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Xu Z, Rauch DE, Mohamed RM, Pashapoor S, Zhou Z, Panthi B, Son JB, Hwang KP, Musall BC, Adrada BE, Candelaria RP, Leung JWT, Le-Petross HTC, Lane DL, Perez F, White J, Clayborn A, Reed B, Chen H, Sun J, Wei P, Thompson A, Korkut A, Huo L, Hunt KK, Litton JK, Valero V, Tripathy D, Yang W, Yam C, Ma J. Deep Learning for Fully Automatic Tumor Segmentation on Serially Acquired Dynamic Contrast-Enhanced MRI Images of Triple-Negative Breast Cancer. Cancers (Basel) 2023; 15:4829. [PMID: 37835523 PMCID: PMC10571741 DOI: 10.3390/cancers15194829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Accurate tumor segmentation is required for quantitative image analyses, which are increasingly used for evaluation of tumors. We developed a fully automated and high-performance segmentation model of triple-negative breast cancer using a self-configurable deep learning framework and a large set of dynamic contrast-enhanced MRI images acquired serially over the patients' treatment course. Among all models, the top-performing one that was trained with the images across different time points of a treatment course yielded a Dice similarity coefficient of 93% and a sensitivity of 96% on baseline images. The top-performing model also produced accurate tumor size measurements, which is valuable for practical clinical applications.
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Affiliation(s)
- Zhan Xu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - David E. Rauch
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Rania M. Mohamed
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanaz Pashapoor
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zijian Zhou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Bikash Panthi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Benjamin C. Musall
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Beatriz E. Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rosalind P. Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jessica W. T. Leung
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Huong T. C. Le-Petross
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Deanna L. Lane
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frances Perez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jason White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alyson Clayborn
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Brandy Reed
- Department of Clinical Research Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Huiqin Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alastair Thompson
- Section of Breast Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Anil Korkut
- Department of Bioinformatics & Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
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Zhou Z, Adrada BE, Candelaria RP, Elshafeey NA, Boge M, Mohamed RM, Pashapoor S, Sun J, Xu Z, Panthi B, Son JB, Guirguis MS, Patel MM, Whitman GJ, Moseley TW, Scoggins ME, White JB, Litton JK, Valero V, Hunt KK, Tripathy D, Yang W, Wei P, Yam C, Pagel MD, Rauch GM, Ma J. Predicting pathological complete response to neoadjuvant systemic therapy for triple-negative breast cancers using deep learning on multiparametric MRIs. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083160 DOI: 10.1109/embc40787.2023.10340987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
We trained and validated a deep learning model that can predict the treatment response to neoadjuvant systemic therapy (NAST) for patients with triple negative breast cancer (TNBC). Dynamic contrast enhanced (DCE) MRI and diffusion-weighted imaging (DWI) of the pre-treatment (baseline) and after four cycles (C4) of doxorubicin/cyclophosphamide treatment were used as inputs to the model for prediction of pathologic complete response (pCR). Based on the standard pCR definition that includes disease status in either breast or axilla, the model achieved areas under the receiver operating characteristic curves (AUCs) of 0.96 ± 0.05, 0.78 ± 0.09, 0.88 ± 0.02, and 0.76 ± 0.03, for the training, validation, testing, and prospective testing groups, respectively. For the pCR status of breast only, the retrained model achieved prediction AUCs of 0.97 ± 0.04, 0.82 ± 0.10, 0.86 ± 0.03, and 0.83 ± 0.02, for the training, validation, testing, and prospective testing groups, respectively. Thus, the developed deep learning model is highly promising for predicting the treatment response to NAST of TNBC.Clinical Relevance- Deep learning based on serial and multiparametric MRIs can potentially distinguish TNBC patients with pCR from non-pCR at the early stage of neoadjuvant systemic therapy, potentially enabling more personalized treatment of TNBC patients.
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Prediction of pathologic complete response to neoadjuvant systemic therapy in triple negative breast cancer using deep learning on multiparametric MRI. Sci Rep 2023; 13:1171. [PMID: 36670144 PMCID: PMC9859781 DOI: 10.1038/s41598-023-27518-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. Neoadjuvant systemic therapy (NAST) followed by surgery are currently standard of care for TNBC with 50-60% of patients achieving pathologic complete response (pCR). We investigated ability of deep learning (DL) on dynamic contrast enhanced (DCE) MRI and diffusion weighted imaging acquired early during NAST to predict TNBC patients' pCR status in the breast. During the development phase using the images of 130 TNBC patients, the DL model achieved areas under the receiver operating characteristic curves (AUCs) of 0.97 ± 0.04 and 0.82 ± 0.10 for the training and the validation, respectively. The model achieved an AUC of 0.86 ± 0.03 when evaluated in the independent testing group of 32 patients. In an additional prospective blinded testing group of 48 patients, the model achieved an AUC of 0.83 ± 0.02. These results demonstrated that DL based on multiparametric MRI can potentially differentiate TNBC patients with pCR or non-pCR in the breast early during NAST.
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Percutaneous Management of Breast Cancer: a Systematic Review. Curr Oncol Rep 2022; 24:1443-1459. [PMID: 35699836 DOI: 10.1007/s11912-022-01290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Surgical treatment of breast cancer is becoming increasingly more minimally invasive. We review the development status of percutaneous management for primary breast cancer and the evidence relating to tumor size as a fundamental determinant of treatment clinical outcome. RECENT FINDINGS It is safe and feasible for percutaneous management to treat breast cancer. For tumor size ≤ 2 cm, percutaneous management is a promising alternative modality. For tumor size ≤ 3 cm, it is controversial whether percutaneous management can achieve similar effects to surgery, especially its long-term effects. For tumor size > 3 cm, it is still in the initial exploration stage and showed the potential in the treatment of unresectable cancer by benefitting the local control of primary cancer. Percutaneous management of breast cancer is a valuable method for breast cancer treatment in selected patients. However, it will be necessary to provide the high level of evidence for widespread clinical application.
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Roknsharifi S, Wattamwar K, Fishman MDC, Ward RC, Ford K, Faintuch S, Joshi S, Dialani V. Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand? Radiographics 2021; 41:945-966. [PMID: 34197250 DOI: 10.1148/rg.2021200156] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. ©RSNA, 2021.
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Affiliation(s)
- Shima Roknsharifi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kapil Wattamwar
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Michael D C Fishman
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Robert C Ward
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kelly Ford
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Salomao Faintuch
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Surekha Joshi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Vandana Dialani
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
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Payne A, Merrill R, Minalga E, Hadley JR, Odeen H, Hofstetter LW, Johnson S, Tunon de Lara C, Auriol S, Recco S, Dumont E, Parker DL, Palussiere J. A Breast-Specific MR Guided Focused Ultrasound Platform and Treatment Protocol: First-in-Human Technical Evaluation. IEEE Trans Biomed Eng 2021; 68:893-904. [PMID: 32784128 PMCID: PMC7878578 DOI: 10.1109/tbme.2020.3016206] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This paper presents and evaluates a breast-specific magnetic resonance guided focused ultrasound (MRgFUS) system. A first-in-human evaluation demonstrates the novel hardware, a sophisticated tumor targeting algorithm and a volumetric magnetic resonance imaging (MRI) protocol. METHODS At the time of submission, N = 10 patients with non-palpable T0 stage breast cancer have been treated with the breast MRgFUS system. The described tumor targeting algorithm is evaluated both with a phantom test and in vivo during the breast MRgFUS treatments. Treatments were planned and monitored using volumetric MR-acoustic radiation force imaging (MR-ARFI) and temperature imaging (MRTI). RESULTS Successful technical treatments were achieved in 80 % of the patients. All patients underwent the treatment with no sedation and 60 % of participants had analgesic support. The total MR treatment time ranged from 73 to 114 minutes. Mean error between desired and achieved targeting in a phantom was 2.9 ±1.8 mm while 6.2 ±1.9 mm was achieved in patient studies, assessed either with MRTI or MR-ARFI measurements. MRTI and MR-ARFI were successful in 60 % and 70 % of patients, respectively. CONCLUSION The targeting accuracy allows the accurate placement of the focal spot using electronic steering capabilities of the transducer. The use of both volumetric MRTI and MR-ARFI provides complementary treatment planning and monitoring information during the treatment, allowing the treatment of all breast anatomies, including homogeneously fatty breasts.
