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Prostate Focused Ultrasound

MR-guided prostate interventions At top right, the 3D Slicer software platform used for MRI-guided biopsy. The 3D Slicer provides guidance and navigation during MRI-guided biopsy, allowing for multiplanar views of image volumes, target selection, and control of the MR scanner imaging plane. Here, T2W images obtained in the axial plane are shown. The control panel shown is used for slice selection to ensure that the real-time planar imaging obtained during needle insertion contains the desired target. On the left, a robotic assistant system for prostate intervention in a 3T closed-bore MRI scanner. The robot is placed between the patient’s legs and the MRI compatible mechanism (bottom right). The pneumatic actuator ensures no interference to MR images.

With industrial partner InSightec, the NCIGT’s Prostate Core has begun preclinical animal tests in dogs of a transrectal MRI-guided focused ultrasound (MRgFUS) system (ExAblate 2000) for thermal ablation of prostate cancer. Animal tests have been performed using the system that combines a 2.3 MHz, 1000-element/channel phased array transducer, a robotic positioning system, a water chiller/degassing/circulation system (for acoustic coupling and to protect the rectum), and a planning/thermal dosimetry workstation with a 3T MRI (GE Healthcare). MRT and thermal dose maps are guided by both the sonication targeting and the sonication exposure levels. Acute treatment effects were investigated with MRI and histology.

These tests demonstrated how MRI guidance can offer controlled and precise ablation of prostatic volumes. MRI guidance allowed controlled thermal dosimetry deposition to precisely target with adequate exposure levels. Given data collected to date, MRgFUS has potential as a non-invasive alternative to existing prostate cancer treatments.

To better control temperature during MRgFUS, investigators are using dynamic contrast enhanced (DCE) MRI prostate perfusion measurements to estimate the pretreatment prostate temperature resulting from the water cooling of a FUS rectal probe. Such a baseline is necessary to understand in relation to MRI thermometry that only measures temperature changes.

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Publications

• Tempany C, Straus S, Hata N, Haker S. MR-guided prostate interventions. J Magn Reson Imaging. 2008 Feb;27(2):356-67. PMID: 18219689.
• Jolesz FA, McDannold N. Current status and future potential of MRI-guided focused ultrasound surgery. J Magn Reson Imaging. 2008 Feb;27(2):391-9. PMID: 18219674.

Involved Investigators

• Ferenc Jolesz, MD, NCIGT PI
• Clare Tempany, MD, NCIGT Co-PI
• Nathan McDannold, PhD, NCIGT Core PI
• Jalil Afnan, MD
• Yongkhi Zhang, MD
• Magdalini Pilatou, PhD
• Vincent Colucci