PRFS-based MR thermometry versus an alternative T1 magnitude method--comparative performance predicting thermally induced necrosis in hepatic tumor ablation.

OBJECTIVE: To compare the accuracy of a semi-quantitative proton resonance frequency shift (PRFS) thermal mapping interface and an alternative qualitative T1 thermometry model in predicting tissue necrosis in an established routine setting of MRI-guided laser ablation in the human liver. MATERIALS AND METHODS: 34 cases of PRFS-guided (GRE) laser ablation were retrospectively matched with 34 cases from an earlier patient population of 73 individuals being monitored through T1 magnitude image evaluation (FLASH 2D). The model-specific real-time estimation of necrotizing thermal impact (above 54 °C zone and T1 signal loss, respectively) was correlated in size with the resulting necrosis as shown by lack of enhancement on the first-day contrast exam (T1). Matched groups were compared using the Mann-Whitney test. RESULTS: Online PRFS guidance was available in 33 of 34 cases. Positive size correlation between calculated impact zone and contrast defect at first day was evident in both groups (p < 0.0004). The predictive error estimating necrosis was median 21% (range 1 %-52%) in the PRFS group and 61 % (range 22-84%) in the T1 magnitude group. Differences in estimating lethal impact were significant (p = 0.004), whereas the real extent of therapy-induced necrosis showed no significant difference (p > 0.28) between the two groups. CONCLUSION: PRFS thermometry is feasible in a clinical setting of thermal hepatic tumor ablation. As an interference-free MR-tool for online therapy monitoring its accuracy to predict tissue necrosis is superior to a competing model of thermally induced alteration of the T1 magnitude signal.

ARFI-prepared MRgHIFU in liver: simultaneous mapping of ARFI-displacement and temperature elevation, using a fast GRE-EPI sequence.

MR acoustic radiation force imaging (ARFI) is an elegant adjunct to MR-guided high intensity focused ultrasound for treatment planning and optimization, permitting in situ assessment of the focusing and targeting quality. The thermal effect of high intensity focused ultrasound pulses associated with ARFI measurements is recommended to be monitored on line, in particular when the beam crosses highly absorbent structures or interfaces (e.g., bones or air-filled cavities). A dedicated MR sequence is proposed here, derived from a segmented gradient echo-echo planar imaging kernel by adding a bipolar motion encoding gradient with interleaved alternating polarities. Temporal resolution was reduced to 2.1 s, with in-plane spatial resolution of 1 mm. MR-ARFI measurements were executed during controlled animal breathing, with trans-costal successively steered foci, to investigate the spatial modulation of the focus intensity and the targeting offset. ARFI-induced tissue displacement measurements enabled the accurate localization, in vivo, of the high intensity focused ultrasound focal point in sheep liver, with simultaneous monitoring of the temperature elevation. ARFI-based precalibration of the focal point position was immediately followed by trans-costal MR-guided high intensity focused ultrasound ablation, monitored with a conventional proton resonance frequency shift MR thermometry sequence. The latter MR thermometry sequence had spatial resolution and geometrical distortion identical with the ARFI maps, hence no coregistration was required.

Reference-free PRFS MR-thermometry using near-harmonic 2-D reconstruction of the background phase.