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Hofstetter LW, Odéen H, Bolster BD, Christensen DA, Payne A, Parker DL. Magnetic resonance shear wave elastography using transient acoustic radiation force excitations and sinusoidal displacement encoding. Phys Med Biol 2021; 66. [PMID: 33352538 DOI: 10.1088/1361-6560/abd5ce] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/22/2020] [Indexed: 12/31/2022]
Abstract
A magnetic resonance (MR) shear wave elastography technique that uses transient acoustic radiation force impulses from a focused ultrasound (FUS) transducer and a sinusoidal-shaped MR displacement encoding strategy is presented. Using this encoding strategy, an analytic expression for calculating the shear wave speed in a heterogeneous medium was derived. Green's function-based simulations were used to evaluate the feasibility of calculating shear wave speed maps using the analytic expression. Accuracy of simulation technique was confirmed experimentally in a homogeneous gelatin phantom. The elastography measurement was compared to harmonic MR elastography in a homogeneous phantom experiment and the measured shear wave speed values differed by less than 14%. This new transient elastography approach was able to map the position and shape of inclusions sized from 8.5 to 14 mm in an inclusion phantom experiment. These preliminary results demonstrate the feasibility of using a straightforward analytic expression to generate shear wave speed maps from MR images where sinusoidal-shaped motion encoding gradients are used to encode the displacement-time history of a transiently propagating wave-packet. This new measurement technique may be particularly well suited for performing elastography before, during, and after MR-guided FUS therapies since the same device used for therapy is also used as an excitation source for elastography.
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Affiliation(s)
- Lorne W Hofstetter
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Henrik Odéen
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Bradley D Bolster
- Siemens Medical Solutions USA, Inc., Salt Lake City, Utah, United States of America
| | - Douglas A Christensen
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America.,Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Allison Payne
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Dennis L Parker
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, United States of America
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Damianou C, Giannakou M, Menikou G, Ioannou L. Magnetic resonance imaging-guided focused ultrasound robotic system with the subject placed in the prone position. ACTA ACUST UNITED AC 2020. [DOI: 10.4103/digm.digm_2_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Peek MCL, Wu F. High-intensity focused ultrasound in the treatment of breast tumours. Ecancermedicalscience 2018; 12:794. [PMID: 29434660 PMCID: PMC5804717 DOI: 10.3332/ecancer.2018.794] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Indexed: 01/16/2023] Open
Abstract
High-intensity focused ultrasound (HIFU) is a minimally invasive technique that has been used for the treatment of both benign and malignant tumours. With HIFU, an ultrasound (US) beam propagates through soft tissue as a high-frequency pressure wave. The US beam is focused at a small target volume, and due to the energy building up at this site, the temperature rises, causing coagulative necrosis and protein denaturation within a few seconds. HIFU is capable of providing a completely non-invasive treatment without causing damage to the directly adjacent tissues. HIFU can be either guided by US or magnetic resonance imaging (MRI). Guided imaging is used to plan the treatment, detect any movement during the treatment and monitor response in real-time. This review describes the history of HIFU, the HIFU technique, available devices and gives an overview of the published literature in the treatment of benign and malignant breast tumours with HIFU.
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Affiliation(s)
- Mirjam C L Peek
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| | - Feng Wu
- HIFU Unit, The Churchill Hospital, Oxford University Hospitals, Headington, Oxford OX3 7LJ, UK
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Knuttel FM, Huijsse SEM, Feenstra TL, Moonen CTW, van den Bosch MAAJ, Buskens E, Greuter MJW, de Bock GH. Early health technology assessment of magnetic resonance-guided high intensity focused ultrasound ablation for the treatment of early-stage breast cancer. J Ther Ultrasound 2017; 5:23. [PMID: 28781881 PMCID: PMC5537939 DOI: 10.1186/s40349-017-0101-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) ablation is in development for minimally invasive treatment of breast cancer. Cost-effectiveness has not been assessed yet. An early health technology assessment was performed to estimate costs of MR-HIFU ablation, compared to breast conserving treatment (BCT). METHODS An MR-HIFU treatment model using the dedicated MR-HIFU breast system (Sonalleve, Philips Healthcare) was developed. Input parameters (treatment steps and duration) were based on the analysis of questionnaire data from an expert panel. MR-HIFU experts assessed face validity of the model. Data collected by questionnaires were compared to published data of an MR-HIFU breast feasibility study. Treatment costs for tumours of 1 to 3 cm were calculated. RESULTS The model structure was considered of acceptable face validity by consulted experts, and questionnaire data and published data were comparable. Costs of MR-HIFU ablation were higher than BCT costs. MR-HIFU best-case scenario costs exceeded BCT costs with approximately €1000. Cooling times and breathing correction contributed most to treatment costs. CONCLUSIONS MR-HIFU ablation is currently not a cost-effective alternative for BCT. MR-HIFU experience is limited, increasing uncertainty of estimations. The potential for cost-effectiveness increases if future research reduces treatment durations and might substantiate equal or improved results.
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Affiliation(s)
- Floortje M Knuttel
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sèvrin E M Huijsse
- Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Talitha L Feenstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Chrit T W Moonen
- Center of Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
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11
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Yiannakou M, Menikou G, Yiallouras C, Ioannides C, Damianou C. MRI guided focused ultrasound robotic system for animal experiments. Int J Med Robot 2017; 13. [PMID: 28211622 DOI: 10.1002/rcs.1804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND In this paper an MRI-guided focused ultrasound (MRgFUS) robotic system was developed that can be used for conducting experiments in small animals.The target for this robotic system regarding motion was to move a therapeutic ultrasound transducer in two Cartesian axes. METHODS A single element spherically focused transducer of 3 cm diameter, focusing at 7 cm and operating at 0.4 MHz was used. The positioning device incorporates only MRI compatible materials. The propagation of ultrasound is a bottom to top approach. The 2-D positioning device is controlled by custom-made software and a custom-made electronic system which controls the two piezoelectric motors. RESULTS The system was tested successfully in agar/silica/evaporated milk phantom for various tasks (robot motion, MR compatibility, and MR thermometry). The robotic system is capable of moving the focused ultrasound transducer to perform MR-guided focused ultrasound experiments in small animals. CONCLUSIONS This system has the potential to be deployed as a cost effective solution for performing experiments in small animals.
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Affiliation(s)
- Marinos Yiannakou
- Electrical Engineering Department, Cyprus University of Technology, Cyprus
| | | | - Christos Yiallouras
- Electrical Engineering Department, Cyprus University of Technology, Cyprus.,R&D, MEDSONIC LTD, Limassol, Cyprus
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Mauri G, Sconfienza LM, Pescatori LC, Fedeli MP, Alì M, Di Leo G, Sardanelli F. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis. Eur Radiol 2017; 27:3199-3210. [PMID: 28050693 DOI: 10.1007/s00330-016-4668-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments. METHODS An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome. RESULTS Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142). CONCLUSIONS Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low. KEY POINTS • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).
