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Semin Musculoskelet Radiol 2021; 25(06): 725-734
DOI: 10.1055/s-0041-1735472
Review Article

Musculoskeletal Applications of Magnetic Resonance-Guided Focused Ultrasound

Matthew D. Bucknor
1   Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
,
Joe D. Baal
1   Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
,
Kevin C. McGill
1   Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
,
Andrew Infosino
2   Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
,
Thomas M. Link
1   Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
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Abstract

Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel noninvasive therapy that uses focused sound energy to thermally ablate focal pathology within the body. In the United States, MRgFUS is approved by the Food and Drug Administration for the treatment of uterine fibroids, palliation of painful bone metastases, and thalamotomy for the treatment of essential tremor. However, it has also demonstrated utility for the treatment of a wide range of additional musculoskeletal (MSK) conditions that currently are treated as off-label indications. Advantages of the technology include the lack of ionizing radiation, the completely noninvasive technique, and the precise targeting that offer unprecedented control of the delivery of the thermal dose, as well as real-time monitoring capability with MR thermometry. In this review, we describe the most common MSK applications of MRgFUS: palliation of bone metastases, treatment of osteoid osteomas, desmoid tumors, facet arthropathy, and other developing indications.

Keywords

magnetic resonance-guided focused ultrasound - high-intensity focused ultrasound - thermal ablation


