Toward the next generation in transcranial MR-guided focused ultrasound: Innovations in thermal and acoustic model-based planning and monitoring for improved safety, efficacy and efficiency

迈向下一代经颅 MR 引导聚焦超声：基于热和声学模型的规划和监测创新，以提高安全性、有效性和效率

• 批准号: 10159735
• 负责人: DENNIS L PARKER
• 金额: $ 63.33万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10159735
• 关键词: 3-Dimensional; Acoustics; Affect; Brain; Cadaver; Clinical; Clinical Research; Clinical Treatment; Communities; Complex; Data; Data Set; Dislocations; Eligibility Determination; Engineering; Environment; Essential Tremor; Evaluation; Failure; Focused Ultrasound; Focused Ultrasound Therapy; Foundations; Funding; Future; Goals; Heating; Human; Hybrids; Image; Imaging Techniques; Intervention; Location; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Methods; Modeling; Monitor; Patients; Phase; Physiologic pulse; Procedures; Property; Research; Safety; Site; Slice; Speed; Surgical Flaps; System; Techniques; Technology; Temperature; Thick; Thinness; Time; Tissues; Treatment Efficacy; Ultrasonography; Variant; Visualization; Visualization software; attenuation; base; cortical bone; cranium; design; experience; image reconstruction; imaging modality; improved; individualized medicine; innovation; nervous system disorder; next generation; novel; open source; personalized medicine; porcine model; pre-clinical; radio frequency; real time monitoring; success; tool; treatment planning; ultra high resolution

Transcranial MRI-guided focused ultrasound (tcMRgFUS) is a completely non-invasive neuro-interventional technique that shows exceptional promise for treating a number of neurological disorders. The success of focused ultrasound in neurointerventional procedures depends on its ability to deliver a finely focused beam exactly to the desired location and accurately monitor the resulting heating. Although current systems have achieved some success there is strong evidence that patient-specific skull attributes cause the focus to be less than ideal and that changes to the skull during treatment cause further attenuation, broadening, and shifting of the focus. While the Insightec Exablate Neuro tcMRgFUS system has received FDA approval to treat essential tremor, it is not able to 1) fully monitor the insonified field, 2) predict or monitor skull heating, or 3) dynamically optimize beam focusing and power levels needed throughout the procedure. These technical limitations adversely affect the safety, efficacy and efficiency of currently approved tcMRgFUS procedures and limit the number of patients that could otherwise benefit from this revolutionary technology. With prior funding, our research team has introduced important technical advancements for tcMRgFUS, including volumetric real-time MR temperature imaging (MRTI) techniques, T1-based ultrashort echo time (UTE) temperature imaging in cortical bone, rapid ultrasound beam modeling using a hybrid angular spectrum (HAS) method, and radiofrequency (RF) coils specific for tcMRgFUS. Building on this background, our goal in this proposal is to fully develop and disseminate critically needed capabilities that will provide next generation treatment modeling, planning, monitoring, assessment and control. We will accomplish this through three specific aims: 1) Develop robust volumetric MRTI monitoring methods for entire brain and skull including a novel mono flip angle method for T1-based MRTI in the skull and system-specific RF coils to improve MRTI accuracy; 2) Develop patient-specific, dynamic modeling of transcranial ultrasound propagation that adapts to measured temperature changes in the skull, dynamically predicting focusing phases and power needed for accurate treatment completion; and 3) Demonstrate the clinical value of advanced treatment modeling and monitoring tools by incorporating them into a developing tcMRgFUS visualization tool and evaluating the methods in increasingly complex preclinical and clinical environments. These new patient-specific tools combined with the visualization environment will significantly advance tcMRgFUS treatments by providing complete, patient-specific eligibility determination, treatment planning and comprehensive monitoring. This will positively impact beam focusing, localization and tracking, treatment accuracy, and clinical workflow, improving existing clinical indications as well as better enabling forward- looking applications that are still in the translational phase.

经颅MRI引导聚焦超声（TCMRGFUS）是一种完全无创的神经间歇性的 表现出对许多神经系统疾病的特殊有望的技术。成功的成功 专注于神经介入程序的超声检查取决于其提供精细聚焦的光束的能力 恰好到所需的位置，并准确监视所得的加热。尽管当前系统有 取得了一些成功，有充分的证据表明患者特定的头骨属性会导致重点较少 比理想，在治疗期间对头骨的变化会导致进一步的衰减，拓宽和转移 重点。虽然Insightec Exablate Neuro TCMRGFUS系统已获得FDA批准以治疗必需品 震颤，它无法1）完全监视无罪的场，2）预测或监视颅骨加热，或3）动态 在整个过程中优化光束聚焦和功率水平。这些技术限制 不利影响当前批准的TCMRGFUS程序的安全性，有效性和效率，并限制 原本可以从这种革命性技术中受益的患者数量。 通过先前的资助，我们的研究团队为TCMRGFUS介绍了重要的技术进步， 包括体积实时MR温度成像（MRTI）技术，基于T1的超短回声时间 （UTE）在皮质骨中的温度成像，使用杂交角光谱的快速超声梁建模 （HAS）方法和针对TCMRGFUS的射频（RF）线圈。在此背景下，我们的目标 该建议是充分发展和传播迫切需要的能力，以提供下一代 治疗模型，计划，监测，评估和控制。我们将通过三个 具体目的：1）为整个大脑和颅骨开发强大的体积MRTI监测方法 用于颅骨和系统特异性RF线圈中基于T1的MORTI的新型单声道角度方法，以改善MRTI 准确性; 2）开发经颅超声传播的患者特异性，动态建模 适应颅骨的测量温度变化，动态预测聚焦阶段和功率 准确的治疗完成所需； 3）证明高级治疗的临床价值 通过将其纳入开发的TCMRGFUS可视化工具和监视工具来建模和监视工具 评估日益复杂的临床前和临床环境中的方法。 这些新的患者特定工具与可视化环境相结合 通过提供完整的，特定于患者的资格确定，治疗计划和 全面的监视。这将积极影响光束聚焦，本地化和跟踪，处理 准确性和临床工作流程，改善了现有的临床适应症，并更好地实现前进 看起来仍处于翻译阶段的应用程序。