Kim Butts Pauly

All Publications

Localization of ultrasound-induced in vivo neurostimulation in the mouse model. Ultrasound in medicine and biology King, R. L., Brown, J. R., Pauly, K. B. 2014; 40 (7): 1512-1522
Abstract

Developments in the use of ultrasound to stimulate and modulate neural activity have raised the possibility of using ultrasound as a new investigative and therapeutic tool in brain research. Although the phenomenon of ultrasound-induced neurostimulation has a long history dating back many decades, until now there has been little evidence of a clearly localized effect in the brain, a necessary requirement for the technique to become genuinely useful. Here we report clearly distinguishable effects in sonicating rostral and caudal regions of the mouse motor cortex. Motor responses measured by normalized electromyography in the neck and tail regions changed significantly when sonicating the two different areas of motor cortex. Response latencies varied significantly according to sonication location, suggesting that different neural circuits are activated depending on the precise focus of the ultrasound beam. Taken together, our findings present good evidence of the ability to target selective parts of the motor cortex with ultrasound neurostimulation in the mouse, an advance that should help to set the stage for developing new applications in larger animal models, including humans.

View details for DOI 10.1016/j.ultrasmedbio.2014.01.020

View details for PubMedID 24642220
Respiration Based Steering for High Intensity Focused Ultrasound Liver Ablation MAGNETIC RESONANCE IN MEDICINE Holbrook, A. B., Ghanouni, P., Santos, J. M., Dumoulin, C., Medan, Y., Pauly, K. B. 2014; 71 (2): 797-806
View details for DOI 10.1002/mrm.24695

View details for Web of Science ID 000330769700036
EFFECTIVE PARAMETERS FOR ULTRASOUND-INDUCED IN VIVO NEUROSTIMULATION ULTRASOUND IN MEDICINE AND BIOLOGY King, R. L., Brown, J. R., Newsome, W. T., Pauly, K. B. 2013; 39 (2): 312-331
Abstract

Ultrasound-induced neurostimulation has recently gained increasing attention, but little is known about the mechanisms by which it affects neural activity or about the range of acoustic parameters and stimulation protocols that elicit responses. We have established conditions for transcranial stimulation of the nervous system in vivo, using the mouse somatomotor response. We report that (1) continuous-wave stimuli are as effective as or more effective than pulsed stimuli in eliciting responses, and responses are elicited with stimulus onset rather than stimulus offset; (2) stimulation success increases as a function of both acoustic intensity and acoustic duration; (3) interactions of intensity and duration suggest that successful stimulation results from the integration of stimulus amplitude over a time interval of 50 to 150 ms; and (4) the motor response elicited appears to be an all-or-nothing phenomenon, meaning stronger stimulus intensities and durations increase the probability of a motor response without affecting the duration or strength of the response.

View details for DOI 10.1016/j.ultrasmedbio.2012.09.009

View details for Web of Science ID 000313207100015

View details for PubMedID 23219040
In vivo MR acoustic radiation force imaging in the porcine liver MEDICAL PHYSICS Holbrook, A. B., Ghanouni, P., Santos, J. M., Medan, Y., Pauly, K. B. 2011; 38 (9): 5081-5089
Abstract

High intensity focused ultrasound (HIFU) in the abdomen can be sensitive to acoustic aberrations that can exist in the beam path of a single sonication. Having an accurate method to quickly visualize the transducer focus without damaging tissue could assist with executing the treatment plan accurately and predicting these changes and obstacles. By identifying these obstacles, MR acoustic radiation force imaging (MR-ARFI) provides a reliable method for visualizing the transducer focus quickly without damaging tissue and allows accurate execution of the treatment plan.MR-ARFI was used to view the HIFU focus, using a gated spin echo flyback readout-segmented echo-planar imaging sequence. HIFU spots in a phantom and in the livers of five live pigs under general anesthesia were created with a 550 kHz extracorporeal phased array transducer initially localized with a phase-dithered MR-tracking sequence to locate microcoils embedded in the transducer. MR-ARFI spots were visualized, observing the change of focal displacement and ease of steering. Finally, MR-ARFI was implemented as the principle liver HIFU calibration system, and MR-ARFI measurements of the focal location relative to the thermal ablation location in breath-hold and breathing experiments were performed.Measuring focal displacement with MR-ARFI was achieved in the phantom and in vivo liver. In one in vivo experiment, where MR-ARFI images were acquired repeatedly at the same location with different powers, the displacement had a linear relationship with power [y?=?0.04x?+?0.83 ?m (R(2)?=?0.96)]. In another experiment, the displacement images depicted the electronic steering of the focus inside the liver. With the new calibration system, the target focal location before thermal ablation was successfully verified. The entire calibration protocol delivered 20.2 J of energy to the animal (compared to greater than 800 J for a test thermal ablation). ARFI displacement maps were compared with thermal ablations during seven breath-hold ablations. The error was 0.83?±?0.38 mm in the S/I direction and 0.99?±?0.45 mm in the L/R direction. For six spots in breathing ablations, the mean error in the nonrespiration direction was 1.02?±?0.89 mm.MR-ARFI has the potential to improve free-breathing plan execution accuracy compared to current calibration and acoustic beam adjustment practices. Gating the acquisition allows for visualization of the focal spot over the course of respiratory motion, while also being insensitive to motion effects that can complicate a thermal test spot. That MR-ARFI measures a mechanical property at the focus also makes it insensitive to high perfusion, of particular importance to highly perfused organs such as the liver.

