To evaluate the impact of the ultrasound (US) focusing on the thermal curves in an in vitro (bone and cement) and in vivo experiment [1Bucknor M.D., 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 (5) : 1418-1422 [cross-ref]

Haga clic aquí para ir a la sección de Referencias]. To compare these results with the acoustic and thermal simulation results [2Tillander M., y al. High intensity focused ultrasound induced in vivo large volume hyperthermia under 3D MRI temperature control Med Phys 2016 ;  43 (3) : 1539-1549 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 3ten Eikelder H.M., y al. Modelling the temperature evolution of bone under high intensity focused ultrasound Phys Med Biol 2016 ;  61 (4) : 1810-1828 [cross-ref]

Haga clic aquí para ir a la sección de Referencias]. To evaluate the US field distortion secondary to dissection needles.

MRgHIFU sonications were performed on a bone marrow (F=1MHz, P=25W during 90 s), on the ilium of a pig (in vivo) (F=1MHz, P=79W during 40 s) and a specimen of cement (F=2.7MHz, P=20W during 45 s). Focusing was superficial (at the periosteum or on the cement), deep (in the marrow or behind the cement) or intermediate (cortical bone). An acoustic and thermal simulation (k-wave) was performed using the same model of bone marrow with two values of bone acoustic absorption coefficient (α=4.7 et 9.9dB/cm) and compared with the MRI thermometry. For spinal and pelvic lesions, a dissection may be necessary to protect nerves during thermal ablation [4Tsoumakidou G., Buy X., Garnon J., Enescu J., Gangi A. Percutaneous thermal ablation: how to protect the surrounding organs Tech Vasc Interv Radiol 2011 ;  14 (3) : 170-176 [cross-ref]

Haga clic aquí para ir a la sección de Referencias]: therefore, the impact of dissection needles (22 to 13-gauge) on the US field was evaluated.

A vaster and higher periosteal heating was observed with deep sonication (Fig. 1). The lateral and vertical heating tended to appear with a delay, which can be explained by thermal inertia. These results were best reproduced with the simulation for α=4.7dB/cm. Simulation with α=9.9dB/cm showed a much higher periosteal heating and different thermal curves. Cement and in vivo thermal curves were similar to the bone marrow results. No US field distortion was observed with 22 to 18-gauge needles.

For the treatment of painful bone metastases, deep focusing may be the most efficient. Simulations can reproduce the in vitro results. However, simulation results depend on tumoral bone α which remains difficult to measure. For spinal or pelvic lesions thermal ablation requiring a protection of neural structures [5Karakitsios I., Mihcin S., Saliev T., Melzer A. Feasibility study of pre-clinical Thiel embalmed human cadaver for MR-guided focused ultrasound of the spine Minim Invasive Ther Allied Technol 2016 ;  25 (3) : 154-161 [cross-ref]

Haga clic aquí para ir a la sección de Referencias], dissection needles may be placed in the HIFU cone without any consequence at the condition that the liquid injected does not spread in front the US.