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Leporace M, Lancellotta V, Baccolini V, Calabria F, Castrovillari F, Filippiadis DK, Tagliaferri L, Iezzi R. Magnetic resonance-guided focused ultrasound versus percutaneous thermal ablation in local control of bone oligometastases: a systematic review and meta-analysis. LA RADIOLOGIA MEDICA 2024; 129:291-306. [PMID: 38302831 DOI: 10.1007/s11547-024-01780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The percutaneous thermal ablation techniques (pTA) are radiofrequency ablation, cryoablation, and microwave ablation, suitable for the treatment of bone oligometastases. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive ablation technique. OBJECTIVES To compare the effectiveness and safety of MRgFUS and pTA for treating bone oligometastases and their complications. METHODS Studies were selected with a PICO/PRISMA protocol: pTA or MRgFUS in patients with bone oligometastases; non-exclusive curative treatment. Exclusion criteria were: primary bone tumor; concurrent radiation therapy; palliative therapy; and absence of imaging at follow-up. PubMed, BioMed Central, and Scopus were searched. The modified Newcastle-Ottawa Scale assessed articles quality. For each treatment (pTA and MRgFUS), we conducted two separate random-effects meta-analyses to estimate the pooled effectiveness and safety. The effectiveness was assessed by combining the proportions of treated lesions achieving local tumor control (LTC); the safety by combining the complications rates of treated patients. Meta-regression analyses were performed to identify any outcome predictor. RESULTS A total of 24 articles were included. Pooled LTC rate for MRgFUS was 84% (N = 7, 95% CI 66-97%, I2 = 74.7%) compared to 65% of pTA (N = 17, 95% CI 51-78%, I2 = 89.3%). Pooled complications rate was similar, respectively, 13% (95% CI 1-32%, I2 = 81.0%) for MRgFUS and 12% (95% CI 8-18%, I2 = 39.9%) for pTA, but major complications were recorded with pTA only. The meta-regression analyses, including technique type, study design, tumor, and follow-up, found no significant predictors. DISCUSSION The effectiveness and safety of the two techniques were found comparable, even though MRgFUS is a noninvasive treatment that did not cause any major complication. Limited data availability on MRgFUS and the lack of direct comparisons with pTA may affect these findings. CONCLUSIONS MRgFUS can be a valid, safe, and noninvasive treatment for bone oligometastases. Direct comparison studies are needed to confirm its promising benefits.
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Affiliation(s)
- Mario Leporace
- Department of Nuclear Medicine and Theragnostics, "Mariano Santo" Cosenza Hospital, Cosenza, Italy.
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Ferdinando Calabria
- Department of Nuclear Medicine and Theragnostics, "Mariano Santo" Cosenza Hospital, Cosenza, Italy
| | | | - Dimitrios K Filippiadis
- Second Department of Radiology, University General Hospital "ATTIKON" - Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Roberto Iezzi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
- Institute of Radiology - Università Cattolica del Sacro Cuore, Rome, Italy
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Zhang Y, Wang J, Ghobadi SN, Zhou H, Huang A, Gerosa M, Hou Q, Keunen O, Golebiewska A, Habte FG, Grant GA, Paulmurugan R, Lee KS, Wintermark M. Molecular Identity Changes of Tumor-Associated Macrophages and Microglia After Magnetic Resonance Imaging-Guided Focused Ultrasound-Induced Blood-Brain Barrier Opening in a Mouse Glioblastoma Model. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1082-1090. [PMID: 36717283 PMCID: PMC10059983 DOI: 10.1016/j.ultrasmedbio.2022.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/11/2022] [Accepted: 12/10/2022] [Indexed: 05/11/2023]
Abstract
An orthotopically allografted mouse GL26 glioma model (Ccr2RFP/wt-Cx3cr1GFP/wt) was used to evaluate the effect of transient, focal opening of the blood-brain barrier (BBB) on the composition of tumor-associated macrophages and microglia (TAMs). BBB opening was induced by magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) combined with microbubbles. CX3CR1-GFP cells and CCR2-RFP cells in brain tumors were quantified in microscopic images. Tumors in animals treated with a single session of MRgFUS did not exhibit significant changes in cell numbers when compared with tumors in animals not receiving FUS. However, tumors that received two or three sessions of MRgFUS had significantly increased amounts of both CX3CR1-GFP and CCR2-RFP cells. The effect of MRgFUS on immune cell composition was also characterized and quantified using flow cytometry. Glioma implantation resulted in increased amounts of lymphocytes, monocytes and neutrophils in the brain parenchyma. Tumors administered MRgFUS exhibited increased numbers of monocytes and monocyte-derived TAMs. In addition, MRgFUS-treated tumors exhibited more CD80+ cells in monocytes and microglia. In summary, transient, focal opening of the BBB using MRgFUS combined with microbubbles can activate the homing and differentiation of monocytes and induce a shift toward a more pro-inflammatory status of the immune environment in glioblastoma.
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Affiliation(s)
- Yanrong Zhang
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Jing Wang
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Sara Natasha Ghobadi
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Haiyan Zhou
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA; Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ai Huang
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA; Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Marco Gerosa
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA; Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Qingyi Hou
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA; Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Olivier Keunen
- In Vivo Imaging Facility, Luxembourg Institute of Health, Luxembourg
| | - Anna Golebiewska
- Department of Oncology, Luxembourg Institute of Health, Luxembourg
| | - Frezghi G Habte
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford, CA, USA
| | - Gerald A Grant
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, USA
| | - Ramasamy Paulmurugan
- Molecular Imaging Program at Stanford (MIPS), Canary Center for Cancer Early Detection, Department of Radiology, Stanford University, Stanford, CA, USA
| | - Kevin S Lee
- Departments of Neuroscience and Neurosurgery and Center for Brain, Immunology, and Glia, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Max Wintermark
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Stroud J, Hao Y, Read TS, Hankiewicz JH, Bilski P, Klodowski K, Brown JM, Rogers K, Stoll J, Camley RE, Celinski Z, Przybylski M. Magnetic particle based MRI thermometry at 0.2 T and 3 T. Magn Reson Imaging 2023; 100:43-54. [PMID: 36933774 DOI: 10.1016/j.mri.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
This study provides insight into the advantages and disadvantages of using ferrite particles embedded in agar gel phantoms as MRI temperature indicators for low-magnetic field scanners. We compare the temperature-dependent intensity of MR images at low-field (0.2 T) to those at high-field (3.0 T). Due to a shorter T1 relaxation time at low-fields, MRI scanners operating at 0.2 T can use shorter repetition times and achieve a significant T2⁎ weighting, resulting in strong temperature-dependent changes of MR image brightness in short acquisition times. Although the signal-to-noise ratio for MR images at 0.2 T MR is much lower than at 3.0 T, it is sufficient to achieve a temperature measurement uncertainty of about ±1.0 °C at 37 °C for a 90 μg/mL concentration of magnetic particles.
