Skull bone marrow injury caused by MR-guided focused ultrasound for cerebral functional procedures
Skull bone marrow injury caused by MR-guided focused ultrasound for cerebral functional procedures
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DOI：
10.3171/2017.11.jns17968
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发表时间：
2019-03-01
影响因子：
4.1
通讯作者：
Hynynen, Kullervo
中科院分区：
文献类型：
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作者：
Schwartz, Michael L.;Yeung, Robert;Hynynen, Kullervo
目的 一名尝试进行 MR 引导聚焦超声 (MRgFUS) 苍白球切开术的患者在尝试治疗 3 个月后发现有多处新的颅骨病变，并在 MRI 扫描中出现梗塞。作者对前 30 名接受 MRgFUS 治疗的患者进行了回顾性审查，以确定接受这些手术的患者颅骨病变的发生率，并考虑可能的原因。 方法 对前 30 名患者的 MRI 扫描进行回顾性审查，其中 1 名尝试苍白球切开术和 29 名腹侧中间核丘脑切除术。研究了平均颅骨密度比 (SDR) 与产生或试图产生脑损伤时所施加的最大能量的相关性。 结果 在 30 名接受 MRgFUS 治疗运动障碍的患者中，7 名患者发现有新的颅骨损伤，这些损伤在治疗前不存在，并且在治疗后第 1 天 MRI 扫描中不可见。一些有或没有颅骨病变的患者在治疗时报告有不适。所有颅骨病变患者均完全无症状。平均 SDR 与是否存在颅骨病变之间没有相关性，但 Exablate 系统施加的最大能量在有颅骨病变的患者中显着高于无颅骨病变的患者。 结论 众所周知，局部颅骨密度、厚度和 SDR 因位置而异。在低 SDR 区域可能会发生足够的能量转移，导致局部加热足以产生骨损伤。在未来的研究中应建立病变位置和局部颅骨特性的相关性。
OBJECTIVE One patient for whom an MR-guided focused ultrasound (MRgFUS) pallidotomy was attempted was discovered to have multiple new skull lesions with the appearance of infarcts on the MRI scan 3 months after his attempted treatment. The authors conducted a retrospective review of the first 30 patients treated with MRgFUS to determine the incidence of skull lesions in patients undergoing these procedures and to consider possible causes.METHODS A retrospective review of the MRI scans of the first 30 patients, 1 attempted pallidotomy and 29 ventral intermediate nucleus thalamotomies, was conducted. The correlation of the mean skull density ratio (SDR) and the maximum energy applied in the production or attempted production of a brain lesion was examined.RESULTS Of 30 patients treated with MRgFUS for movement disorders, 7 were found to have new skull lesions that were not present prior to treatment and not visible on the posttreatment day 1 MRI scan. Discomfort was reported at the time of treatment by some patients with and without skull lesions. All patients with skull lesions were completely asymptomatic. There was no correlation between the mean SDR and the presence or absence of skull lesions, but the maximum energy applied with the Exablate system was significantly greater in patients with skull lesions than in those without.CONCLUSIONS It is known that local skull density, thickness, and SDR vary from location to location. Sufficient energy transfer resulting in local heating sufficient to produce a bone lesion may occur in regions of low SDR. A correlation of lesion location and local skull properties should be made in future studies.