperature maps enable monitoring of the entire sonication field of view, including both the focal spot and near-field tissue/bone interfaces, for full characterization of all heating that may occur. 3D MR thermometry is achieved by a combination of k-space subsampling and a previously described temporally constrained reconstruction method.

RESULTS

We present two different types of treatment envelopes. The first is based only on the focal spot heating-the type that can be derived from 2D MR thermometry. The second type is based on the relative near-field heating and is calculated as the ratio between the focal spot heating and the near-field heating. This utilizes the full 3D MR thermometry data achieved in this study.

CONCLUSIONS

It is shown that 3D MR thermometry can be used to improve the safety assessment in treatment envelope evaluations. Using a non-optimal transducer, it is shown that some regions where therapeutic levels of FUS can be delivered, as suggested by the first type of envelope, are not necessarily safely treated due to the amount of unintended near-field heating occurring. The results presented in this study highlight the need for 3D MR thermometry in tcMRgFUS.

The accuracy and precision of two non-invasive, magnetic resonance-guided focused ultrasound-based thermal diffusivity estimation methods

PURPOSE

The use of correct tissue thermal diffusivity values is necessary for making accurate thermal modelling predictions during magnetic resonance-guided focused ultrasound (MRgFUS) treatment planning. This study evaluates the accuracy and precision of two non-invasive thermal diffusivity estimation methods, a Gaussian temperature method and a Gaussian specific absorption rate (SAR) method.

MATERIALS AND METHODS

Both methods utilise MRgFUS temperature data obtained during cooling following a short (<25 s) heating pulse. The Gaussian SAR method can also use temperatures obtained during heating. Experiments were performed at low heating levels (ΔT∼10 °C) in ex vivo pork muscle and in vivo rabbit back muscle. The non-invasive MRgFUS thermal diffusivity estimates were compared with measurements from two standard invasive methods.

RESULTS

Both non-invasive methods accurately estimated thermal diffusivity when using MR temperature cooling data (overall ex vivo error <6%, in vivo <12%). Including heating data in the Gaussian SAR method further reduced errors (ex vivo error <2%, in vivo <3%). The significantly lower standard deviation values (p < 0.03) of the Gaussian SAR method indicated that it had better precision than the Gaussian temperature method.

CONCLUSIONS

With repeated sonications, either MR-based method could provide accurate thermal diffusivity values for MRgFUS therapies. Fitting to more data simultaneously likely made the Gaussian SAR method less susceptible to noise, and using heating data helped it converge more consistently to the FUS fitting parameters and thermal diffusivity. These effects led to the improved precision of the Gaussian SAR method.

In vivo evaluation of a breast-specific magnetic resonance guided focused ultrasound system in a goat udder model

PURPOSE

This work further evaluates the functionality, efficacy, and safety of a new breast-specific magnetic resonance guided high intensity focused ultrasound (MRgFUS) system in an in vivo goat udder model.

METHODS

Eight female goats underwent an MRgFUS ablation procedure using the breast-specific MRgFUS system. Tissue classification was achieved through the 3D magnetic resonance imaging (MRI) acquisition of several contrasts (T1w, T2w, PDw, 3-point Dixon). The MRgFUS treatment was performed with a grid trajectory executed in one or two planes within the glandular tissue of the goat udder. Temperature was monitored using a 3D proton resonance frequency (PRF) MRI technique. Delayed contrast enhanced-MR images were acquired immediately and 14 days post MRgFUS treatment. A localized tissue excision was performed in one animal and histological analysis was performed. Animals were available for adoption at the conclusion of the study.

RESULTS

The breast-specific MRgFUS system was able to ablate regions ranging in size from 0.4 to 3.6 cm(3) in the goat udder model. Tissue damage was confirmed through the correlation of thermal dose measurements obtained with realtime 3D MR thermometry to delayed contrast enhanced-MR images immediately after the treatment and 14 days postablation. In general, lesions were longer in the ultrasound propagation direction, which is consistent with the dimensions of the ultrasound focal spot. Thermal dose volumes had better agreement with nonenhancing areas of the DCE-MRI images obtained 14 days after the MRgFUS treatment.

