Abstract
The concept of ideal tumor surgery is to remove the neoplastic tissue without damaging adjacent normal structures. High-intensity focused ultrasound (HIFU) was developed in the 1940s as a viable thermal tissue ablation approach. In clinical practice, HIFU has been applied to treat a variety of solid benign and malignant lesions, including pancreas, liver, prostate, and breast carcinomas, soft tissue sarcomas, and uterine fibroids. More recently, magnetic resonance guidance has been applied for treatment monitoring during focused ultrasound procedures (magnetic resonance–guided focused ultrasound, MRgFUS). Intraoperative magnetic resonance imaging provides the best possible tumor extension and dynamic control of energy deposition using real-time magnetic resonance imaging thermometry. We introduce the fundamental principles and clinical indications of the MRgFUS technique; we also report different treatment options and personal outcomes.
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References
DeVita VT Jr, Lawrence TS, Rosenberg SA (2001) Cancer: principles and practice of oncology. Lippincott Williams & Wilkins, Philadelphia
Brown JM, Giaccia AJ (1998) The unique physiology of solid tumors: opportunities (and problems) for cancer therapy. Cancer Res 58:1408–1416
Lee SH, Lee JM, Kim KW et al (2011) Dual-energy computed tomography to assess tumor response to hepatic radiofrequency ablation: potential diagnostic value of virtual noncontrast images and iodine maps. Invest Radiol 46:77–84
Goldberg SN, Grassi CJ, Cardella JF et al (2009) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 20(7 suppl):S377–S390
Goldberg SN, Gazelle GS, Mueller PR (2000) Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 174:323–331
Lynn JG, Zwemer RL, Chick AJ (1942) The biological application of focused ultrasonic waves. Science 96(2483):119–120
Fry WJ, Fry FJ (1960) Fundamental neurological research and human neurosurgery using intense ultrasound. IRE Trans Med Electron ME-7:166–181
Wang ZB, Wu F, Wang Z et al (1997) Targeted damage effects of high intensity focused ultrasound (HIFU) on liver tissues of Guizhou Province miniswine. Ultrason Sonochem 4:181–182
Yu T, Luo J (2011) Adverse events of extracorporeal ultrasound-guided high intensity focused ultrasound therapy. PLoS One 6:e26110
Jolesz FA (2009) MRI-guided focused ultrasound surgery. Annu Rev Med 60:417–430
Jolesz FA, Hynynen K (2002) Magnetic resonance image-guided focused ultrasound surgery. Cancer J 8(suppl 1):S100–S112
Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. Radiographics 25(suppl 1):S69–S83
ter Haar G (2010) Ultrasound bioeffects and safety. Proc Inst Mech Eng H 224:363–373
Jolesz FA, McDannold N (2008) Current status and future potential of MRI-guided focused ultrasound surgery. J Magn Reson Imaging 27:391–399
Rabinovici J, David M, Fukunishi H et al (2010) Pregnancy outcome after magnetic resonance–guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 93:199–209
Schmitt F, Grosu D, Mohr C et al (2004) 3 Tesla MRI: successful results with higher field strengths (review). Radiologe 44:31–47
Stewart EA, Gedroyc WM, Tempany CM et al (2003) Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol 189:48–54
Harding G, Coyne KS, Thompson CL, Spies JB (2008) The responsiveness of the Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire (UFS-QOL). Health Qual Life Outcomes 6:99
Hesley GK, Felmlee JP, Gebhart JB et al (2006) Noninvasive treatment of uterine fibroids: early Mayo Clinic experience with magnetic resonance imaging–guided focused ultrasound. Mayo Clin Proc 81:936–942
Funaki K, Fukunishi H, Sawada K (2009) Clinical outcomes of magnetic resonance–guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol 34:584–589
Behera MA, Leong M, Johnson L, Brown H (2010) Eligibility and accessibility of magnetic resonance–guided focused ultrasound (MRgFUS) for the treatment of uterine leiomyomas. Fertil Steril 94:1864–1868
Kim YS, Kim JH, Rhim H et al (2012) Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes. Radiology 263:600–609
Rabinovici J, Stewart EA (2006) New interventional techniques for adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:617–636
Fukunishi H, Funaki K, Sawada K et al (2008) Early results of magnetic resonance–guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. J Minim Invasive Gynecol 15:571–579
Dong X, Yang Z (2010) High-intensity focused ultrasound ablation of uterine localized adenomyosis. Curr Opin Obstet Gynecol 22:326–330
Hynynen K, Pomeroy O, Smith DN et al (2001) MR imaging–guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology 219:176–185
Gianfelice D, Khiat A, Amara et al (2003) MR imaging–guided focused ultrasound surgery of breast cancer: correlation of dynamic contrast-enhanced MRI with histopathologic findings. Breast Cancer Res Treat 82:93–101
Furusawa H, Namba K, Nakahara H et al (2007) The evolving non-surgical ablation of breast cancer: MR guided focused ultrasound (MRgFUS). Breast Cancer 14:55–58
Wu F, Wang ZB, Zhu H et al (2005) Extracorporeal high intensity focused ultrasound treatment for patients with breast cancer. Breast Cancer Res Treat 92:51–60
Mundy GR (2002) Metastasis to bone: causes, consequences and therapeutic opportunities. Nat Rev Cancer 2:584–593
