In vivo MR acoustic radiation force imaging in the porcine liver

Magnetic Resonance Acoustic Radiation Force Imaging (MR-ARFI) for the monitoring of High Intensity Focused Ultrasound (HIFU) ablation in anisotropic tissue

OBJECTIVE

We introduce a non-invasive MR-Acoustic Radiation Force Imaging (ARFI)-based elastography method that provides both the local shear modulus and temperature maps for the monitoring of High Intensity Focused Ultrasound (HIFU) therapy.

MATERIALS AND METHODS

To take tissue anisotropy into account, the local shear modulus μ is determined in selected radial directions around the focal spot by fitting the phase profiles to a linear viscoelastic model, including tissue-specific mechanical relaxation time τ. MR-ARFI was evaluated on a calibrated phantom, then applied to the monitoring of HIFU in a gel phantom, ex vivo and in vivo porcine muscle tissue, in parallel with MR-thermometry.

RESULTS

As expected, the shear modulus polar maps reflected the isotropy of phantoms and the anisotropy of muscle. In the HIFU monitoring experiments, both the shear modulus polar map and the thermometry map were updated with every pair of MR-ARFI phase images acquired with opposite MR-ARFI-encoding. The shear modulus was found to decrease (phantom and ex vivo) or increase (in vivo) during heating, before remaining steady during the cooling phase. The mechanical relaxation time, estimated pre- and post-HIFU, was found to vary in muscle tissue.

DISCUSSION

MR-ARFI allowed for monitoring of viscoelasticity changes around the HIFU focal spot even in anisotropic muscle tissue.

SPatiotemporal-ENcoded acoustic radiation force imaging of focused ultrasound

Neuromodulation technology has provided novel therapeutic approaches for diseases caused by neural circuit dysfunction. Transcranial focused ultrasound (FU) is an emerging neuromodulation approach that combines noninvasiveness with relatively sharp focus, even in deep brain regions. It has numerous advantages such as high precision and good safety in neuromodulation, allowing for modulation of both peripheral and central nervous systems. To ensure accurate treatment targeting in FU neuromodulation, a magnetic resonance acoustic radiation force imaging (MR-ARFI) sequence is crucial for the visualization of the focal point. Currently, the commonly used 2D Spin Echo ARFI (2D SE-ARFI) sequence suffers from the long acquisition time, while the echo planar imaging ARFI (EPI-ARFI) sequence with a shorter acquisition time is vulnerable to the magnetic field inhomogeneities. To address these problems, we proposed a spatiotemporal-encoded acoustic radiation force imaging sequence (i.e., SE-SPEN-ARFI, shortened to SPEN-ARFI) in this study. The displacement at the focal spot obtained was highly consistent with that of the SE-ARFI sequence. Our research shows that SPEN-ARFI allows for rapid image acquisition and has less image distortions even under great field inhomogeneities. Therefore, a SPEN-ARFI sequence is a practical alternative for the treatment planning in ultrasound neuromodulation.

Reduced-field of view three-dimensional MR acoustic radiation force imaging with a low-rank reconstruction for targeting transcranial focused ultrasound

PURPOSE

To rapidly image and localize the focus in MR-guided focused ultrasound (FUS) while maintaining a low ultrasound duty cycle to minimize tissue effects.

METHODS

MR-acoustic radiation force imaging (ARFI) is key to targeting FUS procedures such as neuromodulation, and works by encoding ultrasound-induced displacements into the phase of MR images. However, it can require long scan times to cover a volume of tissue, especially when minimizing the FUS dose during targeting is paramount. To simultaneously minimize scan time and the FUS duty cycle, a 2-min three-dimensional (3D) reduced-FOV spin echo ARFI scan with two-dimensional undersampling was implemented at 3T with a FUS duty cycle of 0.85%. The 3D k-space sampling scheme incorporated uniform undersampling in one phase-encoded axis and partial Fourier (PF) sampling in the other. The scan interleaved FUS-on and FUS-off data collection to improve displacement map quality via a joint low-rank image reconstruction. Experiments in agarose and graphite phantoms and living macaque brains for neuromodulation and blood-brain barrier opening studied the effects of the sampling and reconstruction strategy on the acquisition, and evaluated its repeatability and accuracy.

