Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU): Overview of Emerging Applications (Part 2)

Abstract

Background High-intensity focused ultrasound (HIFU) allows noninvasive heating of deep-seated tissues. Guidance under magnetic resonance imaging (MR-HIFU) offers spatial targeting based on anatomical MR images as well as MR-based near-real-time temperature maps. Temperature feedback allows delivery of a well-defined thermal dose enabling new applications such as the ablation of malignant tissue.

Methods Peer-reviewed publications on MR-HIFU were studied and are summarized in this review. Literature was restricted to applications in oncology.

Results Several MR-HIFU-based applications for the treatment of malignant diseases are currently part of clinical trials or translational research. Recent trials regarding the treatment of prostate cancer with MR-HIFU have already shown this to be a safe and patient-friendly method. For the treatment of breast cancer and malignancies within abdominal organs, MR-HIFU has been applied so far only in proof of concept studies.

Conclusion MR-HIFU is currently being investigated for the ablative treatment of malignant tissue in a variety of oncological applications. For example, the transrectal as well as transurethral ablation of prostate cancer using MR-HIFU was shown to be a patient-friendly, safe alternative to other local treatment options with low side effects.

Key points: 

• MR guidance offers high soft tissue contrast for treatment planning, near-real-time temperature monitoring, and post-interventional therapy evaluation.

• Special HIFU transducers and technological solutions are available for the treatment of e. g. prostate cancer, breast cancer or abdominal malignancies.

Citation Format

• Siedek F, Yeo SY, Heijman E et al. MR-Guided High-Intensity Focused Ultrasound (MR-HIFU): Overview of Emerging Applications (Part 2). Fortschr Röntgenstr 2019; 191: 531 – 539

Zusammenfassung

Hintergrund Der hochintensive fokussierte Ultraschall (HIFU) ermöglicht das nichtinvasive Erhitzen tief gelegener Gewebsschichten. Die MRT-geführte HIFU-Behandlung (MR-HIFU) erlaubt die präzise Therapieplanung sowie MR-basierte Temperaturmessungen im Gewebe, wodurch eine genau definierte thermale Dosis appliziert werden kann.

Methoden Publikationen zu MR-HIFU wurden studiert und in diesem Review zusammengefasst. Hierbei wurde die Literatur auf onkologische Applikationen beschränkt.

Ergebnisse Neueste Studien zur MR-HIFU-Therapie des Prostatakarzinoms bestätigten diese als sichere und patientenfreundliche Methode. Zur MR-HIFU-Therapie des Mammakarzinoms und Tumorerkrankungen der abdominellen Organe wurden bisher Machbarkeitsstudien publiziert.

Zusammenfassung MR-HIFU wird derzeitig für die Thermoablation von malignem Gewebe bei verschiedenen Krebsentitäten untersucht. Die sowohl transrektale als auch transurethrale Ablation des Prostatakarzinoms mittels MR-HIFU erwies sich als patientenfreundlich und sichere Alternative mit geringen Komplikationen im Vergleich zu anderen lokalen Therapieoptionen.

Kernaussagen: 

• Die MR-Steuerung ermöglicht Therapieplanung auf MR-Bildern, nichtinvasive Temperaturmessungen in Echtzeit sowie postinterventionelle Therapiekontrolle.

• Spezielle HIFU-Transducer und Technologien zur Therapie vom z. B. Prostata- und Mammakarzinom oder malignen Erkrankungen der Abdomen-Organe sind vorhanden.

Key words

HIFU - interventional procedures - ablation procedures - prostate - breast - abdomen

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