Proton resonance frequency shift (PRFS) MR thermometry (MRT) is the generally preferred method for monitoring thermal ablation, typically implemented with gradient-echo (GRE) sequences. Standard PRFS MRT is based on the subtraction of a temporal reference phase map and is, therefore, intrinsically sensitive to tissue motion (including deformation) and to external perturbation of the magnetic field. Reference-free (or reference-less) PRFS MRT has been previously described by Rieke and was based on a 2-D polynomial fit performed on phase data from outside the heated region, to estimate the background phase inside the region of interest. While their approach was undeniably a fundamental progress in terms of robustness against tissue motion and magnetic perturbations, the underlying mathematical formalism requires a thick unheated border and may be subject to numerical instabilities with high order polynomials. A novel method of reference-free PRFS MRT is described here, using a physically consistent formalism, which exploits mathematical properties of the magnetic field in a homogeneous or near-homogeneous medium. The present implementation requires as input the MR GRE phase values along a thin, nearly-closed and unheated border. This is a 2-D restriction of a classic Dirichlet problem, working on a slice per slice basis. The method has been validated experimentally by comparison with the "ground truth" data, considered to be the standard PRFS method for static ex vivo tissue. "Zero measurement" of the gradient-echo phase baseline was performed in healthy volunteer liver with rapid acquisition (300 ms/image). In vivo data acquired in sheep liver during MR-guided high intensity focused ultrasound (MRgHIFU) sonication were post-processed as proof of applicability in a therapeutic scenario. Bland and Altman mean absolute difference between the novel method and the "ground truth" thermometry in ex vivo static tissue ranged between 0.069 °C and 0.968 °C, compared to the inherent "white" noise SD of 0.23 °C. The accuracy and precision of the novel method in volunteer liver were found to be on average 0.13 °C and respectively 0.65 °C while the inherent "white" noise SD was on average 0.51 °C. The method was successfully applied to large ROIs, up to 6.2 cm inner diameter, and the computing time per slice was systematically less than 100 ms using C++. The current limitations of reference-free PRFS thermometry originate mainly from the need to provide a nearly-closed border, where the MR phase is artifact-free and the tissue is unheated, plus the potential need to reposition that border during breathing to track the motion of the anatomic zone being monitored.A reference-free PRFS thermometry method based on the theoretical framework of harmonic functions is described and evaluated here. The computing time is compatible with online monitoring during local thermotherapy. The current reference-free MRT approach expands the workflow flexibility, eliminates the need for respiratory triggers, enables higher temporal resolution, and is insensitive to unique-event motion of tissue.

Correction of susceptibility-induced GRE phase shift for accurate PRFS thermometry proximal to cryoablation iceball.

INTRODUCTION: The susceptibility contrast between frozen and unfrozen tissue disturbs the local magnetic field in the proximity of the ice-ball during cryotherapy. This effect should be corrected for in real time to allow PRFS-based monitoring of near-zero temperatures during intervention. MATERIAL AND METHODS: Susceptibility artifacts were corrected post-processing, using a rapid numerical algorithm. The difference in bulk magnetic susceptibility between frozen and non-frozen tissue was approximated to be uniform over the ice-ball volume and was determined from the isothermal principle applied to the phase-transition frontier of compartments. Subsequently, the magnetic perturbation field was calculated rapidly in 3D using a Fourier-convolution. Experimental studies were performed for two scenarios: tissue defrosting in a water bath and induction of an ice-ball by a MR-compatible cryogenic probe. RESULTS: The susceptibility artifacts yielded PRFS temperature errors as high as 10-12°C proximal to the ice-ball, positive or negative depending on the relative orientation of the position vector from the B(o) direction. These effects were fully corrected for to within the noise range. The susceptibility-corrected PRFS temperature values were consistent with the phase-transition isothermal condition, irrespective of the local orientation of the position vector. CONCLUSION: By implementing on-line the post processing algorithm, PRFS MRT may be used as a safety tool for non-invasive and accurate monitoring of near-zero temperatures during MR-guided clinical cryotherapy.

Clinical evaluation of MR temperature monitoring of laser-induced thermotherapy in human liver using the proton-resonance-frequency method and predictive models of cell death.

PURPOSE: To assess the feasibility, precision, and accuracy of real-time temperature mapping (TMap) during laser-induced thermotherapy (LITT) for clinical practice in patients liver with a gradient echo (GRE) sequence using the proton resonance frequency (PRF) method. MATERIALS AND METHODS: LITT was performed on 34 lesions in 18 patients with simultaneous real-time visualization of relative temperature changes. Correlative contrast-enhanced T1-weighted magnetic resonance (MR) images of the liver were acquired after treatment using the same slice positions and angulations as TMap images acquired during LITT. For each slice, TMap and follow-up images were registered for comparison. Afterwards, segmentation based on temperature (T) >52°C on TMap and based on necrosis seen on follow-up images was performed. These segmented structures were overlaid and divided into zones where the TMap was found to either over- or underestimate necrosis on the postcontrast images. Regions with T>52°C after 20 minutes were defined as necrotic tissue based on data received from two different thermal dose models. RESULTS: The average intersecting region of TMap and necrotic zone was 87% ± 5%, the overestimated 13% ± 4%, and the underestimated 13% ± 5%. CONCLUSION: This study demonstrates that MR temperature mapping appears reasonably capable of predicting tissue necrosis on the basis of indicating regions having greater temperatures than 52°C and could be used to monitor and adjust the thermal therapy appropriately during treatment.

Observation and correction of transient cavitation-induced PRFS thermometry artifacts during radiofrequency ablation, using simultaneous ultrasound/MR imaging.

