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Rifi Z, Harary M, Walshaw PD, Frew AJ, Everson RG, Fallah A, Salamon N, Kim W. Functional magnetic resonance imaging (fMRI) as adjunct for planning laser interstitial thermal therapy (LITT) near eloquent structures. Acta Neurochir (Wien) 2024; 166:66. [PMID: 38316692 PMCID: PMC10844152 DOI: 10.1007/s00701-024-05970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024]
Abstract
LITT is a minimally-invasive laser ablation technique used to treat a wide variety of intracranial lesions. Difficulties performing intraoperative mapping have limited its adoption for lesions in/near eloquent regions. In this institutional case series, we demonstrate the utility of fMRI-adjunct planning for LITT near language or motor areas. Six out of 7 patients proceeded with LITT after fMRI-based tractography determined adequate safety margins for ablation. All underwent successful ablation without new or worsening postoperative symptoms requiring adjuvant corticosteroids, including those with preexisting deficits. fMRI is an easily accessible adjunct which may potentially reduce chances of complications in LITT near eloquent structures.
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Affiliation(s)
- Ziad Rifi
- David Geffen School of Medicine, University of California, Los Angeles, USA
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Maya Harary
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Patricia D Walshaw
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Andrew J Frew
- Department of Neurosurgery, University of California, Los Angeles, USA
- Department of Radiology, University of California, Los Angeles, USA
| | - Richard G Everson
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Aria Fallah
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Noriko Salamon
- Department of Radiology, University of California, Los Angeles, USA
| | - Won Kim
- Department of Neurosurgery, University of California, Los Angeles, USA.
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Xue Z, Guan X, Yuan L, Kang P, Zhang C, Li D, Jia G, Jia W. Laser interstitial thermal therapy in the treatment of brain metastases: the relationship between changes in postoperative magnetic resonance imaging characteristics and tumor recurrence. Acta Neurochir (Wien) 2023; 165:1379-1387. [PMID: 36823478 DOI: 10.1007/s00701-023-05504-x] [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: 11/22/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) has been used to treat brain metastases (BMs) in several countries, and its safety and effectiveness have been confirmed. In most cases, magnetic resonance imaging (MRI) reveals an increase in tumor volume with an enhanced margin after LITT. However, little is known about the relationship between this MRI change and tumor recurrence. OBJECTIVE We report the first case series of BMs treated by LITT in China to evaluate the clinical characteristics and predictive factors of tumor recurrence. MATERIAL AND METHODS Patients with less than four brain metastatic lesions and a Karnofsky performance status (KPS) > 70 were eligible for study inclusion. Standard LITT procedures were performed, and a follow-up MRI was performed to analyze the radiographic changes, especially the volume ratio of the enhanced margin and the whole lesion on MRI at 30 days postoperatively. All the volume-related data were delineated and calculated using 3D Slicer software. Related predictors were also collected to evaluate the correlation with local tumor control. RESULTS Eighteen patients with nineteen lesions were enrolled for treatment and follow-up. Primary tumor histology included pulmonary carcinoma (n = 11) and breast cancer (n = 4). On average, the tumor size measured 3.01 cm3 (range, 0.40-7.40 cm3), the total ablation time was 13.58 min (range, 2.88-37.15 min), and the complete ablation rate was 92.4% (range, 29.2-100%). Comparing 3s0-day follow-up MRI results with preoperative MRI findings, 18 lesions showed a 2.28-fold (range, 1.21-4.88) volume increase; all the lesions displayed an enhanced component with a volume ratio of 42.35% (range, 10.14-100%). Five patients experienced tumor recurrence, and the local tumor control rates at 90 days and 180 days of follow-up were 68.4% and 66.7%, respectively. Univariate analysis indicated that the primary tumor, ablation rate, and enhanced volume ratio (EVR) > 40% in the 30-day MRI were associated with tumor recurrence, whereas multivariate analysis showed that only EVR > 40% was a predictive factor of local control. CONCLUSION LITT is a minimally invasive method used to ablate brain metastases which can be used as the first-line treatment for BM patients under certain indications. After LITT, most tumors showed volume enlargement on the 30-day MRI scan, and EVR > 40% on the 30-day MRI may indicate late tumor recurrence.
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Affiliation(s)
- Zhan Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China
| | - Xiudong Guan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China
| | - Linhao Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China
| | - Peng Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China
| | - Chuanbao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China
| | - Guijun Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People's Republic of China.
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Chan H, Chang HY, Lin WL, Chen GS. Large-Volume Focused-Ultrasound Mild Hyperthermia for Improving Blood-Brain Tumor Barrier Permeability Application. Pharmaceutics 2022; 14:pharmaceutics14102012. [PMID: 36297445 PMCID: PMC9610093 DOI: 10.3390/pharmaceutics14102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Mild hyperthermia can locally enhance permeability of the blood-tumor barrier in brain tumors, improving delivery of antitumor nanodrugs. However, a clinical transcranial focused ultrasound (FUS) system does not provide this modality yet. The study aimed at the development of the transcranial FUS technique dedicated for large-volume mild hyperthermia in the brain. Acoustic pressure, multiple-foci, temperature and thermal dose induced by FUS were simulated in the brain through the skull. A 1-MHz, 114-element, spherical helmet transducer was fabricated to verify large-volume hyperthermia in the phantom. The simulated results showed that two foci were simultaneously formed at (2, 0, 0) and (−2, 0, 0) and at (0, 2, 0) and (0, −2, 0), using the phases of focusing pattern 1 and the phases of focusing pattern 2, respectively. Switching two focusing patterns at 5 Hz produced a hyperthermic zone with an ellipsoid of 7 mm × 6 mm × 11 mm in the brain and the temperature was 41–45 °C in the ellipsoid as the maximum intensity was 150 W/cm2 and sonication time was 3 min. The phased array driven by switching two mode phases generated a 41 °C-contour region of 10 ± 1 mm × 8 ± 2 mm × 13 ± 2 mm in the phantom after 3-min sonication. Therefore, we have demonstrated our developed FUS technique for large-volume mild hyperthermia.