Publication History

Article published online:
22 December 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Adam A, Kenny LM. Interventional oncology in multidisciplinary cancer treatment in the 21st century. Nat Rev Clin Oncol 2015; 12 (02) 105-113
    CrossrefPubMedGoogle Scholar
  • 2 Jolesz FA. MRI-guided focused ultrasound surgery. Annu Rev Med 2009; 60: 417-430
    CrossrefPubMedGoogle Scholar
  • 3 Catane R, Beck A, Inbar Y. et al. MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases–preliminary clinical experience. Ann Oncol 2007; 18 (01) 163-167
    CrossrefPubMedGoogle Scholar
  • 4 Liberman B, Gianfelice D, Inbar Y. et al. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Ann Surg Oncol 2009; 16 (01) 140-146
    CrossrefPubMedGoogle Scholar
  • 5 Baal JD, Chen WC, Baal U. et al. Efficacy and safety of magnetic resonance-guided focused ultrasound for the treatment of painful bone metastases: a systematic review and meta-analysis. Skeletal Radiol 2021; May 21 (Epub ahead of print)
    PubMedGoogle Scholar
  • 6 Napoli A, Mastantuono M, Cavallo Marincola B. et al. Osteoid osteoma: MR-guided focused ultrasound for entirely noninvasive treatment. Radiology 2013; 267 (02) 514-521
    CrossrefPubMedGoogle Scholar
  • 7 Ghanouni P, Dobrotwir A, Bazzocchi A. et al. Magnetic resonance-guided focused ultrasound treatment of extra-abdominal desmoid tumors: a retrospective multicenter study. Eur Radiol 2017; 27 (02) 732-740
    CrossrefPubMedGoogle Scholar
  • 8 Weeks EM, Platt MW, Gedroyc W. MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain—case series of an innovative new technique. Eur Radiol 2012; 22 (12) 2822-283
    CrossrefPubMedGoogle Scholar
  • 9 Jolesz FA, McDannold N. Current status and future potential of MRI-guided focused ultrasound surgery. J Magn Reson Imaging 2008; 27 (02) 391-399
    CrossrefPubMedGoogle Scholar
  • 10 Temple MJ, Waspe AC, Amaral JG. et al. Establishing a clinical service for the treatment of osteoid osteoma using magnetic resonance-guided focused ultrasound: overview and guidelines. J Ther Ultrasound 2016; 4 (01) 16
    CrossrefPubMedGoogle Scholar
  • 11 Yao CL, Trinh T, Wong GTC, Irwin MG. Anaesthesia for high intensity focused ultrasound (HIFU) therapy. Anaesthesia 2008; 63 (08) 865-872
    CrossrefPubMedGoogle Scholar
  • 12 Fang L, Hu X, Xu Y, Sun H, Shen H. Intermittent ice-cooling to prevent skin heat injury caused by high-intensity focused ultrasound therapy targeting desmoid-type fibromatosis: a case report. Int J Nurs Sci 2020; 8 (01) 136-140
    PubMedGoogle Scholar
  • 13 Rieke V, Butts Pauly K. MR thermometry. J Magn Reson Imaging 2008; 27 (02) 376-390
    CrossrefPubMedGoogle Scholar
  • 14 Callstrom MR, York JD, Gaba RC. et al; Technology Assessment Committee of Society of Interventional Radiology. Research reporting standards for image-guided ablation of bone and soft tissue tumors. J Vasc Interv Radiol 2009; 20 (12) 1527-1540
    CrossrefPubMedGoogle Scholar
  • 15 Hashim D, Boffetta P, La Vecchia C. et al. The global decrease in cancer mortality: trends and disparities. Ann Oncol 2016; 27 (05) 926-933
    CrossrefPubMedGoogle Scholar
  • 16 Macedo F, Ladeira K, Pinho F. et al. Bone metastases: an overview. Oncol Rev 2017; 11 (01) 321
    PubMedGoogle Scholar
  • 17 Cleeland CS, Gonin R, Hatfield AK. et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994; 330 (09) 592-596
    CrossrefPubMedGoogle Scholar
  • 18 Selvaggi G, Scagliotti GV. Management of bone metastases in cancer: a review. Crit Rev Oncol Hematol 2005; 56 (03) 365-378
    CrossrefPubMedGoogle Scholar
  • 19 Chow E, Hoskin P, Mitera G. et al; International Bone Metastases Consensus Working Party. Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys 2012; 82 (05) 1730-1737
    CrossrefPubMedGoogle Scholar
  • 20 Oh D, Huh SJ. Insufficiency fracture after radiation therapy. Radiat Oncol J 2014; 32 (04) 213-220
    CrossrefPubMedGoogle Scholar
  • 21 Hurwitz MD, Ghanouni P, Kanaev SV. et al. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. J Natl Cancer Inst 2014; 106 (05) dju082
    CrossrefPubMedGoogle Scholar
  • 22 Gianfelice D, Gupta C, Kucharczyk W, Bret P, Havill D, Clemons M. Palliative treatment of painful bone metastases with MR imaging—guided focused ultrasound. Radiology 2008; 249 (01) 355-363
    CrossrefPubMedGoogle Scholar