CONCLUSIONS

The system was able to successfully ablate lesions up to 3.6 cm(3). The thermal dose volume was found to correlate better with the 14-day postablation nonenhancing delayed contrast enhanced-MR image volumes. While the goat udder is not an ideal model for the human breast, this study has proven the feasibility of using this system on a wide variety of udder shapes and sizes, demonstrating the flexibility that would be required in order to treat human subjects.

An exploratory study of positive and incongruent communication in young children with type 1 diabetes and their mothers

BACKGROUND

The incidence of type 1 diabetes is increasing in young children. However, they are overlooked in treatment adherence and intervention research despite evidence that parents often experience difficulty securing their treatment cooperation, especially with the diet. We investigated positive and incongruent (i.e. the co-occurrence of contradictory verbal and non-verbal messages) communication in the mother-child dyad and their association with child adjustment and dietary adherence outcomes.

METHODS

Participants were 23 6- to 8-year-old children with type 1 diabetes and their mothers. We conducted dietary adherence interviews with mothers and performed nutritional analyses to assess children's consumption of extrinsic sugars (e.g. confectionary). Mothers completed a standardized assessment of child psychological adjustment. Mothers and children engaged in a videotaped problem-solving task related to the dietary regimen, with maternal and child utterances and non-verbal behaviours analysed for positive dyadic and incongruent communication.

RESULTS

Positive dyadic communication correlated with lower levels of child incongruent communication, fewer behavioural problems and better overall adjustment. Higher levels of maternal and child incongruent communication correlated with more behavioural and emotional problems and poorer overall adjustment. Higher levels of maternal incongruent communication correlated with poorer dietary adherence.

CONCLUSIONS

Results converged to form a conceptually and empirically coherent pattern in that behavioural indices of poorer communication in both mother and child consistently correlated with poorer child adjustment outcomes. This study shows that specific features of dyadic, child and maternal communication could be targeted in developmentally sensitive interventions to promote positive communication in the home management of type 1 diabetes care for young children.

In vivo evaluation of multi-echo hybrid PRF/T1 approach for temperature monitoring during breast MR-guided focused ultrasound surgery treatments

PURPOSE

To evaluate the precision of in vivo temperature measurements in adipose and glandular breast tissue using a multi-echo hybrid PRF/T1 pulse sequence.

METHODS

A high-bandwidth, multi-echo hybrid PRF/T1 sequence was developed for monitoring temperature changes simultaneously in fat- and water-based tissues. The multiple echoes were combined with the optimal weightings for magnitude and phase images, allowing for precise measurement of both T1 and the proton resonance frequency (PRF) shift. The sequence was tested during in vivo imaging of 10 healthy volunteers in a breast-specific MR-guided focused ultrasound system and also during focused ultrasound heating of excised breast adipose tissue.

RESULTS

The in vivo results indicated that the sequence can measure PRF temperatures with 1.25 × 1.25 × 3.5 mm resolution, 1.9 s temporal resolution, and 1.0°C temperature precision, and can measure T1 values with 3.75 × 3.75 × 3.5 mm resolution, 3.8 s temporal resolution, and 2.5%-4.8% precision. The excised tissue heating experiments demonstrate the sequence's ability to monitor temperature changes simultaneously in water- and fat-based tissues.

CONCLUSION

The addition of a high-bandwidth, multi-echo readout to the hybrid PRF/T1 sequence improves the precision of each measurement, providing a sequence that will be beneficial to several MR-guided thermal therapies.