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Affiliation(s)
- Hsin Chan
- Institute of Biomedical Engineering, National Taiwan University, Taipei 100, Taiwan
| | - Hsin-Yun Chang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli 35053, Taiwan
| | - Win-Li Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei 100, Taiwan
| | - Gin-Shin Chen
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli 35053, Taiwan
- Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Correspondence: ; Tel.: +886-37-206166 (ext. 37108)
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4
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Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
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Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
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Wu C, Schwalb JM, Rosenow JM, McKhann GM, Neimat JS. The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Neurosurgery 2022; 90:155-160. [PMID: 34995216 DOI: 10.1227/neu.0000000000001799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance image-guided laser interstitial thermal therapy (MRgLITT) is a novel tool in the neurosurgical armamentarium for the management of drug-resistant epilepsy. Given the recent introduction of this technology, the American Society for Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, consisting of failure to respond to, or intolerance of, at least 2 appropriately chosen medications at appropriate doses for disabling, localization-related epilepsy in the setting of well-defined epileptogenic foci, or critical pathways of seizure propagation accessible by MRgLITT. Applications of MRgLITT in mesial temporal lobe epilepsy and hypothalamic hamartoma, along with its contraindications in the treatment of epilepsy, are discussed based on current evidence. To put this position statement in perspective, we detail the evidence and authority on which this ASSFN position statement is based.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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De Tommasi F, Massaroni C, Grasso RF, Carassiti M, Schena E. Temperature Monitoring in Hyperthermia Treatments of Bone Tumors: State-of-the-Art and Future Challenges. SENSORS (BASEL, SWITZERLAND) 2021; 21:5470. [PMID: 34450911 PMCID: PMC8400360 DOI: 10.3390/s21165470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022]
Abstract
Bone metastases and osteoid osteoma (OO) have a high incidence in patients facing primary lesions in many organs. Radiotherapy has long been the standard choice for these patients, performed as stand-alone or in conjunction with surgery. However, the needs of these patients have never been fully met, especially in the ones with low life expectancy, where treatments devoted to pain reduction are pivotal. New techniques as hyperthermia treatments (HTs) are emerging to reduce the associated pain of bone metastases and OO. Temperature monitoring during HTs may significantly improve the clinical outcomes since the amount of thermal injury depends on the tissue temperature and the exposure time. This is particularly relevant in bone tumors due to the adjacent vulnerable structures (e.g., spinal cord and nerve roots). In this Review, we focus on the potential of temperature monitoring on HT of bone cancer. Preclinical and clinical studies have been proposed and are underway to investigate the use of different thermometric techniques in this scenario. We review these studies, the principle of work of the thermometric techniques used in HTs, their strengths, weaknesses, and pitfalls, as well as the strategies and the potential of improving the HTs outcomes.
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Affiliation(s)
- Francesca De Tommasi
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Rosario Francesco Grasso
- Unit of Interventional Radiology, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
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7
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Treiber JM, Curry DJ, Weiner HL, Roth J. Epilepsy surgery in tuberous sclerosis complex (TSC): emerging techniques and redefinition of treatment goals. Childs Nerv Syst 2020; 36:2519-2525. [PMID: 32535771 DOI: 10.1007/s00381-020-04715-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/28/2020] [Indexed: 01/21/2023]
Abstract
Epilepsy occurs in nearly all patients with tuberous sclerosis and is often refractory to medical treatment. The definition of surgical candidacy in these patients has broadened in recent years due to philosophical and technological advances. The goals of surgery have shifted to focusing on quality of life and maximizing neurodevelopmental potential in patients unable to obtain seizure freedom. Novel diagnostic, ablative, and neuromodulatory techniques have been developed that may help patients that were previously considered inoperable to have an improved quality of life. In the coming years, it is expected that these techniques will be further refined and lead to an improvement of neurological prognosis in patients with tuberous sclerosis.
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Affiliation(s)
- Jeffrey M Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.,Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Daniel J Curry
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.,Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA. .,Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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8
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Kuo LW, Dong GC, Pan CC, Chen SF, Chen GS. An MRI-Guided Ring High-Intensity Focused Ultrasound System for Noninvasive Breast Ablation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:1839-1847. [PMID: 32386148 DOI: 10.1109/tuffc.2020.2992764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
High-intensity focused ultrasound (HIFU) has been used for noninvasive treatment of breast tumors, but the present magnetic resonance imaging (MRI)-guided HIFU (MRI-HIFU) systems encounter skin burn. In this study, a novel MRI-HIFU breast ablation system was developed to improve the above problem. The system consisted of the ring HIFU phased-array transducer, a commercial power amplifier, the mechanical positioner, and the graphical user interface control software. MRI thermometry was also established to monitor the temperature in the HIFU-treated tissue. Ablation of pork and the in vivo rabbit leg were carried out to validate the developed system. Results of fat-surrounding pork ablation showed that the ring HIFU system reached a safe margin of 3 mm without fat burn. Moreover, precision of the positioner moving the HIFU focal zone was within 6% error under MRI circumstances. The representative MRI temperature images show that the peak temperatures among the five ablations ranged between 66 °C and 91 °C, and their thermal doses were over 10000. The system could also ablate the biceps femoris of a rabbit without skin burn to form a lesion of 2.5 mm beneath the skin. With the HIFU dose of 315 W/10 s, the MRI temperature map revealed that the maximum temperature and the thermal dose were 60 °C and 3380, respectively. The MRI-guided ring HIFU system can ablate the target tissue near subcutaneous fat without fat burn. The system prototype is a promising tool for clinical implementation.
