Monitoring and visualization techniques for MR‐guided laser ablations in an open MR system

Kettenbach, Joachim; Silverman, Stuart G.; Hata, Nobuhiko; Kuroda, Kagayaki; Saiviroonporn, Pairash; Zientara, Gary P.; Morrison, Paul T.; Hushek, Stephen G.; Black, Peter McLaren; Kikinis, Ron; Jólesz, Ferenc A.

doi:10.1002/jmri.1880080424

Cited by 87 publications

(55 citation statements)

References 37 publications

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“…The addition of MRI to LITT allows the use of real-time MRI for planning, guidance, and thermal monitoring during the ablation. 1,6,9,13,17 Despite the advent of MRgLITT over the last 25 years, this approach has failed to gain wide acceptance in the therapy of malignant and recurrent brain tumors. 2,5,28 Recent advances in the technique have generated a renewed interest in applying MRgLITT to intracranial disease.…”

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confidence: 99%

Does the real-time thermal damage estimate allow for estimation of tumor control after MRI-guided laser-induced thermal therapy? Initial experience with recurrent intracranial ependymomas

Patel

Jethwa

Shetty

et al. 2015

PED

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OBJECT Although control of intracranial ependymomas is highly correlated with degree of resection, it is unknown if the same is true for MRI-guided laser-induced thermal therapy (MRgLITT). The authors report their experience with MRgLITT for ependymoma and examine the utility of the real-time thermal damage estimate (TDE), a recent software advance, with respect to completeness of ablation and impact on tumor control. To the authors' knowledge, this is the largest single-center experience utilizing MRgLITT for recurrent ependymomas. METHODS Five tumors in 4 patients were treated with the Visualase Thermal Therapy System. Two tumors were treated similarly on recurrence. Ablation was performed using a 980-nm diode laser with a real-time image acquisition system. Single-plane TDEs were calculated and compared with the original lesion area to compute percentage area ablated (PAA). Volumetric analysis was performed, and percentage volume ablated (PVA) was estimated and correlated with the TDE. Tumor control was correlated with the TDE and volumetric data during treatment. RESULTS Nine ablations were performed on 5 tumors, 2 of which had multiple recurrences. The average pretreatment lesion volume was 8.4 ± 6.3 cm3, and the average largest 2D area was 5.3 ± 2.7 cm2. The averaged TDE was 3.9 ± 2.1 cm2, average PAA was 80.1% ± 34.3%, and average PVA was 64.4% ± 23.5%. For subtotal ablations, average recurrence time was 4.4 ± 5.3 months; 1 adult case remains recurrence-free at 40 months. Using TDEs, the correlation between recurrence time and PAA was r = 0.93 (p = 0.01), and for PVA was r = 0.88 (p = 0.02). Furthermore, PVA and PAA were strongly correlated (r = 0.88, p = 0.02). CONCLUSIONS Through using the PAA, the real-time TDE correlated with the volume of ablation in this initial investigation. Furthermore, the TDE and volumetric data corresponded to the level of tumor control, with time to recurrence dependent on ablation completeness. MRgLITT may have a role in the management of recurrent ependymomas, especially with recent software advances.

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confidence: 99%

Does the real-time thermal damage estimate allow for estimation of tumor control after MRI-guided laser-induced thermal therapy? Initial experience with recurrent intracranial ependymomas

Patel

Jethwa

Shetty

et al. 2015

PED

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“…Technical difficulties, particularly the lack of small, percutaneously introducible probes that ablate relatively large tissue volumes, slowed down clinical introduction. The development of energy-delivery devices significantly advanced thermal ablation applications by allowing percutaneous treatment, especially with MRI guidance (19)(20)(21)(22)(23). Heat-conducting probes and the way they deposit and distribute energy, however, are suboptimal.…”

Section: Thermal Ablationsmentioning

confidence: 99%

MRI-Guided Focused Ultrasound Surgery

2007

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MRI-guided focused ultrasound (MRgFUS) surgery is a noninvasive thermal ablation method that uses magnetic resonance imaging (MRI) for target definition, treatment planning, and closed-loop control of energy deposition. Integrating FUS and MRI as a therapy delivery system allows us to localize, target, and monitor in real time, and thus to ablate targeted tissue without damaging normal structures. This precision makes MRgFUS an attractive alternative to surgical resection or radiation therapy of benign and malignant tumors. Already approved for the treatment of uterine fibroids, MRgFUS is in ongoing clinical trials for the treatment of breast, liver, prostate, and brain cancer and for the palliation of pain in bone metastasis. In addition to thermal ablation, FUS, with or without the use of microbubbles, can temporarily change vascular or cell membrane permeability and release or activate various compounds for targeted drug delivery or gene therapy. A disruptive technology, MRgFUS provides new therapeutic approaches and may cause major changes in patient management and several medical disciplines.

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“…Intraoperative Magnetic Resonance Imaging (MRI) is a promising imaging tool for monitoring and guiding thermal therapy of liver tumor [1]- [3]. In MR-guided thermal therapies, needle-shaped thermal device is percutaneously inserted to the target tumor(s) under MRI guidance and coagulates the cancerous tissues at effector tip under thermal monitoring.…”

Section: Introductionmentioning

confidence: 99%

“…Up to date, two configurations, i.e. vertical gap scanner and horizontal gap scanner, of open MRI have been in clinical use to assess their feasibilities in thermal therapies with laser, microwave, radiowave, and cryogenic device [1]- [3].…”

Section: Introductionmentioning

confidence: 99%

Needle Guiding Robot with Five-Bar Linkage for MR-Guided Thermotherapy of Liver Tumor

Hata

Ohara

Hashimoto

et al. 2004

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2004

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Abstract. This paper reports the robot for horizontal gap open MRI which controls needle orientation effectively in the vertically limited gantry space. We locate the robot including actuators wholly in MR gantry and puncture needle from side of patient's body. The robot has three Degree-of-Freedom (DOF) and can control needle orientation using five-bar linkage mechanism and gimbal mechanism. Two DOF is to actuate five-bar linkage and the other DOF to make five-bar linkage up and down. In experiments, the accuracy of five-bar linkage was 0.89±0.15[mm] on a whole average and the accuracy of vertical placement of fivebar linkage was 0.13±0.02 [mm]. MR images had insignificant degradation of 19.4% in attrition rate of S/N ratio at the maximum. We conclude that the robot can control needle orientation with high repeatability and high MR compatibility in the limited gantry space.

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Monitoring and visualization techniques for MR‐guided laser ablations in an open MR system

Cited by 87 publications

References 37 publications

Does the real-time thermal damage estimate allow for estimation of tumor control after MRI-guided laser-induced thermal therapy? Initial experience with recurrent intracranial ependymomas

Does the real-time thermal damage estimate allow for estimation of tumor control after MRI-guided laser-induced thermal therapy? Initial experience with recurrent intracranial ependymomas

MRI-Guided Focused Ultrasound Surgery

Needle Guiding Robot with Five-Bar Linkage for MR-Guided Thermotherapy of Liver Tumor

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