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Affiliation(s)
- Giovanni Mauri
- Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100, Milano, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità Operativa di Radiologia / Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milano, Italy
| | - Lorenzo Carlo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Maria Paola Fedeli
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Marco Alì
- Integrative Biomedical Research PhD Program, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Giovanni Di Leo
- Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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13
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Peek MCL, Ahmed M, Napoli A, Usiskin S, Baker R, Douek M. Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis. Int J Hyperthermia 2016; 33:191-202. [PMID: 27575566 DOI: 10.1080/02656736.2016.1230232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Breast-conserving surgery is effective for breast cancer treatment but is associated with morbidity in particular high re-excision rates. We performed a systematic review and meta-analysis to assess the current evidence for clinical outcomes with minimally invasive ablative techniques in the non-surgical treatment of breast cancer. METHODS A systematic search of the literature was performed using PubMed and Medline library databases to identify all studies published between 1994 and May 2016. Studies were considered eligible for inclusion if they evaluated the role of ablative techniques in the treatment of breast cancer and included ten patients or more. Studies that failed to fulfil the inclusion criteria were excluded. RESULTS We identified 63 studies including 1608 patients whose breast tumours were treated with radiofrequency (RFA), high intensity focussed ultrasound (HIFU), cryo-, laser or microwave ablation. Fifty studies reported on the number of patients with complete ablation as found on histopathology and the highest rate of complete ablation was achieved with RFA (87.1%, 491/564) and microwave ablation (83.2%, 89/107). Short-term complications were most often reported with microwave ablation (14.6%, 21/144). Recurrence was reported in 24 patients (4.2%, 24/570) and most often with laser ablation (10.7%, 11/103). The shortest treatment times were observed with RFA (15.6 ± 5.6 min) and the longest with HIFU (101.5 ± 46.6 min). CONCLUSION Minimally invasive ablative techniques are able to successfully induce coagulative necrosis in breast cancer with a low side effect profile. Adequately powered and prospectively conducted cohort trials are required to confirm complete pathological ablation in all patients.
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Affiliation(s)
- Mirjam C L Peek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
| | - Muneer Ahmed
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
| | - Alessandro Napoli
- b Department of Radiological Sciences , Sapienza University of Rome, School of Medicine , Roma , Italy
| | - Sasha Usiskin
- c Department of Radiology , St. Bartholomew's Hospital , London , Great Britain
| | - Rose Baker
- d School of Business, 612, Maxwell Building, University of Salford , Salford , Great Britain
| | - Michael Douek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
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14
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Farrer AI, Almquist S, Dillon CR, Neumayer LA, Parker DL, Christensen DA, Payne A. Phase aberration simulation study of MRgFUS breast treatments. Med Phys 2016; 43:1374-84. [PMID: 26936722 PMCID: PMC4769272 DOI: 10.1118/1.4941013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 01/24/2023] Open
Abstract
PURPOSE This simulation study evaluates the effects of phase aberration in breast MR-guided focused ultrasound (MRgFUS) ablation treatments performed with a phased-array transducer positioned laterally to the breast. A quantification of these effects in terms of thermal dose delivery and the potential benefits of phase correction is demonstrated in four heterogeneous breast numerical models. METHODS To evaluate the effects of varying breast tissue properties on the quality of the focus, four female volunteers with confirmed benign fibroadenomas were imaged using 3T MRI. These images were segmented into numerical models with six tissue types, with each tissue type assigned standard acoustic properties from the literature. Simulations for a single-plane 16-point raster-scan treatment trajectory centered in a fibroadenoma in each modeled breast were performed for a breast-specific MRgFUS system. At each of the 16 points, pressure patterns both with and without applying a phase correction technique were determined with the hybrid-angular spectrum method. Corrected phase patterns were obtained using a simulation-based phase aberration correction technique to adjust each element's transmit phase to obtain maximized constructive interference at the desired focus. Thermal simulations were performed for both the corrected and uncorrected pressure patterns using a finite-difference implementation of the Pennes bioheat equation. The effect of phase correction was evaluated through comparison of thermal dose accumulation both within and outside a defined treatment volume. Treatment results using corrected and uncorrected phase aberration simulations were compared by evaluating the power required to achieve a 20 °C temperature rise at the first treatment location. The extent of the volumes that received a minimum thermal dose of 240 CEM at 43 °C inside the intended treatment volume as well as the volume in the remaining breast tissues was also evaluated in the form of a dose volume ratio (DVR), a DVR percent change between corrected and uncorrected phases, and an additional metric that measured phase spread. RESULTS With phase aberration correction applied, there was an improvement in the focus for all breast anatomies as quantified by a reduction in power required (13%-102%) to reach 20 °C when compared to uncorrected simulations. Also, the DVR percent change increased by 5%-77% in seven out of eight cases, indicating an improvement to the treatment as measured by a reduction in thermal dose deposited to the nontreatment tissues. Breast compositions with a higher degree of heterogeneity along the ultrasound beam path showed greater reductions in thermal dose delivered outside of the treatment volume with correction applied than beam trajectories that propagated through more homogeneous breast compositions. An increasing linear trend was observed between the DVR percent change and the phase-spread metric (R(2) = 0.68). CONCLUSIONS These results indicate that performing phase aberration correction for breast MRgFUS treatments is beneficial for the small-aperture transducer (14.4 × 9.8 cm) evaluated in this work. While all breast anatomies could benefit from phase aberration correction, greater benefits are observed in more heterogeneous anatomies.
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Affiliation(s)
- Alexis I Farrer
- Department of Bioengineering, University of Utah, 36 South Wasatch Drive, Room 3100, Salt Lake City, Utah 84112
| | - Scott Almquist
- Department of Bioengineering, University of Utah, 36 South Wasatch Drive, Room 3100, Salt Lake City, Utah 84112
| | - Christopher R Dillon
- Department of Bioengineering, University of Utah, 36 South Wasatch Drive, Room 3100, Salt Lake City, Utah 84112
| | - Leigh A Neumayer
- Department of Bioengineering, University of Utah, 36 South Wasatch Drive, Room 3100, Salt Lake City, Utah 84112
| | - Dennis L Parker
- Department of Bioengineering, University of Utah, 36 South Wasatch Drive, Room 3100, Salt Lake City, Utah 84112
| | - Douglas A Christensen
- Department of Bioengineering, University of Utah, 36 South Wasatch Drive, Room 3100, Salt Lake City, Utah 84112
| | - Allison Payne
- Department of Bioengineering, University of Utah, 36 South Wasatch Drive, Room 3100, Salt Lake City, Utah 84112
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15
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Knuttel FM, Waaijer L, Merckel LG, van den Bosch MAAJ, Witkamp AJ, Deckers R, van Diest PJ. Histopathology of breast cancer after magnetic resonance-guided high-intensity focused ultrasound and radiofrequency ablation. Histopathology 2016; 69:250-9. [PMID: 26732321 DOI: 10.1111/his.12926] [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: 11/10/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
Abstract
AIMS Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation and radiofrequency ablation (RFA) are being researched as possible substitutes for surgery in breast cancer patients. The histopathological appearance of ablated tissue has not been studied in great detail. This study aimed to compare histopathological features of breast cancer after MR-HIFU ablation and RFA. METHODS AND RESULTS MR-HIFU ablation and RFA were performed in- and ex-vivo. Tumours in six mastectomy specimens were partially ablated with RFA or MR-HIFU. In-vivo MR-HIFU ablation was performed 3-6 days before excision; RFA was performed in the operation room. Tissue was fixed in formalin and processed to haematoxylin and eosin (H&E) and cytokeratin-8 (CK-8)-stained slides. Morphology and cell viability were assessed. Ex-vivo ablation resulted in clear morphological changes after RFA versus subtle differences after MR-HIFU. CK-8 staining was decreased or absent. H&E tended to underestimate the size of thermal damage. In-vivo MR-HIFU resulted in necrotic-like changes. Surprisingly, some ablated lesions were CK-8-positive. Histopathology after in-vivo RFA resembled ex-vivo RFA, with hyper-eosinophilic stroma and elongated nuclei. Lesion borders were sharp after MR-HIFU and indistinct after RFA. CONCLUSION Histopathological differences between MR-HIFU-ablated tissue and RF-ablated tissue were demonstrated. CK-8 was more reliable for cell viability assessment than H&E when used directly after ablation, while H&E was more reliable in ablated tissue left in situ for a few days. Our results contribute to improved understanding of histopathological features in breast cancer lesions treated with minimally invasive ablative techniques.