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Affiliation(s)
- John Stroud
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States; Department of Physics and Energy Science, University of Colorado, Colorado Springs 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Yu Hao
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States; Department of Physics and Energy Science, University of Colorado, Colorado Springs 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Tim S Read
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Janusz H Hankiewicz
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Pawel Bilski
- Department of Physics, A. Mickiewicz University, Uniwersytetu Poznanskiego St. 2, 61-614 Poznan, Poland
| | - Krzysztof Klodowski
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, Mickiewicza Ave. 30, 30-059 Kraków, Poland
| | - Jared M Brown
- Colorado Center for Nanomedicine and Nanosafety, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Keegan Rogers
- Colorado Center for Nanomedicine and Nanosafety, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Josh Stoll
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States; Department of Physics and Energy Science, University of Colorado, Colorado Springs 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Robert E Camley
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States; Department of Physics and Energy Science, University of Colorado, Colorado Springs 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Zbigniew Celinski
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States; Department of Physics and Energy Science, University of Colorado, Colorado Springs 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, United States
| | - Marek Przybylski
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, Mickiewicza Ave. 30, 30-059 Kraków, Poland; Academic Centre for Materials and Nanotechnology, AGH University of Science and Technology, Mickiewicza Ave. 30, 30-059 Kraków, Poland.
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Fishman PS, Fischell JM. Focused Ultrasound Mediated Opening of the Blood-Brain Barrier for Neurodegenerative Diseases. Front Neurol 2021; 12:749047. [PMID: 34803886 PMCID: PMC8599441 DOI: 10.3389/fneur.2021.749047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/27/2021] [Indexed: 01/31/2023] Open
Abstract
The blood brain barrier (BBB) is an obstacle for the delivery of potential molecular therapies for neurodegenerative diseases such as Parkinson's disease (PD), Alzheimer's disease (AD), and amyotrophic lateral sclerosis (ALS). Although there has been a proliferation of potential disease modifying therapies for these progressive conditions, strategies to deliver these large agents remain limited. High intensity MRI guided focused ultrasound has already been FDA approved to lesion brain targets to treat movement disorders, while lower intensity pulsed ultrasound coupled with microbubbles commonly used as contrast agents can create transient safe opening of the BBB. Pre-clinical studies have successfully delivered growth factors, antibodies, genes, viral vectors, and nanoparticles in rodent models of AD and PD. Recent small clinical trials support the safety and feasibility of this strategy in these vulnerable patients. Further study is needed to establish safety as MRI guided BBB opening is used to enhance the delivery of newly developed molecular therapies.
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Schregel K, Baufeld C, Palotai M, Meroni R, Fiorina P, Wuerfel J, Sinkus R, Zhang YZ, McDannold N, White PJ, Guttmann CRG. Targeted Blood Brain Barrier Opening With Focused Ultrasound Induces Focal Macrophage/Microglial Activation in Experimental Autoimmune Encephalomyelitis. Front Neurosci 2021; 15:665722. [PMID: 34054415 PMCID: PMC8149750 DOI: 10.3389/fnins.2021.665722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Experimental autoimmune encephalomyelitis (EAE) is a model of multiple sclerosis (MS). EAE reflects important histopathological hallmarks, dissemination, and diversity of the disease, but has only moderate reproducibility of clinical and histopathological features. Focal lesions are less frequently observed in EAE than in MS, and can neither be constrained to specific locations nor timed to occur at a pre-specified moment. This renders difficult any experimental assessment of the pathogenesis of lesion evolution, including its inflammatory, degenerative (demyelination and axonal degeneration), and reparatory (remyelination, axonal sprouting, gliosis) component processes. We sought to develop a controlled model of inflammatory, focal brain lesions in EAE using focused ultrasound (FUS). We hypothesized that FUS induced focal blood brain barrier disruption (BBBD) will increase the likelihood of transmigration of effector cells and subsequent lesion occurrence at the sonicated location. Lesion development was monitored with conventional magnetic resonance imaging (MRI) as well as with magnetic resonance elastography (MRE) and further analyzed by histopathological means. EAE was induced in 12 6-8 weeks old female C57BL/6 mice using myelin oligodendrocyte glycoprotein (MOG) peptide. FUS-induced BBBD was performed 6, 7, and 9 days after immunization in subgroups of four animals and in an additional control group. MRI and MRE were performed on a 7T horizontal bore small animal MRI scanner. Imaging was conducted longitudinally 2 and 3 weeks after disease induction and 1 week after sonication in control animals, respectively. The scan protocol comprised contrast-enhanced T1-weighted and T2-weighted sequences as well as MRE with a vibration frequency of 1 kHz. Animals were sacrificed for histopathology after the last imaging time point. The overall clinical course of EAE was mild. A total of seven EAE animals presented with focal T2w hyperintense signal alterations in the sonicated hemisphere. These were most frequent in the group of animals sonicated 9 days after immunization. Histopathology revealed foci of activated microglia/macrophages in the sonicated right hemisphere of seven EAE animals. Larger cellular infiltrates or apparent demyelination were not seen. Control animals showed no abnormalities on MRI and did not have clusters of activated microglia/macrophages at the sites targeted with FUS. None of the animals had hemorrhages or gross tissue damage as potential side effects of FUS. EAE-animals tended to have lower values of viscoelasticity and elasticity in the sonicated compared to the contralateral parenchyma. This trend was significant when comparing the right sonicated to the left normal hemisphere and specifically the right sonicated compared to the left normal cortex in animals that underwent FUS-BBBD 9 days after immunization (right vs. left hemisphere: mean viscoelasticity 6.1 vs. 7.2 kPa; p = 0.003 and mean elasticity 4.9 vs. 5.7 kPa, p = 0.024; right vs. left cortex: mean viscoelasticity 5.8 vs. 7.5 kPa; p = 0.004 and mean elasticity 5 vs. 6.5 kPa; p = 0.008). A direct comparison of the biomechanical properties of focal T2w hyperintensities with normal appearing brain tissue did not yield significant results. Control animals showed no differences in viscoelasticity between sonicated and contralateral brain parenchyma. We here provide first evidence for a controlled lesion induction model in EAE using FUS-induced BBBD. The observed lesions in EAE are consistent with foci of activated microglia that may be interpreted as targeted initial inflammatory activity and which have been described as pre-active lesions in MS. Such foci can be identified and monitored with MRI. Moreover, the increased inflammatory activity in the sonicated brain parenchyma seems to have an effect on overall tissue matrix structure as reflected by changes of biomechanical parameters.
