Comprehensive MRI Guidance of Focused Ultrasound Neurosurgery

项目摘要/摘要 原发性震颤(ET)是一种常见的衰弱运动障碍，患病率高达4%的人口。 ET通常是残疾的，写作、进食或喝水的能力降低。患有这种疾病的人通常会减少他们的社交互动 因为尴尬，他们有抑郁的风险。有一些医学疗法可以减轻症状，但 许多患者有震颤，对药物治疗没有反应。深部大脑刺激可以很好地发挥作用，但很多 患者不适合做手术，或者更喜欢非手术的选择。 磁共振引导的聚焦超声(MRgFUS)是一种治疗ET的微创方法，适用于以下患者 对药物治疗很难奏效。聚焦超声(FUS)提供声能，将病灶局部加热至消融术。 温度高于60摄氏度。FUS与MRI引导(MRgFUS)相结合，可实现精确定位 组织消融，由实时磁共振测温仪监测。经颅磁共振血管内超声治疗伴fi异常的ET 和持久的减轻症状。 通过我们的临床经验，我们发现了几个关键领域，在这些领域，改进的治疗监测可以 大大提高了安全性和有效性。该项目的总体目标是提供全面的MRI反馈 为提高经颅聚焦超声治疗的安全性、有效性和准确性，提高治疗的安全性、有效性和准确性，本文对经颅聚焦超声治疗进行了探讨。我们的特殊fic目标是 以下是： 目的1：开发实时容量测温技术来监测热处理。MRgFUS治疗 目前使用用于温度映射的2D脉冲序列来监测。在消融期间，治疗只能是 在飞机内监测，峰值温升的位置可以发生在飞机之外。在这一目标下，我们将发展 实时容量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加热的方法。头骨吸收能量来自于 应用超声波，加热头骨和附近的软组织，包括大脑。目前没有 直接监测这种加热，以及所需的等待时间之间的超声波只能估计使用简单的模型。在……里面 为此，我们将开发新的、快速的、3D超短回波时间相结合的方法来监测颅骨温度的变化 在接受FUS治疗的ET患者的研究中，使用全脑体积测温和测试这些方法。 目的3：开发实时治疗监测技术，以便及早评估患者的生存能力。挑剔的莫尼先生- 治疗功能包括在创建病变时将其可视化。我们假设弥散加权成像可以捕捉到 在早期时间点有临床有用的病变对比。在这个目标中，我们将开发和验证新的扩散方法 在具有挑战性的FUS换能器环境中进行成像，并在患者研究中测试这些方法。 这项研究将从根本上改进MRgFUS治疗特发性震颤的方法，从而推进一项技术-- 可能对这些患者的治疗有显著影响的疾病fi不会影响治疗。

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.