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Affiliation(s)
- Floortje M Knuttel
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laurien Waaijer
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laura G Merckel
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roel Deckers
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
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16
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First clinical experience with a dedicated MRI-guided high-intensity focused ultrasound system for breast cancer ablation. Eur Radiol 2016; 26:4037-4046. [PMID: 26852219 PMCID: PMC5052313 DOI: 10.1007/s00330-016-4222-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/12/2015] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the safety and feasibility of MRI-guided high-intensity focused ultrasound (MR-HIFU) ablation in breast cancer patients using a dedicated breast platform. METHODS Patients with early-stage invasive breast cancer underwent partial tumour ablation prior to surgical resection. MR-HIFU ablation was performed using proton resonance frequency shift MR thermometry and an MR-HIFU system specifically designed for breast tumour ablation. The presence and extent of tumour necrosis was assessed by histopathological analysis of the surgical specimen. Pearson correlation coefficients were calculated to assess the relationship between sonication parameters, temperature increase and size of tumour necrosis at histopathology. RESULTS Ten female patients underwent MR-HIFU treatment. No skin redness or burns were observed in any of the patients. No correlation was found between the applied energy and the temperature increase. In six patients, tumour necrosis was observed with a maximum diameter of 3-11 mm. In these patients, the number of targeted locations was equal to the number of areas with tumour necrosis. A good correlation was found between the applied energy and the size of tumour necrosis at histopathology (Pearson = 0.76, p = 0.002). CONCLUSIONS Our results show that MR-HIFU ablation with the dedicated breast system is safe and results in histopathologically proven tumour necrosis. KEY POINTS • MR-HIFU ablation with the dedicated breast system is safe and feasible • In none of the patients was skin redness or burns observed • No correlation was found between the applied energy and the temperature increase • The correlation between applied energy and size of tumour necrosis was good.
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17
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Knuttel FM, van den Bosch MAAJ. Magnetic Resonance-Guided High Intensity Focused Ultrasound Ablation of Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:65-81. [PMID: 26486332 DOI: 10.1007/978-3-319-22536-4_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This chapter describes several aspects of MR-HIFU treatment for breast cancer. The current and future applications, technical developments and clinical results are discussed. MR-HIFU ablation is under investigation for the treatment of breast cancer, but is not yet ready for clinical implementation. Firstly, the efficacy of MR-HIFU ablation should be investigated in large trials. The existing literature shows that results of initial, small studies are moderate, but opportunities for improvement are available. Careful patient selection, taking treatment margins into account and using a dedicated breast system might improve treatment outcomes. MRI-guidance has proven to be beneficial for the accuracy and safety of HIFU treatments because of its usefulness before, during and after treatments. In conclusion, MR-HIFU is promising for the treatment of breast cancer and might lead to a change in breast cancer care in the future.
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Affiliation(s)
- Floortje M Knuttel
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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18
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Jacobs I, Hectors SJCG, Schabel MC, Grüll H, Strijkers GJ, Nicolay K. Cluster analysis of DCE-MRI data identifies regional tracer-kinetic changes after tumor treatment with high intensity focused ultrasound. NMR IN BIOMEDICINE 2015; 28:1443-1454. [PMID: 26390040 DOI: 10.1002/nbm.3406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 07/27/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023]
Abstract
Evaluation of high intensity focused ultrasound (HIFU) treatment with MRI is generally based on assessment of the non-perfused volume from contrast-enhanced T1-weighted images. However, the vascular status of tissue surrounding the non-perfused volume has not been extensively investigated with MRI. In this study, cluster analysis of the transfer constant K(trans) and extravascular extracellular volume fraction ve , derived from dynamic contrast-enhanced MRI (DCE-MRI) data, was performed in tumor tissue surrounding the non-perfused volume to identify tumor subregions with distinct contrast agent uptake kinetics. DCE-MRI was performed in CT26.WT colon carcinoma-bearing BALB/c mice before (n = 12), directly after (n = 12) and 3 days after (n = 6) partial tumor treatment with HIFU. In addition, a non-treated control group (n = 6) was included. The non-perfused volume was identified based on the level of contrast enhancement. Quantitative comparison between non-perfused tumor fractions and non-viable tumor fractions derived from NADH-diaphorase histology showed a stronger agreement between these fractions 3 days after treatment (R(2) to line of identity = 0.91) compared with directly after treatment (R(2) = 0.74). Next, k-means clustering with four clusters was applied to K(trans) and ve parameter values of all significantly enhanced pixels. The fraction of pixels within two clusters, characterized by a low K(trans) and either a low or high ve , significantly increased after HIFU. Changes in composition of these clusters were considered to be HIFU induced. Qualitative H&E histology showed that HIFU-induced alterations in these clusters may be associated with hemorrhage and structural tissue disruption. Combined microvasculature and hypoxia staining suggested that these tissue changes may affect blood vessel functionality and thereby tumor oxygenation. In conclusion, it was demonstrated that, in addition to assessment of the non-perfused tumor volume, the presented methodology gives further insight into HIFU-induced effects on tumor vascular status. This method may aid in assessment of the consequences of vascular alterations for the fate of the tissue.
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Affiliation(s)
- Igor Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stefanie J C G Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthias C Schabel
- Imaging Research Center, Oregon Health and Science University, Portland, OR, USA
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA
| | - Holger Grüll
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Oncology solutions, Philips Research, Eindhoven, The Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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19
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Peek MCL, Ahmed M, Napoli A, ten Haken B, McWilliams S, Usiskin SI, Pinder SE, van Hemelrijck M, Douek M. Systematic review of high-intensity focused ultrasound ablation in the treatment of breast cancer. Br J Surg 2015; 102:873-82; discussion 882. [PMID: 26095255 DOI: 10.1002/bjs.9793] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/14/2014] [Accepted: 01/27/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND A systematic review was undertaken to assess the clinical efficacy of non-invasive high-intensity focused ultrasound (HIFU) ablation in the treatment of breast cancer. METHODS MEDLINE/PubMed library databases were used to identify all studies published up to December 2013 that evaluated the role of HIFU ablation in the treatment of breast cancer. Studies were eligible if they were performed on patients with breast cancer and objectively recorded at least one clinical outcome measure of response (imaging, histopathological or cosmetic) to HIFU treatment. RESULTS Nine studies fulfilled the inclusion criteria. The absence of tumour or residual tumour after treatment was reported for 95·8 per cent of patients (160 of 167). No residual tumour was found in 46·2 per cent (55 of 119; range 17-100 per cent), less than 10 per cent residual tumour in 29·4 per cent (35 of 119; range 0-53 per cent), and between 10 and 90 per cent residual tumour in 22·7 per cent (27 of 119; range 0-60 per cent). The most common complication associated with HIFU ablation was pain (40·1 per cent) and less frequently oedema (16·8 per cent), skin burn (4·2 per cent) and pectoralis major injury (3·6 per cent). MRI showed an absence of contrast enhancement after treatment in 82 per cent of patients (31 of 38; range 50-100 per cent), indicative of coagulative necrosis. Correlation of contrast enhancement on pretreatment and post-treatment MRI successfully predicted the presence of residual disease. CONCLUSION HIFU treatment can induce coagulative necrosis in breast cancers. Complete ablation has not been reported consistently on histopathology and no imaging modality has been able confidently to predict the percentage of complete ablation. Consistent tumour and margin necrosis with reliable follow-up imaging are required before HIFU ablation can be evaluated within large, prospective clinical trials.