Effects of MRTI sampling characteristics on estimation of HIFU SAR and tissue thermal diffusivity

While the non-invasive and three-dimensional nature of magnetic-resonance temperature imaging (MRTI) makes it a valuable tool for high-intensity focused ultrasound (HIFU) treatments, random and systematic errors in MRTI measurements may propagate into temperature-based parameter estimates used for pretreatment planning. This study assesses the MRTI effects of zero-mean Gaussian noise (SD = 0.0-2.0 °C), temporal sampling (tacq = 1.0-8.0 s), and spatial averaging (Res = 0.5-2.0 mm isotropic) on HIFU temperature measurements and temperature-based estimates of the amplitude and full width half maximum (FWHM) of the HIFU specific absorption rate and of tissue thermal diffusivity. The ultrasound beam used in simulations and ex vivo pork loin experiments has lateral and axial FWHM dimensions of 1.4 mm and 7.9 mm respectively. For spatial averaging simulations, beams with lateral FWHM varying from 1.2-2.2 mm are also assessed. Under noisy conditions, parameter estimates are improved by fitting to data from larger voxel regions. Varying the temporal sampling results in minimal changes in measured temperatures (<2% change) and parameter estimates (<5% change). For the HIFU beams studied, a spatial resolution of 1 × 1 × 3 mm(3) or smaller is required to keep errors in temperature and all estimated parameters less than 10%. By quantifying the errors associated with these sampling characteristics, this work provides researchers with appropriate MRTI conditions for obtaining estimates of parameters essential to pretreatment modeling of HIFU thermal therapies.

Phase reconstruction from multiple coil data using a virtual reference coil

PURPOSE

This study develops a method to obtain optimal estimates of absolute magnetization phase from multiple-coil MRI data.

THEORY AND METHODS

The element-specific phases of a multi-element receiver coil array are accounted for by using the phase of a real or virtual reference coil that is sensitive over the entire imaged volume. The virtual-reference coil is generated as a weighted combination of measurements from all receiver coils. The phase-corrected multiple coil complex images are combined using the inverse covariance matrix. These methods are tested on images of an agar phantom, an in vivo breast, and an anesthetized rabbit obtained using combinations of four, nine, and three receiver channels, respectively.

RESULTS

The four- and three-channel acquisitions require formation of a virtual-reference receiver coil while one channel of the nine-channel receive array has a sensitivity profile covering the entire imaged volume. Referencing to a real or virtual coil gives receiver phases that are essentially identical except for the individual receiver channel noise. The resulting combined images, which account for receiver channel noise covariance, show the expected reduction in phase variance.

CONCLUSION

The proposed virtual reference coil method determines a phase distribution for each coil from which an optimal phase map can be obtained.

Toward real-time temperature monitoring in fat and aqueous tissue during magnetic resonance-guided high-intensity focused ultrasound using a three-dimensional proton resonance frequency T1 method

PURPOSE

To present a three-dimensional (3D) segmented echoplanar imaging (EPI) pulse sequence implementation that provides simultaneously the proton resonance frequency shift temperature of aqueous tissue and the longitudinal relaxation time (T1 ) of fat during thermal ablation.

METHODS

The hybrid sequence was implemented by combining a 3D segmented flyback EPI sequence, the extended two-point Dixon fat and water separation, and the double flip angle T1 mapping techniques. High-intensity focused ultrasound (HIFU) heating experiments were performed at three different acoustic powers on excised human breast fat embedded in ex vivo porcine muscle. Furthermore, T1 calibrations with temperature in four different excised breast fat samples were performed, yielding an estimate of the average and variation of dT1 /dT across subjects.

RESULTS

The water only images were used to mask the complex original data before computing the proton resonance frequency shift. T1 values were calculated from the fat-only images. The relative temperature coefficients were found in five fat tissue samples from different patients and ranged from 1.2% to 2.6%/°C.

CONCLUSION

The results demonstrate the capability of real-time simultaneous temperature mapping in aqueous tissue and T1 mapping in fat during HIFU ablation, providing a potential tool for treatment monitoring in organs with large fat content, such as the breast.

Focused ultrasound-mediated drug delivery to pancreatic cancer in a mouse model

Background

Many aspects of the mechanisms involved in ultrasound-mediated therapy remain obscure. In particular, the relative roles of drug and ultrasound, the effect of the time of ultrasound application, and the effect of tissue heating are not yet clear. The current study was undertaken with the goal to clarify these aspects of the ultrasound-mediated drug delivery mechanism.