RESULTS

In the phantom, the distances between displacement centroids of 10 prospective reconstructions and a fully sampled reference were below 1 mm. In in vivo brain, the distances between centroids ranged from 1.3 to 2.1 mm. Results in phantom and in vivo brain both showed that the proposed method can recover the FUS focus compared to slower fully sampled scans.

CONCLUSION

The proposed 3D MR-ARFI reduced-FOV method enables rapid imaging of the FUS focus while maintaining a low FUS duty cycle.

A Review of Imaging Methods to Assess Ultrasound-Mediated Ablation

Ultrasound ablation techniques are minimally invasive alternatives to surgical resection and have rapidly increased in use. The response of tissue to HIFU ablation differs based on the relative contributions of thermal and mechanical effects, which can be varied to achieve optimal ablation parameters for a given tissue type and location. In tumor ablation, similar to surgical resection, it is desirable to include a safety margin of ablated tissue around the entirety of the tumor. A factor in optimizing ablative techniques is minimizing the recurrence rate, which can be due to incomplete ablation of the target tissue. Further, combining focal ablation with immunotherapy is likely to be key for effective treatment of metastatic cancer, and therefore characterizing the impact of ablation on the tumor microenvironment will be important. Thus, visualization and quantification of the extent of ablation is an integral component of ablative procedures. The aim of this review article is to describe the radiological findings after ultrasound ablation across multiple imaging modalities. This review presents readers with a general overview of the current and emerging imaging methods to assess the efficacy of ultrasound ablative treatments.

Histologic safety of transcranial focused ultrasound neuromodulation and magnetic resonance acoustic radiation force imaging in rhesus macaques and sheep

BACKGROUND

Neuromodulation by transcranial focused ultrasound (FUS) offers the potential to non-invasively treat specific brain regions, with treatment location verified by magnetic resonance acoustic radiation force imaging (MR-ARFI).

OBJECTIVE

To investigate the safety of these methods prior to widespread clinical use, we report histologic findings in two large animal models following FUS neuromodulation and MR-ARFI.

METHODS

Two rhesus macaques and thirteen Dorset sheep were studied. FUS neuromodulation was targeted to the primary visual cortex in rhesus macaques and to subcortical locations, verified by MR-ARFI, in eleven sheep. Both rhesus macaques and five sheep received a single FUS session, whereas six sheep received repeated sessions three to six days apart. The remaining two control sheep did not receive ultrasound but otherwise underwent the same anesthetic and MRI procedures as the eleven experimental sheep. Hematoxylin and eosin-stained sections of brain tissue (harvested zero to eleven days following FUS) were evaluated for tissue damage at FUS and control locations as well as tissue within the path of the FUS beam. TUNEL staining was used to evaluate for the presence of apoptosis in sheep receiving high dose FUS.

RESULTS

No FUS-related pre-mortem histologic findings were observed in the rhesus macaques or in any of the examined sheep. Extravascular red blood cells (RBCs) were present within the meninges of all sheep, regardless of treatment group. Similarly, small aggregates of perivascular RBCs were rarely noted in non-target regions of neural parenchyma of FUS-treated (8/11) and untreated (2/2) sheep. However, no concurrent histologic abnormalities were observed, consistent with RBC extravasation occurring as post-mortem artifact following brain extraction. Sheep within the high dose FUS group were TUNEL-negative at the targeted site of FUS.

CONCLUSIONS

The absence of FUS-related histologic findings suggests that the neuromodulation and MR-ARFI protocols evaluated do not cause tissue damage.