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Affiliation(s)
- M C L Peek
- Research Oncology, King's College London, London, UK.,Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - M Ahmed
- Research Oncology, King's College London, London, UK
| | - A Napoli
- Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, Rome, Italy
| | - B ten Haken
- Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - S McWilliams
- Research Oncology, King's College London, London, UK
| | - S I Usiskin
- Department of Radiology, St Bartholomew's Hospital, London, UK
| | - S E Pinder
- Research Oncology, King's College London, London, UK
| | - M van Hemelrijck
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
| | - M Douek
- Research Oncology, King's College London, London, UK
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Yeo SY, Arias Moreno AJ, van Rietbergen B, Ter Hoeve ND, van Diest PJ, Grüll H. Effects of magnetic resonance-guided high-intensity focused ultrasound ablation on bone mechanical properties and modeling. J Ther Ultrasound 2015; 3:13. [PMID: 26261720 PMCID: PMC4530487 DOI: 10.1186/s40349-015-0033-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a promising technique for palliative treatment of bone pain. In this study, the effects of MR-HIFU ablation on bone mechanics and modeling were investigated. METHODS A total of 12 healthy rat femurs were ablated using 10 W for 46 ± 4 s per sonication with 4 sonications for each femur. At 7 days after treatments, all animals underwent MR and single photon emission computed tomography/computed tomography (SPECT/CT) imaging. Then, six animals were euthanized. At 1 month following ablations, the remaining six animals were scanned again with MR and SPECT/CT prior to euthanization. Thereafter, both the HIFU-treated and contralateral control bones of three animals from each time interval were processed for histology, whereas the remaining bones were subjected to micro-CT (μCT), three-point bending tests, and micro-finite element (micro-FE) analyses. RESULTS At 7 days after HIFU ablations, edema formation around the treated bones coupled with bone marrow and cortical bone necrosis was observed on MRI and histological images. SPECT/CT and μCT images revealed presence of bone modeling through an increased uptake of (99m)Tc-MDP and formation of woven bone, respectively. At 31 days after ablations, as illustrated by imaging and histology, healing of the treated bone and the surrounding soft tissue was noted, marked by decreased in amount of tissue damage, formation of scar tissue, and sub-periosteal reaction. The results of three-point bending tests showed no significant differences in elastic stiffness, ultimate load, and yield load between the HIFU-treated and contralateral control bones at 7 days and 1 month after treatments. Similarly, the elastic stiffness and Young's moduli determined by micro-FE analyses at both time intervals were not statistically different. CONCLUSIONS Multimodality imaging and histological data illustrated the presence of HIFU-induced bone damage at the cellular level, which activated the bone repair mechanisms. Despite that, these changes did not have a mechanical impact on the bone.
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Affiliation(s)
- Sin Yuin Yeo
- Department of Biomedical Engineering, Eindhoven University of Technology, High Tech Campus 11-p1.243, 5656 AE Eindhoven, The Netherlands
| | - Andrés J Arias Moreno
- Department of Biomedical Engineering, Eindhoven University of Technology, High Tech Campus 11-p1.243, 5656 AE Eindhoven, The Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, High Tech Campus 11-p1.243, 5656 AE Eindhoven, The Netherlands
| | - Natalie D Ter Hoeve
- Department of Pathology, University Medical Center Utrecht, Room H04.312, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Room H04.312, Utrecht, The Netherlands
| | - Holger Grüll
- Department of Biomedical Engineering, Eindhoven University of Technology, High Tech Campus 11-p1.243, 5656 AE Eindhoven, The Netherlands ; Philips Research Europe, High Tech Campus 11-p1.261A, 5656 AE Eindhoven, The Netherlands
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Abstract
In this review, several clinical applications of magnetic resonance (MR)-guided focused ultrasound (FUS) are updated. MR-guided FUS is used clinically for thermal ablation of uterine fibroids and bone metastases. Thousands of patients have successfully been treated. Transcranial MR-guided FUS has received CE certification for ablation of deep, central locations in the brain. Thermal ablation of specific parts of the thalamus can result in relief of the symptoms in a number of neurological disorders. Several approaches have been proposed for ablation of prostate and breast cancer and clinical trials should show the potential of MR-guided FUS for these and other applications.
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22
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Deckers R, Merckel LG, Denis de Senneville B, Schubert G, Köhler M, Knuttel FM, Mali WPTM, Moonen CTW, van den Bosch MAAJ, Bartels LW. Performance analysis of a dedicated breast MR-HIFU system for tumor ablation in breast cancer patients. Phys Med Biol 2015; 60:5527-42. [DOI: 10.1088/0031-9155/60/14/5527] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Hectors SJCG, Jacobs I, Moonen CTW, Strijkers GJ, Nicolay K. MRI methods for the evaluation of high intensity focused ultrasound tumor treatment: Current status and future needs. Magn Reson Med 2015; 75:302-17. [PMID: 26096859 DOI: 10.1002/mrm.25758] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/14/2015] [Accepted: 04/10/2015] [Indexed: 01/17/2023]
Abstract
Thermal ablation with high intensity focused ultrasound (HIFU) is an emerging noninvasive technique for the treatment of solid tumors. HIFU treatment of malignant tumors requires accurate treatment planning, monitoring and evaluation, which can be facilitated by performing the procedure in an MR-guided HIFU system. The MR-based evaluation of HIFU treatment is most often restricted to contrast-enhanced T1 -weighted imaging, while it has been shown that the non-perfused volume may not reflect the extent of nonviable tumor tissue after HIFU treatment. There are multiple studies in which more advanced MRI methods were assessed for their suitability for the evaluation of HIFU treatment. While several of these methods seem promising regarding their sensitivity to HIFU-induced tissue changes, there is still ample room for improvement of MRI protocols for HIFU treatment evaluation. In this review article, we describe the major acute and delayed effects of HIFU treatment. For each effect, the MRI methods that have been-or could be-used to detect the associated tissue changes are described. In addition, the potential value of multiparametric MRI for the evaluation of HIFU treatment is discussed. The review ends with a discussion on future directions for the MRI-based evaluation of HIFU treatment.
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Affiliation(s)
- Stefanie J C G Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Igor Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Chrit T W Moonen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Epaminonda E, Drakos T, Kalogirou C, Theodoulou M, Yiallouras C, Damianou C. MRI guided focused ultrasound robotic system for the treatment of gynaecological tumors. Int J Med Robot 2015; 12:46-52. [PMID: 25808561 DOI: 10.1002/rcs.1653] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND A novel MRI-conditional robot that navigates focused ultrasound (FUS) for the treatment of gynaecological tumors endovaginally was developed. METHODS The robotic system has two PC-controlled axes (linear and angular). The robotic system was manufactured using a digital manufacturing 3D printer using acrylonitrile butadiene styrene (ABS) plastic. Evaluation of the device was performed in a 1.5T MRI using excised porcine tissue. RESULTS The robotic system was successfully tested for MRI safety and compatibility. The robotic system has been tested for its functionality for creating multiple (overlapping) lesions in an in vitro model. CONCLUSIONS An MRI-conditional FUS robotic system was developed that has the potential to create thermal lesions with the intention of treating gynaecological tumors. In the future a third axis will be needed that lifts the robot up or down in order to access vaginas which are at a variable height from the MRI table.
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Affiliation(s)
- Eva Epaminonda
- Cyprus University of Technology, Department of Electrical Engineering, computer engineering and Informatics, Limassol, Cyprus
| | - Theoharis Drakos
- Cyprus University of Technology, Department of Electrical Engineering, computer engineering and Informatics, Limassol, Cyprus
| | - Christina Kalogirou
- Cyprus University of Technology, Department of Electrical Engineering, computer engineering and Informatics, Limassol, Cyprus
| | - Margarita Theodoulou
- Cyprus University of Technology, Department of Electrical Engineering, computer engineering and Informatics, Limassol, Cyprus
| | - Christos Yiallouras
- City University, Department of Biomedical Engineering, London, UK.,MEDSONIC, Ltd Research and Development, Limassol, Cyprus
| | - Christakis Damianou
- Cyprus University of Technology, Department of Electrical Engineering, computer engineering and Informatics, Limassol, Cyprus.,MEDSONIC, Ltd Research and Development, Limassol, Cyprus
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Cavallo Marincola B, Pediconi F, Anzidei M, Miglio E, Di Mare L, Telesca M, Mancini M, D’Amati G, Monti M, Catalano C, Napoli A. High-intensity focused ultrasound in breast pathology: non-invasive treatment of benign and malignant lesions. Expert Rev Med Devices 2014; 12:191-9. [DOI: 10.1586/17434440.2015.986096] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Yiallouras C, Damianou C. Review of MRI positioning devices for guiding focused ultrasound systems. Int J Med Robot 2014; 11:247-55. [PMID: 25045075 DOI: 10.1002/rcs.1601] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND This article contains a review of positioning devices that are currently used in the area of magnetic resonance imaging (MRI) guided focused ultrasound surgery (MRgFUS). METHODS The paper includes an extensive review of literature published since the first prototype system was invented in 1991. RESULTS The technology has grown into a fast developing area with application to any organ accessible to ultrasound. The initial design operated using hydraulic principles, while the latest technology incorporates piezoelectric motors. Although, in the beginning there were fears regarding MRI safety, during recent years, the deployment of MR-safe positioning devices in FUS has become routine. Many of these positioning devices are now undergoing testing in clinical trials. CONCLUSION Existing MRgFUS systems have been utilized mostly in oncology (fibroids, brain, liver, kidney, bone, pancreas, eye, thyroid, and prostate). It is anticipated that, in the near future, there will be a positioning device for every organ that is accessible by focused ultrasound.
