Rares Salomir

Reference-Free PRFS MR-Thermometry Using Near-Harmonic 2-D Reconstruction of the Background Phase

Proton resonance frequency shift (PRFS) MR thermometry (MRT) is the generally preferred method for monitoring thermal ablation, typically implemented with gradient-echo (GRE) sequences. Standard PRFS MRT is based on the subtraction of a temporal reference phase map and is, therefore, intrinsically sensitive to tissue motion (including deformation) and to external perturbation of the magnetic field. Reference-free (or reference-less) PRFS MRT has been previously described by Rieke and was based on a 2-D polynomial fit performed on phase data from outside the heated region, to estimate the background phase inside the region of interest. While their approach was undeniably a fundamental progress in terms of robustness against tissue motion and magnetic perturbations, the underlying mathematical formalism requires a thick unheated border and may be subject to numerical instabilities with high order polynomials. A novel method of reference-free PRFS MRT is described here, using a physically consistent formalism, which exploits mathematical properties of the magnetic field in a homogeneous or near-homogeneous medium.

Transient MR elastography (t-MRE) using ultrasound radiation force: Theory, safety, and initial experiments in vitro

The purpose of our study was to assess the feasibility of using ultrasound radiation force as a safe vibration source for transient MR elastography (t‐MRE). We present a theoretical framework to predict the phase shift of the complex MRE signal, the temperature elevation due to ultrasound, and safety indicators (ISPPA, ISPTA, MI). Next, we report wave images acquired in porcine liver samples in vitro. MR thermometry was used to estimate the temperature elevation induced by ultrasound. Finally, we discuss the implications of our results with regard to the feasibility of using radiation force for t‐MRE in a clinical setting, and a specific echo‐planar imaging (EPI) MRE sequence is proposed. Magn Reson Med 60:871–881, 2008.

MRI-guided focused ultrasound: methodology and applications

Focused ultrasound is very well suited for inducing noninvasive local hyperthermia. Since magnetic resonance imaging (MRI) may be employed to obtain real-time temperature maps noninvasively the combination of these two technologies offers great advantages specifically aimed toward oncological studies. Real-time identification of the target region and accurate control of the temperature evolution during the treatment has now become possible. Thermal ablation of pathological tissue, local drug delivery using thermosensitive micro-carriers and controlled transgene expression using thermosensitive promoters have recently been demonstrated with this unique technology. Based on these experiments combined focused ultrasound and MRI thermometry holds promise for future oncological diagnostics and treatment. In this paper, we review some of the recent methodological developments as well as experimental and first clinical studies using this approach

Image-based control of the magnetic resonance imaging-guided focused ultrasound thermotherapy.

Magnetic resonance imaging (MRI)-guided focused ultrasound surgery (FUS) is a full noninvasive approach for localized thermal ablation of deep tissues, coupling the following: (1) a versatile, nonionizing physical agent for therapy and (2) a state-of-the art diagnosis and on-line monitoring tool. A commercially available, Food and Drug Administration-approved device using the MRI-guided FUS exists since 2004 for the ablation of benign tumors (uterine fibroids); however, the ultimate goal of the technological, methodological, and medical research in this field is to provide a clinical-routine tool for fighting localized cancer. When addressing cancer applications, the accurate spatial control of the delivered thermal dose is mandatory. Contiguous destruction of the target volume must be achieved in a minimum time, whereas sparing as much as possible the neighboring healthy tissues and especially when some adjacent regions are critical. This paper reviews some significant developments reported in the literature related to the image-based control of the FUS therapy for kidney, breast, prostate, and brain, including the own experience of the authors on the active feedback control of the temperature during FUS ablation. In addition, preliminary results of an original study of MRI-guided FUS ablation of VX2 carcinoma in kidney, under active temperature control, are described here.

