PURPOSE: To develop a superconducting magnetic resonance (MR) imager that provides direct access to the patient and permits interactive MR-guided interventional procedures. MATERIALS AND METHODS: A 0.5-T superconducting magnet that allows a region of vertical access to the patient was designed and constructed. This magnet was integrated with newly designed shielded gradient coils, flexible surface coils, and nonmagnetic displays and with position-monitoring probes and device-tracking instrumentation. RESULTS: The magnet homogeneity was 12.3 ppm, and the gradient field was linear to within 1% over an imaging region 30 cm in diameter. The signal-to-noise ratio was 10% higher than in a comparable 0.5-T superconducting imager. Images were obtained in several anatomic regions with use of routine pulse sequences. Interactive image plane selection and near real-time imaging, with use of fast gradient-recalled echo sequences, were demonstrated at a rate of one image every 1.5 seconds. CONCLUSION: MR-guided interv...

Superconducting open-configuration MR imaging system for image-guided therapy.

The ability of MRI-derived thermometry to predict thermally induced tissue changes in the brain was tested, and the thermal thresholds for blood-brain barrier (BBB) disruption and brain tissue damage were estimated. In addition, the ability of standard MRI to detect threshold-level effects was confirmed. These safety thresholds are being investigated to provide guidelines for clinical thermal ablation studies in the brain. MRI-monitored focused ultrasound heating was delivered to 63 locations in 26 rabbits. Tissue changes were detected in T(2)-weighted imaging and T(1)-weighted imaging (with and without contrast) and with light microscopy. The probability for tissue damage as a function of the accumulated thermal dose, the peak temperature achieved, the applied acoustic energy, and the peak acoustic power was estimated with probit regression. The discriminative abilities of these parameters were compared using the areas under the receiver operator characteristic (ROC) curves. In MRI, BBB disruption was observed in contrast-enhanced T(1)-weighted imaging shortly after the ultrasound exposures, sometimes accompanied by changes in T(2)-weighted imaging. Two days later, changes in T(2)-weighted imaging were observed, sometimes accompanied by changes in T(1)-weighted imaging. In histology, tissue damage was seen at every location where MRI changes were observed, ranging from small (diameter <1.0 mm) areas of tissue necrosis to severe vascular damage and associated hemorrhagic infarct. In one location, small (diameter: 0.8 mm) damage was not detected in MRI. The thermal dose and peak temperature thresholds were between 12.3-40.1 equivalent min at 43 degrees C and 48.0-50.8 degrees C, respectively, and values of 17.5 equivalent min at 43 degrees C and 48.4 degrees C were estimated to result in tissue damage with 50% probability. Thermal dose and peak temperature were significantly better predictors than the applied acoustic energy and peak acoustic power (P < 0.01). BBB disruption was always accompanied by tissue damage. The temperature information was better than the applied acoustic power or energy for predicting the damage than the ultrasound parameters. MRI was sensitive in detecting threshold-level damage.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/mrm.20060

MRI investigation of the threshold for thermally induced blood-brain barrier disruption and brain tissue damage in the rabbit brain.

Since the inception of radiosurgery, the management of brain metastases has become a common problem for neurosurgeons. Although the use of stereotactic radiosurgery and/or whole brain radiation therapy serves to control the majority of disease burden, patients who survive longer than 6–8 months sometimes face the problem of symptomatic radiographically regrowing lesions with few treatment options. Here we investigate the feasibility of use of MRI-guided stereotactic laser induced thermotherapy (LITT) as a novel treatment option for these lesions. Six patients who had previously undergone gamma knife stereotactic radiosurgery for brain metastases were selected. All patients had an initial favorable response to radiosurgery but subsequently developed regrowth of at least one lesion associated with recurrent edema and progressive neurological symptoms requiring ongoing steroids for symptom control. All lesions were evaluated for craniotomy, but were deemed unresectable due to deep location or patient’s comorbidities. Stereotactic biopsies were performed prior to the thermotherapy procedure in all cases. LITT was performed using the Visualase system and follow-up MRI imaging was used to determine treatment response. In all six patients biopsy results were negative for tumor and consistent with adverse radiation effects also known as radiation necrosis. Patients tolerated the procedure well and were discharged from the hospital within 48 h of the procedure. In 4/6 cases there was durable improvement of neurological symptoms until death. In all cases steroids were weaned off within 2 months. One patient died from systemic causes related to his cancer a month after the procedure. One patient had regrowth of the lesion 3 months after the procedure and required re-initiation of steroids and standard craniotomy for surgical resection. There were no complications directly related to the thermocoagulation procedure. Stereotactic laser induced thermotherapy is a feasible alternative for the treatment of symptomatic regrowing metastatic lesions after radiosurgery. The procedure carries minimal morbidity and, in this small series, shows some effectiveness in the symptomatic relief of edema and neurological symptoms paralleled by radiographic lesional control. Further studies are necessary to elucidate the safety of this technology.

Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery

Three-dimensional imaging, surgical planning, and image-guided therapy.

An MRI guided surgical apparatus includes a heat source formed by a laser and an optical fiber carrying the heat energy into a part to be coagulated by hyperthermia with an end reflector to direct the energy in a beam to one side of the fiber end. A reinforcing sleeve for the fiber is mounted in a shielded, Piezo-electric motor which causes movement of the fiber longitudinally and angularly within a rigid elongate cannula. A magnetic resonance imaging system is arranged to generate a series of output signals over a period of time representative of temperature in the part as the temperature of the part changes during that time. The heat source is controlled in heat energy applied and location and orientation of the beam to stop heating when the temperature at the boundary of a tumor reaches the required hyperthermic temperature. Cooling of the tip portion of the probe is effected by expansion of a supplied cooling fluid in gaseous form through a restrictive orifice into an expansion zone at the probe end. The fiber is thus encased in a stiff tubular titanium probe with a relatively small fluid supply duct along the inside of the probe with the interior of the probe acting as a return duct for the expanded gas. Thus the fiber end is contained in gas rather than liquid and the temperature of the probe end can be monitored by a sensor in the probe end and controlled by controlling the pressure in the supplied cooling fluid. The probe is driven in the longitudinal and rotational directions to move the fiber tip.

Hyperthermia treatment and probe therefor

This paper presents the experimental and clinical results of interstitial 1.06 Nd:YAG laser thermotherapy (ILTT) for brain tumors under real-time monitoring by magnetic resonance imaging. The authors chose a laser heat source for interstitial thermotherapy of brain tumors for several important reasons: (1) Laser heat delivery is less complicated and more controlled; (2) laser effects on tissue can be tested, monitored, and controlled by MRI. A 1.064 nm Nd:YAG laser and a specially designed laser optic fiber (ILTT) were used in C.W. mode this study. The laser was used at 4 W at a C.W. mode pulse and total exposure duration was 10 minutes (total energy was 2400 joules). Temperature distribution was determined with a microprocessor-based thermometer and by the levels of the signal intensity under MRI. The relationship between the temperature and MRI signal intensity allowed exploration of the possibility of using MRI as a noninvasive temperature monitoring method. Two patients with glioblastoma and ...

Interstitial 1.06 Nd:YAG laser thermotherapy for brain tumors under real-time monitoring of MRI: experimental study and phase I clinical trial.

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Interstitial 1.06 Nd:YAG laser thermotherapy for brain tumors under real-time monitoring of MRI: experimental study and phase I clinical trial.