UNASSIGNED: The current study provides insights into the challenges of safely operating a magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) robotic system in a high-field MRI scanner in terms of robotic motion accuracy.
UNASSIGNED: Grid sonications were carried out in phantoms and excised porcine tissue in a 3T MRI scanner using an existing MRgFUS robotic system. Fast low-angle shot-based magnetic resonance thermometry was employed for the intraprocedural monitoring of thermal distribution.
UNASSIGNED: Strong shifting of the heated spots from the intended points was observed owing to electromagnetic interference (EMI)-induced malfunctions in system\'s operation. Increasing the slice thickness of the thermometry sequence to at least 8 mm was proven an efficient method for preserving the robotic motion accuracy.
UNASSIGNED: These findings raise awareness about EMI effects on the motion accuracy of MRgFUS robotic devices and how they can be mitigated by employing suitable thermometry parameters.

Magnetic resonance thermometry (MRT) can measure in-vivo 3D-temperature changes in real-time and noninvasively. However, for the oropharynx region and the entire head and neck, motion potentially introduces large artifacts. Considering long treatment times of 60-90 min, this study aims to evaluate whether MRT around the oropharynx is clinically feasible for hyperthermia treatments and quantify the effects of breathing and swallowing on MRT performance. A 3D-ME-FGRE sequence was used in a phantom cooling down and around the oropharynx of five volunteers over ∼75 min. The imaging protocol consisted of imaging with acceleration (ARC = 2), number of image averages (NEX = 1,2 and 3). For volunteers, the acquisitions included a breath-hold scan and scans with deliberate swallowing. MRT performance was quantified in neck muscle, spinal cord and masseter muscle, using mean average error (MAE), mean error (ME) and spatial standard deviation (SD). In phantom, an increase in NEX leads to a significant decrease in SD, but MAE and ME were unchanged. No significant difference was found in volunteers between the different scans. There was a significant difference between the regions evaluated: neck muscle had the best MAE (=1.96 °C) and SD (=0.82 °C), followed by spinal cord (MAE = 3.17 °C, SD = 0.92 °C) and masseter muscle (MAE = 4.53 °C, SD = 1.16 °C). Concerning the ME, spinal cord did best, then neck muscle and masseter muscle, with values of -0.64 °C, 1.15 °C and -3.05 °C respectively. Breathing, swallowing, and different ways of imaging (acceleration and NEX) do not significantly influence the MRT performance in the oropharynx region. The ROI selected however, leads to significant differences.