Ultrasonography-based 2D motion-compensated HIFU sonication integrated with reference-free MR temperature monitoring: a feasibility study ex vivo

Magnetic resonance imaging (MRI) and ultrasonography have been used simultaneously in this ex vivo study for the image-guidance of high intensity focused ultrasound (HIFU) treatment in moving tissue. A ventilator-driven balloon produced periodic and non-rigid (i.e. breathing-like) motion patterns in phantoms. MR-compatible ultrasound (US) imaging enabled near real-time 2D motion tracking based on optical flow detection, while near-harmonic reference-free proton resonance frequency shift (PRFS) MR thermometry (MRT) was used to monitor the thermal buildup on line. Reference-free MRT was applied to gradient-echo echo-planar imaging phase maps acquired at the frame rate of 250 to 300 ms/slice with voxel size 1.25×1.25×5 mm(3). The MR-US simultaneous imaging was completely free of mutual interferences while minor RF interferences from the HIFU device were detected in the far field of the US images. The effective duty-cycle of the HIFU sonication was close to 100 % and no off-interval was required to temporally decouple it from the ultrasonography. The motion compensation of the HIFU sonication was achieved with an 8 Hz frame rate and sub-millimeter spatial accuracy, both for single-focus mode and for an iterated multi-foci line scan. Near harmonic reference-less PRFS MRT delivered motion-robust thermal maps perpendicular or parallel to the HIFU beam (0.7 °C precision, 0.5 °C absolute accuracy). Out-of-plane motion compensation was not addressed in this study.

3D organ motion prediction for MR-guided high intensity focused ultrasound

MR-guided High Intensity Focused Ultrasound is an emerging non-invasive technique capable of depositing sharply localised energy deep within the body, without affecting the surrounding tissues. This, however, implies exact knowledge of the targets position when treating mobile organs. In this paper we present an atlas-based prediction technique that trains an atlas from time-resolved 3D volumes using 4DMRI, capturing the full patient specific motion of the organ. Based on a breathing signal, the respiratory state of the organ is then tracked and used to predict the targets future position. To additionally compensate for the non-periodic slower organ drifts, the static motion atlas is combined with a population-based statistical exhalation drift model. The proposed method is validated on organ motion data of 12 healthy volunteers. Experiments estimating the future position of the entire liver result in an average prediction error of 1.1 mm over time intervals of up to 13 minutes.

Automatic control of hyperthermic therapy based on real-time Fourier analysis of MR temperature maps.

Local hyperthermia is increasingly being used for therapeutic purposes, such as tumor ablation. Heat conduction and energy absorption in vivo during the hyperthermic procedure are largely unknown, thus making feedback temperature control highly desirable. Here, a general method for temperature control based on Fourier transformation (FT) of the bio‐heat equation is presented, taking into account heat diffusion (D) and energy absorption (α) together with temperature distribution derived from rapid, continuous MR temperature mapping. The main advantages of the new method are: 1) the spatial distribution of heat deposition and conduction over the full region of interest (ROI) is taken into account, and 2) the high speed resulting from the use of fast FT (FFT) of temperature maps allows rapid feedback coupling. Initial tests based on MRI‐guided focused ultrasound (FUS) demonstrated that high‐quality temperature regulation can be obtained even for erroneous values of D and α, so long as their relative error remained in the same range. Performance of the automated control procedure was validated ex vivo and in vivo on rabbit thigh using moderate FUS heating. During the procedure, the standard deviation (SD) of the temperature remained in the range of temperature noise obtained by MRI, indicative of the performance of the regulation algorithm. Magn Reson Med 47:1065–1072, 2002.