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Affiliation(s)
- C Yiallouras
- Department of Bioengineering, City University, London, UK.,R&D, MEDSONIC LTD, Limassol, Cyprus
| | - C Damianou
- Electrical Engineering Department, Cyprus University of Technology, Cyprus.,R&D, MEDSONIC LTD, Limassol, Cyprus
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27
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Nadrljanski M, Maksimović R, Plešinac-Karapandžić V, Nikitović M, Marković-Vasiljković B, Milošević Z. Positive enhancement integral values in dynamic contrast enhanced magnetic resonance imaging of breast carcinoma: ductal carcinoma in situ vs. invasive ductal carcinoma. Eur J Radiol 2014; 83:1363-7. [PMID: 24894697 DOI: 10.1016/j.ejrad.2014.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/16/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to contribute to the standardization of the numeric positive enhancement integral (PEI) values in breast parenchyma, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) and to evaluate the significance of the difference in PEI values between IDC and parenchyma, DCIS and parenchyma and IDC and DCIS. MATERIALS AND METHODS In the prospective trial, we analyzed the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of 60 consecutive patients with histologically confirmed unilateral DCIS (n=30) and IDC (n=30) and defined the PEI values (range; mean ± SD) for the lesions and the breast parenchyma. Tumor-to-non-tumor (T/NT) ratios were calculated for DCIS and IDC and compared. PEI color maps (PEICM) were created. The differences in PEI values between IDC and parenchyma and between DCIS and parenchyma were tested according to t-test. Analysis of variance (ANOVA) was used to test the differences between the mean PEI values of parenchyma, DCIS and IDC. RESULTS IDC showed highly statistically different PEI numeric values compared to breast parenchyma (748.7 ± 32.2 vs. 74.6 ± 17.0; p<0.0001). The same applied to the differences in the group of patients with DCIS (428.0 ± 25.0 vs. 66.0 ± 10.6; p<0.0001). The difference between IDC, DCIS and parenchyma were also considered highly statistically significant (p<0.0001) and so were the T/NT ratios for IDC and DCIS (10.1 ± 2.4 vs. 6.6 ± 1.4; p<0.0001). CONCLUSIONS PEI numeric values may contribute to differentiation between invasive and in situ breast carcinoma.
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Affiliation(s)
- Mirjan Nadrljanski
- Clinic for Radiology and Radiation Oncology, Institute of Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia.
| | - Ružica Maksimović
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia
| | - Vesna Plešinac-Karapandžić
- Clinic for Radiology and Radiation Oncology, Institute of Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia
| | - Marina Nikitović
- Clinic for Radiology and Radiation Oncology, Institute of Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia
| | - Biljana Marković-Vasiljković
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia
| | - Zorica Milošević
- Clinic for Radiology and Radiation Oncology, Institute of Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia
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Sabel MS. Nonsurgical ablation of breast cancer: future options for small breast tumors. Surg Oncol Clin N Am 2014; 23:593-608. [PMID: 24882353 DOI: 10.1016/j.soc.2014.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The surgical management of breast cancer has evolved significantly, facilitated by advancements in technology and imaging and improvements in adjuvant therapy. The changes in surgical management have been characterized by equal or improved outcomes with significantly less morbidity. The next step in this evolution is the minimally invasive or noninvasive ablation of breast cancers as an alternative to lumpectomy. In this article, the various modalities for nonsurgical breast cancer ablation and the clinical experience are reviewed, and some of the next steps necessary for their clinical implementation are outlined.
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Affiliation(s)
- Michael S Sabel
- Department of Surgery, University of Michigan, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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29
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Payne A, Todd N, Minalga E, Wang Y, Diakite M, Hadley R, Merrill R, Factor R, Neumayer L, Parker DL. In vivo evaluation of a breast-specific magnetic resonance guided focused ultrasound system in a goat udder model. Med Phys 2014; 40:073302. [PMID: 23822456 DOI: 10.1118/1.4811103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE This work further evaluates the functionality, efficacy, and safety of a new breast-specific magnetic resonance guided high intensity focused ultrasound (MRgFUS) system in an in vivo goat udder model. METHODS Eight female goats underwent an MRgFUS ablation procedure using the breast-specific MRgFUS system. Tissue classification was achieved through the 3D magnetic resonance imaging (MRI) acquisition of several contrasts (T1w, T2w, PDw, 3-point Dixon). The MRgFUS treatment was performed with a grid trajectory executed in one or two planes within the glandular tissue of the goat udder. Temperature was monitored using a 3D proton resonance frequency (PRF) MRI technique. Delayed contrast enhanced-MR images were acquired immediately and 14 days post MRgFUS treatment. A localized tissue excision was performed in one animal and histological analysis was performed. Animals were available for adoption at the conclusion of the study. RESULTS The breast-specific MRgFUS system was able to ablate regions ranging in size from 0.4 to 3.6 cm(3) in the goat udder model. Tissue damage was confirmed through the correlation of thermal dose measurements obtained with realtime 3D MR thermometry to delayed contrast enhanced-MR images immediately after the treatment and 14 days postablation. In general, lesions were longer in the ultrasound propagation direction, which is consistent with the dimensions of the ultrasound focal spot. Thermal dose volumes had better agreement with nonenhancing areas of the DCE-MRI images obtained 14 days after the MRgFUS treatment. CONCLUSIONS The system was able to successfully ablate lesions up to 3.6 cm(3). The thermal dose volume was found to correlate better with the 14-day postablation nonenhancing delayed contrast enhanced-MR image volumes. While the goat udder is not an ideal model for the human breast, this study has proven the feasibility of using this system on a wide variety of udder shapes and sizes, demonstrating the flexibility that would be required in order to treat human subjects.
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Affiliation(s)
- A Payne
- Utah Center for Advanced Imaging Research, University of Utah, 729 Arapeen Drive, Salt Lake City, Utah 84108, USA.
