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.

The influence of Nd:YAG laser irradiation on Fluoroptic® temperature measurement: an experimental evaluation.

The aim of this study was to experimentally evaluate temperature monitoring with a Fluoroptic® temperature probe in the presence of laser irradiation from a Nd:YAG laser, which is mainly used for clinical MR-guided laser-induced interstitial thermotherapy. Temperature measurements were performed using a Fluoroptic® probe in comparison to a thermocouple probe in a gel phantom and an ex vivo pig liver at distances of 6.5 to 14 mm to the laser applicator (laser energy of 30.8 W). To evaluate the artifacts in the temperature measurement, the laser was turned on and off three times during the entire experiment. A comparison of the fiber-optic measurements with MR thermometry was also performed in pig liver by means of the proton resonance frequency method at a distance of 6 mm. Depending on the distance, the temperature measured by the fiber-optic probe deviated from the thermocouple probe temperature. The phantom deviations of 0.4 to 34.3 % were observed. The differences in the liver were smaller and ranged from 1.6 to 5.2 %. The Bland-Altman mean of differences between MR and fiber-optic temperature measurements was 0.02 °C and the 95 % limits of agreement value was ± 2.25°C. During laser application, considerable artifacts occurred in the Fluoroptic® measurements in short distances which was induced by laser energy absorption by the probe coating. No artifacts were verifiable at a distance of 14 mm in both mediums. The good conformity with MR thermometry resulted from the shorter turn-on times of the laser since the laser irradiation had only a minor effect on the measurements.

A pilot study for clinical feasibility of the near-harmonic 2D referenceless PRFS thermometry in liver under free breathing using MR-guided LITT ablation data.

OBJECTIVES: The conventional implementations of proton resonance frequency shift (PRFS) magnetic resonance thermometry (MRT) require the subtraction of single or multiple temporal references, a motion sensitive critical feature. A pilot study was conducted here to investigate the clinical feasibility of near-harmonic two-dimensional (2D) referenceless PRFS MRT, using patient data from MR-guided laser ablation of liver malignancies. METHODS: PRFS MRT with respiratory-triggered multi-slice gradient-recalled (GRE) acquisition was performed under free breathing in six patients. The precision of the novel referenceless MRT was compared with the reference phase subtraction. Coupling the referenceless MRT with a model-based, real-time compatible regularisation algorithm was also investigated. RESULTS: The precision of MRT was improved by a factor of 3.3 when using the referenceless method as compared to the reference phase subtraction. The approach combining referenceless PRFS MRT and model-based regularisation yielded an estimated precision of 0.7° to 2.1°C, resulting in millimetre-range agreement between the calculated thermal dose and the 24 h post-treatment unperfused regions in liver. CONCLUSIONS: The application of the near-harmonic 2D referenceless MRT method was feasible in a clinical scenario of MR-guided laser-induced thermal therapy (LITT) ablation in liver and permitted accurate prediction of the thermal lesion under free breathing in conscious patients, obviating the need for a controlled breathing under general anaesthesia.

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.

Threshold-based prediction of the coagulation zone in sequential temperature mapping in MR-guided radiofrequency ablation of liver tumours.

OBJECTIVE: To evaluate different cut-off temperature levels for a threshold-based prediction of the coagulation zone in magnetic resonance (MR)-guided radiofrequency (RF) ablation of liver tumours. METHODS: Temperature-sensitive measurements were acquired during RF ablation of 24 patients with primary (6) and secondary liver lesions (18) using a wide-bore 1.5 T MR sytem and compared with the post-interventional coagulation zone. Temperature measurements using the proton resonance frequency shift method were performed directly subsequent to energy application. The temperature maps were registered on the contrast-enhanced follow-up MR images acquired 4 weeks after treatment. Areas with temperatures above 50°, 55° and 60°C were segmented and compared with the coagulation zones. Sensitivity and positive predictive value were calculated. RESULTS: No major complications occurred and all tumours were completely treated. No tumour recurrence was observed at the follow-up examination after 4 weeks. Two patients with secondary liver lesions showed local tumour recurrence after 4 and 7 months. The 60°C threshold level achieved the highest positive predictive value (87.7 ± 9.9) and the best prediction of the coagulation zone. CONCLUSIONS: For a threshold-based prediction of the coagulation zone, the 60°C cut-off level achieved the best prediction of the coagulation zone among the tested levels. KEY POINTS: • Temperature monitoring can be used to survey MR-guided radiofrequency ablation • The developing ablation zone can be estimated based on post-interventional temperature measurements • A 60°C threshold level can be used to predict the ablation zone • The 50°C and 55°C temperature zones tend to overestimate the ablation zone.