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9
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Zemmar A, Nelson BJ, Neimat JS. Laser thermal therapy for epilepsy surgery: current standing and future perspectives. Int J Hyperthermia 2020; 37:77-83. [DOI: 10.1080/02656736.2020.1788175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Ajmal Zemmar
- Department of Neurosurgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China
- Department of Neurosurgery, University of Louisville, School of Medicine, Louisville, KY, USA
| | - Bradley J. Nelson
- Multi-Scale Robotics Laboratory, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Joseph S. Neimat
- Department of Neurosurgery, University of Louisville, School of Medicine, Louisville, KY, USA
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10
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Mahammedi A, Bachir S, Escott EJ, Barnett GH, Mohammadi AM, Larvie M. Prediction of recurrent glioblastoma after laser interstitial thermal therapy: The role of diffusion imaging. Neurooncol Adv 2020; 1:vdz021. [PMID: 32642657 PMCID: PMC7212867 DOI: 10.1093/noajnl/vdz021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Evaluate the utility of diffusion-weighted imaging (DWI) for the assessment of local recurrence of glioblastoma (GBM) on imaging performed 24 h following MRI-guided laser interstitial thermal therapy (LITT). We hypothesize that microscopic peritumoral infiltration correlates with early subtle variations on DWI images and apparent diffusion coefficient (ADC) maps. Methods Of 64 patients with GBM treated with LITT, 39 had MRI scans within 24 h after undergoing LITT. Patterns on DWI images and ADC maps 24 h following LITT were correlated with areas of future GBM recurrence identified through coregistration of subsequent MRI examinations. In the areas of suspected recurrence within the periphery of post-LITT lesions, signal intensity values on ADC maps were recorded and compared with the remaining peritumoral ring. Results Thirty-nine patients with GBM met the inclusion criteria. For predicting recurrent GBM, areas of decreased DWI signal and increased signal on ADC maps within the expected peritumoral ring of restricted diffusion identified 24 h following LITT showed 86.1% sensitivity, 75.2% specificity, and high correlation (r = 0.53) with future areas of GBM recurrence (P < .01). Areas of future recurrence demonstrated a 37% increase in the ADC value (P < .001), compared with findings in the surrounding treated peritumoral region. A significantly greater area under the receiver operating characteristics curve was determined for ADC values (P < .01). Conclusions DWI obtained 24 h following LITT can help predict the location of GBM recurrence months before the development of abnormal enhancement. This may alter future treatment planning, perhaps suggesting areas that may be targeted for additional therapy.
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Affiliation(s)
| | - Suha Bachir
- Department of Pediatrics and Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Edward J Escott
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Alireza M Mohammadi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Mykol Larvie
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
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Salem U, Kumar VA, Madewell JE, Schomer DF, de Almeida Bastos DC, Zinn PO, Weinberg JS, Rao G, Prabhu SS, Colen RR. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging 2019; 19:65. [PMID: 31615562 PMCID: PMC6792239 DOI: 10.1186/s40644-019-0250-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/30/2019] [Indexed: 02/02/2023] Open
Abstract
MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.
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Affiliation(s)
- Usama Salem
- Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA.
| | - Vinodh A Kumar
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - John E Madewell
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Donald F Schomer
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Pascal O Zinn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. .,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
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13
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Han D, Xu J, Wang Z, Yang N, Li X, Qian Y, Li G, Dai R, Xu S. Penetrating effect of high-intensity infrared laser pulses through body tissue. RSC Adv 2018; 8:32344-32357. [PMID: 35547482 PMCID: PMC9086259 DOI: 10.1039/c8ra05285a] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/02/2018] [Indexed: 12/12/2022] Open
Abstract
Researchers have utilized infrared (IR) lasers as energy sources in laser therapy for curing skin diseases and skin injuries with remarkable effects. Preliminary experiments have also shown that high-intensity IR laser pulses could penetrate thick body tissues, resulting in remarkable effects for recovery from injuries in deep muscles and cartilage tissues. However, for deep-level IR laser therapy, it is unclear how much of the laser power density penetrates the body tissues at certain depths and which of the three major effects of laser irradiation, namely, laser-induced photo-chemical effect, photo-thermal effect and mechanical dragging effect, play a key role in the curing process. Thus, in this study, we developed micro-sized thin-film thermocouple (TFTC) arrays on freestanding Si3N4 thin-film windows as sensors for laser power density and local temperature. These devices showed excellent linear responses in output voltage to laser power density with wavelengths in the range of 325-1064 nm, and also indicated the local temperature at the laser spot. We systematically measured the penetrating effect and thermal effect through thick porcine tissues for high-intensity IR pulses with a laser system used in clinical treatment and subtracted the attenuation parameters for the porcine skin, fat and muscle tissue from the experimental data. The results offered reliable quantitative references for safe irradiation doses of high-intensity IR laser pulses in practical laser therapy.
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Affiliation(s)
- Danhong Han
- Key Laboratory for the AGA & Chemistry of Nanodevices, Department of Electronics, Peking University Beijing 100871 P. R. China +86-10-62757261
| | - Jingjing Xu
- Key Laboratory for the AGA & Chemistry of Nanodevices, Department of Electronics, Peking University Beijing 100871 P. R. China +86-10-62757261
| | - Zhenhai Wang
- Key Laboratory for the AGA & Chemistry of Nanodevices, Department of Electronics, Peking University Beijing 100871 P. R. China +86-10-62757261
| | - Nana Yang
- Key Laboratory for the AGA & Chemistry of Nanodevices, Department of Electronics, Peking University Beijing 100871 P. R. China +86-10-62757261
| | - Xunzhou Li
- TED Healthcare Technology Ltd Unit 350, 3/F, Block B, Beijing Venture Plaza, A11, An Xiang Bei li Rd. Beijing 100101 P. R. China
| | - Yingying Qian
- TED Healthcare Technology Ltd Unit 350, 3/F, Block B, Beijing Venture Plaza, A11, An Xiang Bei li Rd. Beijing 100101 P. R. China
| | - Ge Li
- TED Healthcare Technology Ltd Unit 350, 3/F, Block B, Beijing Venture Plaza, A11, An Xiang Bei li Rd. Beijing 100101 P. R. China
| | - Rujun Dai
- TED Healthcare Technology Ltd Unit 350, 3/F, Block B, Beijing Venture Plaza, A11, An Xiang Bei li Rd. Beijing 100101 P. R. China
| | - Shengyong Xu
- Key Laboratory for the AGA & Chemistry of Nanodevices, Department of Electronics, Peking University Beijing 100871 P. R. China +86-10-62757261
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Laser-Induced Thermal Therapy in Neuro-Oncology: A Review. World Neurosurg 2018; 112:166-177. [PMID: 29410102 DOI: 10.1016/j.wneu.2018.01.123] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Laser therapy has become an appealing treatment modality in neurosurgery. In this review, we report on the history, physics, surgical steps, indications and uses, and complications that have been reported to date. METHODS An extensive literature search was performed for laser interstitial thermal therapy (LITT) and laser therapy in the context of glial tumors, metastatic lesions, pediatric brain tumors, and radiation necrosis. Reported complications in each series also were reviewed. RESULTS In the past decade, multiple studies have demonstrated the use, outcomes, and complications associated with LITT in neurosurgery. These same studies have consistently reported an overall benefit of LITT in cases in which traditional surgical approaches may be limited by the patient's clinical status, tumor location, or overall prognosis. However, there have been complications reported from local effects of thermal damage, technical error, and edema development. Increased experience has reduced complications and brought more promising results. CONCLUSIONS With the advent of real-time monitoring and damage estimation, LITT has gained ground in the management of intracranial tumors. Larger scale trials must be performed to develop standard protocols to define specific indications for use. Further large clinical studies for LITT in non-oncologic cases are also of interest.
