Prospective 3-D Treatment Planning for MR-Guided Laser Induced Thermal Therapy Pr

描述(申请人提供)：MR引导激光诱导热疗(MRgLITT)用于治疗脑部癌症病变是一种传统手术的微创替代疗法，目前在全球范围内获得了多项正在进行的临床试验。这些疗法结合了实时磁共振温度成像(MRTI)来提供反馈，使这些程序安全可行。然而，随着这些疗法转化为临床研究，有两个不足值得解决。首先，在存在组织界面和对流换热(例如，脑室、血管和组织灌流)的情况下进行激光加热可能使得通过假设对称椭圆形病变的产生来计划治疗变得困难，特别是当使用具有任意位置的多个敷贴器时。其次，MRTI信息可能在某些区域被破坏(例如，由于温度依赖的信号损失、血液或界面上的敏感性效应)，并且温度信息可能丢失或变得非常不确定，使得关于治疗结果的决定变得困难。因此，为了提高治疗的安全性、有效性和一致性，迫切需要对MRgLITT程序进行前瞻性的3D治疗计划，以及更强大的实时监测来补充MRTI。拟议研究的主要目标是开发和验证算法，为大脑中的MRgLITT程序提供前瞻性3D治疗计划和实时模型驱动的治疗监测。这种系统将结合目前用于神经外科和立体定向治疗计划的3D MRI采集的使用，并允许用户交互地导航组织并模拟各种敷贴器轨迹和激光曝光的效果，一旦激光被定位就更新这些计划，以及基于所获取的多层MR温度成像输入提供实时3D损伤估计。该项目的完成不仅将提供上述工具，还将为我们的长期目标提供一个框架，即将这些模型应用于计算机优化的反向治疗计划以及用于自适应治疗控制的实时建模。这个项目既创新又及时，因为目前还没有技术来对这一新兴的治疗方案进行前瞻性的3D规划，更不用说将这种算法与用于监测和治疗评估的数据驱动的模型预测辅助相结合。这项研究是高风险的，因为要近实时解决的计算问题的复杂性提出了需要克服的物理和理论障碍，但我们在这一领域的先前经验表明它是可行的。 公共卫生相关性：MR引导的激光诱导热疗(MRgLITT)用于治疗脑部癌症病变是传统手术的微创替代方案，现已作为商业化产品提供，许多临床试验正在进行中或开始。拟议研究的主要目标是开发、调查和验证3D前瞻性治疗计划和实时MRTI驱动的模型预测辅助脑内MRgLITT过程的监测，以提高这些过程的有效性和安全性。这个项目既创新又及时，因为目前还没有技术来支持这一新兴治疗方案的前瞻性3D治疗计划，也没有数据驱动的实时建模来预测温度和组织损伤。

DESCRIPTION (provided by applicant): MR-guided laser induced thermal therapy (MRgLITT) for treatment of cancerous lesions in the brain presents a minimally invasive alternative to conventional surgery, gaining use worldwide with multiple on-going clinical trials currently. These therapies incorporate real-time MR temperature imaging (MRTI) to provide feedback which makes these procedures safe and feasible. However, as these therapies translate into clinical studies, there are two deficiencies worth addressing. Firstly, laser heating in the presence of tissue interfaces and convective heat transfer (e.g., ventricles, vessels and tissue perfusion) may render planning of treatments by assuming symmetric ellipsoidal lesion generation difficult, particularly when multiple applicators with arbitrary placement are used. Second, MRTI information may become corrupt in some regions (e.g., from temperature dependent signal losses, blood, or susceptibility effects at interfaces) and the temperature information may be lost or become extremely uncertain, making decisions about treatment outcome difficult. Therefore, in order to enhance the safety, efficacy and conformality of treatment delivery, there exists a critical need for prospective 3D treatment planning of MRgLITT procedures as well as more robust real-time monitoring to complement MRTI. The primary goal of the proposed research is to develop and validate algorithms to provide both prospective 3D treatment planning and real-time model driven treatment monitoring for MRgLITT procedures in the brain. Such a system will incorporate the use of 3D MRI acquisitions currently used for neurosurgical and stereotactic treatment planning and allow the user to interactively navigate the tissue and simulate the effects of various applicator trajectories and laser exposures, update these plans once the laser is positioned, as well as provide real-time 3D estimation of damage based on the acquired multi-slice MR temperature imaging input. Completion of this project will provide not only the tools outlined above, but a framework for our long term goal of applying these models for computer optimized inverse treatment planning as well as real-time modeling for adaptive control of therapy. This project is both innovative and timely in that no technology presently exists for prospective 3D planning of this emerging therapeutic option, much less, integration of such an algorithm with data driven model prediction assistance for monitoring and treatment assessment. This research is high risk in that the complexity of the computational problems to be addressed in near real-time present both physical and theoretical hurdles to overcome, but our previous experience in this area indicate it is feasible. PUBLIC HEALTH RELEVANCE: MR-guided laser induced thermal therapy (MRgLITT) for the treatment of cancerous lesions in the brain is a minimally invasive alternative to conventional surgery and is now available as a commercialized product with many clinical trials in operation or beginning. The primary goal of the proposed research is to develop, investigate and validate 3D prospective treatment planning and real-time MRTI driven model prediction assisted monitoring for MRgLITT procedures in the brain in order to enhance the efficacy and safety of these procedures. This project is both innovative and timely in that no technology presently exists to support prospective 3D treatment planning of this emerging therapeutic option nor data driven real-time modeling for prediction of temperature and tissue damage.