Predicting Bone Marrow Damage in the Skull After Clinical Transcranial MRI-Guided Focused Ultrasound With Acoustic and Thermal Simulations.
Predicting Bone Marrow Damage in the Skull After Clinical Transcranial MRI-Guided Focused Ultrasound With Acoustic and Thermal Simulations.
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DOI：
10.1109/tmi.2020.2989121
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发表时间：
2020-10
影响因子：
10.6
通讯作者：
Cosgrove R
中科院分区：
文献类型：
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作者：
McDannold N;White PJ;Cosgrove R
经颅MRI引导聚焦超声（TcMRgFUS）热消融是一种无创性功能性神经外科技术。之前的报告表明，在高声能下可能会发生颅骨骨髓损伤。虽然这种损伤是无症状的，但最好避免它。在这里，我们研究了声学和热模拟是否可以预测骨髓中发生热损伤的位置。在40次临床TcMRgFUS手术后3-15个月获得治疗后成像，并在16次治疗后观察骨髓病变。通过阈值为18.1-21.1 kJ（使用的最大声能）和97-112 kJ（整个治疗期间施加的总声能）的声能预测是否存在病变。病变的大小并不总是由单独治疗期间使用的声能预测。相比之下，由声学和热模拟估计的加热区域的位置、大小和形状与病变的位置、大小和形状在定性上相似。这些病变通常出现在预测会有高温的地区。虽然需要更多的工作来验证颅骨内和周围的温度估计，但能够预测骨髓中病变的位置和发作可以使声能在颅骨上更好地分布。了解TcMRgFUS的颅骨吸收特性也有助于优化经颅聚焦。
Transcranial MRI-guided focused ultrasound (TcMRgFUS) thermal ablation is a noninvasive functional neurosurgery technique. Previous reports have shown that damage in the skull bone marrow can occur at high acoustic energies. While this damage is asymptomatic, it would be desirable to avoid it. Here we examined whether acoustic and thermal simulations can predict where the thermal lesions in the marrow occurred. Post-treatment imaging was obtained at 3–15 months after 40 clinical TcMRgFUS procedures, and bone marrow lesions were observed after 16 treatments. The presence of lesions was predicted by the acoustic energy with a threshold of 18.1–21.1 kJ (maximum acoustic energy used) and 97–112 kJ (total acoustic energy applied over the whole treatment). The size of the lesions was not always predicted by the acoustic energy used during treatment alone. In contrast, the locations, sizes, and shapes of the heated regions estimated by the acoustic and thermal simulations were qualitatively similar to those of the lesions. The lesions generally appeared in areas that were predicted to have high temperatures. While more work is needed to validate the temperature estimates in and around the skull, being able to predict the locations and onset for lesions in the bone marrow could allow for better distribution of the acoustic energy over the skull. Understanding skull absorption characteristics of TcMRgFUS could also be useful in optimizing transcranial focusing.