Acoustic radiation force imaging using a single-shot spiral readout

The purpose of this study is to develop and validate rapid magnetic resonance acoustic radiation force imaging (MR-ARFI) using a single shot spiral readout for focused ultrasound (FUS) guidance and for local tissue displacement measurements. A magnetic resonance guided FUS system was used to focus a 3 MHz ultrasound beam to a predetermined position. MR-ARFI was performed with a Bruker 7 T MRI using a modified single-shot spiral readout, with additional motion encoding gradients that convert local displacement into the phase image. Post processing was then used to analyze the resulting displacement and to evaluate the method's performance for the detection of tissue changes resulting from thermal ablation. The single-shot spiral readout acquires a single MR-ARFI image in one second, which is up to two orders of magnitude faster than conventional 2D spin-warp spin echo that acquires the k-space data line by line. The ARFI displacement in tissue mimicking phantoms was detected and localized with less than 5% geometric distortion. The ARFI displacement was also measured pre and post thermal ablation in an ex vivo chicken breast. For transmitted peak negative pressure of 8.6 MPa, the maximum displacement of the tissue that was ablated to 70 °C was 78% lower than the pre-ablated tissue. Since spiral readout is not prone to geometrical distortion, it is well-suited for FUS guidance, without generating undesired temperature elevation. Additionally, local displacement measurements of tissues can be performed rapidly during thermal ablation procedures and may help to assess the success of the treatment.

Production of acoustic radiation force using ultrasound: methods and applications

INTRODUCTION

Acoustic radiation force (ARF) is used in many biomedical applications. The transfer of momentum in acoustic waves can be used in a multitude of ways to perturb tissue and manipulate cells.

AREAS COVERED

This review will briefly cover the acoustic theory related to ARF, particularly that related to application in tissues. The use of ARF in measurement of mechanical properties will be treated in detail with emphasis on the spatial and temporal modulation of the ARF. Additional topics covered will be the manipulation of particles with ARF, correction of phase aberration with ARF, modulation of cellular behavior with ARF, and bioeffects related to ARF use.

EXPERT COMMENTARY

The use of ARF can be tailored to specific applications for measurements of mechanical properties or correction of focusing for ultrasound beams. Additionally, noncontact manipulation of particles and cells with ARF enables a wide array of applications for tissue engineering and biosensing.

Magnetic resonance elastography of liver and spleen: Methods and applications

The viscoelastic properties of the liver and spleen can be assessed with magnetic resonance elastography (MRE). Several actuators, MRI acquisition sequences and reconstruction algorithms have been proposed for this purpose. Reproducible results are obtained, especially when the examination is performed in standard conditions with the patient fasting. Accurate staging of liver fibrosis can be obtained by measuring liver stiffness or elasticity with MRE. Moreover, emerging evidence shows that assessing the tissue viscous parameters with MRE is useful for characterizing liver inflammation, non-alcoholic steatohepatitis, hepatic congestion, portal hypertension, and hepatic tumors. Further advances such as multifrequency acquisitions and compression-sensitive MRE may provide novel quantitative markers of hepatic and splenic mechanical properties that may improve the diagnosis of hepatic and splenic diseases.

High sensitivity MR acoustic radiation force imaging using transition band balanced steady-state free precession

PURPOSE

MR acoustic radiation force imaging (MR-ARFI) provides a method to visualize the focal spot of a focused ultrasound (FUS) beam without introducing a significant temperature rise. With conventional spoiled MR-ARFI pulse sequences, the ARFI phase always equals the motion-encoded phase. In this work, MR-ARFI using transition band balanced steady-state free precession (bSSFP) is presented, which improves the sensitivity of MR-ARFI with high acquisition speed.

THEORY AND METHODS

Motion-encoding gradients (MEG) are inserted into bSSFP sequences for MR-ARFI. By applying an ultrasound pulse during the MEG, motion-encoded phase is generated, which leads to an amplified change in the image phase when operating in the bSSFP transition band. MR-ARFI was performed on a homemade gel phantom using both the proposed technique and a spoiled gradient echo ARFI sequence with identical MEG and FUS, and ARFI images were compared.

RESULTS

The bSSFP-ARFI sequence generated an ARFI image phase that is more than 5 times larger than the motion-encoded phase in a few seconds with 2DFT readout. By keeping FUS pulses as short as 1.45 ms, temperature rise was insignificant during the measurement.

