Feasibility of palliating recurrent gynecological tumors with MRGHIFU: comparison of symptom, quality-of-life, and imaging response in intra and extra-pelvic disease

Imseeh, Georgios; Giles, Sharon; Taylor, Alexandra; Brown, Matthew; Rivens, Ian; Gordon-Williams, Richard; Haar, Gail ter; deSouza, Nandita M.

doi:10.1080/02656736.2021.1904154

Cited by 5 publications

(2 citation statements)

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“…High-intensity focused ultrasound (HIFU), under the guidance of ultrasound or MRI, has also been used as a non-invasive technique for tissue ablation in prostate cancer and more recently in recurrent gynecological malignancy ( 115 ). The use of HIFU for hepatic tumour lesions is still in the exploratory stage.…”

Section: What Are Common Recist Limitations?mentioning

confidence: 99%

Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group – ESOI Joint Paper

et al. 2022

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Response evaluation criteria in solid tumours (RECIST) v1.1 are currently the reference standard for evaluating efficacy of therapies in patients with solid tumours who are included in clinical trials, and they are widely used and accepted by regulatory agencies. This expert statement discusses the principles underlying RECIST, as well as their reproducibility and limitations. While the RECIST framework may not be perfect, the scientific bases for the anticancer drugs that have been approved using a RECIST-based surrogate endpoint remain valid. Importantly, changes in measurement have to meet thresholds defined by RECIST for response classification within thus partly circumventing the problems of measurement variability. The RECIST framework also applies to clinical patients in individual settings even though the relationship between tumour size changes and outcome from cohort studies is not necessarily translatable to individual cases. As reproducibility of RECIST measurements is impacted by reader experience, choice of target lesions and detection/interpretation of new lesions, it can result in patients changing response categories when measurements are near threshold values or if new lesions are missed or incorrectly interpreted. There are several situations where RECIST will fail to evaluate treatment-induced changes correctly; knowledge and understanding of these is crucial for correct interpretation. Also, some patterns of response/progression cannot be correctly documented by RECIST, particularly in relation to organ-site (e.g. bone without associated soft-tissue lesion) and treatment type (e.g. focal therapies). These require specialist reader experience and communication with oncologists to determine the actual impact of the therapy and best evaluation strategy. In such situations, alternative imaging markers for tumour response may be used but the sources of variability of individual imaging techniques need to be known and accounted for. Communication between imaging experts and oncologists regarding the level of confidence in a biomarker is essential for the correct interpretation of a biomarker and its application to clinical decision-making. Though measurement automation is desirable and potentially reduces the variability of results, associated technical difficulties must be overcome, and human adjudications may be required.

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Section: What Are Common Recist Limitations?mentioning

confidence: 99%

Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group – ESOI Joint Paper

et al. 2022

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“…Where there is a lack of hydrogen bonds disruptable by heating, such as in pre-focal fat, it is not possible to generate MR thermometry measurements. All applications of HIFU in the body, such as the treatment of fibroids ( 9 ), pancreatic tumors ( 21 ) and pelvic tumors ( 22 ) involve traversing subcutaneous and abdominal fat of variable thickness, which may be layered with muscle of soft-tissue density. Because of the higher attenuation coefficient of fatty tissues compared to non-fatty soft tissues, e.g.…”

Section: Fatmentioning

confidence: 99%

Tissue specific considerations in implementing high intensity focussed ultrasound under magnetic resonance imaging guidance

et al. 2022

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High-intensity focused ultrasound can ablate a target permanently, leaving tissues through which it passes thermally unaffected. When delivered under magnetic resonance (MR) imaging guidance, the change in tissue relaxivity on heating is used to monitor the temperatures achieved. Different tissue types in the pre-focal beam path result in energy loss defined by their individual attenuation coefficients. Furthermore, at interfaces with different acoustic impedances the beam will be both reflected and refracted, changing the position of the focus. For complex interfaces this effect is exacerbated. Moreover, blood vessels proximal to the focal region can dissipate heat, altering the expected region of damage. In the target volume, the temperature distribution depends on the thermal conductivity (or diffusivity) of the tissue and its heat capacity. These are different for vascular tissues, water and fat containing tissues and bone. Therefore, documenting the characteristics of the pre-focal and target tissues is critical for effective delivery of HIFU. MR imaging provides excellent anatomic detail and characterization of soft tissue components. It is an ideal modality for real-time planning and monitoring of HIFU ablation, and provides non-invasive temperature maps. Clinical applications involve soft-tissue (abdomino-pelvic applications) or bone (brain applications) pre-focally and at the target (soft-tissue tumors and bone metastases respectively). This article addresses the technical difficulties of delivering HIFU effectively when vascular tissues, densely cellular tissues, fat or bone are traversed pre-focally, and the clinical applications that target these tissues. The strengths and limitations of MR techniques used for monitoring ablation in these tissues are also discussed.

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Suppressing the HIFU interference in ultrasound guiding images with a diffusion-based deep learning model

Cai,

Yang,

Liu

et al. 2024

Computer Methods and Programs in Biomedicine

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Feasibility of palliating recurrent gynecological tumors with MRGHIFU: comparison of symptom, quality-of-life, and imaging response in intra and extra-pelvic disease

Cited by 5 publications

References 37 publications

Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group – ESOI Joint Paper

Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group – ESOI Joint Paper

Tissue specific considerations in implementing high intensity focussed ultrasound under magnetic resonance imaging guidance

Suppressing the HIFU interference in ultrasound guiding images with a diffusion-based deep learning model

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