Targeting accuracy of transcranial magnetic resonance–guided high-intensity focused ultrasound brain therapy: a fresh cadaver model

Laboratory investigation

Restricted access

Object

This work aimed at evaluating the accuracy of MR-guided high-intensity focused ultrasound (MRgHIFU) brain therapy in human cadaver heads.

Methods

Eighteen heads of fresh human cadavers were removed with a dedicated protocol preventing intracerebral air penetration. The MR images allowed determination of the ultrasonic target: a part of the thalamic nucleus ventralis intermedius implicated in essential tremor. Osseous aberrations were corrected with simulation-based time reversal by using CT data from the heads. The ultrasonic session was performed with a 512-element phased-array transducer system operating at 1 MHz under stereotactic conditions with thermometric real-time MR monitoring performed using a 1.5-T imager.

Results

Dissection, imaging, targeting, and planning have validated the feasibility of this human cadaver model. The average temperature elevation measured by proton resonance frequency shift was 7.9°C ± 3°C. Based on MRI data, the accuracy of MRgHIFU is 0.4 ± 1 mm along the right/left axis, 0.7 ± 1.2 mm along the dorsal/ventral axis, and 0.5 ± 2.4 mm in the rostral/caudal axis.

Conclusions

Despite its limits (temperature, vascularization), the human cadaver model is effective for studying the accuracy of MRgHIFU brain therapy. With the 1-MHz system investigated here, there is millimetric accuracy.

Abbreviations used in this paper:HIFU = high-intensity focused ultrasound; MRgHIFU = MR-guided HIFU; VIM = nucleus ventralis intermedius.

Article Information

Address correspondence to: Jean-François Aubry, Ph.D., Institut Langevin, ESPCI, 10 rue Vauquelin, 75005 Paris, France. email: jean-francois.aubry@espci.fr.

Please include this information when citing this paper: published online March 1, 2012; DOI: 10.3171/2013.1.JNS12559.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Photograph showing the ultrasonic 512-element array with head holder. A dry skull is placed for illustration.

  • View in gallery

    Screen capture showing planning software in use.

  • View in gallery

    Sagittal (left) and coronal (right) views of the treatment setup (T1-weighted MR images).

  • View in gallery

    Typical MR temperature elevation in a view of the full head (left) and in the VIM (inset and right). deg = degrees.

  • View in gallery

    Examples of calcifications on the inner skull surface. Upper: Coronal and sagittal views of the CT data. Lower: Photograph of the inner surface of the corresponding extracted skull bone.

References

  • 1

    Aubry JFTanter MPernot MThomas JLFink M: Experimental demonstration of noninvasive transskull adaptive focusing based on prior computed tomography scans. J Acoust Soc Am 113:84932003

  • 2

    Benabid ALPollak PSeigneuret EHoffmann DGay EPerret J: Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias. Acta Neurochir Suppl (Wien) 58:39441993

  • 3

    Bradley WG Jr: MR-guided focused ultrasound: a potentially disruptive technology. J Am Coll Radiol 6:5105132009

  • 4

    Bricout JGuiot G: Stereotaxic atlas of the arterial network of the central gray nuclei. Ann Radiol (Paris) 7:7017221964

  • 5

    Clement GTHynynen K: A non-invasive method for focusing ultrasound through the human skull. Phys Med Biol 47:121912362002

  • 6

    Clement GTSun JGiesecke THynynen K: A hemisphere array for non-invasive ultrasound brain therapy and surgery. Phys Med Biol 45:370737192000

  • 7

    Cline HESchenck JFWatkins RDHynynen KJolesz FA: Magnetic resonance-guided thermal surgery. Magn Reson Med 30:981061993

  • 8

    Crouzet SMurat FJPasticier GCassier PChapelon JYGelet A: High intensity focused ultrasound (HIFU) for prostate cancer: current clinical status, outcomes and future perspectives. Int J Hyperthermia 26:7968032010

  • 9

    Fry FJBarger JE: Acoustical properties of the human skull. J Acoust Soc Am 63:157615901978

  • 10

    Gâteau JMarsac LPernot MAubry JFTanter MFink M: Transcranial ultrasonic therapy based on time reversal of acoustically induced cavitation bubble signature. IEEE Trans Biomed Eng 57:1341442010

  • 11

    Hershkovitz IGreenwald CRothschild BMLatimer BDutour OJellema LM: Hyperostosis frontalis interna: an anthropological perspective. Am J Phys Anthropol 109:3033251999