CONCLUSION

bSSFP-ARFI has enhanced sensitivity compared with conventional MR-ARFI pulse sequences and could provide an efficient way to visualize the focal spot. Magn Reson Med 79:1532-1537, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

MR techniques for guiding high-intensity focused ultrasound (HIFU) treatments

To make full use of the ability of magnetic resonance (MR) to guide high-intensity focused ultrasound (HIFU) treatment, effort has been made to improve techniques for thermometry, motion tracking, and sound beam visualization. For monitoring rapid temperature elevation with proton resonance frequency (PRF) shift, data acquisition and processing can be accelerated with parallel imaging and/or sparse sampling in conjunction with appropriate signal processing methods. Thermometry should be robust against tissue motion, motion-induced magnetic field variation, and susceptibility change. Thus, multibaseline, referenceless, or hybrid techniques have become important. In cases with adipose or bony tissues, for which PRF shift cannot be used, thermometry with relaxation times or signal intensity may be utilized. Motion tracking is crucial not only for thermometry but also for targeting the focus of an ultrasound in moving organs such as the liver, kidney, or heart. Various techniques for motion tracking, such as those based on an anatomical image atlas with optical-flow displacement detection, a navigator echo to seize the diaphragm position, and/or rapid imaging to track vessel positions, have been proposed. Techniques for avoiding the ribcage and near-field heating have also been examined. MR acoustic radiation force imaging (MR-ARFI) is an alternative to thermometry that can identify the location and shape of the focal spot and sound beam path. This technique could be useful for treating heterogeneous tissue regions or performing transcranial therapy. All of these developments, which will be discussed further in this review, expand the applicability of HIFU treatments to a variety of clinical targets while maintaining safety and precision.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:316-331.

Focal point determination in magnetic resonance-guided focused ultrasound using tracking coils

PURPOSE

To develop a method for rapid prediction of the geometric focus location in MR coordinates of a focused ultrasound (US) transducer with arbitrary position and orientation without sonicating.

METHODS

Three small tracker coil circuits were designed, constructed, attached to the transducer housing of a breast-specific MR-guided focused US (MRgFUS) system with 5 degrees of freedom, and connected to receiver channel inputs of an MRI scanner. A one-dimensional sequence applied in three orthogonal directions determined the position of each tracker, which was then corrected for gradient nonlinearity. In a calibration step, low-level heating located the US focus in one transducer position orientation where the tracker positions were also known. Subsequent US focus locations were determined from the isometric transformation of the trackers. The accuracy of this method was verified by comparing the tracking coil predictions to thermal center of mass calculated using MR thermometry data acquired at 16 different transducer positions for MRgFUS sonications in a homogeneous gelatin phantom.

RESULTS

The tracker coil predicted focus was an average distance of 2.1 ± 1.1 mm from the thermal center of mass. The one-dimensional locator sequence and prediction calculations took less than 1 s to perform.

CONCLUSION

This technique accurately predicts the geometric focus for a transducer with arbitrary position and orientation without sonicating. Magn Reson Med 77:2424-2430, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Respiration based steering for high intensity focused ultrasound liver ablation

PURPOSE

Respiratory motion makes hepatic ablation using high intensity focused ultrasound (HIFO) challenging. Previous HIFU liver treatment had required apnea induced during general anesthesia. We describe and test a system that allows treatment of the liver in the presence of breathing motion.

METHODS

Mapping a signal from an external respiratory bellow to treatment locations within the liver allows the ultrasound transducer to be steered in real time to the target location. Using a moving phantom, three metrics were used to compare static, steered, and unsteered sonications: the area of sonications once a temperature rise of 15°C was achieved, the energy deposition required to reach that temperature, and the average rate of temperature rise during the first 10 s of sonication. Steered HIFU in vivo ablations of the porcine liver were also performed and compared to breath-hold ablations.

RESULTS

For the last phantom metric, all groups were found to be statistically significantly different (P ≤ 0.003). However, in the other two metrics, the static and unsteered sonications were not statistically different (P > 0.9999). Steered in vivo HIFU ablations were not statistically significantly different from ablations during breath-holding.