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Affiliation(s)
- Katharina Schregel
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Institute of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Caroline Baufeld
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Miklos Palotai
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Roberta Meroni
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Boston, MA, United States
| | - Paolo Fiorina
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, Milan, Italy
| | - Jens Wuerfel
- MIAC AG and Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Ralph Sinkus
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom.,INSERM UMR S1148 - Laboratory for Vascular Translational Science, University Paris, Paris, France
| | - Yong-Zhi Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nathan McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - P Jason White
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Charles R G Guttmann
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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López-Aguirre M, Caballero-Insaurriaga J, Urso D, Rodríguez-Rojas R, Máñez-Miró JU, Del-Alamo M, Rachmilevitch I, Martínez-Fernández R, Pineda-Pardo JA. Lesion 3D modeling in transcranial MR-guided focused ultrasound thalamotomy. Magn Reson Imaging 2021; 80:71-80. [PMID: 33905832 DOI: 10.1016/j.mri.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 01/21/2023]
Abstract
Transcranial magnetic resonance-guided focused ultrasound (tMRgFUS) allows to perform incisionless thermoablation of deep brain structures. This feature makes it a very useful tool for the treatment of multiple neurological and psychiatric disorders. Currently, feedback of the thermoablation process is based on peak temperature readings assessed on real-time two-dimensional MRI thermometry. However, an accurate methodology relating thermal dosimetry with three-dimensional topography and temporal evolution of the lesion is still to be defined, thus hurdling the establishment of well-defined, evidence-based criteria to perform safe and effective treatments. In here we propose threshold-based thermoablation models to predict the volumetric topography of the lesion (whole lesion and necrotic core) in the short-to-mid-term based on thermal dosimetry estimated from intra-treatment MRI thermometry. To define and validate our models we retrospectively analyzed the data of sixty-three tMRgFUS thalamotomies for treating tremor. We used intra-treatment MRI thermometry to estimate whole-treatment three-dimensional thermal dose maps, defined either as peak temperature reached (Tmax) or thermal isoeffective dose (TID). Those maps were thresholded to find the dosimetric level that maximize the agreement (Sorensen-Dice coefficient - SDc) with the boundaries of the whole lesion and its core, assessed on T2w images 1-day (post-24h) and 3-months (post-3M) after treatment. Best predictions were achieved for the whole lesion at post-24h (SDc = 0.71), with Tmax /TID over 50.0 °C/90.5 CEM43. The core at post-24h and whole lesion at post-3M lesions reported a similar behavior in terms of shape accuracy (SDc ~0.35), and thermal dose thresholds ~55 °C/4100.0 CEM43. Finally, the optimal levels for post-3M core lesions were 55.5 °C/5800.0 CEM43 (SDc = 0.21). These thermoablation models could contribute to the real-time decision-making process and improve the outcome of tMRgFUS interventions both in terms of safety and efficacy.
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Affiliation(s)
- Miguel López-Aguirre
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Jaime Caballero-Insaurriaga
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad Politécnica de Madrid, Madrid, Spain
| | - Daniele Urso
- King's College (KCL), Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Rafael Rodríguez-Rojas
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas Instituto Carlos III, Madrid, Spain
| | - Jorge U Máñez-Miró
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Marta Del-Alamo
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | | | - Raúl Martínez-Fernández
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas Instituto Carlos III, Madrid, Spain
| | - José A Pineda-Pardo
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas Instituto Carlos III, Madrid, Spain.
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Iacopino DG, Gagliardo C, Giugno A, Giammalva GR, Napoli A, Maugeri R, Graziano F, Valentino F, Cosentino G, D'Amelio M, Bartolotta TV, Catalano C, Fierro B, Midiri M, Lagalla R. Preliminary experience with a transcranial magnetic resonance-guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson's disease. Neurosurg Focus 2019; 44:E7. [PMID: 29385927 DOI: 10.3171/2017.11.focus17614] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Transcranial magnetic resonance-guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson's disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world's first tcMRgFUS system integrated with a 1.5-T MRI unit. METHODS The authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was performed in both ET and PD patients. In all the tcMRgFUS treatments, a 1.5-T MRI scanner was used for both planning and monitoring the procedure. RESULTS During the study period, a total of 26 patients underwent tcMRgFUS thalamic ablation for different movement disorders. Among these patients, 18 were diagnosed with ET and 4 were affected by PD. All patients with PD were treated using tcMRgFUS thalamic ablation and all completed the procedure. Among the 18 patients with ET, 13 successfully underwent tcMRgFUS, 4 aborted the procedure during ultrasound delivery, and 1 did not undergo the tcMRgFUS procedure after stereotactic frame placement. Two patients with ET were not included in the results because of the short follow-up duration at the time of this study. A monolateral VIM thalamic ablation in both ET and PD patients was performed. All the enrolled patients were evaluated before the treatment and 2 days after, with a clinical control of the treatment effectiveness using the graphic items of the Fahn-Tolosa-Marin tremor rating scale. A global reevaluation was performed 3 months (17/22 patients) and 6 months (11/22 patients) after the treatment; the reevaluation consisted of clinical questionnaires, neurological tests, and video recordings of the tests. All the ET and PD treated patients who completed the procedure showed an immediate amelioration of tremor severity, with no intra- or posttreatment severe permanent side effects. CONCLUSIONS Although this study reports on a small number of patients with a short follow-up duration, the tcMRgFUS procedure using a 1.5-T MRI unit resulted in a safe and effective treatment option for motor symptoms in patients with ET and PD. To the best of the authors' knowledge, this is the first clinical series in which thalamotomy was performed using tcMRgFUS integrated with a 1.5-T magnet.
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Affiliation(s)
- Domenico Gerardo Iacopino
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
| | - Antonella Giugno
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Giuseppe Roberto Giammalva
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Alessandro Napoli
- Radiology Section, Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" University of Rome; and
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Francesca Graziano
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Francesca Valentino
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Giuseppe Cosentino
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Marco D'Amelio
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
| | - Carlo Catalano
- Radiology Section, Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" University of Rome; and
| | - Brigida Fierro
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
| | - Roberto Lagalla
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
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8
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Pineda-Pardo JA, Urso D, Martínez-Fernández R, Rodríguez-Rojas R, del-Alamo M, Millar Vernetti P, Máñez-Miró JU, Hernández-Fernández F, de Luis-Pastor E, Vela-Desojo L, Obeso JA. Transcranial Magnetic Resonance-Guided Focused Ultrasound Thalamotomy in Essential Tremor: A Comprehensive Lesion Characterization. Neurosurgery 2019; 87:256-265. [DOI: 10.1093/neuros/nyz395] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/21/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) thalamotomy is a novel and effective treatment for controlling tremor in essential tremor patients.
OBJECTIVE
To provide a comprehensive characterization of the radiological, topographical, and volumetric aspects of the tcMRgFUS thalamic lesion, and to quantify how they relate to the clinical outcomes.
METHODS
In this study, clinical and radiological data from forty patients with medically-refractory essential tremor treated with unilateral tcMRgFUS thalamotomy were retrospectively analyzed. Treatment efficacy was assessed with Clinical Rating Scale for Tremor (CRST). Lesions were manually segmented on T1, T2, and susceptibility-weighted images, and 3-dimensional topographical analysis was then carried out. Statistical comparisons were performed using nonparametric statistics.
RESULTS
The greatest clinical improvement was correlated with a more inferior and posterior lesion, a bigger lesion volume, and percentage of the ventral intermediate nucleus covered by the lesion; whereas, the largest lesions accounted for the occurrence of gait imbalance. Furthermore, the volume of the lesion was significantly predicted by the number of sonications surpassing 52°C.
CONCLUSION
Here we provide a comprehensive characterization of the thalamic tcMRgFUS lesion including radiological and topographical analysis. Our results indicate that the location and volume of the lesion were significantly associated with the clinical outcome and that mid-temperatures may be responsible for the lesion size. This could serve ultimately to improve targeting and judgment and to optimize clinical outcome of tcMRgFUS thalamotomy.