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.

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.

Magnetic resonance-guided upper abdominal biopsies in a high-field wide-bore 3-T MRI system: feasibility, handling, and needle artefacts.

OBJECTIVE: To investigate the feasibility and handling of abdominal MRI-guided biopsies in a 3-T MRI system. METHODS: Over a 1-year period, 50 biopsies were obtained in 47 patients with tumours of the upper abdominal organs guided by 3-T MRI with a large-bore diameter of 70 cm. Lesions in liver (47), spleen (1) and kidney (2) were biopsied with a coaxial technique using a 16-G biopsy needle guided by a T1-weighted three-dimensional gradient recalled echo volumetric interpolated breath-hold examination (T1w-3D-GRE-VIBE) sequence. Sensitivity, specificity, accuracy, complication rate, interventional complexity, room/intervention time and needle artefacts were determined. RESULTS: A sensitivity of 0.93, specificity of 1.0 and accuracy of 0.94 were observed. Three patients required a rebiopsy. There was a minor complications rate of 13.6%, and no major complications were observed. Histopathology revealed 38 malignant lesions, and 3-month follow-up confirmed 9 benign lesions. Mean lesion diameter was 3.4 ± 3.1 cm (50% being smaller than 2 cm). Mean needle tract length was 10.8 ± 3.3 cm. Median room time was 42.0 ± 19.8 min and intervention time 9.3 ± 8.1 min. Needle artefact size was about 9-fold greater for perpendicular access versus access parallel to the main magnetic field. CONCLUSION: Biopsies of the upper abdomen can be performed with great technical success and easy handling because of the large-bore diameter. The MRI-guided biopsy needle had an acceptable susceptibility artefact at 3 T. However future research must aim to reduce the susceptibility effects of the biopsy systems.

Prediction of cell necrosis with sequential temperature mapping after radiofrequency ablation.

PURPOSE: To assess the feasibility of magnetic resonance (MR) thermometry after thermoablative therapy and to quantitatively evaluate the ability of two sequence types to predict cell necrosis. METHODS: Twenty patients with hepatic tumors were treated by MR-guided radiofrequency ablation. For each 10 patients, postinterventionally performed gradient echo and segmented echo planar imaging sequences were used to calculate temperature maps based on the proton resonance frequency shift method. Contrast-enhanced images acquired 1 month after therapy were registered on the temperature maps and the necrotic, nonenhanced area was segmented and compared to the area with a displayed temperature above 60 degrees C. Sensitivity and positive predictive value of the temperature map was calculated, using the follow-up imaging as the gold standard. RESULTS: Temperature mapping reached acceptable image quality in 45/47 cases. Sensitivity, ie, the rate of correctly detected coagulated tissue was 0.82 +/- 0.08 for the gradient echo imaging (GRE) sequence and 0.81 +/- 0.14 for the echo planar imaging (EPI) sequence. Positive predictive value, ie, the rate of voxel in the temperature map over 60 degrees C that actually developed necrosis, was 0.90 +/- 0.07 for the GRE sequence and 0.84 +/- 0.11 for the EPI sequence. CONCLUSION: Sequential MR temperature mapping allows for the prediction of the coagulation zone with an acceptable sensitivity and positive predictive value using EPI and GRE sequences.

MR temperature monitoring applying the proton resonance frequency method in liver and kidney at 0.2 and 1.5 T: segment-specific attainable precision and breathing influence.

OBJECT: The objective of this study was to evaluate breathing influence on precision in temperature determination by using the proton resonance frequency (PRF) shift method depending on the location in abdominal organs at 0.2 and 1.5 T. MATERIALS AND METHODS: Phase images were acquired with gradient echo sequences in a total of 12 volunteers at 1.5 and 0.2 T. Different examination protocols were performed (each 8 measurements with (1) in-/expiration, (2) free breathing, (3) under breathhold, (4) with breathing belt triggering, and (5) with navigator triggering (integrated in MR signal acquisition). Regions of interest were placed on liver and kidneys, and the resulting phase differences between the measurements were transformed into corresponding temperature differences. RESULTS: Precision significantly varied depending on the liver segment or location in the kidney. Gating techniques were found better than breathhold techniques and clearly better than non-gated examinations. The most precise approach reached a standard deviation of 2.0 degrees C under continuous breathing when navigator gating was used at 1.5 T. CONCLUSION: PRF temperature measurement is feasible even for moving organs in the abdomen at 0.2 and 1.5 T. The location of the target region and the required precision of the measurements should direct the choice of examination mode.