Methods

Focused ultrasound-mediated drug delivery was performed under magnetic resonance imaging guidance (MRgFUS) in a pancreatic ductal adenocarcinoma (PDA) model grown subcutaneously in nu/nu mice. Paclitaxel (PTX) was used as a chemotherapeutic agent because it manifests high potency in the treatment of gemcitabine-resistant PDA. Poly(ethylene oxide)-co-poly(d,l-lactide) block copolymer stabilized perfluoro-15-crown-5-ether nanoemulsions were used as drug carriers. MRgFUS was applied at sub-ablative pressure levels in both continuous wave and pulsed modes, and only a fraction of the tumor was treated.

Results

Positive treatment effects and even complete tumor resolution were achieved by treating the tumor with MRgFUS after injection of nanodroplet encapsulated drug. The MRgFUS treatment enhanced the action of the drug presumably through enhanced tumor perfusion and blood vessel and cell membrane permeability that increased the drug supply to tumor cells. The effect of the pulsed MRgFUS treatment with PTX-loaded nanodroplets was clearly smaller than that of continuous wave MRgFUS treatment, supposedly due to significantly lower temperature increase as measured with MR thermometry and decreased extravasation. The time of the MRgFUS application after drug injection also proved to be an important factor with the best results observed when ultrasound was applied at least 6 h after the injection of drug-loaded nanodroplets. Some collateral damage was observed with particular ultrasound protocols supposedly associated with enhanced inflammation.

Conclusion

This presented data suggest that there exists an optimal range of ultrasound application parameters and drug injection time. Decreased tumor growth, or complete resolution, was achieved with continuous wave ultrasound pressures below or equal to 3.1 MPa and drug injection times of at least 6 h prior to treatment. Increased acoustic pressure or ultrasound application before or shortly after drug injection gave increased tumor growth when compared to other protocols.

Design and characterization of a laterally mounted phased-array transducer breast-specific MRgHIFU device with integrated 11-channel receiver array

PURPOSE

This work presents the design and preliminary evaluation of a new laterally mounted phased-array MRI-guided high-intensity focused ultrasound (MRgHIFU) system with an integrated 11-channel phased-array radio frequency (RF) coil intended for breast cancer treatment. The design goals for the system included the ability to treat the majority of tumor locations, to increase the MR image's signal-to-noise ratio (SNR) throughout the treatment volume and to provide adequate comfort for the patient.

METHODS

In order to treat the majority of the breast volume, the device was designed such that the treated breast is suspended in a 17-cm diameter treatment cylinder. A laterally shooting 1-MHz, 256-element phased-array ultrasound transducer with flexible positioning is mounted outside the treatment cylinder. This configuration achieves a reduced water volume to minimize RF coil loading effects, to position the coils closer to the breast for increased signal sensitivity, and to reduce the MR image noise associated with using water as the coupling fluid. This design uses an 11-channel phased-array RF coil that is placed on the outer surface of the cylinder surrounding the breast. Mechanical positioning of the transducer and electronic steering of the focal spot enable placement of the ultrasound focus at arbitrary locations throughout the suspended breast. The treatment platform allows the patient to lie prone in a face-down position. The system was tested for comfort with 18 normal volunteers and SNR capabilities in one normal volunteer and for heating accuracy and stability in homogeneous phantom and inhomogeneous ex vivo porcine tissue.

RESULTS

There was a 61% increase in mean relative SNR achieved in a homogeneous phantom using the 11-channel RF coil when compared to using only a single-loop coil around the chest wall. The repeatability of the system's energy delivery in a single location was excellent, with less than 3% variability between repeated temperature measurements at the same location. The execution of a continuously sonicated, predefined 48-point, 8-min trajectory path resulted in an ablation volume of 8.17 cm(3), with one standard deviation of 0.35 cm(3) between inhomogeneous ex vivo tissue samples. Comfort testing resulted in negligible side effects for all volunteers.

