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Background: Clinical Laser-Induced Thermotherapy (LITT) currently lacks precise control of tissue temperature increase during the procedure. This study presents a new method to automatically regulate the maximum temperature increase in vivo at different positions by adjusting LITT power delivered by multiple laser probes using real-time volumetric MR-thermometry., Methods: The regulation algorithm was evaluated in vivo on a pig leg muscle. Temperature regulation was performed in volumes surrounding each laser probe tip. The power delivered to each laser probe was automatically adjusted every second using a feedback control algorithm by processing on-the-fly MR-thermometry images (10 slices/second) on a 1.5 T clinical scanner (1.56 mm × 1.56 mm x 3 mm resolution), using the proton-resonance frequency (PRF) shift technique. Several experimental conditions were tested with predefined temperature-time profiles corresponding to conditions of thermal ablation (+30 °C above body temperature) or moderate hyperthermia (+10 and + 15 °C). Control images were acquired after injection of Gadolinium at the end of experiment and were compared with the thermal dose images calculated from the thermometry images., Results: The mean difference and root mean squared error between target temperatures and measured ones remained below 0.5 °C and 2 °C respectively, for 5 min duration. Lesion sizes observed on thermal dose and on images acquired after gadolinium injection were in good agreement., Conclusion: Automatic regulation of in vivo temperature increase during LITT procedures with multiple laser emitters control is feasible. The method provides an adaptative solution to improve the safety and efficacity of such clinical procedures., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Manon Desclides reports a relationship with Certis Therapeutics that includes: employment. Bruno Quesson reports a relationship with Certis Therapeutics that includes: consulting or advisory and equity or stocks. Valery Ozenne reports a relationship with Certis Therapeutics that includes: consulting or advisory and equity or stocks. Pierre Bour reports a relationship with Certis Therapeutics that includes: employment. Thibaut Faller reports a relationship with Certis Therapeutics that includes: employment. Stephane Chemouny reports a relationship with Certis Therapeutics that includes: employment and equity or stocks. Guillaume Machinet reports a relationship with ALPhANOV Optical and Laser Technological Centre that includes: employment. Christophe Pierre reports a relationship with ALPhANOV Optical and Laser Technological Centre that includes: employment. Julie Carcreff reports a relationship with ALPhANOV Optical and Laser Technological Centre that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Transcranial magnetic resonance imaging (MRI)-guided histotripsy has been demonstrated to treat various locations in in vivo swine brain through a human skull. To ensure that the histotripsy treatment is delivered to the intended target location, accurate pre-treatment targeting is necessary. In this work, we investigate the feasibility of MR-thermometry and MR-acoustic radiation force imaging (MR-ARFI) to perform pre-treatment targeting of histotripsy in ex vivo bovine brain through a human skull., Methods: A 700 kHz, 128-element MR-compatible histotripsy array was used to generate histotripsy and tone-burst sonications. The array's electronic drivers were modified to also generate low-amplitude tone-burst sonications to perform MR-thermometry and MR-ARFI-based targeting. Twelve ex vivo bovine brains were treated with histotripsy at 35 MPa, 75 MPa and through a skull at 36 MPa. Before treating the tissue, both MR-ARFI and MR-thermometry were used to estimate the lesion location. Finally, the location of the histotripsy lesion was compared with the focus estimated by MR-thermometry and MR-ARFI., Results: MR-thermometry and MR-ARFI were able to successfully perform pre-treatment targeting of histotripsy using the modified histotripsy array driver. Histotripsy focus was estimated with mean absolute errors along the transverse/longitudinal axis of 2.06/2.95 mm and 2.13/2.51 mm for MR-ARFI and MR-thermometry, respectively. The presence of the human skull reduced the pressure at the focal region, but it did not compromise the targeting accuracy of either of the two methods with a mean absolute error of 1.10/2.91 mm and 1.29/2.91 mm for MR-ARFI and MR-thermometry, respectively., Conclusion: This study demonstrated that transcranial histotripsy pre-treatment targeting is feasible with MR-thermometry and MR-ARFI., Competing Interests: Conflict of interest Z.X., T.H., and the University of Michigan have financial and/or other relationships with HistoSonics Inc., (Copyright © 2024. Published by Elsevier Inc.)

