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: 9803678
• 负责人: DENNIS L PARKER
• 金额: $ 59.67万
• 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/9803678
• 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; Family suidae; Focused Ultrasound; Focused Ultrasound Therapy; Foundations; Funding; Future; Goals; Heating; Human; Hybrids; Image; Imagery; 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 software; attenuation; base; cortical bone; cranium; design; experience; image reconstruction; imaging modality; improved; innovation; nervous system disorder; next generation; novel; open source; personalized medicine; 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）是一种完全非侵入性的神经介入治疗 该技术在治疗多种神经系统疾病方面显示出非凡的前景。的成功 神经介入手术中的聚焦超声取决于其提供精细聚焦波束的能力 准确地到达所需位置并准确监控由此产生的加热。虽然当前的系统有 取得了一些成功 有强有力的证据表明患者特定的颅骨属性导致焦点较少 比理想情况要好，治疗期间头骨的变化会导致颅骨进一步衰减、扩大和转移 焦点。虽然 Insightec Exablate Neuro tcMRgFUS 系统已获得 FDA 批准用于治疗基本疾病 震颤，它无法 1) 完全监测声场，2) 预测或监测头骨加热，或 3) 动态 优化整个过程中所需的光束聚焦和功率水平。这些技术限制 对目前批准的 tcMRgFUS 程序的安全性、有效性和效率产生不利影响，并限制 许多患者本来可以从这项革命性技术中受益。 在先前的资助下，我们的研究团队为 tcMRgFUS 引入了重要的技术进步， 包括体积实时 MR 温度成像 (MRTI) 技术、基于 T1 的超短回波时间 (UTE) 皮质骨温度成像，使用混合角谱进行快速超声波束建模 (HAS) 方法和 tcMRgFUS 专用的射频 (RF) 线圈。在此背景下，我们的目标 该提案旨在充分开发和传播为下一代提供迫切需要的能力 治疗建模、规划、监测、评估和控制。我们将通过三个方面来实现这一目标 具体目标： 1) 开发针对整个大脑和颅骨的强大体积 MRTI 监测方法，包括 一种新颖的单翻转角方法，用于颅骨中基于 T1 的 MRTI 和系统特定的射频线圈，以改善 MRTI 准确性; 2) 开发针对特定患者的经颅超声传播动态模型 适应头骨中测量的温度变化，动态预测聚焦相位和功率 准确完成治疗所需的； 3）展示先进治疗的临床价值 通过将建模和监控工具合并到正在开发的 tcMRgFUS 可视化工具中， 在日益复杂的临床前和临床环境中评估这些方法。 这些新的患者专用工具与可视化环境相结合将显着进步 tcMRgFUS 治疗通过提供完整的、针对特定患者的资格确定、治疗计划和 全面监控。这将对光束聚焦、定位和跟踪、治疗产生积极影响 准确性和临床工作流程，改善现有的临床适应症以及更好地实现前瞻性 寻找仍处于翻译阶段的应用程序。