BACKGROUND: Percutaneous microwave ablation (pMWA) is a minimally invasive procedure that uses a microwave antenna placed at the tip of a needle to induce lethal tissue heating. It can treat cancer and other diseases with lower morbidity than conventional surgery, but one major limitation is the lack of control over the heating region around the ablation needle. Superparamagnetic iron oxide nanoparticles have the potential to enhance and control pMWA heating due to their ability to absorb microwave energy and their ease of local delivery.
OBJECTIVE: The purpose of this study is to experimentally quantify the capabilities of FDA-approved superparamagnetic iron oxide Feraheme nanoparticles (FHNPs) to enhance and control pMWA heating. This study aims to determine the effectiveness of locally injected FHNPs in increasing the maximum temperature during pMWA and to investigate the ability of FHNPs to create a controlled ablation zone around the pMWA needle.
METHODS: PMWA was performed using a clinical ablation system at 915 MHz in ex-vivo porcine liver tissues. Prior to ablation, 50 uL 5 mg/mL FHNP injections were made on one side of the pMWA needle via a 23-gauge needle. Local temperatures at the FHNP injection site were directly compared to equidistant control sites without FHNP. First, temperatures were compared using directly inserted thermocouples. Next, temperatures were measured non-invasively using magnetic resonance thermometry (MRT), which enabled comprehensive four-dimensional (volumetric and temporal) assessment of heating effects relative to nanoparticle distribution, which was quantified using dual-echo ultrashort echo time (UTE) subtraction MR imaging. Maximum heating within FHNP-exposed tissues versus control tissues were compared at multiple pMWA energy delivery settings. The ability to generate a controlled asymmetric ablation zone using multiple FHNP injections was also tested. Finally, intra-procedural MRT-derived heat maps were correlated with gold standard gross pathology using Dice similarity analysis.
RESULTS: Maximum temperatures at the FHNP injection site were significantly higher than control (without FHNP) sites when measured using direct thermocouples (93.1 ± 6.0°C vs. 57.2 ± 8.1°C, p = 0.002) and using non-invasive MRT (115.6 ± 13.4°C vs. 49.0 ± 10.6°C, p = 0.02). Temperature difference between FHNP-exposed and control sites correlated with total energy deposition: 66.6 ± 17.6°C, 58.1 ± 8.5°C, and 20.8 ± 9.2°C at high (17.5 ± 2.2 kJ), medium (13.6 ± 1.8 kJ), and low (8.8 ± 1.1 kJ) energies, respectively (all pairwise p < 0.05). Each FHNP injection resulted in a nanoparticle distribution within 0.9 ± 0.2 cm radially of the injection site and a local lethal heating zone confined to within 1.1 ± 0.4 cm radially of the injection epicenter. Multiple injections enabled a controllable, asymmetric ablation zone to be generated around the ablation needle, with maximal ablation radius on the FHNP injection side of 1.6 ± 0.2 cm compared to 0.7 ± 0.2 cm on the non-FHNP side (p = 0.02). MRT intra-procedural predicted ablation zone correlated strongly with post procedure gold-standard gross pathology assessment (Dice similarity 0.9).
CONCLUSIONS: Locally injected FHNPs significantly enhanced pMWA heating in liver tissues, and were able to control the ablation zone shape around a pMWA needle. MRI and MRT allowed volumetric real-time visualization of both FHNP distribution and FHNP-enhanced pMWA heating that was useful for intra-procedural monitoring. This work strongly supports further development of a FHNP-enhanced pMWA paradigm; as all individual components of this approach are approved for patient use, there is low barrier for clinical translation.

Proton resonance frequency shift (PRFS) MR thermometry is the most common method used in clinical thermal treatments because of its fast acquisition and high sensitivity to temperature. However, motion is the biggest obstacle in PRFS MR thermometry for monitoring thermal treatment in moving organs. This challenge arises because of the introduction of phase errors into the PRFS calculation through multiple methods, such as image misregistration, susceptibility changes in the magnetic field, and intraframe motion during MRI acquisition. Various approaches for motion correction have been developed for real-time, motion-robust, and volumetric MR thermometry. However, current technologies have inherent trade-offs among volume coverage, processing time, and temperature accuracy. These tradeoffs should be considered and chosen according to the thermal treatment application. In hyperthermia treatment, precise temperature measurements are of increased importance rather than the requirement for exceedingly high temporal resolution. In contrast, ablation procedures require robust temporal resolution to accurately capture a rapid temperature rise. This paper presents a comprehensive review of current cutting-edge MRI techniques for motion-robust MR thermometry, and recommends which techniques are better suited for each thermal treatment. We expect that this study will help discern the selection of motion-robust MR thermometry strategies and inspire the development of motion-robust volumetric MR thermometry for practical use in clinics.

Difficulty in heating tumors with high spatial selectivity while protecting surrounding healthy tissues from thermal harm is a challenge for cancer photothermal treatment (PTT). To mitigate this problem, PTT mediated by photothermal agents (PTAs) has been established as a potential therapeutic technique to boost selectivity and reduce damage to surrounding healthy tissues. Various gold nanoparticles (AuNP) have been effectively utilized as PTAs, mainly using strategies to target cancerous tissue and increase selective thermal damage. Meanwhile, imaging can be used in tandem to monitor the AuNP distribution and guide the PTT. Mainly, the parameters impacting the induced temperature can be determined using simulation tools before treatment for effective PTT. However, accurate simulations can only be performed if the amount of AuNPs accumulated in the tumor is known. This study introduces Photo-Magnetic Imaging (PMI), which can appropriately recover the AuNP concentration to guide the PTT. Using multi-wavelength measurements, PMI can provide AuNP concentration based on their distinct absorption spectra. Tissue-simulating phantom studies are conducted to demonstrate the potential of PMI in recovering AuNP concentration for PTT planning. The recovered AuNP concentration is used to model the temperature increase accurately in a small inclusion representing tumor using a multiphysics solver that takes into account the light propagation and heat diffusion in turbid media.