CONCLUSIONS

The initial results suggest that this new device will potentially be suitable for MRgHIFU treatment in a wide range of breast sizes and tumor locations.

Toward real-time availability of 3D temperature maps created with temporally constrained reconstruction

PURPOSE

To extend the previously developed temporally constrained reconstruction (TCR) algorithm to allow for real-time availability of three-dimensional (3D) temperature maps capable of monitoring MR-guided high intensity focused ultrasound applications.

METHODS

A real-time TCR (RT-TCR) algorithm is developed that only uses current and previously acquired undersampled k-space data from a 3D segmented EPI pulse sequence, with the image reconstruction done in a graphics processing unit implementation to overcome computation burden. Simulated and experimental data sets of HIFU heating are used to evaluate the performance of the RT-TCR algorithm.

RESULTS

The simulation studies demonstrate that the RT-TCR algorithm has subsecond reconstruction time and can accurately measure HIFU-induced temperature rises of 20°C in 15 s for 3D volumes of 16 slices (RMSE = 0.1°C), 24 slices (RMSE = 0.2°C), and 32 slices (RMSE = 0.3°C). Experimental results in ex vivo porcine muscle demonstrate that the RT-TCR approach can reconstruct temperature maps with 192 × 162 × 66 mm 3D volume coverage, 1.5 × 1.5 × 3.0 mm resolution, and 1.2-s scan time with an accuracy of ±0.5°C.

CONCLUSION

The RT-TCR algorithm offers an approach to obtaining large coverage 3D temperature maps in real-time for monitoring MR-guided high intensity focused ultrasound treatments.

3D multi-parametric breast MRI segmentation using hierarchical support vector machine with coil sensitivity correction

RATIONALE AND OBJECTIVES

The goal of the study is to develop a technique to achieve accurate volumetric breast tissue segmentation using magnetic resonance imaging (MRI) data. This segmentation can be useful to aid in the diagnosis of breast cancers and to assess breast cancer risk based on breast density. Tissue segmentation is also essential for development of acoustic and thermal models used in magnetic resonance guided high-intensity focused ultrasound treatment of breast lesions.

MATERIALS AND METHODS

In addition to commonly used T1-, T2-, and proton density-weighted images, three-point Dixon water- and fat-only images were also included as part of the multiparametric inputs to a tissue segmentation algorithm using a hierarchical support vector machine (SVM). The effectiveness of a variety of preprocessing schemes was evaluated through two in vivo datasets. The performance of the hierarchical SVM was investigated and compared to the conventional classification algorithms-conventional SVM and fuzzy C-mean (FCM).

RESULTS

The need for co-registration, zero-filled interpolation, coil sensitivity correction, and optimal SNR reconstruction before the final stage classification was demonstrated. The overlap ratios of the hierarchical SVM, conventional SVM and FCM were 93.25%-94.08%, 81.68-92.28%, and 75.96%-91.02%, respectively. Classification outputs from in vivo experiments showed that the presented methodology is consistent and outperforms other algorithms.

CONCLUSION

The presented hierarchical SVM-based technique showed promising results in automatically segmenting breast tissues into fat, fibroglandular tissue, skin, and lesions. The results provide evidence that both the multiparametric breast MRI inputs and the preprocessing procedures contribute to the high accuracy of tissue classification.

An 11-channel radio frequency phased array coil for magnetic resonance guided high-intensity focused ultrasound of the breast

In this study, a radio frequency phased array coil was built to image the breast in conjunction with a magnetic resonance guided high-intensity focused ultrasound (MRgHIFU) device designed specifically to treat the breast in a treatment cylinder with reduced water volume. The MRgHIFU breast coil was comprised of a 10-channel phased array coil placed around an MRgHIFU treatment cylinder where nearest-neighbor decoupling was achieved with capacitive decoupling in a shared leg. In addition a single loop coil was placed at the chest wall making a total of 11 channels. The radio frequency coil array design presented in this work was chosen based on ease of implementation, increased visualization into the treatment cylinder, image reconstruction speed, temporal resolution, and resulting signal-to-noise ratio profiles. This work presents a dedicated 11-channel coil for imaging of the breast tissue in the MRgHIFU setup without obstruction of the ultrasound beam and, specifically, compares its performance in signal-to-noise, overall imaging time, and temperature measurement accuracy to that of the standard single chest-loop coil typically used in breast MRgHIFU.