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Kang JY, Sperling MR. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy. Neurotherapeutics 2017; 14:176-181. [PMID: 27905093 PMCID: PMC5233636 DOI: 10.1007/s13311-016-0498-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Surgery is the most effective treatment for drug-resistant epilepsy. Long-term studies demonstrate that about 60% to 80% of patients become seizure-free after anterior temporal lobectomy and a majority of patients (about 95%) report significant seizure reduction after surgery. In the last few years, there has been significant advances in minimally invasive surgical techniques to treat drug-resistant epilepsy. These minimally invasive procedures have significant advantages over open surgery in that they produce less immediate discomfort and disability, while allowing for greater preservation of functional tissue. Laser interstitial thermal therapy (LiTT) is an example of such a procedure. Recent advances in imaging, surgical navigation, and real-time thermal monitoring have made LiTT safer and easier to implement, offering an effective and powerful neurosurgical tool for drug-resistant epilepsy. This article will review the technical considerations, uses, and potential future directions for LiTT in drug-resistant epilepsy.
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Affiliation(s)
- Joon Y Kang
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD, 21287, USA.
| | - Michael R Sperling
- Thomas Jefferson University Hospital, 900 Walnut Street Suite 200, Philadelphia, PA, 19107, USA
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LaRiviere MJ, Gross RE. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery. Front Surg 2016; 3:64. [PMID: 27995127 PMCID: PMC5136731 DOI: 10.3389/fsurg.2016.00064] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/21/2016] [Indexed: 12/02/2022] Open
Abstract
Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one-third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular, radiofrequency (RF) ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT), the development of which began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided RF ablation series for mesial temporal lobe epilepsy. The developments of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided LITT systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.
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Affiliation(s)
- Michael J. LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E. Gross
- Departments of Neurosurgery and Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Ciris PA, Cheng CC, Mei CS, Panych LP, Madore B. Dual-Pathway sequences for MR thermometry: When and where to use them. Magn Reson Med 2016; 77:1193-1200. [PMID: 26968318 DOI: 10.1002/mrm.26177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/21/2016] [Accepted: 01/31/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE Dual-pathway sequences have been proposed to help improve the temperature-to-noise ratio (TNR) in MR thermometry. The present work establishes how much of an improvement these so-called "PSIF-FISP" sequences may bring in various organs and tissues. METHODS Simulations and TNR calculations were validated against analytical equations, phantom, abdomen, and brain scans. Relative TNRs for PSIF-FISP, as compared to a dual-FISP reference standard, were calculated for flip angle (FA) = 1 to 85 º and repetition time (TR) = 6 to 60 ms, for gray matter, white matter, cervix, endometrium, myometrium, prostate, kidney medulla and cortex, bone marrow, pancreas, spleen, muscle, and liver tissues. RESULTS PSIF-FISP was TNR superior in the kidney, pelvis, spleen, or gray matter at most tested TR and FA settings, and benefits increased at shorter TRs. PSIF-FISP was TNR superior in other tissues, e.g., liver, muscle, pancreas, for only short TR settings (20 ms or less). The TNR benefits of PSIF-FISP increased slightly with FA, and strongly with decreasing TR. Up to two- to three-fold reductions in TR with 20% TNR gains were achievable. In any given tissue, TNR performance is expected to further improve with heating, due to changes in relaxation rates. CONCLUSION Dual-pathway PSIF-FISP can improve TNR and acquisition speed over standard gradient-recalled echo sequences, but optimal acquisition parameters are tissue dependent. Magn Reson Med 77:1193-1200, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Pelin Aksit Ciris
- Department of Biomedical Engineering, Akdeniz University, Antalya, Turkey.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cheng-Chieh Cheng
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Lawrence P Panych
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruno Madore
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Han M, Rieke V, Scott SJ, Ozhinsky E, Salgaonkar VA, Jones PD, Larson PEZ, Diederich CJ, Krug R. Quantifying temperature-dependent T1 changes in cortical bone using ultrashort echo-time MRI. Magn Reson Med 2015; 74:1548-55. [PMID: 26390357 DOI: 10.1002/mrm.25994] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 08/05/2015] [Accepted: 08/30/2015] [Indexed: 11/06/2022]
Abstract
PURPOSE To demonstrate the feasibility of using ultrashort echo-time MRI to quantify T1 changes in cortical bone due to heating. METHODS Variable flip-angle T1 mapping combined with 3D ultrashort echo-time imaging was used to measure T1 in cortical bone. A calibration experiment was performed to detect T1 changes with temperature in ex vivo cortical bone samples from a bovine femur. Ultrasound heating experiments were performed using an interstitial applicator in ex vivo bovine femur specimens, and heat-induced T1 changes were quantified. RESULTS The calibration experiment demonstrated that T1 increases with temperature in cortical bone. We observed a linear relationship between temperature and T1 with a linear coefficient between 0.67 and 0.84 ms/°C over a range of 25-70°C. The ultrasound heating experiments showed increased T1 changes in the heated regions, and the relationship between the temperature changes and T1 changes was similar to that of the calibration. CONCLUSION We demonstrated a temperature dependence of T1 in ex vivo cortical bone using a variable flip-angle ultrashort echo-time T1 mapping method.