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Evolution of the ablation region after magnetic resonance-guided high-intensity focused ultrasound ablation in a Vx2 tumor model. Invest Radiol 2014; 48:381-6. [PMID: 23399810 DOI: 10.1097/rli.0b013e3182820257] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Volumetric magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) is a completely noninvasive image-guided thermal ablation technique. Recently, there has been growing interest in the use of MR-HIFU for noninvasive ablation of malignant tumors. Of particular interest for noninvasive ablation of malignant tumors is reliable treatment monitoring and evaluation of response. At this point, there is limited evidence on the evolution of the ablation region after MR-HIFU treatment. The purpose of the present study was to comprehensively characterize the evolution of the ablation region after volumetric MR-HIFU ablation in a Vx2 tumor model using MR imaging, MR temperature data, and histological data. MATERIALS AND METHODS Vx2 tumors in the hind limb muscle of New Zealand White rabbits (n = 30) were ablated using a clinical MR-HIFU system. Twenty-four animals were available for analyses. Magnetic resonance imaging was performed before and immediately after ablation; MR temperature mapping was performed during the ablation. The animals were distributed over 7 groups with different follow-up lengths. Depending on the group, animals were reimaged and then killed on day 0, 1, 3, 7, 14, 21, or 28 after ablation. For all time points, the size of nonperfused areas (NPAs) on contrast-enhanced T1-weighted (CE-T1-w) images was compared with lethal thermal dose areas (ie, the tissue area that received a thermal dose of 240 equivalent minutes or greater [EM] at 43°C) and with the necrotic tissue areas on histology sections. RESULTS The NPA on CE-T1-w imaging showed an increase in median size from 266 ± 148 to 392 ± 178 mm(2) during the first day and to 343 ± 170 mm(2) on day 3, followed by a gradual decrease to 113 ± 103 mm(2) on day 28. Immediately after ablation, the NPA was 1.6 ± 1.4 times larger than the area that received a thermal dose of 240 EM or greater in all animals. The median size of the necrotic area on histology was 1.7 ± 0.4 times larger than the NPA immediately after ablation. After 7 days, the size of the NPA was in agreement with the necrotic tissue area on histology (ratio, 1.0 ± 0.2). CONCLUSIONS During the first 3 days after MR-HIFU ablation, the ablation region increases in size, after which it gradually decreases in size. The NPA on CE-T1-w imaging underestimates the extent of tissue necrosis on histology in the initial few days, but after 1 week, the NPA is reliable in delineating the necrotic tissue area. The 240-EM thermal dose limit underestimates the necrotic tissue area immediately after MR-HIFU ablation. Reliable treatment evaluation techniques are particularly important for noninvasive, image-guided tumor ablation. Our results indicate that CE-T1-w imaging is reliable for MR-HIFU treatment evaluation after 1 week.
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31
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Brenin D. HiFrequency Ultrasound. Breast Cancer 2014. [DOI: 10.1007/978-1-4614-8063-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Yiallouras C, Mylonas N, Damianou C. MRI-compatible positioning device for guiding a focused ultrasound system for transrectal treatment of prostate cancer. Int J Comput Assist Radiol Surg 2013; 9:745-53. [DOI: 10.1007/s11548-013-0964-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/12/2013] [Indexed: 10/25/2022]
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33
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Utility of semiquantitative parameters to differentiate benign and malignant focal hepatic lesions. Clin Imaging 2013; 37:692-6. [DOI: 10.1016/j.clinimag.2013.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/10/2012] [Accepted: 01/17/2013] [Indexed: 11/20/2022]
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Shmatukha A, Sethi B, Shurrab M, Ghate S, Qi X, Barry J, Wright G, Crystal E. Visualization of thermal ablation lesions using cumulative dynamic contrast enhancement MRI. Phys Med Biol 2013; 58:3321-37. [PMID: 23615319 DOI: 10.1088/0031-9155/58/10/3321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A novel robust and user friendly method for post-processing dynamic contrast enhanced (DCE) MRI data is presented, which provides reliable real-time delineation of the borders of thermal ablation lesions on low SNR images shortly after contrast agent injection without any model-based curve fitting. Some simple descriptors of the DCE process are calculated in a time efficient recursive manner and combined into a single image reflecting both current and previous enhancement states of each pixel, which allows robust discrimination between tissue areas with different perfusion properties. The resulting cumulative DCE (CDCE) images are shown to exhibit a strong correlation with histopathology and late gadolinium enhancement representations of the thermal damage in soft tissue. It is shown that the outer border of the non-perfused ablation lesion core on CDCE MRI corresponds to the histopathological lesion border. The described method has a potential not only to facilitate thermal ablation outcome assessment, but also to improve detection of infiltrative tumours and reduce the administered contrast agent dose in any DCE scans.
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Affiliation(s)
- Andriy Shmatukha
- Cardiac and Interventional Applied Science Laboratory, General Electric Healthcare, Toronto, Ontario, Canada.
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35
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Li S, Wu PH. Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer. CHINESE JOURNAL OF CANCER 2012; 32:441-52. [PMID: 23237221 PMCID: PMC3845578 DOI: 10.5732/cjc.012.10104] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Image-guided high-intensity focused ultrasound (HIFU) has been used for more than ten years, primarily in the treatment of liver and prostate cancers. HIFU has the advantages of precise cancer ablation and excellent protection of healthy tissue. Breast cancer is a common cancer in women. HIFU therapy, in combination with other therapies, has the potential to improve both oncologic and cosmetic outcomes for breast cancer patients by providing a curative therapy that conserves mammary shape. Currently, HIFU therapy is not commonly used in breast cancer treatment, and efforts to promote the application of HIFU is expected. In this article, we compare different image-guided models for HIFU and reviewed the status, drawbacks, and potential of HIFU therapy for breast cancer.
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Affiliation(s)
- Sheng Li
- State Key Laboratory of Oncology in South China; Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China..
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36
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MR-guided high-intensity focused ultrasound ablation of breast cancer with a dedicated breast platform. Cardiovasc Intervent Radiol 2012; 36:292-301. [PMID: 23232856 DOI: 10.1007/s00270-012-0526-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
Abstract
Optimizing the treatment of breast cancer remains a major topic of interest. In current clinical practice, breast-conserving therapy is the standard of care for patients with localized breast cancer. Technological developments have fueled interest in less invasive breast cancer treatment. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a completely noninvasive ablation technique. Focused beams of ultrasound are used for ablation of the target lesion without disrupting the skin and subcutaneous tissues in the beam path. MRI is an excellent imaging method for tumor targeting, treatment monitoring, and evaluation of treatment results. The combination of HIFU and MR imaging offers an opportunity for image-guided ablation of breast cancer. Previous studies of MR-HIFU in breast cancer patients reported a limited efficacy, which hampered the clinical translation of this technique. These prior studies were performed without an MR-HIFU system specifically developed for breast cancer treatment. In this article, a novel and dedicated MR-HIFU breast platform is presented. This system has been designed for safe and effective MR-HIFU ablation of breast cancer. Furthermore, both clinical and technical challenges are discussed, which have to be solved before MR-HIFU ablation of breast cancer can be implemented in routine clinical practice.
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MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain—case series of an innovative new technique. Eur Radiol 2012; 22:2822-35. [DOI: 10.1007/s00330-012-2628-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 07/17/2012] [Accepted: 07/19/2012] [Indexed: 01/14/2023]
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38
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McWilliams JP, Lee EW, Yamamoto S, Loh CT, Kee ST. Image-guided tumor ablation: emerging technologies and future directions. Semin Intervent Radiol 2012; 27:302-13. [PMID: 22550370 DOI: 10.1055/s-0030-1261789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
As the trend continues toward the decreased invasiveness of medical procedures, image-guided percutaneous ablation has begun to supplant surgery for the local control of small tumors in the liver, kidney, and lung. New ablation technologies, and refinements of existing technologies, will enable treatment of larger and more complex tumors in these and other organs. At the same time, improvements in intraprocedural imaging promise to improve treatment accuracy and reduce complications. In this review, the latest advancements in clinical and experimental ablation technologies will be summarized, and new applications of image-guided tumor ablation will be discussed.
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Affiliation(s)
- Justin P McWilliams
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Postma EL, van Hillegersberg R, Daniel BL, Merckel LG, Verkooijen HM, van den Bosch MAAJ. MRI-guided ablation of breast cancer: where do we stand today? J Magn Reson Imaging 2012; 34:254-61. [PMID: 21780220 DOI: 10.1002/jmri.22599] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The treatment of patients with localized breast cancer has changed considerably over the past few decades. The next challenge is to use image-guided minimally invasive tumor ablation techniques. The fact that MRI is the most accurate imaging modality for visualization and delineation of breast tumor margins in three dimensions and provides MRI-based temperature mapping, makes it particularly applicable for monitoring during minimally invasive ablation techniques. The overall result of the studies performed on MRI-guided minimally invasive tumor ablation studies are varying, with reported total tumor ablation rates ranging between 20% and 100%. Strict selection of patients, consensus on the treatment zone margin and optimization of MR-imaging, should make MRI-guided breast cancer tumor ablation a useful tool in clinical practice.
