MRI-Guided Focused Ultrasound Surgery @ Radiology, Brigham and Women’s Hospital, Harvard


MRI-Guided Focused Ultrasound Surgery

Annual Review of Medicine
Vol. 60: 417-430 (Volume publication date February 2009)
Ferenc A. Jolesz
Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115; email: jolesz@bwh.harvard.edu

Abstract
MRI-guided focused ultrasound (MRgFUS) surgery is a noninvasive thermal ablation method that uses magnetic resonance imaging (MRI) for target definition, treatment planning, and closed-loop control of energy deposition. Integrating FUS and MRI as a therapy delivery system allows us to localize, target, and monitor in real time, and thus to ablate targeted tissue without damaging normal structures. This precision makes MRgFUS an attractive alternative to surgical resection or radiation therapy of benign and malignant tumors. Already approved for the treatment of uterine fibroids, MRgFUS is in ongoing clinical trials for the treatment of breast, liver, prostate, and brain cancer and for the palliation of pain in bone metastasis. In addition to thermal ablation, FUS, with or without the use of microbubbles, can temporarily change vascular or cell membrane permeability and release or activate various compounds for targeted drug delivery or gene therapy. A disruptive technology, MRgFUS provides new therapeutic approaches and may cause major changes in patient management and several medical disciplines.

Conclusions
MRgFUS is an advanced image-guided and controlled therapy method for noninvasive ablation and the targeted delivery of drugs. It is an alternative to surgery or radiation therapy. A disruptive technology, MRgFUS can lead to profound changes in the management of various disease conditions and may transform several medical fields. MRgFUS is performed on an outpatient basis and, in most cases, without general anesthesia. It holds great potential for improved outcomes, shorter hospitalizations, faster recovery, and a reduced economic burden on societies for health care.

Early experiences with MRgFUS treatment give good reason to conclude that, without MRI-guided localization, targeting, and MRI thermometry, the method is inadequate, especially for treating tumors.

Today the primary use of MRgFUS is thermal ablation of benign and malignant tumors. In the future, however, nonthermal effects of US will offer new therapeutic platforms, such as targeted drug delivery and gene therapy. Further advances in acoustic technology and high-field MRI will likely result in better target definition, improved accuracy, and shorter treatment times.

At an early stage in its development, MRgFUS’s safety and efficacy to address specific diseases must be demonstrated through rigorous clinical trials that are scrutinized by regulatory agencies including the FDA. In the future, insurance companies must accept MRgFUS as standard treatment. Physicians and patients may need to be made more aware of its advantages over conventional treatments.

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