CONCLUSIONS

A system for performing HIFU steering during ablation of the liver with breathing motion is presented and shown to achieve results equivalent to ablation performed with breath-holding.

Evaluation of a three-dimensional MR acoustic radiation force imaging pulse sequence using a novel unbalanced bipolar motion encoding gradient

PURPOSE

MR guided focused ultrasound procedures require accurate focal spot localization in three dimensions. This study presents a three-dimensional (3D) pulse sequence for acoustic radiation force imaging (ARFI) that efficiently localizes the focal spot by means of ultrasound induced tissue displacement over a large field-of-view.

METHODS

A novel unbalanced bipolar motion encoding gradient was implemented to maximize time available for motion encoding, reduce echo times, and allow for longer echo train lengths. Two advanced features, kz reduction factor (KZRF) and kz -level interleaving, were implemented to reduce tissue heating. Studies in gelatin phantoms compared the location of peak displacement and temperature measured by 3D MR thermometry. MR-ARFI induced tissue heating was evaluated through a parametric study of sequence parameters and MR thermometry measurements during repeated application of ARFI sonication patterns. Sequence performance was characterized in the presence of respiration and tissue inhomogeneity.

RESULTS

The location of peak displacement and temperature rise agreed within 0.2 ± 0.1 mm and 0.5 ± 0.3 mm in the transverse and longitudinal direction, respectively. The 3D displacement maps were acquired safely, and the KZRF and kz -level interleaving features reduced tissue heating by 51%. High quality displacement maps were obtained despite respiration and tissue inhomogeneities.

CONCLUSION

This sequence provides a safe, accurate, and simple approach to localizing the focal spot in three dimensions with a single scan. Magn Reson Med 76:803-813, 2016. © 2015 Wiley Periodicals, Inc.

A simulation technique for 3D MR-guided acoustic radiation force imaging

PURPOSE

In magnetic resonance-guided focused ultrasound (MRgFUS) therapies, the in situ characterization of the focal spot location and quality is critical. MR acoustic radiation force imaging (MR-ARFI) is a technique that measures the tissue displacement caused by the radiation force exerted by the ultrasound beam. This work presents a new technique to model the displacements caused by the radiation force of an ultrasound beam in a homogeneous tissue model.

METHODS

When a steady-state point-source force acts internally in an infinite homogeneous medium, the displacement of the material in all directions is given by the Somigliana elastostatic tensor. The radiation force field, which is caused by absorption and reflection of the incident ultrasound intensity pattern, will be spatially distributed, and the tensor formulation takes the form of a convolution of a 3D Green's function with the force field. The dynamic accumulation of MR phase during the ultrasound pulse can be theoretically accounted for through a time-of-arrival weighting of the Green's function. This theoretical model was evaluated experimentally in gelatin phantoms of varied stiffness (125-, 175-, and 250-bloom). The acoustic and mechanical properties of the phantoms used as parameters of the model were measured using independent techniques. Displacements at focal depths of 30- and 45-mm in the phantoms were measured by a 3D spin echo MR-ARFI segmented-EPI sequence.

RESULTS

The simulated displacements agreed with the MR-ARFI measured displacements for all bloom values and focal depths with a normalized RMS difference of 0.055 (range 0.028-0.12). The displacement magnitude decreased and the displacement pattern broadened with increased bloom value for both focal depths, as predicted by the theory.

CONCLUSIONS

A new technique that models the displacements caused by the radiation force of an ultrasound beam in a homogeneous tissue model theory has been rigorously validated through comparison with experimentally obtained 3D displacement data in homogeneous gelatin phantoms using a 3D MR-ARFI sequence. The agreement of the experimentally measured and simulated results demonstrates the potential to use MR-ARFI displacement data in MRgFUS therapies.

Accelerated MRI thermometry by direct estimation of temperature from undersampled k-space data

PURPOSE

Acceleration of magnetic resonance (MR) thermometry is desirable for several applications of MR-guided focused ultrasound, such as those requiring greater volume coverage, higher spatial resolution, or higher frame rates.