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Affiliation(s)
- Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Serena J Scott
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Eugene Ozhinsky
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Vasant A Salgaonkar
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Peter D Jones
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Joint Graduate Program in Bioengineering, University of California San Francisco/Berkeley, San Francisco, California, USA
| | - Chris J Diederich
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA.,Joint Graduate Program in Bioengineering, University of California San Francisco/Berkeley, San Francisco, California, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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Patel NV, Jethwa PR, Shetty A, Danish SF. Does the real-time thermal damage estimate allow for estimation of tumor control after MRI-guided laser-induced thermal therapy? Initial experience with recurrent intracranial ependymomas. J Neurosurg Pediatr 2015; 15:363-71. [PMID: 25580512 DOI: 10.3171/2014.10.peds13698] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although control of intracranial ependymomas is highly correlated with degree of resection, it is unknown if the same is true for MRI-guided laser-induced thermal therapy (MRgLITT). The authors report their experience with MRgLITT for ependymoma and examine the utility of the real-time thermal damage estimate (TDE), a recent software advance, with respect to completeness of ablation and impact on tumor control. To the authors' knowledge, this is the largest single-center experience utilizing MRgLITT for recurrent ependymomas. METHODS Five tumors in 4 patients were treated with the Visualase Thermal Therapy System. Two tumors were treated similarly on recurrence. Ablation was performed using a 980-nm diode laser with a real-time image acquisition system. Single-plane TDEs were calculated and compared with the original lesion area to compute percentage area ablated (PAA). Volumetric analysis was performed, and percentage volume ablated (PVA) was estimated and correlated with the TDE. Tumor control was correlated with the TDE and volumetric data during treatment. RESULTS Nine ablations were performed on 5 tumors, 2 of which had multiple recurrences. The average pretreatment lesion volume was 8.4 ± 6.3 cm(3), and the average largest 2D area was 5.3 ± 2.7 cm(2). The averaged TDE was 3.9 ± 2.1 cm(2), average PAA was 80.1% ± 34.3%, and average PVA was 64.4% ± 23.5%. For subtotal ablations, average recurrence time was 4.4 ± 5.3 months; 1 adult case remains recurrence-free at 40 months. Using TDEs, the correlation between recurrence time and PAA was r = 0.93 (p = 0.01), and for PVA was r = 0.88 (p = 0.02). Furthermore, PVA and PAA were strongly correlated (r = 0.88, p = 0.02). CONCLUSIONS Through using the PAA, the real-time TDE correlated with the volume of ablation in this initial investigation. Furthermore, the TDE and volumetric data corresponded to the level of tumor control, with time to recurrence dependent on ablation completeness. MRgLITT may have a role in the management of recurrent ependymomas, especially with recent software advances.
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Affiliation(s)
- Nitesh V Patel
- Division of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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20
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Lee YF, Lin CC, Cheng JS, Chen GS. Nerve conduction block in diabetic rats using high-intensity focused ultrasound for analgesic applications. Br J Anaesth 2015; 114:840-6. [PMID: 25904608 DOI: 10.1093/bja/aeu443] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Nerve conduction block using high-intensity focused ultrasound (HIFU) has been conducted with nerves of mixed fibres in normal animal models. This study tested the feasibility and safety of HIFU for sensory nerve conduction block in diabetic neuropathic nerves to determine its potential for pain relief. METHODS Diabetes was induced in Sprague-Dawley rats using streptozotocin, and HIFU at 2.68 MHz was used for the block. This study consisted of two sections, in vitro and in vivo. For the in vitro experiments, the entire contiguous sciatic-sural nerves were obtained. Compound action potentials and sensory action potentials were recorded in the sciatic and sural nerves, respectively. For the in vivo experiments, compound muscle action potentials (CMAPs) were recorded from the gastrocnemius muscles. All data were expressed as median (range). RESULTS The in vitro results showed that HIFU temporarily inhibited sensory action potentials of the control and diabetic rat nerves to 33.9 (8.2) and 14.0 (10.7)% of the baseline values, respectively, whereas the compound action potentials were suppressed to 53.6 (8.4) and 76.2 (7.5)% of baseline, respectively. The in vivo results showed that HIFU acutely blocked CMAPs to 32.9 (12.6) and 19.9 (10.9)% of baseline in control and diabetic rat nerves, respectively. Measurements of CMAPs and histological exanmination were used for indirect assessment of the safety of the HIFU technique. CONCLUSIONS High-intensity focused ultrasound safely and reversibly suppressed nerve conduction in diabetic rat nerves when the stimulation parameters were appropriate. The results suggest that HIFU may have potential to block sensory nerves reversibly and provide peripheral pain relief.
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Affiliation(s)
- Y-F Lee
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - C-C Lin
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - J-S Cheng
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - G-S Chen
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
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21
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Lee YF, Lin CC, Cheng JS, Chen GS. High-intensity focused ultrasound attenuates neural responses of sciatic nerves isolated from normal or neuropathic rats. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:132-142. [PMID: 25438842 DOI: 10.1016/j.ultrasmedbio.2014.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 06/04/2023]
Abstract
Patients with diabetic neuropathy often have neuropathic pain. The purpose of our work was to investigate the effects of high-intensity focused ultrasound (HIFU) on the conduction block of normal and neuropathic nerves for soothing pain. Adult male Sprague-Dawley rats were used, and diabetes was induced by streptozotocin injection. Diabetic neuropathy was evaluated with animal behavior tests. Sciatic nerves of both control and neuropathic rats were dissected from the starting point of the sciatic nerve to the point where the sural nerve ends near the ankle. The nerves were stored in Ringer's solution. The in vitro nerve was placed on a self-developed experimental platform for HIFU exposure. Stimulation and recording of the compound action potentials (CAPs) and sensory action potentials (SAPs) were performed. Control and neuropathic nerves exposed or not exposed to HIFU were submitted to histologic analysis. For the control and neuropathic nerves, suppression of CAPs and SAPs started 2 min post-HIFU treatment. Maximum suppression of SAPs was 34.4 ± 3.2% for the control rats and 11.6 ± 2.0% and 9.8 ± 3.0% for rats 4 wk post-injection and 8 wk post-injection, respectively. Time to full recovery was 25, 70 and 80 min, respectively. Histologic analysis revealed that the nerves in which CAPs and SAPs did not fully recover were damaged thermally or mechanically by HIFU. It is feasible to reversibly block nerves with appropriate HIFU treatment. Diabetic nerves were less suppressed by HIFU and were more vulnerable to permanent damage.
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Affiliation(s)
- Yee-Fun Lee
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Chou-Ching Lin
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jung-Sung Cheng
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Gin-Shin Chen
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan.