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Affiliation(s)
- José Angel Pineda-Pardo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Daniele Urso
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Raul Martínez-Fernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Rafael Rodríguez-Rojas
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Marta del-Alamo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | | | - Jorge U Máñez-Miró
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Frida Hernández-Fernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Nursing
| | | | - Lydia Vela-Desojo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - José A Obeso
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
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9
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Ferri M, Bravo JM, Redondo J, Jiménez-Gambín S, Jiménez N, Camarena F, Sánchez-Pérez JV. On the Evaluation of the Suitability of the Materials Used to 3D Print Holographic Acoustic Lenses to Correct Transcranial Focused Ultrasound Aberrations. Polymers (Basel) 2019; 11:E1521. [PMID: 31546807 PMCID: PMC6780887 DOI: 10.3390/polym11091521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022] Open
Abstract
The correction of transcranial focused ultrasound aberrations is a relevant topic for enhancing various non-invasive medical treatments. Presently, the most widely accepted method to improve focusing is the emission through multi-element phased arrays; however, a new disruptive technology, based on 3D printed holographic acoustic lenses, has recently been proposed, overcoming the spatial limitations of phased arrays due to the submillimetric precision of the latest generation of 3D printers. This work aims to optimize this recent solution. Particularly, the preferred acoustic properties of the polymers used for printing the lenses are systematically analyzed, paying special attention to the effect of p-wave speed and its relationship to the achievable voxel size of 3D printers. Results from simulations and experiments clearly show that, given a particular voxel size, there are optimal ranges for lens thickness and p-wave speed, fairly independent of the emitted frequency, the transducer aperture, or the transducer-target distance.
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Affiliation(s)
- Marcelino Ferri
- Centro de Tecnologías Físicas, Universitat Politècnica de València, Camino de Vera S/N, 46020 Valencia, Spain.
| | - José María Bravo
- Centro de Tecnologías Físicas, Universitat Politècnica de València, Camino de Vera S/N, 46020 Valencia, Spain.
| | - Javier Redondo
- Instituto para la Gestión Integrada de las zonas Costeras, Universitat Politècnica de València, Carretera Nazaret-Oliva S/N, 46730 Valencia, Spain.
| | - Sergio Jiménez-Gambín
- Instituto de Instrumentación para Imagen Molecular, Centro Mixto CSIC-Universitat Politècnica de València, Camino de Vera S/N, 46022 València, Spain.
| | - Noé Jiménez
- Instituto de Instrumentación para Imagen Molecular, Centro Mixto CSIC-Universitat Politècnica de València, Camino de Vera S/N, 46022 València, Spain.
| | - Francisco Camarena
- Instituto de Instrumentación para Imagen Molecular, Centro Mixto CSIC-Universitat Politècnica de València, Camino de Vera S/N, 46022 València, Spain.
| | - Juan Vicente Sánchez-Pérez
- Centro de Tecnologías Físicas, Universitat Politècnica de València, Camino de Vera S/N, 46020 Valencia, Spain.
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10
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Sugrue LP, Desikan RS. Precision neuroradiology: mapping the nodes and networks that link genes to behaviour. Br J Radiol 2019; 92:20190093. [PMID: 31294609 PMCID: PMC6732927 DOI: 10.1259/bjr.20190093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
What is the future of neuroradiology in the era of precision medicine? As with any big change, this transformation in medicine presents both challenges and opportunities, and to flourish in this new environment we will have to adapt. It is difficult to predict exactly how neuroradiology will evolve in this shifting landscape, but there will be changes in both what we image and what we do. In terms of imaging, we will need to move beyond simply imaging brain anatomy and toward imaging function, both at the molecular and circuit level. In terms of what we do, we will need to move from the periphery of the clinical enterprise toward its center, with a new emphasis on integrating imaging with genetic and clinical data to form a comprehensive picture of the patient that can be used to direct further testing and care.The payoff is that these changes will align neuroradiology with the emerging field of precision psychiatry, which promises to replace symptom-based diagnosis and trial-and-error treatment of psychiatric disorders with diagnoses based on quantifiable genetic, imaging, physiologic, and behavioural criteria and therapies targeted to the particular pathophysiology of individual patients. Here we review some of the recent developments in behavioural genetics and neuroscience that are laying the foundation for precision psychiatry. By no means comprehensive, our goal is to introduce some of the perspectives and techniques that are likely to be relevant to the precision neuroradiologist of the future.
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Affiliation(s)
- Leo P Sugrue
- 1Departments of Radiology and Biomedical Imaging, University California, San Francisco, USA
| | - Rahul S Desikan
- 1Departments of Radiology and Biomedical Imaging, University California, San Francisco, USA.,2Department of Neurology, University California, San Francisco, USA
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11
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Gasca-Salas C, Guida P, Piredda R, Obeso I, Vela Desojo L, Martínez-Fernández R, Hernández-Fernández F, Máñez-Miró J, Pineda-Pardo JA, Del Álamo M, Rodriguez-Rojas R, Mata-Marín D, Alonso-Frech F, de Luis E, Obeso JA. Cognitive safety after unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. J Neurol Neurosurg Psychiatry 2019; 90:830-831. [PMID: 30850471 DOI: 10.1136/jnnp-2018-320129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Carmen Gasca-Salas
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain .,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Pasqualina Guida
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain
| | - Rosanna Piredda
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain
| | - Ignacio Obeso
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Lydia Vela Desojo
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain.,Neurology, Hospital Fundación Alcorcon, Alcorcon, Spain
| | - Raúl Martínez-Fernández
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | | | - Jorge Máñez-Miró
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain
| | - José A Pineda-Pardo
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Marta Del Álamo
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Rafael Rodriguez-Rojas
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - David Mata-Marín
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Fernando Alonso-Frech
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain.,Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Esther de Luis
- Radiology Department, University Hospital HM Puerta del Sur, Madrid, Spain
| | - Jose Angel Obeso
- Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
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12
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Caballero‐Insaurriaga J, Rodríguez‐Rojas R, Martínez‐Fernández R, Del‐Alamo M, Díaz‐Jiménez L, Ávila M, Martínez‐Rodrigo M, García‐Polo P, Pineda‐Pardo JA. Zero TE MRI applications to transcranial MR‐guided focused ultrasound: Patient screening and treatment efficiency estimation. J Magn Reson Imaging 2019; 50:1583-1592. [DOI: 10.1002/jmri.26746] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/29/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Jaime Caballero‐Insaurriaga
- hmCINAC (Centro Integral de Neurociencias)University Hospital HM Puerta del Sur, CEU‐San Pablo University Móstoles Madrid Spain
| | - Rafael Rodríguez‐Rojas
- hmCINAC (Centro Integral de Neurociencias)University Hospital HM Puerta del Sur, CEU‐San Pablo University Móstoles Madrid Spain
| | - Raúl Martínez‐Fernández
- hmCINAC (Centro Integral de Neurociencias)University Hospital HM Puerta del Sur, CEU‐San Pablo University Móstoles Madrid Spain
| | - Marta Del‐Alamo
- hmCINAC (Centro Integral de Neurociencias)University Hospital HM Puerta del Sur, CEU‐San Pablo University Móstoles Madrid Spain
| | - Laura Díaz‐Jiménez
- Department of RadiologyUniversity Hospital HM Puerta del Sur Móstoles Madrid Spain
| | - María Ávila
- hmCINAC (Centro Integral de Neurociencias)University Hospital HM Puerta del Sur, CEU‐San Pablo University Móstoles Madrid Spain
| | - María Martínez‐Rodrigo
- hmCINAC (Centro Integral de Neurociencias)University Hospital HM Puerta del Sur, CEU‐San Pablo University Móstoles Madrid Spain
| | | | - José A. Pineda‐Pardo
- hmCINAC (Centro Integral de Neurociencias)University Hospital HM Puerta del Sur, CEU‐San Pablo University Móstoles Madrid Spain
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13
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Pineda-Pardo JA, Martínez-Fernández R, Rodríguez-Rojas R, Del-Alamo M, Hernández F, Foffani G, Dileone M, Máñez-Miró JU, De Luis-Pastor E, Vela L, Obeso JA. Microstructural changes of the dentato-rubro-thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor. Hum Brain Mapp 2019; 40:2933-2942. [PMID: 30865338 DOI: 10.1002/hbm.24569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/05/2019] [Accepted: 02/28/2019] [Indexed: 12/13/2022] Open
Abstract
Essential tremor is the most common movement disorder in adults. In patients who are not responsive to medical treatment, functional neurosurgery and, more recently, transcranial MR-guided focused ultrasound thalamotomy are considered effective therapeutic approaches. However, the structural brain changes following a thalamotomy that mediates the clinical improvement are still unclear. In here diffusion weighted images were acquired in a cohort of 24 essential tremor patients before and 3 months after unilateral transcranial MR-guided focused ultrasound thalamotomy targeting at the posteroventral part of the VIM. Microstructural changes along the DRTT were quantified by means of probabilistic tractography, and later related to the clinical improvement of the patients at 3-months and at 1-year after the intervention. In addition the changes along two neighboring tracts, that is, the corticospinal tract and the medial lemniscus, were assessed, as well as the relation between these changes and the presence of side effects. Thalamic lesions produced local and distant alterations along the trajectory of the DRTT, and each correlated with clinical improvement. Regarding side effects, gait imbalance after thalamotomy was associated with greater impact on the DRTT, whereas the presence of paresthesias was significantly related to a higher overlap between the lesion and the medial lemniscus. This work represents the largest series describing the microstructural changes following transcranial MR-guided focused ultrasound thalamotomy in essential tremor. These results suggest that clinical benefits are specific for the impact on the cerebello-thalamo-cortical pathway, thus reaffirming the potential of tractography to aid thalamotomy targeting.