LV wall segmentation using the variational level set method (LSM) with additional shape constraint for oedema quantification

In this paper an automatic algorithm for the left ventricle (LV) wall segmentation and oedema quantification from T2-weighted cardiac magnetic resonance (CMR) images is presented. The extent of myocardial oedema delineates the ischaemic area-at-risk (AAR) after myocardial infarction (MI). Since AAR can be used to estimate the amount of salvageable myocardial post-MI, oedema imaging has potential clinical utility in the management of acute MI patients. This paper presents a new scheme based on the variational level set method (LSM) with additional shape constraint for the segmentation of T2-weighted CMR image. In our approach, shape information of the myocardial wall is utilized to introduce a shape feature of the myocardial wall into the variational level set formulation. The performance of the method is tested using real CMR images (12 patients) and the results of the automatic system are compared to manual segmentation. The mean perpendicular distances between the automatic and manual LV wall boundaries are in the range of 1-2 mm. Bland-Altman analysis on LV wall area indicates there is no consistent bias as a function of LV wall area, with a mean bias of -121 mm(2) between individual investigator one (IV1) and LSM, and -122 mm(2) between individual investigator two (IV2) and LSM when compared to two investigators. Furthermore, the oedema quantification demonstrates good correlation when compared to an expert with an average error of 9.3% for 69 slices of short axis CMR image from 12 patients.

Pathway based microarray analysis, utilising enzyme compounds and cascade events

BACKGROUND

Pathway based microarray analysis is an effort to integrate microarray and pathway data in a holistic analytical approach, looking for coordinated changes in the expression of sets of genes forming pathways. However, it has been observed that the results produced are often cryptic, with cases of closely related genes in a pathway showing quite variable, even opposing expression.

OBJECTIVES

We propose a methodology to identify the state of activation of individual pathways, based on our hypothesis that gene members of many pathways or modules exhibit differential expression that results from their contribution to any combination of all their constituent pathways. Therefore, the observed expression of such a gene does not necessarily imply the activation state of a given pathway where its product participates, but reflects the net expression resulting from its participation in all its constituent pathways.

METHODS

Firstly, in an effort to validate the hypothesis, we split the genes into two groups; single and multi-membership. We then determined and compared the proportion of differentially expressed genes in each group, for each experiment. In addition, we estimated the cumulative binomial probability of observing as many or more expressed genes in each group, in each experiment, simply by chance. Second, we propose a hill climbing methodology, aiming to maximise the agreement of gene expression per module.

RESULTS

We detected more frequent expression of multi-membership genes and significantly lower probabilities of observing such a high proportion of differentially expressed multi-membership genes, as the one present in the dataset. The algorithm was able to correctly identify the state of activation of the KEGG glycolysis and gluconeogenesis modules, using a number of Saccharomyces cerevisiae datasets. We show that the result is equivalent to the best solution found following exhaustive search.

CONCLUSIONS

The proposed method takes into account the multi-membership nature of genes and our knowledge of the competitive nature of our exemplar modules, revealing the state of activity of a pathway.

