MR-Guided Focused Ultrasound Treatment

  • Alessandro Napoli
  • Roberto Scipione
  • Rocco Cannata
  • Oreste MoreschiniEmail author


Magnetic resonance-guided focused ultrasound (MRgFUS) is an innovative noninvasive technique for pain management in skeletal metastases. This technology enables the performance of three-dimensional treatment planning with MR imaging and continuous real-time temperature monitoring of target zone with MR thermometric map, ensuring an accurate identification of the lesion and its margins and preventing surrounding healthy tissues from unwanted procedure-related damages. Acoustic energy application on the intact bone surface determines a rapid heating that induces critical thermal damage to the adjacent periosteum, with necrosis of local nerve endings and effective pain management. This procedure has also a potential role in effective local tumor control, allowing the complete ablation of target lesion, or the reduction of its size, and remineralization of trabecular bone. The whole MRgFUS protocol for ablation of bone metastases includes a pre-procedural imaging study, the choice for a strategy of simple palliation of pain or of local tumor control, the choice of the most appropriate anesthetic approach, the technical planning stage, the focal ablation treatment, the post-intervention management, and the clinical and imaging evaluation of treatment outcomes at different subsequent follow-ups.


MRgFUS Skeletal metastases Pain management High-intensity focused ultrasound Ablative treatment 


  1. 1.
    Napoli A, Anzidei M, Ciolina F, Marotta E, Marincola BC, Brachetti G, et al. MR-guided high-intensity focused ultrasound: current status of an emerging technology. Cardiovasc Intervent Radiol. 2013;36(5):1190–203.CrossRefPubMedGoogle Scholar
  2. 2.
    Dick E, Gedroyc W. ExAblate® magnetic resonance-guided focused ultrasound system in multiple body applications. Expert Rev Med Devices. 2010;7(5):589–97.CrossRefPubMedGoogle Scholar
  3. 3.
    Napoli A, Anzidei M, Marincola BC, Brachetti G, Noce V, Boni F, et al. MR imaging–guided focused ultrasound for treatment of bone metastasis. Radiographics. 2013;33(6):1555–68.CrossRefPubMedGoogle Scholar
  4. 4.
    Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications 1. Radiographics. 2005;25(suppl_1):S69–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Jolesz FA, Hynynen K. Magnetic resonance image-guided focused ultrasound surgery. Cancer J (Sudbury, Mass). 2001;8:S100–12.Google Scholar
  6. 6.
    Sapareto SA, Dewey WC. Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys. 1984;10(6):787–800.CrossRefPubMedGoogle Scholar
  7. 7.
    Catane R, Beck A, Inbar Y, Rabin T, Shabshin N, Hengst S, et al. MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases—preliminary clinical experience. Ann Oncol. 2007;18(1):163–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Chen W, Zhu H, Zhang L, Li K, Su H, Jin C, et al. Primary bone malignancy: effective treatment with high-intensity focused ultrasound ablation 1. Radiology. 2010;255(3):967–78.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Alessandro Napoli
    • 1
  • Roberto Scipione
    • 1
  • Rocco Cannata
    • 2
  • Oreste Moreschini
    • 2
    Email author
  1. 1.Department of Radiological, Oncological and Anatomopathological Sciences - Radiology“Sapienza” University of RomeRomeItaly
  2. 2.Department of Anatomical Sciences, Histological, Forensic Medicine and Locomotive System“Sapienza” University of RomeRomeItaly

Personalised recommendations