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Affiliation(s)
- Jose A Pineda-Pardo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Raul Martínez-Fernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Rafael Rodríguez-Rojas
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Marta Del-Alamo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
| | - Frida Hernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
| | - Guglielmo Foffani
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Michele Dileone
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
| | - Jorge U Máñez-Miró
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
| | | | - Lydia Vela
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - José A Obeso
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
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14
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Ferri M, Bravo JM, Redondo J, Sánchez-Pérez JV. Enhanced Numerical Method for the Design of 3-D-Printed Holographic Acoustic Lenses for Aberration Correction of Single-Element Transcranial Focused Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:867-884. [PMID: 30600128 DOI: 10.1016/j.ultrasmedbio.2018.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Abstract
The correction of transcranial focused ultrasound aberrations is a relevant issue for enhancing various non-invasive medical treatments. The emission through multi-element phased arrays has been the most widely accepted method to improve focusing in recent years; however, the number and size of transducers represent a bottleneck that limits the focusing accuracy of the technique. To overcome this limitation, a new disruptive technology, based on 3-D-printed acoustic lenses, has recently been proposed. As the submillimeter precision of the latest generation of 3-D printers has been proven to overcome the spatial limitations of phased arrays, a new challenge is to improve the accuracy of the numerical simulations required to design this type of ultrasound lens. In the study described here, we evaluated two improvements in the numerical model applied in previous works for the design of 3-D-printed lenses: (i) allowing the propagation of shear waves in the skull by means of its simulation as an isotropic solid and (ii) introduction of absorption into the set of equations that describes the dynamics of the wave in both fluid and solid media. The results obtained in the numerical simulations are evidence that the inclusion of both s-waves and absorption significantly improves focusing.
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Affiliation(s)
- Marcelino Ferri
- Centro de Tecnologías Físicas, Universidad Politécnica de Valencia, Valencia, Spain.
| | - José M Bravo
- Centro de Tecnologías Físicas, Universidad Politécnica de Valencia, Valencia, Spain
| | - Javier Redondo
- Instituto para la Gestión Integrada de las zonas Costeras, Universidad Politécnica de Valencia, Valencia, Spain
| | - Juan V Sánchez-Pérez
- Centro de Tecnologías Físicas, Universidad Politécnica de Valencia, Valencia, Spain
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15
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Bobola MS, Chen L, Ezeokeke CK, Kuznetsova K, Lahti AC, Lou W, Myroniv AN, Schimek NW, Selby ML, Mourad PD. A Review of Recent Advances in Ultrasound, Placed in the Context of Pain Diagnosis and Treatment. Curr Pain Headache Rep 2018; 22:60. [PMID: 29987680 PMCID: PMC6061208 DOI: 10.1007/s11916-018-0711-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ultrasound plays a significant role in the diagnosis and treatment of pain, with significant literature reaching back many years, especially with regard to diagnostic ultrasound and its use for guiding needle-based delivery of drugs. Advances in ultrasound over at least the last decade have opened up new areas of inquiry and potential clinical efficacy in the context of pain diagnosis and treatment. Here we offer an overview of the recent literature associated with ultrasound and pain in order to highlight some promising frontiers at the intersection of these two subjects. We focus first on peripheral application of ultrasound, for which there is a relatively rich, though still young, literature. We then move to central application of ultrasound, for which there is little literature but much promise.
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Affiliation(s)
- Michael S Bobola
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Lucas Chen
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | | | - Katy Kuznetsova
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Annamarie C Lahti
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Weicheng Lou
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Aleksey N Myroniv
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Nels W Schimek
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Madison L Selby
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Pierre D Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA.
- Division of Engineering and Mathematics, University of Washington, Bothell, WA, USA.
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16
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Kim YG, Chang JW. High-Intensity Focused Ultrasound Surgery for the Treatment of Obsessive–Compulsive Disorder. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00086-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Alghamdi NA, Hankiewicz JH, Anderson NR, Stupic KF, Camley RE, Przybylski M, Zukrowski J, Celinski Z. Development of Ferrite-Based Temperature Sensors for Magnetic Resonance Imaging: A Study of Cu 1-xZn xFe 2O 4. PHYSICAL REVIEW APPLIED 2018; 9:10.1103/PhysRevApplied.9.054030. [PMID: 31093520 PMCID: PMC6512831 DOI: 10.1103/physrevapplied.9.054030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We investigate the use of Cu1-x Zn x Fe2O4 ferrites (0.60 < x < 0.76) as potential sensors for magnetic- resonance-imaging thermometry. Samples are prepared by a standard ceramic technique. Their structural and magnetic properties are determined using x-ray diffraction, scanning electron microscopy, super-conducting quantum-interference device magnetometry, and Mossbauer and 3-T nuclear-magnetic-resonance spectroscopies. We use the mass magnetization of powdered ferrites and transverse relaxivity r*2 of water protons in Ringer's-solution-based agar gels with embedded micron-sized particles to determine the best composition for magnetic-resonance-imaging (MRI) temperature sensors in the (280-323)-K range. A preclinical 3-T MRI scanner is employed to acquire T*2 weighted temperature-dependent images. The brightness of the MRI images is cross-correlated with the temperature of the phantoms, which allows for a temperature determination with approximately 1°C accuracy. We determine that the composition of 0.65 < x < 0.70 is the most suitable for MRI thermometry near human body temperature.