BACKGROUND: Mild hyperthermia has been demonstrated to improve the efficacy of chemotherapy, radiation, and immunotherapy in various cancer types. One localized, non-invasive method of administering mild hyperthermia is magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU). However, challenges for ultrasound such as beam deflection, refraction and coupling issues may result in a misalignment of the HIFU focus and the tumor during hyperthermia. Currently, the best option is to stop the treatment, wait for the tissue to cool, and redo the treatment planning before restarting the hyperthermia. This current workflow is both time-consuming and unreliable.
OBJECTIVE: An adaptive targeting algorithm was developed for MRgHIFU controlled hyperthermia treatments for cancer therapeutics. This algorithm executes in real time while hyperthermia is being administered to ensure that the focus is within our target region. If a mistarget is detected, the HIFU system will electronically steer the focus of the HIFU beam to the correct target. The goal of this study was to quantify the accuracy and precision of the adaptive targeting algorithm\'s ability to correct a purposely misplanned hyperthermia treatment in real-time using a clinical MRgHIFU system.
METHODS: A gelatin phantom with acoustic properties matched to the average speed of sound in human tissue was used to test the adaptive targeting algorithm\'s accuracy and precision. The target was purposely offset 10 mm away from the focus at the origin, in four orthogonal directions, allowing the algorithm to correct for this mistarget. In each direction, 10 data sets were collected for a total sample size of 40. Hyperthermia was administered with a target temperature set at 42°C. The adaptive targeting algorithm was run during the hyperthermia treatment and 20 thermometry images were collected after the beam steering occurred. The location of the focus was quantified by calculating the center of heating on the MR thermometry data.
RESULTS: The average calculated trajectory passed to the HIFU system was 9.7 mm ± 0.4 mm where the target trajectory was 10 mm. The accuracy of the adaptive targeting algorithm after the beam steering correction was 0.9 mm and the precision was 1.6 mm.
CONCLUSIONS: The adaptive targeting algorithm was implemented successfully and was able to correct the 10 mm mistargets with high accuracy and precision in gelatin phantoms. The results demonstrate the capability to correct the MRgHIFU focus location during controlled hyperthermia.

OBJECTIVE: To investigate the daily fluctuations in brain temperature in healthy individuals using magnetic resonance (MR) diffusion-weighted imaging (DWI) thermometry and to clarify the associations between the brain and body temperatures and sex.
METHODS: Thirty-two age-matched healthy male and female volunteers (male = 16, 20-38 years) were recruited between July 2021 and January 2022. Brain MR examinations were performed in the morning and evening phases on the same day to calculate the brain temperatures using DWI thermometry. Body temperature was also measured in each MR examination. Group comparisons of body and brain temperatures between the two phases were performed using paired t-tests. A multiple linear regression model was used to predict the morning brain temperature using sex, evening brain temperature, and the interaction between sex and evening brain temperature as covariates.
RESULTS: Body temperatures were significantly higher in the evening than in the morning in all participants, male group, and female group (p < 0.001, = 0001, and < 0.001, respectively). Meanwhile, no significant difference was observed between the morning and evening brain temperatures in each analysis (p = 0.23, 0.70, and 0.16, respectively). Multiple linear regression analysis showed significant associations of morning brain temperature with sex (p = 0.038), evening brain temperature (p < 0.001), and the interaction between sex and evening brain temperature (p = 0.036).
CONCLUSIONS: Unlike body temperature, brain temperature showed no significant daily fluctuations; however, daily fluctuations in brain temperature may vary depending on sex.