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22
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Saccomandi P, Schena E, Silvestri S. Techniques for temperature monitoring during laser-induced thermotherapy: an overview. Int J Hyperthermia 2013; 29:609-19. [PMID: 24032415 DOI: 10.3109/02656736.2013.832411] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laser-induced thermotherapy (LITT) is a hyperthermic procedure recently employed to treat cancer in several organs. The amount of coagulated tissue depends on the temperature distribution around the applicator, which plays a crucial role for an optimal outcome: the removal of the whole neoplastic tissue, whilst preventing damage to the surrounding healthy tissue. Although feedback concerning tissue temperature could be useful to drive the physician in the adjustment of laser settings and treatment duration, LITT is usually performed without real-time monitoring of tissue temperature. During recent decades, many thermometric techniques have been developed to be used during thermal therapies. This paper provides an overview of techniques and sensors employed for temperature measurement during tissue hyperthermia, focusing on LITT, and an investigation of their performances in this application. The paper focuses on the most promising and widespread temperature monitoring techniques, splitting them into two groups: the former includes invasive techniques based on the use of thermocouples and fibre-optic sensors; the second analyses non-invasive methods, i.e. magnetic resonance imaging-, computerised tomography- and ultrasound-based thermometry. Background information on measuring principle, medical applications, advantages and weaknesses of each method are provided and discussed.
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Affiliation(s)
- Paola Saccomandi
- Unit of Measurements and Biomedical Instrumentation, Centre for Integrated Research, University Campus Bio-Medico , Rome , Italy
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23
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McDannold N, Zhang YZ, Power C, Jolesz F, Vykhodtseva N. Nonthermal ablation with microbubble-enhanced focused ultrasound close to the optic tract without affecting nerve function. J Neurosurg 2013; 119:1208-20. [PMID: 24010975 DOI: 10.3171/2013.8.jns122387] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Tumors at the skull base are challenging for both resection and radiosurgery given the presence of critical adjacent structures, such as cranial nerves, blood vessels, and brainstem. Magnetic resonance imaging-guided thermal ablation via laser or other methods has been evaluated as a minimally invasive alternative to these techniques in the brain. Focused ultrasound (FUS) offers a noninvasive method of thermal ablation; however, skull heating limits currently available technology to ablation at regions distant from the skull bone. Here, the authors evaluated a method that circumvents this problem by combining the FUS exposures with injected microbubble-based ultrasound contrast agent. These microbubbles concentrate the ultrasound-induced effects on the vasculature, enabling an ablation method that does not cause significant heating of the brain or skull. METHODS In 29 rats, a 525-kHz FUS transducer was used to ablate tissue structures at the skull base that were centered on or adjacent to the optic tract or chiasm. Low-intensity, low-duty-cycle ultrasound exposures (sonications) were applied for 5 minutes after intravenous injection of an ultrasound contrast agent (Definity, Lantheus Medical Imaging Inc.). Using histological analysis and visual evoked potential (VEP) measurements, the authors determined whether structural or functional damage was induced in the optic tract or chiasm. RESULTS Overall, while the sonications produced a well-defined lesion in the gray matter targets, the adjacent tract and chiasm had comparatively little or no damage. No significant changes (p > 0.05) were found in the magnitude or latency of the VEP recordings, either immediately after sonication or at later times up to 4 weeks after sonication, and no delayed effects were evident in the histological features of the optic nerve and retina. CONCLUSIONS This technique, which selectively targets the intravascular microbubbles, appears to be a promising method of noninvasively producing sharply demarcated lesions in deep brain structures while preserving function in adjacent nerves. Because of low vascularity--and thus a low microbubble concentration--some large white matter tracts appear to have some natural resistance to this type of ablation compared with gray matter. While future work is needed to develop methods of monitoring the procedure and establishing its safety at deep brain targets, the technique does appear to be a potential solution that allows FUS ablation of deep brain targets while sparing adjacent nerve structures.
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Affiliation(s)
- Nathan McDannold
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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24
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Colen RR, Jolesz FA. MR-Guided Focused Ultrasound of the Brain. INTERVENTIONAL MAGNETIC RESONANCE IMAGING 2012. [DOI: 10.1007/174_2012_616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Chen JW, Huang TY, Peng HH, Chen WS, Tseng WYI. Proton resonance frequency shift-weighted imaging for monitoring MR-guided high-intensity focused ultrasound transmissions. J Magn Reson Imaging 2011; 33:1474-81. [PMID: 21591018 DOI: 10.1002/jmri.22582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To combine temperature-related information of phase images and magnitude images acquired from an MR spoiled gradient echo sequence using a postprocessing method referred to as PRF-shift-weighted imaging (PRFSWI). MATERIALS AND METHODS Phase images are capable of detecting shifts in proton resonance frequency (PRF) caused by local changes in temperature. Magnitude images provide anatomical information for treatment planning and positioning as well as temperature-related contrast. We used PRFSWI to produce a phase-mask and performed multiplication on the magnitude image to increase temperature-related contrast. RESULTS Through MRI-guided focused ultrasound (MRIgFUS) experiments (both ex vivo and in vivo), we determined that PRFSWI is capable of enhancing the contrast of a heated area even in the initial stages of transmitting high-intensity focused ultrasound energy. CONCLUSION The PRFSWI images are sensitive to changes in temperature and display the heated spot directly in the magnitude images. Although the images do not provide quantitative data related to temperature, this method could be used as a complement to the phase temperature mapping method in the real-time monitoring of MRIgFUS experiments.
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Affiliation(s)
- Jyun-Wen Chen
- Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
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26
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Colen RR, Kekhia H, Jolesz FA. Multimodality intraoperative MRI for brain tumor surgery. Expert Rev Neurother 2011; 10:1545-58. [PMID: 20945538 DOI: 10.1586/ern.10.145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intraoperative MRI has already fundamentally changed the way current brain tumor surgery is performed. The ability to integrate high-field MRI into the operating room has allowed intraoperative MRI to emerge as an important adjunct to CNS tumor treatment. Furthermore, the ability of MRI to successfully couple with molecular imaging (PET and/or optical imaging), neuroendoscopy and therapeutic devices, such as focused ultrasound, will allow it to emerge as an important image-guidance modality for improving brain tumor therapy and outcomes.