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Affiliation(s)
- N. A. Alghamdi
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs 1420 Austin Bluffs Parkway, Colorado 80918, USA
- Corresponding author.
| | - J. H. Hankiewicz
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs 1420 Austin Bluffs Parkway, Colorado 80918, USA
| | - N. R. Anderson
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs 1420 Austin Bluffs Parkway, Colorado 80918, USA
| | - K. F. Stupic
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - R. E. Camley
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs 1420 Austin Bluffs Parkway, Colorado 80918, USA
| | - M. Przybylski
- Academic Centre for Materials and Nanotechnology, AGH University of Science and Technology, 30-059 Krakow, Poland
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, 30-059 Krakow, Poland
| | - J. Zukrowski
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, 30-059 Krakow, Poland
| | - Z. Celinski
- UCCS BioFrontiers Center, University of Colorado, Colorado Springs 1420 Austin Bluffs Parkway, Colorado 80918, USA
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18
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19
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Fishman PS, Frenkel V. Focused Ultrasound: An Emerging Therapeutic Modality for Neurologic Disease. Neurotherapeutics 2017; 14:393-404. [PMID: 28244011 PMCID: PMC5398988 DOI: 10.1007/s13311-017-0515-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Therapeutic ultrasound is only beginning to be applied to neurologic conditions, but the potential of this modality for a wide spectrum of brain applications is high. Engineering advances now allow sound waves to be targeted through the skull to a brain region selected with real time magnetic resonance imaging and thermography, using a commercial array of focused emitters. High intensities of sonic energy can create a coagulation lesion similar to that of older radiofrequency stereotactic methods, but without opening the skull. This has led to the recent Food and Drug Administration approval of focused ultrasound (FUS) thalamotomy for unilateral treatment of essential tremor. Clinical studies of stereotactic FUS for aspects of Parkinson's disease, chronic pain, and refractory psychiatric indications are underway, with promising results. Moderate-intensity FUS has the potential to safely open the blood-brain barrier for localized delivery of therapeutics, while low levels of sonic energy can be used as a form of neuromodulation.
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Affiliation(s)
- Paul S Fishman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Victor Frenkel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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20
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Vyas U, Ghanouni P, Halpern CH, Elias J, Pauly KB. Predicting variation in subject thermal response during transcranial magnetic resonance guided focused ultrasound surgery: Comparison in seventeen subject datasets. Med Phys 2017; 43:5170. [PMID: 27587047 DOI: 10.1118/1.4955436] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) treatments, the acoustic and spatial heterogeneity of the skull cause reflection, absorption, and scattering of the acoustic beams. These effects depend on skull-specific parameters and can lead to patient-specific thermal responses to the same transducer power. In this work, the authors develop a simulation tool to help predict these different experimental responses using 3D heterogeneous tissue models based on the subject CT images. The authors then validate and compare the predicted skull efficiencies to an experimental metric based on the subject thermal responses during tcMRgFUS treatments in a dataset of seventeen human subjects. METHODS Seventeen human head CT scans were used to create tissue acoustic models, simulating the effects of reflection, absorption, and scattering of the acoustic beam as it propagates through a heterogeneous skull. The hybrid angular spectrum technique was used to model the acoustic beam propagation of the InSightec ExAblate 4000 head transducer for each subject, yielding maps of the specific absorption rate (SAR). The simulation assumed the transducer was geometrically focused to the thalamus of each subject, and the focal SAR at the target was used as a measure of the simulated skull efficiency. Experimental skull efficiency for each subject was calculated using the thermal temperature maps from the tcMRgFUS treatments. Axial temperature images (with no artifacts) were reconstructed with a single baseline, corrected using a referenceless algorithm. The experimental skull efficiency was calculated by dividing the reconstructed temperature rise 8.8 s after sonication by the applied acoustic power. RESULTS The simulated skull efficiency using individual-specific heterogeneous models predicts well (R(2) = 0.84) the experimental energy efficiency. CONCLUSIONS This paper presents a simulation model to predict the variation in thermal responses measured in clinical ctMRGFYS treatments while being computationally feasible.
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Affiliation(s)
- Urvi Vyas
- Department of Radiology, Stanford University, Stanford, California 94305
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, Stanford, California 94305
| | - Casey H Halpern
- Department of Radiology, Stanford University, Stanford, California 94305
| | - Jeff Elias
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia 22908
| | - Kim Butts Pauly
- Department of Radiology, Stanford University, Stanford, California 94305
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21
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Restoring Neurological Physiology: The Innovative Role of High-Energy MR-Guided Focused Ultrasound (HIMRgFUS). Preliminary Data from a New Method of Lesioning Surgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017. [PMID: 28120053 DOI: 10.1007/978-3-319-39546-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Tremor is a disabling condition, common to several neurodegenerative diseases. Lesioning procedures and deep brain stimulation, respectively, of the ventralis intermedius nucleus for intentional tremor, and of the subthalamic nucleus for parkinsonian resting tremor, have been introduced in clinical practice for patients refractory to medical treatment. The combination of high-energy focused ultrasound (HIFUS) with sophisticated magnetic resonance (MR) instrumentation, together with accurate knowledge of the stereotactic brain coordinates, represents a revolution in neuromodulation. METHODS At the Neurosurgical Clinic and the Radiology Department of the University of Palermo,, two patients affected by severe and refractory forms of intentional tremor were treated by MRI-guided FUS (MRgFUS) with a unique 1.5 T MR scanner prototype that uses FUS. This apparatus is the only one of its type in the world." FINDINGS This is the first Italian experience, and the second in Europe, of treatment with MRI-gFUS for intentional tremor. But this is the very first experience in which a 1.5 T MRI apparatus was used. In both patients, the treatment completely abolished the tremor on the treated side, with results being excellent and stable after 7 and 5 months, respectively; no side effects were encountered. CONCLUSION MRgFUS, recently introduced in clinical practice, and widely used at several clinical centers, has been shown to be a valid therapeutic alternative in the treatment of tremor in several neurodegenerative diseases. It is virtually safe, noninvasive, and very efficacious. We report this technique in which a 1.5 T MR scanner was used. Further investigations with long-term follow up and larger clinical series are needed.
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22
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Tsai SJ. Therapeutic Potential of Transcranial Focused Ultrasound for Rett Syndrome. Med Sci Monit 2016; 22:4026-4029. [PMID: 27786169 PMCID: PMC5087669 DOI: 10.12659/msm.898041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rett syndrome (RTT) is a severe neurodevelopmental disorder occurring almost exclusively in females and is caused by loss-of-function mutations in the gene encoding methyl-CpG-binding protein 2 (MeCP2) in the majority of cases. MeCP2 is essential for the normal function of nerve cells, including neuronal development, maturation, and synaptic activity. RTT is characterized by normal early development followed by autistic-like features, slowed brain and head growth, gait abnormalities, seizures, breathing irregularities, and cognitive disabilities. Medical management in RTT remains supportive and symptomatic. Brain-derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of RTT. Recent studies have shown a phenotypic reversal by increasing BDNF expression in a RTT mouse model. Thus, manipulation of BDNF expression/signaling in the brain could be therapeutic for this disease. Transcranial focused ultrasound for (tFUS) can noninvasively focally modulate human cortical function, stimulate neurogenesis, and increase BDNF in animal studies. Consequently, tFUS may be of therapeutic potential for Rett syndrome. Further evaluation of the therapeutic effects of tFUS in Mecp2 deficient animal models is needed before clinical trials can begin.