Intraluminal high intensity ultrasound treatment in the esophagus under fast MR temperature mapping: In vivo studies

New curative and palliative treatments are needed to respond to the poor prognosis of esophageal cancer. The purpose of this study was to determine whether magnetic resonance imaging (MRI) and MR thermometry can be used to monitor the thermal ablation induced by an intraluminal high‐intensity ultrasound applicator positioned in the esophagus. Experiments were performed in vivo in 2 pig esophagi (25 thermal lesions per pig). Respiratory gated or cardiac gated MR thermometry was performed with segmented echo‐planar imaging gradient echo sequences. All MR acquisitions were performed without susceptibility artifacts or radiofrequency interference with the ultrasound device. The experimental procedure proposed for accurate measurement of temperature in the esophagus was found to achieve an SD of ± 1.5°C for respiratory gating and ± 3.1°C for cardiac gating. Gd‐enhanced T1‐weighted images were used to depict coagulation necrosis. Autopsy was performed immediately after the treatment. Ultrasound effects were inspected visually, and the dimensions of the lesions in the liver neighboring the esophagus were compared with those determined on the MRI images. The visually assessed thermal lesions showed good correlation with the MRI data (10% mean volume difference). The feasibility of esophageal thermal ablation using intraluminal high‐intensity ultrasound and of on‐line MR temperature monitoring was demonstrated. Magn Reson Med, 2005.

Hybrid Ultrasound/Magnetic Resonance Simultaneous Acquisition and Image Fusion for Motion Monitoring in the Upper Abdomen

ObjectivesThe combination of ultrasound (US) and magnetic resonance imaging (MRI) may provide a complementary description of the investigated anatomy, together with improved guidance and assessment of image-guided therapies. The aim of the present study was to integrate a clinical setup for simultaneous US and magnetic resonance (MR) acquisition to obtain synchronized monitoring of liver motion. The feasibility of this hybrid imaging and the precision of image fusion were evaluated. Materials and MethodsUltrasound imaging was achieved using a clinical US scanner modified to be MR compatible, whereas MRI was achieved on 1.5- and 3-T clinical scanners. Multimodal registration was performed between a high-resolution T1 3-dimensional (3D) gradient echo (volume interpolated gradient echo) during breath-hold and a simultaneously acquired 2D US image, or equivalent, retrospective registration of US imaging probe in the coordinate frame of MRI. A preliminary phantom study was followed by 4 healthy volunteer acquisitions, performing simultaneous 4D MRI and 2D US harmonic imaging (Fo = 2.2 MHz) under free breathing. ResultsNo characterized radiofrequency mutual interferences were detected under the tested conditions with commonly used MR sequences in clinical routine, during simultaneous US/MRI acquisition. Accurate spatial matching between the 2D US and the corresponding MRI plane was obtained during breath-hold. In situ fused images were delivered. Our 4D MRI sequence permitted the dynamic reconstruction of the intra-abdominal motion and the calculation of high temporal resolution motion field vectors. ConclusionsThis study demonstrates that, truly, simultaneous US/MR dynamic acquisition in the abdomen is achievable using clinical instruments. A potential application is the US/MR hybrid guidance of high-intensity focused US therapy in the liver.

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

MR acoustic radiation force imaging (ARFI) is an elegant adjunct to MR‐guided high intensity focused ultrasound for treatment planning and optimization, permitting in situ assessment of the focusing and targeting quality. The thermal effect of high intensity focused ultrasound pulses associated with ARFI measurements is recommended to be monitored on line, in particular when the beam crosses highly absorbent structures or interfaces (e.g., bones or air‐filled cavities). A dedicated MR sequence is proposed here, derived from a segmented gradient echo‐echo planar imaging kernel by adding a bipolar motion encoding gradient with interleaved alternating polarities. Temporal resolution was reduced to 2.1 s, with in‐plane spatial resolution of 1 mm. MR‐ARFI measurements were executed during controlled animal breathing, with trans‐costal successively steered foci, to investigate the spatial modulation of the focus intensity and the targeting offset. ARFI‐induced tissue displacement measurements enabled the accurate localization, in vivo, of the high intensity focused ultrasound focal point in sheep liver, with simultaneous monitoring of the temperature elevation. ARFI‐based precalibration of the focal point position was immediately followed by trans‐costal MR‐guided high intensity focused ultrasound ablation, monitored with a conventional proton resonance frequency shift MR thermometry sequence. The latter MR thermometry sequence had spatial resolution and geometrical distortion identical with the ARFI maps, hence no coregistration was required. Magn Reson Med, 2012.