Investigation of interstitial ultrasound ablation of spinal and paraspinal tumors: A patient-specific and parametric simulation study

Abstract

Preferential acoustic absorption and heating of bone can significantly impact interstitial ultrasound ablation of tumors within or bordering the spine. Furthermore, intervening cortical bone may provide acoustic and thermal insulation that can protect sensitive structures nearby, such as the spinal cord. The objectives of this study are firstly, to apply parametric and patient-specific models to theoretically assess the feasibility of interstitial ultrasound ablation of tumors within and near the spine, and secondly, to identify potential energy delivery strategies, safety criteria, advantages, and disadvantages of interstitial ultrasound in this setting. Transient biothermal models using previously validated approximations for power deposition within bone from interstitial sources were employed. Multilayered axisymmetric models were used to perform a parametric assessment of the impact of tumor dimensions, attenuation (dependent on residual bone content), perfusion, and maximum temperature thresholds on necessary treatment parameters and on treatment effectiveness. 3D patient-specific finite element models were generated based on segmented CT scans for nine representative patient cases selected to bracket a range of clinical interest, with tumors in or near the vertebrae, sacrum, and ilium. Tumors were 10-27 mm in diameter, 10-43 mm long, and 0-14 mm from the spinal canal. Paraspinal tumors, osteolytic vertebral tumors, and a mixed osteolytic/osteoblastic iliac bone tumor were considered. 7 MHz (1.5 mm OD) and 3.0 MHz (3.2 mm OD) applicators with an array of 1-4 tubular transducers (0.5 -1.5 cm long, 150-360° sector angles), were applied in various implant configurations. Variable thicknesses of bone insulating critical anatomy from the tumor and insulation of the spinal cord with injected carbon dioxide were also investigated for definition of safety margins and possible protection of critical structures. 6-44 mm diameter osteolytic tumors surrounded by bone and blastic (high bone content) lesions up to 20 mm in diameter could be fully ablated by 7 MHz interstitial ultrasound using 120-5,900 J and treatment durations of 0.4-15 min. 100% of the volumes of five simulated tumors located 4.3-14 mm from the spinal canal and 94.6-99.9% of the volumes of four simulated tumors 0-4.5 mm from the spinal canal were ablated (>240 EM43°C) within 15 min without damaging (<6 EM43°C) critical nerves. Preferential ultrasound absorption and concomitant heating at bone surfaces allowed for faster, more effective ablations with less delivered energy. 3-5 mm of normal cortical bone was found to provide a safety margin and reduce temperature elevations in untargeted tissues. Critical anatomy less than 3–5 mm from a tumor encapsulated by bone could be preserved by reducing the acoustic energy aimed towards these structures and/or through injection of insulating CO2. Parametric and patient-specific studies demonstrated the feasibility of interstitial ultrasound ablation of paraspinal tumors and osteolytic tumors within the spine. Preferential absorption of ultrasound by bone may provide improved localization, faster treatment times, and larger treatment zones in highly osteolytic and soft tissue tumors in and near bone compared to other heating modalities. This work was supported by the NIH grant R44CA112852.