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Affiliation(s)
- Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taiepi, Taiwan
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23
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Mangraviti A, Gullotti D, Tyler B, Brem H. Nanobiotechnology-based delivery strategies: New frontiers in brain tumor targeted therapies. J Control Release 2016; 240:443-453. [DOI: 10.1016/j.jconrel.2016.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/05/2016] [Accepted: 03/18/2016] [Indexed: 02/06/2023]
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Hersh DS, Nguyen BA, Dancy JG, Adapa AR, Winkles JA, Woodworth GF, Kim AJ, Frenkel V. Pulsed ultrasound expands the extracellular and perivascular spaces of the brain. Brain Res 2016; 1646:543-550. [PMID: 27369449 DOI: 10.1016/j.brainres.2016.06.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Diffusion within the extracellular and perivascular spaces of the brain plays an important role in biological processes, therapeutic delivery, and clearance mechanisms within the central nervous system. Recently, ultrasound has been used to enhance the dispersion of locally administered molecules and particles within the brain, but ultrasound-mediated effects on the brain parenchyma remain poorly understood. We combined an electron microscopy-based ultrastructural analysis with high-resolution tracking of non-adhesive nanoparticles in order to probe changes in the extracellular and perivascular spaces of the brain following a non-destructive pulsed ultrasound regimen known to alter diffusivity in other tissues. Freshly obtained rat brain neocortical slices underwent sham treatment or pulsed, low intensity ultrasound for 5min at 1MHz. Transmission electron microscopy revealed intact cells and blood vessels and evidence of enlarged spaces, particularly adjacent to blood vessels, in ultrasound-treated brain slices. Additionally, ultrasound significantly increased the diffusion rate of 100nm, 200nm, and 500nm nanoparticles that were injected into the brain slices, while 2000nm particles were unaffected. In ultrasound-treated slices, 91.6% of the 100nm particles, 20.7% of the 200nm particles, 13.8% of the 500nm particles, and 0% of the 2000nm particles exhibited diffusive motion. Thus, pulsed ultrasound can have meaningful structural effects on the brain extracellular and perivascular spaces without evidence of tissue disruption.
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Affiliation(s)
- David S Hersh
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S Greene St Suite 12D, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
| | - Ben A Nguyen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W Redwood St Suite 110, Baltimore, MD 21201, USA
| | - Jimena G Dancy
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S Greene St Suite 12D, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
| | - Arjun R Adapa
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S Greene St Suite 12D, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
| | - Jeffrey A Winkles
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA; Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, UMB BioPark, One Room 210, 800 West Baltimore Street Baltimore, MD 21201, USA
| | - Graeme F Woodworth
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S Greene St Suite 12D, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
| | - Anthony J Kim
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S Greene St Suite 12D, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA; Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn Street, HSFII Room 520, Baltimore, MD 21201, USA; Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, 111 S. Penn St. Suite 104, Baltimore, MD 21201, USA.
| | - Victor Frenkel
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 419 W Redwood St Suite 110, Baltimore, MD 21201, USA.
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25
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Focused ultrasound to transiently disrupt the blood brain barrier. J Clin Neurosci 2016; 28:187-9. [PMID: 26883350 DOI: 10.1016/j.jocn.2015.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
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26
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McDannold N, Zhang Y, Vykhodtseva N. Nonthermal ablation in the rat brain using focused ultrasound and an ultrasound contrast agent: long-term effects. J Neurosurg 2016; 125:1539-1548. [PMID: 26848919 DOI: 10.3171/2015.10.jns151525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Thermal ablation with transcranial MRI-guided focused ultrasound (FUS) is currently under investigation as a less invasive alternative to radiosurgery and resection. A major limitation of the method is that its use is currently restricted to centrally located brain targets. The combination of FUS and a microbubble-based ultrasound contrast agent greatly reduces the ultrasound exposure level needed to ablate brain tissue and could be an effective means to increase the "treatment envelope" for FUS in the brain. This method, however, ablates tissue through a different mechanism: destruction of the microvasculature. It is not known whether nonthermal FUS ablation in substantial volumes of tissue can safely be performed without unexpected effects. The authors investigated this question by ablating volumes in the brains of normal rats. METHODS Overlapping sonications were performed in rats (n = 15) to ablate a volume in 1 hemisphere per animal. The sonications (10-msec bursts at 1 Hz for 60 seconds; peak negative pressure 0.8 MPa) were combined with the ultrasound contrast agent Optison (100 µl/kg). The rats were followed with MRI for 4-9 weeks after FUS, and the brains were examined with histological methods. RESULTS Two weeks after sonication and later, the lesions appeared as cyst-like areas in T2-weighted MR images that were stable over time. Histological examination demonstrated well-defined lesions consisting of a cyst-like cavity that remained lined by astrocytic tissue. Some white matter structures within the sonicated area were partially intact. CONCLUSIONS The results of this study indicate that nonthermal FUS ablation can be used to safely ablate tissue volumes in the brain without unexpected delayed effects. The findings are encouraging for the use of this ablation method in the brain.
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Affiliation(s)
- Nathan McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yongzhi Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Natalia Vykhodtseva
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Xiong X, Sun Y, Sattiraju A, Jung Y, Mintz A, Hayasaka S, Li KCP. Remote spatiotemporally controlled and biologically selective permeabilization of blood-brain barrier. J Control Release 2015; 217:113-20. [PMID: 26334482 DOI: 10.1016/j.jconrel.2015.08.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 12/13/2022]
Abstract
The blood-brain barrier (BBB), comprised of brain endothelial cells with tight junctions (TJ) between them, regulates the extravasation of molecules and cells into and out of the central nervous system (CNS). Overcoming the difficulty of delivering therapeutic agents to specific regions of the brain presents a major challenge to treatment of a broad range of brain disorders. Current strategies for BBB opening are invasive, not specific, and lack precise control over the site and timing of BBB opening, which may limit their clinical translation. In the present report, we describe a novel approach based on a combination of stem cell delivery, heat-inducible gene expression and mild heating with high-intensity focused ultrasound (HIFU) under MRI guidance to remotely permeabilize BBB. The permeabilization of the BBB will be controlled with, and limited to where selected pro-inflammatory factors will be secreted secondary to HIFU activation, which is in the vicinity of the engineered stem cells and consequently both the primary and secondary disease foci. This therapeutic platform thus represents a non-invasive way for BBB opening with unprecedented spatiotemporal precision, and if properly and specifically modified, can be clinically translated to facilitate delivery of different diagnostic and therapeutic agents which can have great impact in treatment of various disease processes in the central nervous system.
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Affiliation(s)
- Xiaobing Xiong
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem 27157, USA
| | - Yao Sun
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem 27157, USA
| | - Anirudh Sattiraju
- Comprehensive Cancer Center, Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem 27157, USA
| | - Youngkyoo Jung
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem 27157, USA; Comprehensive Cancer Center, Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem 27157, USA; Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem 27157, USA
| | - Akiva Mintz
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem 27157, USA; Comprehensive Cancer Center, Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem 27157, USA
| | - Satoru Hayasaka
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem 27157, USA; Department of Biostatistics Sciences, Wake Forest School of Medicine, Winston-Salem 27157, USA
| | - King C P Li
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem 27157, USA.
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28
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Ghanouni P, Pauly KB, Elias WJ, Henderson J, Sheehan J, Monteith S, Wintermark M. Transcranial MRI-Guided Focused Ultrasound: A Review of the Technologic and Neurologic Applications. AJR Am J Roentgenol 2015; 205:150-9. [PMID: 26102394 PMCID: PMC4687492 DOI: 10.2214/ajr.14.13632] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This article reviews the physical principles of MRI-guided focused ultra-sound and discusses current and potential applications of this exciting technology. CONCLUSION MRI-guided focused ultrasound is a new minimally invasive method of targeted tissue thermal ablation that may be of use to treat central neuropathic pain, essential tremor, Parkinson tremor, and brain tumors. The system has also been used to temporarily disrupt the blood-brain barrier to allow targeted drug delivery to brain tumors.