Practical non-invasive equipment modifications and effective acquisition methods to achieve robust and reliable real-time MR thermometry for monitoring of clinical hepatic microwave ablations were implemented. These included selection of the microwave generator location (inside versus outside the MR scan room), the number of radiofrequency chokes added to the microwave generator's coaxial lines, and the use of copper wool to maximize their electrical grounding. Signal-to-noise ratio (SNR) of MR thermometry images of a small fluid-filled phantom acquired during activation of microwave antenna were used to evaluate image quality as a function of each modification. SNR measurements corresponding to both locations of the microwave generator were comparable and so it was located outside the MR scan room. For this location, addition of one RF choke on the power and four chokes on the sensor coaxial lines was found to be optimal, corresponding to a 68% increase in SNR. Furthermore, image quality strongly depended on the proper electrical grounding of the power and sensor lines. SNR ratio (relative to SNR of baseline images) during activation of microwave generator was found to be 0.49 ± 0.28 without adequate grounding, and 0.88 ± 0.08 with adequate grounding (p = 0.002, Student's t-test). These SNR measurements were sufficiently sensitive to detect issues related to equipment performance and hence formed part of the quality assurance testing performed prior to each clinical treatment. Incorporating these non-invasive approaches resulted in significant improvements to image quality and, importantly while maintaining the clinical integrity of the microwave system which is of paramount importance in a highly regulated healthcare environment., (Copyright © 2019 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Purpose: To correlate the accumulated thermal dose (ATD) with lesion size in magnetic resonance (MR)-guided focused ultrasound (MRgFUS) thalamotomy to help guide future clinical treatments., Materials and Methods: Thirty-six patients with medication-refractory essential tremor were treated using a commercial MRgFUS brain system (ExAblate 4000, InSightec) in a 3T MR scanner (MR750, GE Healthcare). Intraoperative MR-thermometry was performed to measure the induced temperature and thermal dose distributions (thermal coefficient = -0.00909 ppm/°C). The ATD was calculated over multiple sonications with appropriate corrections for spatial-shifting artifacts. The ATD profile sizes obtained for dose values of 17, 40, 100, 200, and 240 cumulative equivalent minutes at 43°C (CEM) were correlated with the corresponding lesion sizes measured via axial T1- and T2-weighted MR images acquired 1 day post-treatment., Results: Of a total of 232 included sonications, 83 required corrections for off-resonance-induced spatial-shifting artifacts (correction range = [1.1,2.2] mm). The mean lesion sizes measured on T2-weighted MR images (6.2 ± 1.3 mm, mean ± SD) were 15% larger than those measured on corresponding T1-weighted MR images (5.3 ± 1.2 mm, mean ± SD). The ATD values that provided the best correlations with the measured lesion sizes on T2- and T1-weighted MR images were 100 and 200 CEM, respectively., Conclusion: The ATD was correlated with lesion size measured 1 day following MRgFUS thalamotomy for essential tremor. These data provide useful information for predicting brain lesion size and determining treatment endpoints in future clinical MRgFUS procedures., (© 2018 American Association of Physicists in Medicine.)

Proton resonance frequency shift-based magnetic resonance thermometry is a currently used technique for monitoring temperature during targeted thermal therapies. However, in order to provide temperature updates with very short latency times, fast MR acquisition schemes are usually employed, which in turn might lead to noisy temperature measurements. This will, in general, have a direct impact on therapy control and endpoint detection. In this paper, we address this problem through an improved non-local filtering technique applied on the temperature images. Compared with previous non-local filtering methods, the proposed approach considers not only spatial information but also exploits temporal redundancies. The method is fully automatic and designed to improve the precision of the temperature measurements while at the same time maintaining output accuracy. In addition, the implementation was optimized in order to ensure real-time availability of the temperature measurements while having a minimal impact on latency. The method was validated in three complementary experiments: a simulation, an ex-vivo and an in-vivo study. Compared to the original non-local means filter and two other previously employed temperature filtering methods, the proposed approach shows considerable improvement in both accuracy and precision of the filtered data. Together with the low computational demands of the numerical scheme, the proposed filtering technique shows great potential for improving temperature measurements during real-time MR thermometry dedicated to targeted thermal therapies. [ABSTRACT FROM PUBLISHER]

Purpose: MR thermometry based on the proton resonance frequency shift (PRFS) is the most commonly used method for the monitoring of thermal therapies. As the chemical shift of water protons is temperature dependent, the local temperature variation (relative to an initial baseline) may be calculated from time-dependent phase changes in gradient-echo (GRE) MR images. Dynamic phase shift in GRE images is also produced by time-dependent changes in the magnetic bulk susceptibility of tissue. Gas bubbles (known as “white cavitation”) are frequently visualized near the RF electrode in ultrasonography-guided radio frequency ablation (RFA). This study aimed to investigate RFA-induced cavitation’s effects by using simultaneous ultrasonography and MRI, to both visualize the cavitation and quantify the subsequent magnetic susceptibility-mediated errors in concurrent PRFS MR-thermometry (MRT) as well as to propose a first-order correction for the latter errors. Methods: RF heating in saline gels and in ex vivo tissues was performed with MR-compatible bipolar and monopolar electrodes inside a 1.5 T MR clinical scanner. Ultrasonography simultaneous to PRFS MRT was achieved using a MR-compatible phased-array ultrasonic transducer. PRFS MRT was performed interleaved in three orthogonal planes and compared to measurements from fluoroptic sensors, under low and, respectively, high RFA power levels. Control experiments were performed to isolate the main source of errors in standard PRFS thermometry. Results: Ultrasonography, MRI and digital camera pictures clearly demonstrated generation of bubbles every time when operating the radio frequency equipment at therapeutic powers (>=30 W). Simultaneous bimodal (ultrasonography and MRI) monitoring of high power RF heating demonstrated a correlation between the onset of the PRFS-thermometry errors and the appearance of bubbles around the applicator. In an ex vivo study using a bipolar RF electrode under low power level (5 W), the MR measured temperature curves accurately matched the reference fluoroptic data. In similar ex vivo studies when applying higher RFA power levels (30 W), the correlation plots of MR thermometry versus fluoroptic data showed large errors in PRFS-derived temperature (up to 45 °C absolute deviation, positive or negative) depending not only on fluoroptic tip position but also on the RF electrode orientation relative to the B0 axis. Regions with apparent decrease in the PRFS-derived temperature maps as much as 30 °C below the initial baseline were visualized during RFA high power application. Ex vivo data were corrected assuming a Gaussian dynamic source of susceptibility, centered in the anode/cathode gap of the RF bipolar electrode. After correction, the temperature maps recovered the revolution symmetry pattern predicted by theory and matched the fluoroptic data within 4.5 °C mean offset. Conclusions: RFA induces dynamic changes in magnetic bulk susceptibility in biological tissue, resulting in large and spatially dependent errors of phase-subtraction-only PRFS MRT and unexploitable thermal dose maps. These thermometry artifacts were strongly correlated with the appearance of transient cavitation. A first-order dynamic model of susceptibility provided a useful method for minimizing these artifacts in phantom and ex vivo experiments. [ABSTRACT FROM AUTHOR]