MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

Bazzocchi, Alberto; Napoli, Alessandro; Sacconi, Beatrice; Battista, Giuseppe; Guglielmi, Giuseppe; Catalano, Carlo; Albisinni, Ugo

doi:10.1259/bjr.20150358

Cited by 25 publications

(13 citation statements)

References 157 publications

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“…MRg-HIFU focuses noninvasive delivery of 4 to 400 MHz of US waves via a probe to deliver 65 to 85°C thermal ablation, resulting in coagulative necrosis with both pain palliation and locoregional tumor control. This technique has been applied thus far to bladder, prostate, and uterine tumors, although recent case series were published of early results trialing its utility in OOs 90,91 and bone metastasis [91][92][93][94] (►Fig. 13 and ►Fig.…”

Section: Techniquementioning

confidence: 99%

“…• Benign: OO 95 and OB can be successfully treated with MRg-HIFU with complete pain relief and no morbidity, despite radiologic persistence of vascularity within the tumor nidus on follow-up imaging. 90,91 Similarly, MRg- HIFU was successfully used for targeting extra-abdominal desmoid tumors. 96 • Malignant: MRg-HIFU has been applied to treating metastasis and/or multiple myeloma, plasmacytoma, and other focal myeloproliferative disorders: potential radical treatment of bone metastasis has also been reported with MRg-HIFU, with 33.3% complete curative or partial response observed in the literature.…”

Section: Techniquementioning

confidence: 99%

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Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation

Dalili

Isaac

Bazzocchi

et al. 2020

Semin Musculoskelet Radiol

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Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.

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Section: Techniquementioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation

Dalili

Isaac

Bazzocchi

et al. 2020

Semin Musculoskelet Radiol

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“…Magnetic resonance (MR) imaging-guided high-intensity focused ultrasound (HIFU) is a completely noninvasive modality (14,15) with which the therapeutic energy can be focused transcutaneously, facilitating thermal ablation of the periosteal nerves and penetrating the medullary bone. This process leads to coagulation of the osteoid osteoma nidus, with promising results in terms of safety and clinical success (16)(17)(18)(19).…”

Section: Study Design and Patient Enrollmentmentioning

confidence: 99%

Noninvasive Therapy for Osteoid Osteoma: A Prospective Developmental Study with MR Imaging–guided High-Intensity Focused Ultrasound

et al. 2017

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Purpose To demonstrate that magnetic resonance (MR) imaging-guided high-intensity focused ultrasound (HIFU) is a safe, effective, and durable treatment option for the management of osteoid osteoma in children and young adults. Materials and Methods This prospective study was institutional review board approved and is registered with clinicaltrials.gov (identification number NCT02302651). Written informed consent was obtained from patients or their parents. Patients who had both clinical and radiologic findings that were diagnostic for nonvertebral osteoid osteoma and no contraindications to MR imaging-guided HIFU were enrolled between June 2010 and June 2013. The feasibility, safety, and clinical effectiveness of MR imaging-guided HIFU were considered primary outcomes; tumor control at imaging was considered a secondary outcome. Analyses were conducted on a per-protocol basis. Results Forty-five of the 50 recruited patients underwent MR imaging-guided HIFU. All patients were discharged without treatment-related complications. The median visual analog scale (VAS) pain score (scale, 0-10) decreased from 8 before treatment to 0 at 1-week and 1- , 6- , 12- , 24- , and 36-month follow-up. Similarly, median VAS scores for the degree to which pain interfered with sleep and physical and daily activities decreased to 0 within the 1st month after treatment and remained stable at subsequent follow-up. Overall, 39 (87%) of the 45 patients achieved and maintained a VAS score of 0 during the 3-year observation period. Quality of life, as assessed by using Functional Assessment of Cancer Therapy-Bone Pain (FACT-BP) scores (scale, 0-60 points), improved, with the median FACT-BP score of 28 (points) before treatment increasing to a median score of 55 at 1-week follow-up and 60 at 6-month and subsequent follow-ups. At (final) 36-month follow-up, MR imaging depicted an absence of residual nidus vascularity in 32 (76%) of the 42 patients who were treated with MR imaging-guided HIFU only. Conclusion The durable clinical efficacy and safety of MR imaging-guided HIFU were demonstrated. These features are evidence of the potential of MR imaging-guided HIFU to be part of a routine strategy for the treatment of osteoid osteoma. RSNA, 2017.

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“…In particular, imaging techniques for lesion detection without the need of contrast would allow potential repetitions of focused ultrasound (FUS) treatment within the same session. However, this is not possible once contrast has been administered [ 21 ]. Hijnen et al [ 22 ] investigated several effects of contrast agent before FUS treatment.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of MRI protocols for the assessment of lumbar facet joints after MR-guided focused ultrasound treatment

Krug

Rieke

et al. 2016

J Ther Ultrasound

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BackgroundMR-guided focused ultrasound (MRgFUS) might be a very safe and effective minimally invasive technique to treat facet joint pain caused by arthritis and other degenerative changes. However, there are still safety concerns for this treatment and challenges regarding MR imaging and temperature mapping due to susceptibility effects between the bone and soft tissue near the joint, which has resulted in poor MR image quality. The goal of this research was to evaluate multiple magnetic resonance imaging (MRI) pulse sequences for characterizing ablated lumbar facet joint lesions created by high-intensity focused ultrasound (FUS) and compare the findings to histological tissue assessment. In particular, we investigated the use of T2-weighted MRI to assess treatment effects without contrast administration.MethodsAn IACUC approved study (n = 6 pigs) was performed using a 3T widebore MRI system equipped with an MRgFUS system. Facet joints of the lumbar vertebra were ablated using 1-MHz frequency and multiple sonication energies (300–800 J). In addition to T2-weighted MRI for treatment planning, T1-, T2-, and T2*-weighted and perfusion MRI sequences were applied. Signal intensity ratios of the lesions were determined. Histopathology was used to characterize cellular changes.ResultsAblation of the facet joint, using MRgFUS, was successful in all animals. T2-weighted images showed high signal intensity in the edematous facet joint and adjacent muscle, while delayed contrast-enhanced T1-weighted images showed an enhanced ring surrounding the target volume. T2*-weighted GRE images revealed inconsistent lesion visualization. Histopathology confirmed the presence of cellular coagulation (shrinkage), extracellular expansion (edema), and hemorrhage in the bone marrow.ConclusionsMRgFUS provided sufficient precision and image quality for visualization and characterization of ablated facet joints directly after ablation. MRI may help in monitoring the efficacy of FUS ablation without contrast after treating patients with back pain.

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MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

Cited by 25 publications

References 157 publications

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation

Noninvasive Therapy for Osteoid Osteoma: A Prospective Developmental Study with MR Imaging–guided High-Intensity Focused Ultrasound

Evaluation of MRI protocols for the assessment of lumbar facet joints after MR-guided focused ultrasound treatment

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