Image-guided ablation of tumors is assuming an increasingly important role in many oncology services as a minimally invasive alternative to conventional surgical interventions for patients who are not good candidates for surgery. Laser-induced thermal therapy (LITT) is a percutaneous tumor-ablation technique that utilizes high-power lasers placed interstitially in the tumor to deliver therapy. Multiple laser fibers can be placed into the treatment volume and, unlike other interstitial heating techniques, can be fired simultaneously to rapidly treat large volumes of tissue. Modern systems utilize small, compact, high-power laser diode systems with actively cooled applicators to help keep tissue from charring during procedures. Additionally, because this approach to thermal therapy is easily made magnetic resonance (MR) compatible, the incorporation of magnetic resonance imaging (MRI) for treatment planning, targeting, monitoring, and verification has helped to expand the number of applications in which LITT can be applied safely and effectively. We provide an overview of the clinically used technology and algorithms that provide the foundations for current state-of-the-art MR-guided LITT (MRgLITT), including procedures in the brain, liver, bone, and prostate as examples. In addition to advances in imaging and delivery, such as the incorporation of nanotechnology, next-generation MRgLITT systems are anticipated to incorporate an increasing presence of in silico-based modeling of MRgLITT procedures to provide human-assisted computational tools for planning, MR model-assisted temperature monitoring, thermal-dose assessment, and optimal control.

MRI is integral to the evaluation and treatment of endometrial cancer, and contemporary multiparametric MRI plays a key role in pretreatment planning, therapy selection, radiation therapy guidance,... Created with BioRender.com Endometrial cancer is the second most common gynecologic cancer worldwide and the most common gynecologic cancer in the United States, with an increasing incidence in high-income countries. Althoug...

We report the initial results of a pilot clinical trial exploring the safety and feasibility of the first real-time magnetic resonance-guided laser-induced thermal therapy of treatment-resistant focal metastatic intracranial tumors. Patients with resistant metastatic intracranial tumors who had previously undergone chemotherapy, whole-brain radiation therapy, and radiosurgery and who were recused from surgery were eligible for this trial. Under local anesthesia, a Leksell stereotactic head frame was used to insert a water-cooled interstitial fiberoptic laser applicator inside the cranium. In the bore of a magnetic resonance imaging (MRI) scanner, laser energy was delivered to heat the tumor while continuous MRI was performed. A computer workstation extracted temperature-sensitive information to display images of laser heating and computed estimates of the thermal damage zone. Posttreatment MRI scans were used to confirm the zone of thermal necrosis, and follow-up was performed at 7, 15, 30, and 90 days after treatment. In all cases, the procedure was well tolerated without secondary effect, and patients were discharged to home within 14 hours after the procedure. Follow-up imaging showed an acute increase in apparent lesion volume followed by a gradual and steady decrease. No tumor recurrence within thermal ablation zones was noted. In this ongoing trial, a total of four patients have had six metastatic tumors treated with laser thermal ablations. Magnetic resonance-guided laser-induced thermal therapy appears to provide a new, efficient treatment for recurrent focal metastatic brain disease. This therapy is a prelude to the future development of closed-head interventional MRI techniques in neurosurgery.

Purpose: We evaluated a newly Food and Drug Administration cleared, closed loop, magnetic resonance guided laser induced interstitial thermal therapy system for targeted ablation of prostate tissue...

Purpose: Several methods in MRI use the phase information of the complex signal and require phase unwrapping (e.g., B0 field mapping, chemical shift imaging, and velocity measurements). In this work, an algorithm was developed focusing on the needs and requirements of MR temperature imaging applications.Methods: The proposed method performs fully automatic unwrapping using a list of all pixels sorted by magnitude in descending order and creates and merges clusters of unwrapped pixels until the entire image is unwrapped. The algorithm was evaluated using simulated phantom data and in vivo clinical temperature imaging data.Results: The evaluation of the phantom data demonstrated no errors in regions with signal‐to‐noise ratios of at least 4.5. For the in vivo data, the algorithm did not fail at an average of more than one pixel for signal‐to‐noise ratios greater than 6.3. Processing times less than 30 ms per image were achieved by unwrapping pixels inside a region of interest (53 × 53 pixels) used for referenceless MR temperature imaging.Conclusions: The algorithm has been demonstrated to operate robustly with clinical in vivo data in this study. The processing time for common regions of interest in referenceless MR temperature imaging allows for online updates of temperature maps without noticeable delay. Magn Reson Med 73:1662–1668, 2015. © 2014 Wiley Periodicals, Inc.