METHODS

We propose and validate a constrained reconstruction method that estimates focal temperature changes directly from k-space without spatial or temporal regularization. A model comprising fully-sampled baseline images is fit to undersampled k-space data, which removes aliased temperature maps from the solution space. Reconstructed temperature maps are compared to maps reconstructed using parallel imaging (iterative self-consistent parallel imaging reconstruction [SPIRiT]) and conventional hybrid thermometry, and temporally constrained reconstruction thermometry.

RESULTS

Temporal step response simulations demonstrate finer temporal resolution and lower error in 4×-undersampled radial k-space reconstructions compared to temporally constrained reconstruction. Simulations show that the k-space method can achieve higher accelerations with multiple receive coils. Phantom heating experiments further demonstrate the algorithm's advantage over reconstructions relying on parallel imaging alone to overcome undersampling artifacts. In vivo model error comparisons show the algorithm achieves low temperature error at higher acceleration factors (up to 32× with a radial trajectory) than compared reconstructions.

CONCLUSION

High acceleration factors can be achieved using the proposed temperature reconstruction algorithm, without sacrificing temporal resolution or accuracy.

Magnetic resonance imaging for the exploitation of bubble-enhanced heating by high-intensity focused ultrasound: a feasibility study in ex vivo liver

Bubble-enhanced heating (BEH) may be exploited to improve the heating efficiency of high-intensity focused ultrasound in liver and to protect tissues located beyond the focal point. The objectives of this study, performed in ex vivo pig liver, were (i) to develop a method to determine the acoustic power threshold for induction of BEH from displacement images measured by magnetic resonance acoustic radiation force imaging (MR-ARFI), and (ii) to compare temperature distribution with MR thermometry for HIFU protocols with and without BEH. The acoustic threshold for generation of BEH was determined in ex vivo pig liver from MR-ARFI calibration curves of local tissue displacement resulting from sonication at different powers. Temperature distributions (MR thermometry) resulting from "conventional" sonications (20 W, 30 s) were compared with those from "composite" sonications performed at identical parameters, but after a HIFU burst pulse (0.5 s, acoustic power over the threshold for induction of BEH). Displacement images (MR-ARFI) were acquired between sonications to measure potential modifications of local tissue displacement associated with modifications of tissue acoustic characteristics induced by the burst HIFU pulse. The acoustic threshold for induction of BEH corresponded to a displacement amplitude of approximately 50 μm in ex vivo liver. The displacement and temperature images of the composite group exhibited a nearly spherical pattern, shifted approximately 4 mm toward the transducer, in contrast to elliptical shapes centered on the natural focal position for the conventional group. The gains in maximum temperature and displacement values were 1.5 and 2, and the full widths at half-maximum of the displacement data were 1.7 and 2.2 times larger than in the conventional group in directions perpendicular to ultrasound propagation axes. Combination of MR-ARFI and MR thermometry for calibration and exploitation of BEH appears to increase the efficiency and safety of HIFU treatment.

Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction

PURPOSE

Device tracking is crucial for interventional MRI (iMRI) because conventional device materials do not contribute to the MR signal, may cause susceptibility artifacts and are generally invisible if moved out of the scan plane. A robust method for wireless tracking and dynamic guidance of interventional devices equipped with wirelessly connected resonant circuits (wRC) is presented.

METHODS

The proposed method uses weak spatially-selective excitation pulses with very low flip angle (0.3°), a Hadamard multiplexed tracking scheme and employs phase-field dithering to obtain the 3D position of a wRC. RF induced heating experiments (ASTM protocol) and balloon angioplasties of the iliac artery were conducted in a perfused vascular phantom and three Thiel soft-embalmed human cadavers.

RESULTS

Device tip tracking was interleaved with various user-selectable fast pulse sequences receiving a geometry update from the tracking kernel in less than 30ms. Integrating phase-field dithering significantly improved our tracking robustness for catheters with small diameters (4-6 French). The volume root mean square distance error was 2.81mm (standard deviation: 1.31mm). No significant RF induced heating (<0.6°C) was detected during heating experiments.