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Affiliation(s)
- Rivka R Colen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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27
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Madore B, Panych LP, Mei CS, Yuan J, Chu R. Multipathway sequences for MR thermometry. Magn Reson Med 2011; 66:658-68. [PMID: 21394774 DOI: 10.1002/mrm.22844] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 12/31/2022]
Abstract
MR-based thermometry is a valuable adjunct to thermal ablation therapies as it helps to determine when lethal doses are reached at the target and whether surrounding tissues are safe from damage. When the targeted lesion is mobile, MR data can further be used for motion-tracking purposes. The present work introduces pulse sequence modifications that enable significant improvements in terms of both temperature-to-noise-ratio properties and target-tracking abilities. Instead of sampling a single magnetization pathway as in typical MR thermometry sequences, the pulse-sequence design introduced here involves sampling at least one additional pathway. Image reconstruction changes associated with the proposed sampling scheme are also described. The method was implemented on two commonly used MR thermometry sequences: the gradient-echo and the interleaved echo-planar imaging sequences. Data from the extra pathway enabled temperature-to-noise-ratio improvements by up to 35%, without increasing scan time. Potentially of greater significance is that the sampled pathways featured very different contrast for blood vessels, facilitating their detection and use as internal landmarks for tracking purposes. Through improved temperature-to-noise-ratio and lesion-tracking abilities, the proposed pulse-sequence design may facilitate the use of MR-monitored thermal ablations as an effective treatment option even in mobile organs such as the liver and kidneys.
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Affiliation(s)
- Bruno Madore
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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28
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Colen RR, Jolesz FA. Future potential of MRI-guided focused ultrasound brain surgery. Neuroimaging Clin N Am 2010; 20:355-66. [PMID: 20708551 DOI: 10.1016/j.nic.2010.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Magnetic resonance image-guided focused ultrasound surgery (MRgFUS) has surfaced as a viable noninvasive image-guided therapeutic method that integrates focused ultrasound (FUS), the therapeutic component, with magnetic resonance imaging (MRI), the image guidance module, into a real-time therapy delivery system with closed-loop control of energy delivery. The main applications for MRgFUS of the brain are thermal ablations for brain tumors and functional neurosurgery, and nonthermal, nonablative uses for disruption of the blood brain barrier (BBB) or blood clot and hematoma dissolution by liquification. The disruption of the BBB by FUS can be used for targeted delivery of chemotherapy and other therapeutic agents. MRI is used preoperatively for target definition and treatment planning, intraoperatively for procedure monitoring and control, and postoperatively for validating treatment success. Although challenges still remain, this integrated noninvasive therapy delivery system is anticipated to change current treatment paradigms in neurosurgery and the clinical neurosciences.
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Affiliation(s)
- Rivka R Colen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Abstract
Conventional surgical treatments of liver cancer are invasive (including minimally invasive) with a high incidence of new metastasis and poor success, even after multiple resections or ablations. These limitations motivated research into new, less invasive solutions for liver cancer treatment.Focused ultrasound surgery (FUS), or high-intensity focused ultrasound, has been recognized as a noninvasive technology for benign and malignant tumor treatment. Previously, FUS was guided with ultrasound that has limited target definition and monitoring capability of the ablation process. Combining magnetic resonance imaging (MRI) with multiple-element phased-array transducers to create MRI-guided focused ultrasound thermal therapy provides more accurate targeting and real-time temperature monitoring. This treatment is hindered by the ribcage that limits the acoustic windows to the liver and the respiratory motion of the liver. New advances in MRI and transducer design will likely resolve these limitations and make MRI-guided FUS a powerful tool in local liver cancer therapy. This article reviews this technology and advances that can expand its use for cancer treatment in general and liver cancer in particular.
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McDannold N, Clement GT, Black P, Jolesz F, Hynynen K. Transcranial magnetic resonance imaging- guided focused ultrasound surgery of brain tumors: initial findings in 3 patients. Neurosurgery 2010; 66:323-32; discussion 332. [PMID: 20087132 DOI: 10.1227/01.neu.0000360379.95800.2f] [Citation(s) in RCA: 381] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This work evaluated the clinical feasibility of transcranial magnetic resonance imaging-guided focused ultrasound surgery. METHODS Transcranial magnetic resonance imaging-guided focused ultrasound surgery offers a potential noninvasive alternative to surgical resection. The method combines a hemispherical phased-array transducer and patient-specific treatment planning based on acoustic models with feedback control based on magnetic resonance temperature imaging to overcome the effects of the cranium and allow for controlled and precise thermal ablation in the brain. In initial trials in 3 glioblastoma patients, multiple focused ultrasound exposures were applied up to the maximum acoustic power available. Offline analysis of the magnetic resonance temperature images evaluated the temperature changes at the focus and brain surface. RESULTS We found that it was possible to focus an ultrasound beam transcranially into the brain and to visualize the heating with magnetic resonance temperature imaging. Although we were limited by the device power available at the time and thus seemed to not achieve thermal coagulation, extrapolation of the temperature measurements at the focus and on the brain surface suggests that thermal ablation will be possible with this device without overheating the brain surface, with some possible limitation on the treatment envelope. CONCLUSION Although significant hurdles remain, these findings are a major step forward in producing a completely noninvasive alternative to surgical resection for brain disorders.
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Affiliation(s)
- Nathan McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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STOLLBERGER R, EBNER F, FAN M, ASCHER PW. Temperaturmapping mittels MR-lmaging am Beispiel der Laserkoagulation von Gehirngewebe. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1992.37.s1.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Seibel RMM, Grönemeyer DH, Schmidt AM, Melzer A. Minimally invasive treatment of spinal diseases. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709609153296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Roberts HRS, Paley M, Sams VR, Wilkinson ID, Lees WR, Hall-craggs MA, Bown SG. Magnetic resonance imaging of interstitial laser photocoagulation of normal rat liver: Imaging-histopathological correlation. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709709152825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Roberts HRS, Paley M, Sams VR, Wilkinson ID, Lees WR, Hall-craggs MA, Bown SG. Magnetic resonance imaging control of laser destruction of hepatic metastases: Correlation with post-operative dynamic helical CT. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709709152826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kettenbach J, Kuroda K, Hata N, Morrison P, McDannold NJ, Gering D, Saiviroonporn P, Zientara GP, Black PM, Kikinis R, Jolesz FA. Laser-induced thermotherapy of cerebral neoplasia under MR tomographic control. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709809152908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Russ D, Orth K, Steiner R. The potential of laser-induced interstitial thermotherapy to treat liver metastases. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709809152897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mack MG, Vogl TJ, Eichler K, Müller P, Straub R, Roggan A, Felix R. Laser-induced thermoablation of tumours of the head and neck under MR tomographic control. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709809152906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Grönemeyermd DH, Seibelmd RM, Melzermd A, Schmidt A, Deli M, Friebe M, Busch M. Future of advanced guidance techniques by interventional CT and MRI. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13645709509152803] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Grönemeyer DHW, Gevargez A, Möhlenkamp S, Deli M, Kriener P, Schmermund A, Melzer A, Erbel R. Workstation for tomographic microtherapy. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709809153114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McDannold N. Quantitative MRI-based temperature mapping based on the proton resonant frequency shift: Review of validation studies. Int J Hyperthermia 2009; 21:533-46. [PMID: 16147438 DOI: 10.1080/02656730500096073] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
MRI-based temperature imaging that exploits the temperature-sensitive water proton resonant frequency shift is currently the only available method for reliable quantification of temperature changes in vivo. Extensive pre-clinical work has been performed to validate this method for guiding thermal therapies. That work has shown the method to be useful for all stages of the thermal therapy, from resolving heating below the threshold for damage to ensuring that the thermal exposure is sufficient within the target volume and protecting surrounding critical structures and to accurately predicting the extent of the ablated volume. In this paper, these validation studies will be reviewed. In addition, clinical studies that have shown this method feasible in human treatments will be overviewed.