  • 12

    Hynynen KClement GTMcDannold NVykhodtseva NKing RWhite PJ: 500-element ultrasound phased array system for noninvasive focal surgery of the brain: a preliminary rabbit study with ex vivo human skulls. Magn Reson Med 52:1001072004

  • 13

    Hynynen KJolesz FA: Demonstration of potential noninvasive ultrasound brain therapy through an intact skull. Ultrasound Med Biol 24:2752831998

  • 14

    Jagannathan JSanghvi NTCrum LAYen CPMedel RDumont AS: High-intensity focused ultrasound surgery of the brain: part 1—a historical perspective with modern applications. Neurosurgery 64:2012112009

  • 15

    Jeanmonod DWerner BMorel AMichels LZadicario ESchiff G: Transcranial magnetic resonance imaging-guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain. Neurosurg Focus 32:1E12012

  • 16

    Larrat BPernot MMontaldo GFink MTanter M: MR-guided adaptive focusing of ultrasound. IEEE Trans Ultrason Ferroelectr Freq Control 57:173417372010

  • 17

    Louis EDFerreira JJ: How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord 25:5345412010

  • 18

    Marquet FPernot MAubry JFMontaldo GMarsac LTanter M: Non-invasive transcranial ultrasound therapy based on a 3D CT scan: protocol validation and in vitro results. Phys Med Biol 54:259726132009

  • 19

    Martin EJeanmonod DMorel AZadicario EWerner B: High-intensity focused ultrasound for noninvasive functional neurosurgery. Ann Neurol 66:8588612009

  • 20

    McDannold NArvanitis CDVykhodtseva NLivingstone MS: Temporary disruption of the blood-brain barrier by use of ultrasound and microbubbles: safety and efficacy evaluation in rhesus macaques. Cancer Res 72:365236632012

  • 21

    McDannold NClement GTBlack PJolesz FHynynen K: Transcranial magnetic resonance imaging-guided focused ultrasound surgery of brain tumors: initial findings in 3 patients. Neurosurgery 66:3233322010

  • 22

    McDannold NPark EJMei CSZadicario EJolesz F: Evaluation of three-dimensional temperature distributions produced by a low-frequency transcranial focused ultrasound system within ex vivo human skulls. IEEE Trans Ultrason Ferroelectr Freq Control 57:196719762010

  • 23

    O'Neill BELi KC: Augmentation of targeted delivery with pulsed high intensity focused ultrasound. Int J Hyperthermia 24:5065202008

  • 24

    Parker DLSmith VSheldon PCrooks LEFussell L: Temperature distribution measurements in two-dimensional NMR imaging. Med Phys 10:3213251983

  • 25

    Pernot MAubry JFTanter MBoch ALMarquet FKujas M: In vivo transcranial brain surgery with an ultrasonic time reversal mirror. J Neurosurg 106:106110662007

  • 26

    Pernot MAubry JFTanter MThomas JLFink M: High power transcranial beam steering for ultrasonic brain therapy. Phys Med Biol 48:257725892003

  • 27

    Shoji SNakano MNagata YUsui YTerachi TUchida T: Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. Int J Urol 17:7157192010

  • 28

    Stewart EAGedroyc WMWTempany CMCQuade BJInbar YEhrenstein T: Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol 189:48542003

  • 29

    Tanter MPernot MAubry JFMontaldo GMarquet FFink M: Compensating for bone interfaces and respiratory motion in high-intensity focused ultrasound. Int J Hyperthermia 23:1411512007

  • 30

    White DNClark JMChesebrough JNWhite MNCampbell JK: Effect of the skull in degrading the display of echoencephalographic B and C scans. J Acoust Soc Am 44:133913451968

  • 31

    Wu FWang ZBChen WZWang WGui YZhang M: Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview. Ultrason Sonochem 11:1491542004

  • 32

    Yelnik JBardinet EDormont DMalandain GOurselin STandé D: A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data. Neuroimage 34:6186382007

  • 33

    Yoon SWLee CCha SHYu JSNa YJKim KA: Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fibroids: a pictorial guide to relevant findings in screening pelvic MRI. Eur Radiol 18:299730062008

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 161 161 30
Full Text Views 183 183 0
PDF Downloads 117 117 0
EPUB Downloads 0 0 0

PubMed

Google Scholar