Saarto T, Janes R, Tenhunen M, Kouri M (2002) Palliative radiotherapy in the treatment of skeletal metastases. Eur J Pain 6:323–330
Catane R, Beck A, Inbar Y et al (2007) MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases—preliminary clinical experience. Ann Oncol 18:163–167
Gianfelice D, Gupta C, Kucharczyk W et al (2008) Palliative treatment of painful bone metastases with MR imaging–guided focused ultrasound. Radiology 249:355–363
Liberman B, Gianfelice D, Inbar Y et al (2009) Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Ann Surg Oncol 16:140–146
Weeks EM, Platt MW, Gedroyc W (2012) MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain-case series of an innovative new technique. Eur Radiol 22:2822–2835
Warmuth M, Johansson T, Mad P (2010) Systematic review of the efficacy and safety of high-intensity focussed ultrasound for the primary and salvage treatment of prostate cancer. Eur Urol 58:803–815
Crouzet S, Poissonnier L, Murat FJ et al (2011) Outcomes of HIFU for localised prostate cancer using the Ablatherm Integrate Imaging(R) device. Prog Urol 21:191–197
Blana A, Rogenhofer S, Ganzer R et al (2008) Eight years’ experience with high-intensity focused ultrasonography for treatment of localized prostate cancer. Urology 72:1329–1333
Ahmed HU, Hindley RG, Dickinson L et al (2012) Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol 13:622–632
Nau WH, Diederich CJ, Ross AB et al (2005) MRI-guided interstitial ultrasound thermal therapy of the prostate: a feasibility study in the canine model. Med Phys 32:733–743
Pauly KB, Diederich CJ, Rieke V et al (2006) Magnetic resonance–guided high-intensity ultrasound ablation of the prostate. Top Magn Reson Imaging 17:195–207
Ram Z, Cohen ZR, Harnof S et al (2006) Magnetic resonance imaging–guided, high-intensity focused ultrasound for brain tumor therapy. Neurosurgery 59:949–955
McDannold N, Clement GT, Black P et al (2010) Transcranial magnetic resonance imaging– guided focused ultrasound surgery of brain tumors: initial findings in 3 patients. Neurosurgery 66:323–332
Hynynen K, Colucci V, Chung A, Jolesz F (1996) Noninvasive arterial occlusion using MRI-guided focused ultrasound. Ultrasound Med Biol 22:1071–1077
Hynynen K, McDannold N, Vykhodtseva N, Jolesz FA (2001) Noninvasive MR imaging–guided focal opening of the blood–brain barrier in rabbits. Radiology 220:640–646
McDannold N, Vykhodtseva N, Hynynen K (2006) Targeted disruption of the blood–brain barrier with focused ultrasound: association with cavitation activity. Phys Med Biol 51:793–807
Kinoshita M, McDannold N, Jolesz FA, Hynynen K (2006) Noninvasive localized delivery of Herceptin to the mouse brain by MRI-guided focused ultrasound-induced blood–brain barrier disruption. Proc Natl Acad Sci USA 103:11719–11723
Kinoshita M, McDannold N, Jolesz FA, Hynynen K (2006) Targeted delivery of antibodies through the blood–brain barrier by MRI-guided focused ultrasound. Biochem Biophys Res Commun 340:1085–1090
Broggi G, Dones I, Ferroli P, Franzini A, Pluderi M (2000) Contribution of thalamotomy, cordotomy and dorsal root entry zone Caudalis trigeminalis lesions in the treatment of chronic pain. Neurochirurgie 46:447–453
Jeanmonod D, Werner B, Morel A et al (2012) Transcranial magnetic resonance imaging–guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain. Neurosurg Focus 32:E1
Orsi F, Zhang L, Arnone P et al (2010) High-intensity focused ultrasound ablation: effective and safe therapy for solid tumors in difficult locations. AJR Am J Roentgenol 195:W245–W252
Wu F, Wang Z, Chen W (2001) Pathological study of extracorporeally ablated hepatocellular carcinoma with high-intensity focused ultrasound. Zhonghua Zhong Liu Za Zhi 23:237–239
Wu F, Wang ZB, Zhu H et al (2005) Feasibility of US-guided high-intensity focused ultrasound treatment in patients with advanced pancreatic cancer: initial experience. Radiology 236:1034–1040
Wu F, Wang ZB, Chen WZ et al (2003) Preliminary experience using high intensity focused ultrasound for the treatment of patients with advanced stage renal malignancy. J Urol 170(6 pt 1):2237–2240
Wu F, Wang ZB, Chen WZ et al (2005) Advanced hepatocellular carcinoma: treatment with high-intensity focused ultrasound ablation combined with transcatheter arterial embolization. Radiology 235:659–667
Illing RO, Kennedy JE, Wu F et al (2005) The safety and feasibility of extracorporeal high-intensity focused ultrasound (HIFU) for the treatment of liver and kidney tumours in a Western population. Br J Cancer 93:890–895
Zhang L, Zhu H, Jin C et al (2009) High-intensity focused ultrasound (HIFU): effective and safe therapy for hepatocellular carcinoma adjacent to major hepatic veins. Eur Radiol 19:437–445
Sung HY, Jung SE, Cho SH et al (2011) Long-term outcome of high-intensity focused ultrasound in advanced pancreatic cancer. Pancreas 40:1080–1086
Ritchie RW, Leslie T, Phillips R et al (2010) Extracorporeal high intensity focused ultrasound for renal tumours: a 3-year follow-up. BJU Int 106:1004–1009
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Napoli, A., Anzidei, M., Ciolina, F. et al. MR-Guided High-Intensity Focused Ultrasound: Current Status of an Emerging Technology. Cardiovasc Intervent Radiol 36, 1190–1203 (2013). https://doi.org/10.1007/s00270-013-0592-4
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DOI: https://doi.org/10.1007/s00270-013-0592-4