PURPOSE: MR thermometry based on the proton resonance frequency shift (PRFS) is the most commonly used method for the monitoring of thermal therapies. As the chemical shift of water protons is temperature dependent, the local temperature variation (relative to an initial baseline) may be calculated from time-dependent phase changes in gradient-echo (GRE) MR images. Dynamic phase shift in GRE images is also produced by time-dependent changes in the magnetic bulk susceptibility of tissue. Gas bubbles (known as "white cavitation") are frequently visualized near the RF electrode in ultrasonography-guided radio frequency ablation (RFA). This study aimed to investigate RFA-induced cavitation's effects by using simultaneous ultrasonography and MRI, to both visualize the cavitation and quantify the subsequent magnetic susceptibility-mediated errors in concurrent PRFS MR-thermometry (MRT) as well as to propose a first-order correction for the latter errors. METHODS: RF heating in saline gels and in ex vivo tissues was performed with MR-compatible bipolar and monopolar electrodes inside a 1.5 T MR clinical scanner. Ultrasonography simultaneous to PRFS MRT was achieved using a MR-compatible phased-array ultrasonic transducer. PRFS MRT was performed interleaved in three orthogonal planes and compared to measurements from fluoroptic sensors, under low and, respectively, high RFA power levels. Control experiments were performed to isolate the main source of errors in standard PRFS thermometry. RESULTS: Ultrasonography, MRI and digital camera pictures clearly demonstrated generation of bubbles every time when operating the radio frequency equipment at therapeutic powers (> or = 30 W). Simultaneous bimodal (ultrasonography and MRI) monitoring of high power RF heating demonstrated a correlation between the onset of the PRFS-thermometry errors and the appearance of bubbles around the applicator. In an ex vivo study using a bipolar RF electrode under low power level (5 W), the MR measured temperature curves accurately matched the reference fluoroptic data. In similar ex vivo studies when applying higher RFA power levels (30 W), the correlation plots of MR thermometry versus fluoroptic data showed large errors in PRFS-derived temperature (up to 45 degrees C absolute deviation, positive or negative) depending not only on fluoroptic tip position but also on the RF electrode orientation relative to the B0 axis. Regions with apparent decrease in the PRFS-derived temperature maps as much as 30 degrees C below the initial baseline were visualized during RFA high power application. Ex vivo data were corrected assuming a Gaussian dynamic source of susceptibility, centered in the anode/cathode gap of the RF bipolar electrode. After correction, the temperature maps recovered the revolution symmetry pattern predicted by theory and matched the fluoroptic data within 4.5 degrees C mean offset. CONCLUSIONS: RFA induces dynamic changes in magnetic bulk susceptibility in biological tissue, resulting in large and spatially dependent errors of phase-subtraction-only PRFS MRT and unexploitable thermal dose maps. These thermometry artifacts were strongly correlated with the appearance of transient cavitation. A first-order dynamic model of susceptibility provided a useful method for minimizing these artifacts in phantom and ex vivo experiments.

Validation of fast MR thermometry at 1.5 T with gradient-echo echo planar imaging sequences: phantom and clinical feasibility studies.

The purpose of this work was to validate in phantom studies and demonstrate the clinical feasibility of MR proton resonance frequency thermometry at 1.5 T with segmented gradient-echo echo planar imaging (GRE-EPI) sequences during liver tumour radiofrequency (RF) ablation. Classical GRE acquisitions and segmented GRE-EPI acquisitions were performed at 1.5 T during simultaneous RF heating with an MR-compatible RF electrode placed in an agar gel phantom. Temperature increments were calculated and compared with four optical temperature probe measurements using Bland- Altman analysis. In a preliminary clinical feasibility study, the rapid GRE-EPI sequence (echo train length = 13) was used for MR temperature monitoring of RF ablation of liver tumours in three patient procedures. For phantom experiments, the Bland-Altman mean of differences between MR and optical probe temperature measurements was <0.4 degrees C, and the 95% limits of agreement value was <1.4 degrees C. For the in vivo studies, respiratory-triggered GRE-EPI acquisitions yielded a temperature accuracy of 1.3 +/- 0.4 degrees C (acquisition time = 0.6 s/image, spatial coverage of three slices/respiratory cycle). MR proton resonance frequency thermometry at 1.5 T yields precise and accurate measurements of temperature increment with both classical GRE and rapid GRE-EPI sequences. Rapid GRE-EPI sequences minimize intra-scan motion effects and can be used for MR thermometry during RF ablation in moving organs.