  • 23 Mercadante S, Fulfaro F. Management of painful bone metastases. Curr Opin Oncol 2007; 19 (04) 308-314
    CrossrefPubMedGoogle Scholar
  • 24 Bitton RR, Rosenberg J, LeBlang S. et al. MRI-guided focused ultrasound of osseous metastases: treatment parameters associated with successful pain reduction. Invest Radiol 2021; 56 (03) 141-146
    CrossrefPubMedGoogle Scholar
  • 25 Bertrand A-S, Iannessi A, Natale R. et al. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. J Ther Ultrasound 2018; 6 (01) 8-9
    CrossrefPubMedGoogle Scholar
  • 26 Huisman M, Lam MK, Bartels LW. et al. Feasibility of volumetric MRI-guided high intensity focused ultrasound (MR-HIFU) for painful bone metastases. J Ther Ultrasound 2014; 2 (01) 16
    CrossrefPubMedGoogle Scholar
  • 27 Kopelman D, Inbar Y, Hanannel A. et al. Magnetic resonance guided focused ultrasound surgery. Ablation of soft tissue at bone-muscle interface in a porcine model. Eur J Clin Invest 2008; 38 (04) 268-275
    CrossrefPubMedGoogle Scholar
  • 28 Bitton RR, Webb TD, Pauly KB, Ghanouni P. Prolonged heating in nontargeted tissue during MR-guided focused ultrasound of bone tumors. J Magn Reson Imaging 2019; 50 (05) 1526-1533
    CrossrefPubMedGoogle Scholar
  • 29 Jawad MU, Scully SP. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res 2010; 468 (10) 2825-2827
    CrossrefPubMedGoogle Scholar
  • 30 Scipione R, Anzidei M, Bazzocchi A, Gagliardo C, Catalano C, Napoli A. HIFU for bone metastases and other musculoskeletal applications. Semin Intervent Radiol 2018; 35 (04) 261-267
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Sharma KV, Yarmolenko PS, Celik H. et al. Comparison of noninvasive high-intensity focused ultrasound with radiofrequency ablation of osteoid osteoma. J Pediatr 2017; 190: 222-228.e1
    CrossrefPubMedGoogle Scholar
  • 32 Geiger D, Napoli A, Conchiglia A. et al. MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. J Bone Joint Surg Am 2014; 96 (09) 743-751
    CrossrefPubMedGoogle Scholar
  • 33 Masciocchi C, Zugaro L, Arrigoni F. et al. Radiofrequency ablation versus magnetic resonance guided focused ultrasound surgery for minimally invasive treatment of osteoid osteoma: a propensity score matching study. Eur Radiol 2016; 26 (08) 2472-2481
    CrossrefPubMedGoogle Scholar
  • 34 Arrigoni F, Spiliopoulos S, de Cataldo C. et al. A bicentric propensity score matched study comparing percutaneous computed tomography-guided radiofrequency ablation to magnetic resonance-guided focused ultrasound for the treatment of osteoid osteoma. J Vasc Interv Radiol 2021; 32 (07) 1044-1051
    CrossrefPubMedGoogle Scholar
  • 35 von Kalle T, Langendörfer M, Fernandez FF, Winkler P. Combined dynamic contrast-enhancement and serial 3D-subtraction analysis in magnetic resonance imaging of osteoid osteomas. Eur Radiol 2009; 19 (10) 2508-2517
    CrossrefPubMedGoogle Scholar
  • 36 Bucknor MD, Ozhinsky E, Shah R, Krug R, Rieke V. Effect of sonication duration and power on ablation depth during MR-guided focused ultrasound of bone. J Magn Reson Imaging 2017; 46 (05) 1418-1422
    CrossrefPubMedGoogle Scholar
  • 37 Bucknor MD, Rieke V, Seo Y. et al. Bone remodeling after MR imaging-guided high-intensity focused ultrasound ablation: evaluation with MR imaging, CT, Na(18)F-PET, and histopathologic examination in a swine model. Radiology 2015; 274 (02) 387-394
    CrossrefPubMedGoogle Scholar
  • 38 Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 2013; 9 (04) 216-224
    CrossrefPubMedGoogle Scholar
  • 39 Hooten WM, Cohen SP. Evaluation and treatment of low back pain: a clinically focused review for primary care specialists. Mayo Clin Proc 2015; 90 (12) 1699-1718
    CrossrefPubMedGoogle Scholar
  • 40 Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity?. Spine 1994; 19 (10) 1132-1137
    CrossrefPubMedGoogle Scholar
  • 41 Greher M, Kirchmair L, Enna B. et al. Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by computed tomography. Anesthesiology 2004; 101 (05) 1195-1200
    CrossrefPubMedGoogle Scholar
  • 42 Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician 2007; 10 (01) 229-253
    CrossrefPubMedGoogle Scholar
  • 43 Engel A, Rappard G, King W, Kennedy DJ. Standards Division of the International Spine Intervention Society. The effectiveness and risks of fluoroscopically-guided cervical medial branch thermal radiofrequency neurotomy: a systematic review with comprehensive analysis of the published data. Pain Med 2016; 17 (04) 658-669