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Affiliation(s)
- Pejman Ghanouni
- Stanford University, Department of Radiology, Division of Body MRI, Stanford, CA
| | - Kim Butts Pauly
- Stanford University, Departments of Radiology and Electrical Engineering and Bioengineering, Stanford, CA
| | - W. Jeff Elias
- University of Virginia, Department of Neurosurgery, Charlottesville, VA
| | - Jaimie Henderson
- Stanford University, Department of Neurosurgery and Neurology and Neurological Sciences, Stanford, CA
| | - Jason Sheehan
- University of Virginia, Department of Neurosurgery, Charlottesville, VA
| | | | - Max Wintermark
- Stanford University, Department of Radiology, Division of Neuroradiology, Stanford, CA
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29
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Tsai SJ. Transcranial focused ultrasound as a possible treatment for major depression. Med Hypotheses 2015; 84:381-3. [PMID: 25665863 DOI: 10.1016/j.mehy.2015.01.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/27/2014] [Accepted: 01/21/2015] [Indexed: 12/28/2022]
Abstract
Antidepressants are currently used as initial therapies for major depressive disorder (MDD). However, despite the remarkable increase in medications validated as effective in MDD, treatments are still plagued by inadequate responses in part of MDD patients. For MDD with inadequate responses to medications, brain stimulation methods such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) have been used as alternative strategies for treatment of depression, although each of these modalities has an indication for MDD treatment resistance and suffers from a limitation or weakness. Thus, development of new strategies based on novel theories of MDD may help to develop faster and more effective treatments for MDD. Recent studies have suggested that decreased brain brain-derived neurotrophic factor (BDNF) may be involved in the pathogenesis of MDD. Moreover, increasing brain BDNF and adult hippocampal neurogenesis have been implicated in some of the therapeutic mechanisms of antidepressants. Transcranial focused ultrasound (tFUS), a novel technique to deliver highly focused acoustic energy to a small brain region, has been used for targeted drug delivery by increasing blood-brain barrier permeability, and it can noninvasively focally modulate human cortical function. Recent animal studies have demonstrated that tFUS stimulation can increase BDNF and neurogenesis in mice. Furthermore, the increase blood-brain barrier (BBB) permeability may increase delivery of serum BDNF to the brain. From the above evidence, tFUS can increase brain BDNF levels and neurogenesis in the hippocampus, suggesting it could be an alternative strategy for the treatment of MDD. Further investigations into the frequency and duration of tFUS stimulation are needed to verify the efficacy of this intervention in depressive disorders.
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Affiliation(s)
- Shih-Jen Tsai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taiwan, ROC; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taiwan, ROC.
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30
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Jolesz FA. Science to practice: opening the blood-brain barrier with focused ultrasound-a potential treatment for Alzheimer disease? Radiology 2015; 273:631-3. [PMID: 25420161 DOI: 10.1148/radiol.14142033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Burgess et al ( 1 ) present intriguing results of repetitive transient opening of the blood-brain barrier (BBB) in a transgenic mouse model of advanced Alzheimer disease (AD). The results underscore the potential of using magnetic resonance (MR) imaging-guided focused ultrasound and microbubble ultrasonography (US) contrast agents for the disruption of the BBB as a potential long-term therapy to reduce amyloid plaque burden and improve cognitive performance. This daring conclusion that is based on an experimental animal model should now be confirmed in humans. Considering that the technology is commercially available and given the immense clinical need, clinical trials in this AD treatment should be initiated as soon as possible.
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Affiliation(s)
- Ferenc A Jolesz
- Department of Radiology Brigham and Women's Hospital 75 Francis St, Boston, MA 02115
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31
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Coluccia D, Fandino J, Schwyzer L, O'Gorman R, Remonda L, Anon J, Martin E, Werner B. First noninvasive thermal ablation of a brain tumor with MR-guided focused ultrasound. J Ther Ultrasound 2014; 2:17. [PMID: 25671132 PMCID: PMC4322509 DOI: 10.1186/2050-5736-2-17] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 08/27/2014] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) allows for precise
thermal ablation of target tissues. While this emerging modality is increasingly
used for the treatment of various types of extracranial soft tissue tumors, it
has only recently been acknowledged as a modality for noninvasive neurosurgery.
MRgFUS has been particularly successful for functional neurosurgery, whereas its
clinical application for tumor neurosurgery has been delayed for various
technical and procedural reasons. Here, we report the case of a 63-year-old
patient presenting with a centrally located recurrent glioblastoma who was
included in our ongoing clinical phase I study aimed at evaluating the
feasibility and safety of transcranial MRgFUS for brain tumor ablation. Applying
25 high-power sonications under MR imaging guidance, partial tumor ablation
could be achieved without provoking neurological deficits or other adverse
effects in the patient. This proves, for the first time, the feasibility of
using transcranial MR-guided focused ultrasound to safely ablate substantial
volumes of brain tumor tissue.
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Affiliation(s)
- Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Brain Tumor Center, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Brain Tumor Center, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Lucia Schwyzer
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland ; Brain Tumor Center, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Ruth O'Gorman
- Center for MR Research, University Children's Hospital, 8032 Zürich, Switzerland ; Children's Research Center, University Children's Hospital, 8032 Zürich, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Javier Anon
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Ernst Martin
- Center for MR Research, University Children's Hospital, 8032 Zürich, Switzerland ; Children's Research Center, University Children's Hospital, 8032 Zürich, Switzerland
| | - Beat Werner
- Center for MR Research, University Children's Hospital, 8032 Zürich, Switzerland ; Children's Research Center, University Children's Hospital, 8032 Zürich, Switzerland
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32
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Schramm J. Epilepsy Surgery and the Evolution of Clinical and Translational Science. Neurosurgery 2014; 61 Suppl 1:54-65. [DOI: 10.1227/neu.0000000000000399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Johannes Schramm
- Professor emeritus, Medical Faculty, Bonn University, Bonn, Germany
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33
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Christian E, Yu C, Apuzzo MLJ. Focused ultrasound: relevant history and prospects for the addition of mechanical energy to the neurosurgical armamentarium. World Neurosurg 2014; 82:354-65. [PMID: 24952224 DOI: 10.1016/j.wneu.2014.06.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/08/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
Although the concept of focused ultrasonography emerged more than 70 years ago, the need for a craniectomy obviated its development as a noninvasive technology. Since then advances in phased array transducers and magnetic resonance imaging technology have resurrected the ultrasound as a noninvasive therapeutic for a plethora of neurological conditions ranging from embolic stroke and intracranial hemorrhage to movement disorders and brain neoplasia. In the same way that stereotactic radiosurgery has fundamentally changed the scope and treatment paradigms of tumor and specifically skull base surgery, focused ultrasound has a similar potential to revolutionize the field of neurological surgery. In addition, focused ultrasound comes without the general complexity or the risks of ionizing radiation that accompany radiosurgery. As the quest for minimally invasive and noninvasive therapeutics continues to define the new neurosurgery, the focused ultrasound evolves to join the neurosurgical armamentarium.
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Affiliation(s)
- Eisha Christian
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Cheng Yu
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
| | - Michael L J Apuzzo
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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