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Affiliation(s)
- Emily L Postma
- Department of Surgery, University Medical Center Utrecht, The Netherlands
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Huisman M, van den Bosch MAAJ. MR-guided high-intensity focused ultrasound for noninvasive cancer treatment. Cancer Imaging 2011; 11:S161-6. [PMID: 22180520 PMCID: PMC3266576 DOI: 10.1102/1470-7330.2011.9041] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Magnetic resonance (MR)-high-intensity focused ultrasound (HIFU) is an innovative, noninvasive tumour ablation technique. MR imaging and focused ultrasound are combined allowing real-time anatomic guidance and temperature mapping during treatment. Recently, the volumetric ablation approach has been introduced in order to reduce treatment length and provide more homogeneous tumour ablation. After successful treatment of uterine fibroids, MR-HIFU is currently being investigated for the treatment of malignant tumours. Palliative treatment of painful bone metastases is already applied in clinical practice. Several issues need to be further investigated for successful cancer treatment with MR-HIFU, including patient selection criteria, definition of treatment margins and optimal transducer technology.
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Affiliation(s)
- M Huisman
- Department of Radiology, University Medical Center Utrecht, The Netherlands
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41
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Brenin DR. Focused Ultrasound Ablation for the Treatment of Breast Cancer. Ann Surg Oncol 2011; 18:3088-94. [DOI: 10.1245/s10434-011-2011-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Indexed: 11/18/2022]
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42
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Sprinkhuizen SM, Konings MK, van der Bom MJ, Viergever MA, Bakker CJG, Bartels LW. Temperature-induced tissue susceptibility changes lead to significant temperature errors in PRFS-based MR thermometry during thermal interventions. Magn Reson Med 2010; 64:1360-72. [DOI: 10.1002/mrm.22531] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Enholm JK, Köhler MO, Quesson B, Mougenot C, Moonen CTW, Sokka SD. Improved volumetric MR-HIFU ablation by robust binary feedback control. IEEE Trans Biomed Eng 2009; 57:103-13. [PMID: 19846364 DOI: 10.1109/tbme.2009.2034636] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Volumetric high-intensity focused ultrasound (HIFU) guided by multiplane magnetic resonance (MR) thermometry has been shown to be a safe and efficient method to thermally ablate large tissue volumes. However, the induced temperature rise and thermal lesions show significant variability, depending on exposure parameters, such as power and timing, as well as unknown tissue parameters. In this study, a simple and robust feedback-control method that relies on rapid MR thermometry to control the HIFU exposure during heating is introduced. The binary feedback algorithm adjusts the durations of the concentric ablation circles within the target volume to reach an optimal temperature. The efficacy of the binary feedback control was evaluated by performing 90 ablations in vivo and comparing the results with simulations. Feedback control of the sonications improved the reproducibility of the induced lesion size. The standard deviation of the diameter was reduced by factors of 1.9, 7.2, 5.0, and 3.4 for 4-, 8-, 12-, and 16-mm lesions, respectively. Energy efficiency was also improved, as the binary feedback method required less energy to create the desired lesion. These results show that binary feedback improves the quality of volumetric ablation by consistently producing thermal lesions of expected size while reducing the required energy as well.
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Köhler MO, Mougenot C, Quesson B, Enholm J, Le Bail B, Laurent C, Moonen CTW, Ehnholm GJ. Volumetric HIFU ablation under 3D guidance of rapid MRI thermometry. Med Phys 2009; 36:3521-35. [PMID: 19746786 DOI: 10.1118/1.3152112] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A volumetric sonication method is proposed that produces volume ablations by steering the focal point along a predetermined trajectory consisting of multiple concentric outward-moving circles. This method was tested in vivo on pig thigh muscle (32 ablations in nine animals). Trajectory diameters were 4, 12, and 16 mm with sonication duration depending on the trajectory size and ranging from 20 to 73 s. Despite the larger trajectories requiring more energy to reach necrosis within the desired volume, the ablated volume per unit applied energy increased with trajectory size, indicating improved treatment efficiency for larger trajectories. The higher amounts of energy required for the larger trajectories also increased the risk of off-focus heating, especially along the beam axis in the near field. To avoid related adverse effects, rapid volumetric multiplane MR thermometry was introduced for simultaneous monitoring of the temperature and thermal dose evolution along the beam axis and in the near field, as well as in the target region with a total coverage of six slices acquired every 3 s. An excellent correlation was observed between the thermal dose and both the nonperfused (R=0.929 for the diameter and R=0.964 for the length) and oedematous (R=0.913 for the diameter and R=0.939 for the length) volumes as seen in contrast-enhanced T1-weighted difference images and T2-weighted postsonication images, respectively. Histology confirmed the presence of a homogeneous necrosis inside the heated volumes. These results show that volumetric high-intensity focused ultrasound (HIFU) sonication allows for efficiently creating large thermal lesions while reducing treatment duration and also that the rapid multiplane MR thermometry improves the safety of the therapeutic procedure by monitoring temperature evolution both inside as well as outside the targeted volume.
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Gianfelice D, Gupta C, Kucharczyk W, Bret P, Havill D, Clemons M. Palliative Treatment of Painful Bone Metastases with MR Imaging–guided Focused Ultrasound. Radiology 2008; 249:355-63. [DOI: 10.1148/radiol.2491071523] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Schmitz AC, Gianfelice D, Daniel BL, Mali WPTM, van den Bosch MAAJ. Image-guided focused ultrasound ablation of breast cancer: current status, challenges, and future directions. Eur Radiol 2008; 18:1431-41. [PMID: 18351348 PMCID: PMC2441491 DOI: 10.1007/s00330-008-0906-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 12/04/2007] [Accepted: 01/15/2008] [Indexed: 01/06/2023]
Abstract
Image-guided focussed ultrasound (FUS) ablation is a non-invasive procedure that has been used for treatment of benign or malignant breast tumours. Image-guidance during ablation is achieved either by using real-time ultrasound (US) or magnetic resonance imaging (MRI). The past decade phase I studies have proven MRI-guided and US-guided FUS ablation of breast cancer to be technically feasible and safe. We provide an overview of studies assessing the efficacy of FUS for breast tumour ablation as measured by percentages of complete tumour necrosis. Successful ablation ranged from 20% to 100%, depending on FUS system type, imaging technique, ablation protocol, and patient selection. Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented. Finally, potential future applications of FUS for breast cancer treatment such as FUS-induced anti-tumour immune response, FUS-mediated gene transfer, and enhanced drug delivery are discussed. Currently, breast-conserving surgery remains the gold standard for breast cancer treatment.
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Affiliation(s)
- A C Schmitz
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Yankeelov TE, Gore JC. Dynamic Contrast Enhanced Magnetic Resonance Imaging in Oncology: Theory, Data Acquisition, Analysis, and Examples. Curr Med Imaging 2007; 3:91-107. [PMID: 19829742 DOI: 10.2174/157340507780619179] [Citation(s) in RCA: 284] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dynamic contrast enhanced MRI (DCE-MRI) enables the quantitative assessment of tumor status and has found application in both pre-clinical tumor models as well as clinical oncology. DCE-MRI requires the serial acquisition of images before and after the injection of a paramagnetic contrast agent so that the variation of MR signal intensity with time can be recorded for each image voxel. As the agent enters into a tissue, it changes the MR signal intensity from the tissue to a degree that depends on the local concentration. After the agent is transported out of the tissue, the MR signal intensity returns to its' baseline value. By analyzing the associated signal intensity time course using an appropriate mathematical model, physiological parameters related to blood flow, vessel permeability, and tissue volume fractions can be extracted for each voxel or region of interest.In this review we first discuss the basic physics of this methodology, and then present technical aspects of how DCE-MRI data are acquired and analyzed. We also discuss appropriate models of contrast agent kinetics and how these can be used to elucidate tissue characteristics of importance in cancer biology. We conclude by briefly summarizing some future goals and demands of DCE-MRI.
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