    PubMedGoogle Scholar
  • 44 Poetscher AW, Gentil AF, Lenza M, Ferretti M. Radiofrequency denervation for facet joint low back pain: a systematic review. Spine 2014; 39 (14) E842-E849
    CrossrefPubMedGoogle Scholar
  • 45 Harnof S, Zibly Z, Shay L. et al. Magnetic resonance-guided focused ultrasound treatment of facet joint pain: summary of preclinical phase. J Ther Ultrasound 2014; 2 (01) 9-10
    CrossrefPubMedGoogle Scholar
  • 46 Krug R, Do L, Rieke V, Wilson MW, Saeed M. Evaluation of MRI protocols for the assessment of lumbar facet joints after MR-guided focused ultrasound treatment. J Ther Ultrasound 2016; 4 (01) 14
    CrossrefPubMedGoogle Scholar
  • 47 Kaye EA, Monette S, Srimathveeravalli G, Maybody M, Solomon SB, Gulati A. MRI-guided focused ultrasound ablation of lumbar medial branch nerve: feasibility and safety study in a swine model. Int J Hyperthermia 2016; 32 (07) 786-794
    CrossrefPubMedGoogle Scholar
  • 48 Tiegs-Heiden CA, Lehman VT, Gorny KR, Boon AJ, Hesley GK. Improved treatment response following magnetic resonance imaging-guided focused ultrasound for lumbar facet joint pain. Mayo Clin Proc Innov Qual Outcomes 2019; 4 (01) 109-113
    CrossrefPubMedGoogle Scholar
  • 49 Namba H, Kawasaki M, Izumi M, Ushida T, Takemasa R, Ikeuchi M. Effects of MRgFUS treatment on musculoskeletal pain: comparison between bone metastasis and chronic knee/lumbar osteoarthritis. Pain Res Manag 2019; 2019: 4867904
    CrossrefPubMedGoogle Scholar
  • 50 Browne JE, Tiegs-Heiden CA, Lehman VT. et al. Magnetic resonance imaging-guided focused ultrasound ablation of lumbar facet joints of a patient with a magnetic resonance image non-conditional pacemaker at 1.5T. Mayo Clin Proc Innov Qual Outcomes 2020; 4 (04) 464-468
    CrossrefPubMedGoogle Scholar
  • 51 Zhang W, Trivedi H, Adams M. et al. Anatomic thermochromic tissue-mimicking phantom of the lumbar spine for pre-clinical evaluation of MR-guided focused ultrasound (MRgFUS) ablation of the facet joint. Int J Hyperthermia 2021; 38 (01) 130-135
    CrossrefPubMedGoogle Scholar
  • 52 Bonvalot S, Desai A, Coppola S. et al. The treatment of desmoid tumors: a stepwise clinical approach. Ann Oncol 2012; 23 (Suppl. 10) x158-x166
    CrossrefPubMedGoogle Scholar
  • 53 Melis M, Zager JS, Sondak VK. Multimodality management of desmoid tumors: how important is a negative surgical margin?. J Surg Oncol 2008; 98 (08) 594-602
    CrossrefPubMedGoogle Scholar
  • 54 Rutenberg MS, Indelicato DJ, Knapik JA. et al. External-beam radiotherapy for pediatric and young adult desmoid tumors. Pediatr Blood Cancer 2011; 57 (03) 435-442
    CrossrefPubMedGoogle Scholar
  • 55 Bucknor MD, Rieke V. MRgFUS for desmoid tumors within the thigh: early clinical experiences. J Ther Ultrasound 2017; 5: 4
    CrossrefPubMedGoogle Scholar
  • 56 Nuyttens JJ, Rust PF, Thomas Jr CR, Turrisi III AT. Surgery versus radiation therapy for patients with aggressive fibromatosis or desmoid tumors: A comparative review of 22 articles. Cancer 2000; 88 (07) 1517-1523
    CrossrefPubMedGoogle Scholar
  • 57 Shim J, Staruch RM, Koral K, Xie X-J, Chopra R, Laetsch TW. Pediatric sarcomas are targetable by MR-guided high intensity focused ultrasound (MR-HIFU): anatomical distribution and radiological characteristics. Pediatr Blood Cancer 2016; 63 (10) 1753-1760
    CrossrefPubMedGoogle Scholar
  • 58 Ghanouni P, Pauly KB, Bitton R, Avedian R, Bucknor M, Gold G. MR guided focused ultrasound treatment of soft tissue tumors of the extremities—preliminary experience. J Ther Ultrasound 2015; 3 (01) 1-2
    CrossrefPubMedGoogle Scholar
  • 59 Chen W, Zhu H, Zhang L. et al. Primary bone malignancy: effective treatment with high-intensity focused ultrasound ablation. Radiology 2010; 255 (03) 967-978
    CrossrefPubMedGoogle Scholar
  • 60 Ghanouni P, Kishore S, Lungren MP. et al. Treatment of low-flow vascular malformations of the extremities using MR-guided high intensity focused ultrasound: preliminary experience. J Vasc Interv Radiol 2017; 28 (12) 1739-1744
    CrossrefPubMedGoogle Scholar
  • 61 Izumi M, Ikeuchi M, Kawasaki M. et al. MR-guided focused ultrasound for the novel and innovative management of osteoarthritic knee pain. BMC Musculoskelet Disord 2013; 14 (01) 267
    CrossrefPubMedGoogle Scholar