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3D MR neurography targeted peripheral nerve ablation with MR-guided high intensity focused ultrasound (MR-HIFU): initial results of a feasibility study in a swine model

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MR-guided HIFU is an effective treatment for metastatic bone pain through periosteal nerve ablation, and is being investigated for treating back pain through facet joint denervation... We present initial investigations into the use of MRI to guide HIFU ablation of peripheral nerves in a swine model... The objectives were 1) to evaluate the feasibility of identifying peripheral nerves using MR neurography on the clinical MR-HIFU system, 2) to monitor HIFU ablation of peripheral nerves using MR thermometry, and 3) to evaluate the ability to measure thermal lesions in peripheral nerves using contrast-enhanced T1-weighted images and thermal dose maps calculated from MR thermometry... Volumetric MR-HIFU was used to induce seven thermal lesions in the sciatic nerves of three pigs. 3D MR neurography and T1-weighted images at 3T were used for target identification and treatment planning... Sonications were performed at 1.2 MHz with acoustic power ranging from 160 to 300 W over fixed durations of 20 or 36 seconds (energy 3.2 to 10.8 kJ)... Ablation dimensions were measured and compared using thermal dose maps, contrast-enhanced T1-weighted images, and gross pathology... All targeted sciatic nerves were identifiable on MR neurography and T1-weighted images (Fig 1)... For sonications at 160 to 300 W, MR thermometry measured peak temperatures of 60.3 to 85.7°C, with 240 equivalent minute thermal dose diameters of 8.5 to 15.9 mm (Fig 2)... Thermal lesions were visible on late phase contrast-enhanced T1 (Fig 3), with dimensions matching the coagulated region observed at necropsy (Fig 4)... Our preliminary results indicate that targeted peripheral nerve ablation is feasible with MR-HIFU... Diffusion-prep 3D MR neurography has potential for guiding therapy procedures where either nerve targeting or avoidance is desired.

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MRI targeting of peripheral nerve. Pig sciatic nerve is hyperintense on oblique 3D MR neurography (top), and isointense on T1 where dual-bundle fascicular structures are seen against surrounding fat (bottom). HIFU beam overlay (white) indicates target.
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Figure 1: MRI targeting of peripheral nerve. Pig sciatic nerve is hyperintense on oblique 3D MR neurography (top), and isointense on T1 where dual-bundle fascicular structures are seen against surrounding fat (bottom). HIFU beam overlay (white) indicates target.

Mentions: All targeted sciatic nerves were identifiable on MR neurography and T1-weighted images (Fig 1). For sonications at 160 to 300 W, MR thermometry measured peak temperatures of 60.3 to 85.7°C, with 240 equivalent minute thermal dose diameters of 8.5 to 15.9 mm (Fig 2). Thermal lesions were visible on late phase contrast-enhanced T1 (Fig 3), with dimensions matching the coagulated region observed at necropsy (Fig 4). Our preliminary results indicate that targeted peripheral nerve ablation is feasible with MR-HIFU. Diffusion-prep 3D MR neurography has potential for guiding therapy procedures where either nerve targeting or avoidance is desired.


3D MR neurography targeted peripheral nerve ablation with MR-guided high intensity focused ultrasound (MR-HIFU): initial results of a feasibility study in a swine model
MRI targeting of peripheral nerve. Pig sciatic nerve is hyperintense on oblique 3D MR neurography (top), and isointense on T1 where dual-bundle fascicular structures are seen against surrounding fat (bottom). HIFU beam overlay (white) indicates target.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4489376&req=5

Figure 1: MRI targeting of peripheral nerve. Pig sciatic nerve is hyperintense on oblique 3D MR neurography (top), and isointense on T1 where dual-bundle fascicular structures are seen against surrounding fat (bottom). HIFU beam overlay (white) indicates target.
Mentions: All targeted sciatic nerves were identifiable on MR neurography and T1-weighted images (Fig 1). For sonications at 160 to 300 W, MR thermometry measured peak temperatures of 60.3 to 85.7°C, with 240 equivalent minute thermal dose diameters of 8.5 to 15.9 mm (Fig 2). Thermal lesions were visible on late phase contrast-enhanced T1 (Fig 3), with dimensions matching the coagulated region observed at necropsy (Fig 4). Our preliminary results indicate that targeted peripheral nerve ablation is feasible with MR-HIFU. Diffusion-prep 3D MR neurography has potential for guiding therapy procedures where either nerve targeting or avoidance is desired.

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

MR-guided HIFU is an effective treatment for metastatic bone pain through periosteal nerve ablation, and is being investigated for treating back pain through facet joint denervation... We present initial investigations into the use of MRI to guide HIFU ablation of peripheral nerves in a swine model... The objectives were 1) to evaluate the feasibility of identifying peripheral nerves using MR neurography on the clinical MR-HIFU system, 2) to monitor HIFU ablation of peripheral nerves using MR thermometry, and 3) to evaluate the ability to measure thermal lesions in peripheral nerves using contrast-enhanced T1-weighted images and thermal dose maps calculated from MR thermometry... Volumetric MR-HIFU was used to induce seven thermal lesions in the sciatic nerves of three pigs. 3D MR neurography and T1-weighted images at 3T were used for target identification and treatment planning... Sonications were performed at 1.2 MHz with acoustic power ranging from 160 to 300 W over fixed durations of 20 or 36 seconds (energy 3.2 to 10.8 kJ)... Ablation dimensions were measured and compared using thermal dose maps, contrast-enhanced T1-weighted images, and gross pathology... All targeted sciatic nerves were identifiable on MR neurography and T1-weighted images (Fig 1)... For sonications at 160 to 300 W, MR thermometry measured peak temperatures of 60.3 to 85.7°C, with 240 equivalent minute thermal dose diameters of 8.5 to 15.9 mm (Fig 2)... Thermal lesions were visible on late phase contrast-enhanced T1 (Fig 3), with dimensions matching the coagulated region observed at necropsy (Fig 4)... Our preliminary results indicate that targeted peripheral nerve ablation is feasible with MR-HIFU... Diffusion-prep 3D MR neurography has potential for guiding therapy procedures where either nerve targeting or avoidance is desired.

No MeSH data available.