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Affiliation(s)
- N McDannold
- Department of Radiology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.
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Viard R. Présentation des différentes avancées techniques en imagerie interventionnelle par résonance magnétique. Ing Rech Biomed 2009. [DOI: 10.1016/j.irbm.2008.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Development of Quantum Dot-Mediated Fluorescence Thermometry for Thermal Therapies. Ann Biomed Eng 2009; 37:1230-9. [DOI: 10.1007/s10439-009-9681-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 03/17/2009] [Indexed: 12/28/2022]
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Castro DJ, Saxton RE, Lufkin RB, Haugland RP, Zwarun AA, Fetterman HR, Soudant J, Castro DJ, Ward PH, Kangarloo H. Future Directions of Laser Phototherapy for Diagnosis and Treatment of Malignancies: Fantasy, Fallacy, or Reality? Laryngoscope 2009. [DOI: 10.1002/lary.1991.101.s55.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rempp H, Martirosian P, Boss A, Clasen S, Kickhefel A, Kraiger M, Schraml C, Claussen C, Pereira P, Schick F. MR temperature monitoring applying the proton resonance frequency method in liver and kidney at 0.2 and 1.5 T: segment-specific attainable precision and breathing influence. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2008; 21:333-43. [DOI: 10.1007/s10334-008-0139-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 07/18/2008] [Accepted: 08/07/2008] [Indexed: 12/13/2022]
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Hushek SG, Martin AJ, Steckner M, Bosak E, Debbins J, Kucharzyk W. MR systems for MRI-guided interventions. J Magn Reson Imaging 2008; 27:253-66. [PMID: 18219680 DOI: 10.1002/jmri.21269] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The field of MR imaging has grown from diagnosis via morphologic imaging to more sophisticated diagnosis via both physiologic and morphologic imaging and finally to the guidance and control of interventions. A wide variety of interventional procedures from open brain surgeries to noninvasive focused ultrasound ablations have been guided with MR and the differences between diagnostic and interventional MR imaging systems have motivated the creation of a new field within MR. This review discusses the various systems that research groups and vendors have designed to meet the requirements of interventional MR and suggest possible solutions to those requirements that have not yet been met. The common requirements created by MR imaging guidance of interventional procedures are reviewed and different imaging system designs will be independently considered. The motivation and history of the different designs are discussed and the ability of the designs to satisfy the requirements is analyzed.
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Viard R, Piron B, Steiner A, Wassmer B, Rousseau J, Mordon S. Non-invasive 3d magnetic resonance thermal mapping: determination of the lesion size during laser-therapy in ex vivo tissues. Int J Comput Assist Radiol Surg 2008. [DOI: 10.1007/s11548-007-0141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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MacFall JR, Soher BJ. From the RSNA refresher courses: MR imaging in hyperthermia. Radiographics 2008; 27:1809-18. [PMID: 18025519 DOI: 10.1148/rg.276075097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is growing clinical evidence that the combination of radiation therapy and hyperthermia, when delivered at moderate temperatures (40 degrees-45 degrees C) for sustained times (30-90 minutes), is of benefit with regard to palliative relief of cancer, tumor response, local control, and survival. Adequate measurement of the temperature distribution achieved with the hyperthermia is a key element in successful therapy. Thermal dosimetry, even invasive dosimetry, is a complex topic when applied to the heterogeneous tissue of a tumor and associated organ systems. Imaging in hyperthermia therapy is performed primarily for estimation and control of temperature. Magnetic resonance (MR) imaging has unique parameter dependences that make it possible to monitor hyperthermia therapy by detection of proton resonant frequency changes or diffusion coefficient changes. In addition, MR imaging can be used to assess vascular parameters that not only allow selection of suitable patients for therapy but may also allow demonstration of response to therapy. Finally, as the use of thermally sensitive liposomes for delivery of chemotherapeutic agents is developed, MR imaging may allow determination of local drug dose.
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Affiliation(s)
- James R MacFall
- Department of Radiology, Duke University Medical Center, Box 3808, Erwin Road, Durham, NC 27710, USA.
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Viard R, Rousseau J. [Interventional MR imaging: state of the art and technological advances]. JOURNAL DE RADIOLOGIE 2008; 89:13-20. [PMID: 18288022 DOI: 10.1016/s0221-0363(08)70365-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Due to its excellent soft tissue contrast and lack of ionizing radiation, MR imaging is well suited for interventional procedures. MRI is being increasingly used for guidance during percutaneous procedures or surgery. Technical advances in interventional MR imaging are reviewed in this paper. Ergonomical factors with improved access to patients as well as advances in informatics, electronics and robotics largely explain this increasing role. Different elements are discussed from improved access to patients in the scanners to improved acquisition pulse sequences. Selected clinical applications and recent publications will be presented to illustrate the current status of this technique.
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Affiliation(s)
- R Viard
- INSERM, U703, ITM, Pavillon Vancostenobel, CHRU de Lille, 2 avenue Oscar Lambret, 59000 Lille Cedex.
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Viard R, Emptaz A, Piron B, Rochon P, Wassmer B, Mordon S. Determination of the Lesion Size in Laser-Induced Interstitial Thermal Therapy (LITT) using a Low-Field MRI. ACTA ACUST UNITED AC 2007; 2007:214-7. [DOI: 10.1109/iembs.2007.4352261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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