An analytical solution for improved HIFU SAR estimation

Accurate determination of the specific absorption rates (SARs) present during high intensity focused ultrasound (HIFU) experiments and treatments provides a solid physical basis for scientific comparison of results among HIFU studies and is necessary to validate and improve SAR predictive software, which will improve patient treatment planning, control and evaluation. This study develops and tests an analytical solution that significantly improves the accuracy of SAR values obtained from HIFU temperature data. SAR estimates are obtained by fitting the analytical temperature solution for a one-dimensional radial Gaussian heating pattern to the temperature versus time data following a step in applied power and evaluating the initial slope of the analytical solution. The analytical method is evaluated in multiple parametric simulations for which it consistently (except at high perfusions) yields maximum errors of less than 10% at the center of the focal zone compared with errors up to 90% and 55% for the commonly used linear method and an exponential method, respectively. For high perfusion, an extension of the analytical method estimates SAR with less than 10% error. The analytical method is validated experimentally by showing that the temperature elevations predicted using the analytical method's SAR values determined for the entire 3D focal region agree well with the experimental temperature elevations in a HIFU-heated tissue-mimicking phantom.

Irreversible change in the T1 temperature dependence with thermal dose using the proton resonance frequency-T1 technique

Denaturation of macromolecules within the tissues is believed to be the major factor contributing to the damage of tissues upon hyperthermia. As a result, the value of the spin-lattice relaxation time T1 of the tissue water, which is related to the translational and rotational rates of water, represents an intrinsic probe for investigating structural changes in tissues at high temperature. Therefore, the goal of this work is to investigate whether the simultaneous measurement of temperature and T1 using a hybrid proton resonance frequency (PRF)-T1 measurement technique can be used to detect irreversible changes in T1 that might be indicative of tissue damage. A new hybrid PRF-T1 sequence was implemented based on the variable flip angle driven-equilibrium single-pulse observation (DESPOT)1 method from a standard three dimensional segmented echo-planar imaging sequence by alternating two flip angles from measurement to measurement. The structural changes of the heated tissue volumes were analyzed based on the derived T1 values and the corresponding PRF temperatures. Using the hybrid PRF-T1 technique, we demonstrate that the change of spin lattice relaxation time T1 is reversible with temperature for low thermal dose (thermal dose ≤ 240 cumulative equivalent minutes [CEM] 43°C) and irreversible with temperature after significant accumulation of thermal dose in ex vivo chicken breast tissue. These results suggest that the hybrid PRF-T1 method may be a potentially powerful tool to investigate the extent and mechanism of heat damage of biological tissues.

Hybrid proton resonance frequency/T1 technique for simultaneous temperature monitoring in adipose and aqueous tissues

Thermal therapy procedures being carried out under MR guidance would be safer if temperature changes could be accurately monitored in both water-based and fat-based tissues. To this end, we present a hybrid proton resonance frequency (PRF)/T(1) approach for simultaneously measuring PRF shift temperatures in water-based tissues and T(1) changes in fat-based tissues. The hybrid PRF/T(1) sequence is a standard radiofrequency spoiled gradient echo sequence executed in a dynamic mode with two flip angles alternating every time frame. The PRF information is extracted every time frame using the image phase in the standard approach, and the T(1) information is extracted every two time frames using a variable flip angle approach. Simulation studies, ex vivo high intensity focused ultrasound heating experiments, and in vivo stability experiments were performed to test the feasibility of the approach. The results indicate that the hybrid PRF/T(1) approach provides PRF temperature maps of the same quality as those obtained by traditional PRF methods while simultaneously being able to track T(1) changes in fat-based tissues. Although several potential error sources exist for the T(1) measurements, the approach is a promising start toward realizing quantitative temperature measurements in both water-based and fat-based tissues.

F8 and F9 mutations in US haemophilia patients: correlation with history of inhibitor and race/ethnicity