The potential of transcranial magnetic resonance (MR)-guided histotripsy for brain applications has been described in prior in vivo studies in the swine brain through an excised human skull. The safety and accuracy of transcranial MR-guided histotripsy (tcMRgHt) rely on pre-treatment targeting guidance. In the work described here, we investigated the feasibility and accuracy of using ultrasound-induced low-temperature heating and MR thermometry for histotripsy pre-treatment targeting in ex vivo bovine brain.
A 15-element, 750-kHz MRI-compatible ultrasound transducer with modified drivers that can deliver both low-temperature heating and histotripsy acoustic pulses was used to treat seven bovine brain samples. The samples were first heated to an approximately 1.6°C temperature increase at the focus, and MR thermometry was used to localize the target. Once the targeting was confirmed, a histotripsy lesion was generated at the focus and visualized on post-histotripsy MR images.
The accuracy of MR thermometry targeting was evaluated with the mean/standard deviation of the difference between the locus of peak heating identified by MR thermometry and the center of mass of the post-treatment histotripsy lesion, which was 0.59/0.31 mm and 1.31/0.93 mm in the transverse and longitudinal directions, respectively.
This study determined that MR thermometry could provide reliable pre-treatment targeting for transcranial MR-guided histotripsy treatment.

Real-time temperature monitoring is critical to the success of thermally ablative therapies. This work validates a 3D thermometry sequence with k-space field drift correction designed for use in magnetic resonance-guided focused ultrasound treatments for breast cancer. Fiberoptic probes were embedded in tissue-mimicking phantoms, and temperature change measurements from the probes were compared with the magnetic resonance temperature imaging measurements following heating with focused ultrasound. Precision and accuracy of measurements were also evaluated in free-breathing healthy volunteers (N = 3) under a non-heating condition. MR temperature measurements agreed closely with those of fiberoptic probes, with a 95% confidence interval of measurement difference from -2.0 °C to 1.4 °C. Field drift-corrected measurements in vivo had a precision of 1.1 ± 0.7 °C and were accurate within 1.3 ± 0.9 °C across the three volunteers. The field drift correction method improved precision and accuracy by an average of 46 and 42%, respectively, when compared to the uncorrected data. This temperature imaging sequence can provide accurate measurements of temperature change in aqueous tissues in the breast and support the use of this sequence in clinical investigations of focused ultrasound treatments for breast cancer.

UNASSIGNED: The safety and effectiveness of laser interstitial thermal therapy (LITT) relies critically on the ability to continuously monitor the ablation based on real-time temperature mapping using magnetic resonance thermometry (MRT). This technique uses gradient recalled echo (GRE) sequences that are especially sensitive to susceptibility effects from air and blood. LITT for brain tumors is often preceded by a biopsy and is anecdotally associated with artifact during ablation. Thus, we reviewed our experience and describe the qualitative signal dropout that can interfere with ablation.
UNASSIGNED: We retrospectively reviewed all LITT cases performed in our intraoperative MRI suite for tumors between 2017 and 2020. We identified a total of 17 LITT cases. Cases were reviewed for age, sex, pathology, presence of artifact, operative technique, and presence of blood/air on post-operative scans.
UNASSIGNED: We identified six cases that were preceded by biopsy, all six had artifact present during ablation, and all six were noted to have air/blood on their post-operative MRI or CT scans. In two of those cases, the artifactual signal dropout qualitatively interfered with thermal damage thresholds at the borders of the tumor. There was no artifact in the 11 non-biopsy cases and no obvious blood or air was noted on the post-ablation scans.
UNASSIGNED: Additional consideration should be given to pre-LITT biopsies. The presence of air/blood caused an artifactual signal dropout effect in cases with biopsy that was severe enough to interfere with ablation in a significant number of those cases. Additional studies are needed to identify modifying strategies.