Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound Treatment at 1.5 T: A Retrospective Study on Treatment- and Patient-Related Parameters Obtained From 52 Procedures

Cesare Gagliardo,Maurizio Marrale,Costanza D'Angelo,Giorgio Collura,Roberto Lagalla,Roberto Cannella,Massimo Midiri,Marco D'Amelio,Carlo Catalano,Gerardo Iacopino,Alessandro Napoli,Tommaso Vincenzo Bartolotta

doi:10.3389/fphy.2019.00223

Cesare Gagliardo, Maurizio Marrale + Show 10 more

Open Access

https://doi.org/10.3389/fphy.2019.00223

Copy DOI

Abstract

To present a retrospective analysis of patient- and sonication-related parameters of a group of patients treated with a transcranial magnetic resonance imaging-guided focused ultrasound (tcMRgFUS) system integrated with a 1.5-T MRI unit. The data obtained from 59 patients were retrospectively reviewed for this study. The following data were mainly collected: skull density ratio (SDR), skull area (SA), transducer elements (Tx), and estimated focal power at target (FP). For each treatment stage, we calculated the number of sonication (Sn), sonication power (Sp), measured power (Smp), sonication duration (Sd), energy (E), measured energy (Em), maximum temperature (Tmax), and MR thermometry plane orientation. Furthermore, the time delay between each sonication (St) and the total treatment time (Tt) were recorded. Fifty-two patients (40 males and 12 females; age – 64.51 ± SD 11.90; range 26–86), who underwent unilateral Vim thalamotomy (left = 50, 96.15%; right = 2, 3.85%) for medication refractory essential tremor (n=39; 78%) or Parkinson tremor (n=13; 22%) were considered. A total of 1068 (95.10%) sonication were included in our final analysis (average Sn per treatment: 20.65 ± 6.18; range 13–41). The energy released onto the planned target was found to decrease with the SDR for all temperature ranges. A positive correlation was observed between the slope of Tmax vs. Em plot and the SDR (R2=0.765; p<0.001). In addition, the Tmax was positively correlated with SDR (R2=0.398; p<0.005). On the contrary, no significant correlation was found between SDR and SA or Tx. An analysis of the MR Thermometry scanning plane indicated that, at our site, the axial and the coronal planes were mostly used. Our results confirm the factors that significantly influence the course of a tcMRgFUS procedure even when a 1.5-T MRI scanner is used for procedure guidance. The experience we gained in this study indicates that the SDR still remains one of the most significant technical parameters to be considered in a tcMRgFUS procedure. The possibility of prospectively setting the sonication energy according to the presented curves of energy delivery as a function of SDR for each treatment stage could provide a further understanding and awareness of this technology.

Highlights

Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a non-invasive thermal ablation method that involves high-intensity FUS energy and MRI for anatomical imaging and real-time thermal mapping [1]
Various studies conducted on patients with movement disorders have reported interesting clinical results that indicate minimal invasiveness and a very low rate of tcMRgFUS procedureassociated risks and adverse events
This retrospective study was conducted to investigate about treatment- and patient-related parameters obtained from FUS procedures performed using a 1.5-T integrated tcMRgFUS system

Summary

Introduction

Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a non-invasive thermal ablation method that involves high-intensity FUS energy and MRI for anatomical imaging and real-time thermal mapping [1]. Stereotactic radiosurgery, non-invasive, utilizes ionizing radiations; targeting is performed only using atlas coordinates, and the physicians cannot anticipate the clinical results because the radiobiological effects occur delayed and are not always predictable [4]. DBS is invasive and involves procedure-related risks, possible hardware malfunction, and requires battery replacement that may discourage patients [3, 5], it has been widely employed in the past few years because it introduced the prospect of neuromodulation. The tcMRgFUS method does not use ionizing radiation and is non-invasive; in addition, patient feedback allows the physician to optimize the target before a permanent lesion is made because its clinical effects can be evaluated immediately.

Methods

Results

Discussion

Conclusion