Blood-brain barrier disruption in humans using an implantable ultrasound device: quantification with MR images and correlation with local acoustic pressure
Blood-brain barrier disruption in humans using an implantable ultrasound device: quantification with MR images and correlation with local acoustic pressure
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DOI：
10.3171/2018.9.jns182001
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发表时间：
2020-03-01
影响因子：
4.1
通讯作者：
Carpentier, Alexandre
中科院分区：
文献类型：
--
作者：
Asquier, Nicolas;Bouchoux, Guillaume;Carpentier, Alexandre
目的本研究的目的之一是建立一种半自动的方法，利用植入式、无聚焦的超声设备来评估胶质母细胞瘤患者血脑屏障的破坏程度。另一个目标是将显着的超声诱导信号增强(SUISE)的概率与脑内局部声压相关联。方法前瞻性分析超声治疗前后的Gd增强MR图像。对图像集进行分割、归一化和共配准，以评估对比度增强。用标记为灰质或白质的体素计算Suise的体积，在感兴趣的圆柱形区域内，并且增强超过给定的阈值。为了验证该方法，将所得到的Suise体积与之前由3名临床医生为15名患者的40次超声治疗分配的定性分级进行了比较。为了优化定性等级的算法预测，进行了参数研究。通过水中测量和模拟脑内超声衰减来估计脑内的3D声场，并叠加在每个MR图像上，将局部声压与Suise的概率(定义为增强10%)关联起来。结果该算法预测了2级或3级和3级开口，接收器操作特征曲线下的面积分别为0.831和0.995。Suise的概率与局部声压相关(R2=0.98)，灰质的概率是白质的3.33倍。结论一种评估血脑屏障破坏的算法是有效的，可用于未来的临床试验，以进一步了解和量化这项技术在人类中的应用。
OBJECTIVE One of the goals in this study was to set up a semiautomatic method to estimate blood-brain barrier disruption obtained in patients with glioblastoma by using an implantable, unfocused, ultrasound device. Another goal was to correlate the probability of significant ultrasound-induced signal enhancement (SUISE) with local acoustic pressure in the brain.METHODS Gd-enhanced MR images acquired before and after ultrasound treatments were analyzed prospectively. The image sets were segmented, normalized, and coregistered to evaluate contrast enhancement. The volume of SUISE was calculated with voxels labeled as gray or white matter, in a cylindrical region of interest, and with enhancement above a given threshold. To validate the method, the resulting volumes of SUISE were compared to qualitative grades previously assigned by 3 clinicians for 40 ultrasound treatments in 15 patients. A parametric study was performed to optimize the algorithm prediction of the qualitative grades. The 3D acoustic field in the brain was estimated from measurements in water combined with simulations accounting for ultrasound attenuation in brain and overlaid on each MR image to correlate local acoustic pressure with the probability of SUISE (defined as enhancement > 10%).RESULTS The algorithm predicted grade 2 or 3 and grade 3 openings with areas under the receiver operating characteristic curve of 0.831 and 0.995, respectively. The probability of SUISE was correlated with local acoustic pressure (R-2 = 0.98) and was 3.33 times higher for gray matter than for white matter.CONCLUSIONS An algorithm for evaluating blood-brain barrier disruption was validated and can be used for future clinical trials to further understand and quantify this technique in humans.