Both genetic and treatment-related risk factors contribute to the development of inhibitors in haemophilia. An inhibitor surveillance system piloted at 12 US sites has the goal of assessing risk factors through prospective data collection. This report examines the relationship of genotype and race/ethnicity to history of inhibitor in a large cohort of US haemophilia patients. Mutation analysis was performed on 676 haemophilia A (HA) and 153 haemophilia B (HB) patients by sequencing, Multiplex Ligation-dependent Probe Amplification, and PCR for inversions in F8 introns 22 (inv22) and 1 (inv1). Two HB patients with deletions had history of inhibitor. In severe HA, frequency of history of inhibitor was: large deletion 57.1%, splice site 35.7%, inv22 26.8%, nonsense 24.5%, frameshift 12.9%, inv1 11.1% and missense 9.5%. In HA, 19.6% of 321 White non-Hispanics (Whites), 37.1% of 35 Black non-Hispanics (Blacks) and 46.9% of 32 Hispanics had history of inhibitor (P = 0.0003). Mutation types and novel mutation rates were similar across ethnicities. When F8 haplotypes were constructed, Whites and Hispanics showed only H1 and H2. Within H1, history of inhibitor was 12.4% in Whites, 40.0% in Blacks (P = 0.009) and 32.4% in Hispanics (P = 0.002). Inhibitor frequency is confirmed to vary by mutation type and race in a large US population. White patients with history of inhibitor did not exhibit rare F8 haplotypes. F8 gene analysis did not reveal a cause for the higher inhibitor frequencies in Black and Hispanic patients.

The effect of electronically steering a phased array ultrasound transducer on near-field tissue heating

PURPOSE

This study presents the results obtained from both simulation and experimental techniques that show the effect of mechanically or electronically steering a phased array transducer on proximal tissue heating.

METHODS

The thermal response of a nine-position raster and a 16-mm diameter circle scanning trajectory executed through both electronic and mechanical scanning was evaluated in computer simulations and experimentally in a homogeneous tissue-mimicking phantom. Simulations were performed using power deposition maps obtained from the hybrid angular spectrum (HAS) method and applying a finite-difference approximation of the Pennes' bioheat transfer equation for the experimentally used transducer and also for a fully sampled transducer to demonstrate the effect of acoustic window, ultrasound beam overlap and grating lobe clutter on near-field heating.

RESULTS

Both simulation and experimental results show that electronically steering the ultrasound beam for the two trajectories using the 256-element phased array significantly increases the thermal dose deposited in the near-field tissues when compared with the same treatment executed through mechanical steering only. In addition, the individual contributions of both beam overlap and grating lobe clutter to the near-field thermal effects were determined through comparing the simulated ultrasound beam patterns and resulting temperature fields from mechanically and electronically steered trajectories using the 256-randomized element phased array transducer to an electronically steered trajectory using a fully sampled transducer with 40 401 phase-adjusted sample points.

CONCLUSIONS

Three distinctly different three distinctly different transducers were simulated to analyze the tradeoffs of selected transducer design parameters on near-field heating. Careful consideration of design tradeoffs and accurate patient treatment planning combined with thorough monitoring of the near-field tissue temperature will help to ensure patient safety during an MRgHIFU treatment.

Reconstruction of fully three-dimensional high spatial and temporal resolution MR temperature maps for retrospective applications

Many areas of MR-guided thermal therapy research would benefit from temperature maps with high spatial and temporal resolution that cover a large three-dimensional volume. This article describes an approach to achieve these goals, which is suitable for research applications where retrospective reconstruction of the temperature maps is acceptable. The method acquires undersampled data from a modified three-dimensional segmented echo-planar imaging sequence and creates images using a temporally constrained reconstruction algorithm. The three-dimensional images can be zero-filled to arbitrarily small voxel spacing in all directions and then converted into temperature maps using the standard proton resonance frequency shift technique. During high intensity focused ultrasound heating experiments, the proposed method was used to obtain temperature maps with 1.5 mm × 1.5 mm × 3.0 mm resolution, 288 mm × 162 mm × 78 mm field of view, and 1.7 s temporal resolution. The approach is validated to demonstrate that it can accurately capture the spatial characteristics and time dynamics of rapidly changing high intensity focused ultrasound-induced temperature distributions. Example applications from MR-guided high intensity focused ultrasound research are shown to demonstrate the benefits of the large coverage fully three-dimensional temperature maps, including characterization of volumetric heating trajectories and near- and far-field heating.