Comprehensive MRI Guidance of Focused Ultrasound Neurosurgery

聚焦超声神经外科综合MRI指导

• 批准号: 10442602
• 负责人: CRAIG H MEYER
• 金额: $ 54.83万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10442602
• 关键词: 3-Dimensional; Ablation; Acoustics; Adverse event; Animal Experiments; Animal Model; Animals; Area; Brain; Brain Neoplasms; Brain region; Clinical; Clinical Research; Dangerousness; Deep Brain Stimulation; Development; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Dose; Eating; Effectiveness; Engineering; Environment; Essential Tremor; Excision; Feedback; Focused Ultrasound; Focused Ultrasound Therapy; Frequencies; Future; Goals; Heating; Hemorrhage; Histology; Hot Spot; Image; Infection; International; Lead; Lesion; Location; Magnetic Resonance Imaging; Medical; Medicare; Mental Depression; Methods; Modeling; Monitor; Movement Disorders; Multicenter Trials; Neurologic; Operative Surgical Procedures; Pain; Parkinson Disease; Patient Care; Patients; Performance; Persons; Physiologic pulse; Pilot Projects; Population; Prevalence; Procedures; Protons; Refractory; Research; Research Project Grants; Risk; Safety; Social Interaction; Sonication; Spatial Distribution; Symptoms; System; Techniques; Technology; Temperature; Testing; Therapeutic; Thermometry; Time; Tissues; Treatment Efficacy; Tremor; Ultrasonic Transducer; Ultrasonography; Universities; Virginia; Wait Time; Work; Writing; adverse event risk; cranium; design; experience; experimental study; high risk; imaging modality; improved; innovation; minimally invasive; neurosurgery; overtreatment; pre-clinical; programs; rapid technique; real time monitoring; reduce symptoms; simulation; soft tissue; sound; ultrasound; volunteer

PROJECT SUMMARY/ABSTRACT Essential tremor (ET) is a debilitating, common movement disorder, with prevalence as high as 4% of the population. ET is often disabling, with reduced ability to write, eat, or drink. People with the disorder often curtail their social interactions because of embarrassment and are at risk for depression. There are medical therapies that can reduce symptoms, but many patients have tremor that is not responsive to medical treatment. Deep brain stimulation can work well, but many patients are not candidates for surgery or would prefer a non-surgical option. MR-guided Focused Ultrasound (MRgFUS) is a minimally invasive method of treating ET that works in patients who are refractory to medical therapy. Focused ultrasound (FUS) delivers acoustic energy that focally heats lesions to ablative temperatures of greater than 60C. The combination of FUS with MRI guidance (MRgFUS) enables precisely localized tissue ablation, monitored by real-time MR thermometry. Transcranial MRgFUS has been used to treat ET with significant and durable reduction in symptoms. Through our clinical experience, we have identified several critical areas where improved treatment monitoring could dramatically increase safety and effectiveness. The overall goal of this project is to provide comprehensive MRI feedback for transcranial focused ultrasound to improve the safety, efficiency and efficacy of treatment. Our specific aims are the following: Aim 1: Develop real-time volumetric thermometry techniques to monitor thermal treatment. MRgFUS treatments are currently monitored using a 2D pulse sequence for temperature mapping. During ablation, the treatment can only be monitored in a plane, and the location of peak temperature rise can occur outside of the plane. In this aim, we will develop new methods for real-time volumetric MR thermometry and validate these techniques in pre-clinical and volunteer studies. Aim 2: Develop methods to monitor unintended heating of the brain and skull. The skull absorbs energy from the applied ultrasound, which results in heating of the skull and the nearby soft tissue, including the brain. There is currently no direct monitoring of this heating, and the required wait time between sonications is only estimated using simple models. In this aim, we will develop new, rapid, 3D ultrashort-echo-time methods for monitoring skull temperature changes combined with whole-brain volumetric thermometry and test these methods in studies of patients undergoing FUS treatment for ET. Aim 3: Develop real-time treatment monitoring techniques to give early assessment of viability. Critical MR moni- toring functions include visualizing the lesion as it is created. We hypothesize that diffusion-weighted imaging can capture clinically useful lesion contrast at early time points. In this aim, we will develop and validate new methods for diffusion imaging in the challenging environment of a FUS transducer and test these methods in studies of patients. This research will fundamentally improve the treatment of essential tremor using MRgFUS, thereby advancing a tech- nology that can have a significant impact on the treatment of these patients.

项目概要/摘要 特发性震颤 (ET) 是一种使人衰弱的常见运动障碍，患病率高达 4%。 ET 通常会导致残疾，导致书写、进食或饮水的能力下降。患有这种疾病的人经常减少社交互动 因为尴尬而有患抑郁症的风险。有一些药物疗法可以减轻症状，但是 许多患者患有对药物治疗无效的震颤。深部脑刺激效果很好，但很多 患者不适合手术或更喜欢非手术选择。 MR 引导聚焦超声 (MRgFUS) 是一种治疗 ET 的微创方法，适用于以下患者： 对药物治疗难治。聚焦超声 (FUS) 提供声能，将病灶集中加热至消融状态 温度大于60°C。 FUS 与 MRI 引导 (MRgFUS) 的结合可实现精确定位 通过实时 MR 测温法监测组织消融。经颅 MRgFUS 已用于治疗 ET，效果显着 并持久减轻症状。 通过我们的临床经验，我们已经确定了可以改进治疗监测的几个关键领域 显着提高安全性和有效性。该项目的总体目标是提供全面的 MRI 反馈 经颅聚焦超声可提高治疗的安全性、效率和功效。我们的具体目标是 下列的： 目标 1：开发实时体积测温技术来监测热处理。 MRgFUS 治疗 目前使用二维脉冲序列进行温度测绘监测。消融期间，治疗只能 在飞机内进行监测，并且峰值温升的位置可能出现在飞机外。为了这个目标，我们将开发 实时体积磁共振测温的新方法，并在临床前和志愿者研究中验证这些技术。 目标 2：开发监测大脑和头骨意外发热的方法。头骨吸收能量 应用超声波，导致头骨和附近的软组织（包括大脑）加热。目前没有 直接监测这种加热，并且仅使用简单的模型来估计超声处理之间所需的等待时间。在 为了实现这一目标，我们将开发新的、快速的 3D 超短回波时间方法来监测头骨温度变化 并在接受 FUS 治疗 ET 的患者的研究中测试这些方法。 目标 3：开发实时治疗监测技术，以便及早评估可行性。危重 MR 监测 扭转功能包括在损伤形成时将其可视化。我们假设扩散加权成像可以捕获 在早期时间点进行临床上有用的病变对比。为此，我们将开发并验证新的扩散方法 在 FUS 传感器的挑战性环境中进行成像，并在患者研究中测试这些方法。 这项研究将从根本上改善使用 MRgFUS 治疗原发性震颤的方法，从而推进技术的发展。 可以对这些患者的治疗产生重大影响的科学。