CONCLUSION

This tip tracking approach provides flexible, fast and robust feedback loop, intuitive iMRI scanner interaction, does not constrain the physician and delivers very low specific absorption rates. Devices with wRC can be exchanged during a procedure without modifications to the iMRI setup or the pulse sequence. A drawback of our current implementation is that position information is available for a single tracking coil only. This was satisfactory for balloon angioplasties of the iliac artery, but further studies are required for complex navigation and catheter shapes before animal trials and clinical application.

MR-guided focused ultrasound surgery, present and future

MR-guided focused ultrasound surgery (MRgFUS) is a quickly developing technology with potential applications across a spectrum of indications traditionally within the domain of radiation oncology. Especially for applications where focal treatment is the preferred technique (for example, radiosurgery), MRgFUS has the potential to be a disruptive technology that could shift traditional patterns of care. While currently cleared in the United States for the noninvasive treatment of uterine fibroids and bone metastases, a wide range of clinical trials are currently underway, and the number of publications describing advances in MRgFUS is increasing. However, for MRgFUS to make the transition from a research curiosity to a clinical standard of care, a variety of challenges, technical, financial, clinical, and practical, must be overcome. This installment of the Vision 20∕20 series examines the current status of MRgFUS, focusing on the hurdles the technology faces before it can cross over from a research technique to a standard fixture in the clinic. It then reviews current and near-term technical developments which may overcome these hurdles and allow MRgFUS to break through into clinical practice.

Adapting MRI acoustic radiation force imaging for in vivo human brain focused ultrasound applications

A variety of magnetic resonance imaging acoustic radiation force imaging (MR-ARFI) pulse sequences as the means for image guidance of focused ultrasound therapy have been recently developed and tested ex vivo and in animal models. To successfully translate MR-ARFI guidance into human applications, ensuring that MR-ARFI provides satisfactory image quality in the presence of patient motion and deposits safe amount of ultrasound energy during image acquisition is necessary. The first aim of this work was to study the effect of motion on in vivo displacement images of the brain obtained with 2D Fourier transform spin echo MR-ARFI. Repeated bipolar displacement encoding configuration was shown less sensitive to organ motion. The optimal signal-to-noise ratio of displacement images was found for the duration of encoding gradients of 12 ms. The second aim was to further optimize the displacement signal-to-noise ratio for a particular tissue type by setting the time offset between the ultrasound emission and encoding based on the tissue response to acoustic radiation force. A method for measuring tissue response noninvasively was demonstrated. Finally, a new method for simultaneous monitoring of tissue heating during MR-ARFI acquisition was presented to enable timely adjustment of the ultrasound energy aimed at ensuring the safety of the MR-ARFI acquisition.

ARFI-prepared MRgHIFU in liver: simultaneous mapping of ARFI-displacement and temperature elevation, using a fast GRE-EPI sequence

MR acoustic radiation force imaging (ARFI) is an elegant adjunct to MR-guided high intensity focused ultrasound for treatment planning and optimization, permitting in situ assessment of the focusing and targeting quality. The thermal effect of high intensity focused ultrasound pulses associated with ARFI measurements is recommended to be monitored on line, in particular when the beam crosses highly absorbent structures or interfaces (e.g., bones or air-filled cavities). A dedicated MR sequence is proposed here, derived from a segmented gradient echo-echo planar imaging kernel by adding a bipolar motion encoding gradient with interleaved alternating polarities. Temporal resolution was reduced to 2.1 s, with in-plane spatial resolution of 1 mm. MR-ARFI measurements were executed during controlled animal breathing, with trans-costal successively steered foci, to investigate the spatial modulation of the focus intensity and the targeting offset. ARFI-induced tissue displacement measurements enabled the accurate localization, in vivo, of the high intensity focused ultrasound focal point in sheep liver, with simultaneous monitoring of the temperature elevation. ARFI-based precalibration of the focal point position was immediately followed by trans-costal MR-guided high intensity focused ultrasound ablation, monitored with a conventional proton resonance frequency shift MR thermometry sequence. The latter MR thermometry sequence had spatial resolution and geometrical distortion identical with the ARFI maps, hence no coregistration was required.