View details for DOI 10.1118/1.3622610

View details for Web of Science ID 000294482900019

View details for PubMedID 21978053
Hybrid referenceless and multibaseline subtraction MR thermometry for monitoring thermal therapies in moving organs MEDICAL PHYSICS Grissom, W. A., Rieke, V., Holbrook, A. B., Medan, Y., Lustig, M., Santos, J., McConnell, M. V., Pauly, K. B. 2010; 37 (9): 5014-5026
Abstract

Magnetic resonance thermometry using the proton resonance frequency (PRF) shift is a promising technique for guiding thermal ablation. For temperature monitoring in moving organs, such as the liver and the heart, problems with motion must be addressed. Multi-baseline subtraction techniques have been proposed, which use a library of baseline images covering the respiratory and cardiac cycle. However, main field shifts due to lung and diaphragm motion can cause large inaccuracies in multi-baseline subtraction. Referenceless thermometry methods based on polynomial phase regression are immune to motion and susceptibility shifts. While referenceless methods can accurately estimate temperature within the organ, in general, the background phase at organ/tissue interfaces requires large polynomial orders to fit, leading to increased danger that the heated region itself will be fitted by the polynomial and thermal dose will be underestimated. In this paper, a hybrid method for PRF thermometry in moving organs is presented that combines the strengths of referenceless and multi-baseline thermometry.The hybrid image model assumes that three sources contribute to image phase during thermal treatment: Background anatomical phase, spatially smooth phase deviations, and focal, heat-induced phase shifts. The new model and temperature estimation algorithm were tested in the heart and liver of normal volunteers, in a moving phantom HIFU heating experiment, and in numerical simulations of thermal ablation. The results were compared to multi-baseline and referenceless methods alone.The hybrid method allows for in vivo temperature estimation in the liver and the heart with lower temperature uncertainty compared to multi-baseline and referenceless methods. The moving phantom HIFU experiment showed that the method accurately estimates temperature during motion in the presence of smooth main field shifts. Numerical simulations illustrated the method's sensitivity to algorithm parameters and hot spot features.This new hybrid method for MR thermometry in moving organs combines the strengths of both multi-baseline subtraction and referenceless thermometry and overcomes their fundamental weaknesses.

View details for DOI 10.1118/1.3475943

View details for Web of Science ID 000281906000053

View details for PubMedID 20964221
A strategy for blood biomarker amplification and localization using ultrasound PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA D'Souza, A. L., Tseng, J. R., Pauly, K. B., Guccione, S., Rosenberg, J., Gambhir, S. S., Glazer, G. M. 2009; 106 (40): 17152-17157
Abstract

Blood biomarkers have significant potential applications in early detection and management of various diseases, including cancer. Most biomarkers are present in low concentrations in blood and are difficult to discriminate from noise. Furthermore, blood measurements of a biomarker do not provide information about the location(s) where it is produced. We hypothesize a previously undescribed strategy to increase the concentration of biomarkers in blood as well as localize the source of biomarker signal using ultrasound energy directly applied to tumor cells. We test and validate our hypothesis in cell culture experiments and mouse tumor xenograft models using the human colon cancer cell line LS174T, while measuring the biomarker carcinoembryonic antigen (CEA) before and after the use of ultrasound to liberate the biomarker from the tumor cells. The results demonstrate that the application of low-frequency ultrasound to tumor cells causes a significant release of tumor biomarker, which can be measured in the blood. Furthermore, we establish that this release is specific to the direct application of the ultrasound to the tumor, enabling a method for localization of biomarker production. This work shows that it is possible to use ultrasound to amplify and localize the source of CEA levels in blood of tumor-bearing mice and will allow for a previously undescribed way to determine the presence and localization of disease more accurately using a relatively simple and noninvasive strategy.

View details for DOI 10.1073/pnas.0903437106

View details for Web of Science ID 000270537500053

View details for PubMedID 19805109
MR thermometry JOURNAL OF MAGNETIC RESONANCE IMAGING Rieke, V., Pauly, K. B. 2008; 27 (2): 376-390
Abstract

Minimally invasive thermal therapy as local treatment of benign and malignant diseases has received increasing interest in recent years. Safety and efficacy of the treatment require accurate temperature measurement throughout the thermal procedure. Noninvasive temperature monitoring is feasible with magnetic resonance (MR) imaging based on temperature-sensitive MR parameters such as the proton resonance frequency (PRF), the diffusion coefficient (D), T1 and T2 relaxation times, magnetization transfer, the proton density, as well as temperature-sensitive contrast agents. In this article the principles of temperature measurements with these methods are reviewed and their usefulness for monitoring in vivo procedures is discussed. Whereas most measurements give a temperature change relative to a baseline condition, temperature-sensitive contrast agents and spectroscopic imaging can provide absolute temperature measurements. The excellent linearity and temperature dependence of the PRF and its near independence of tissue type have made PRF-based phase mapping methods the preferred choice for many in vivo applications. Accelerated MRI imaging techniques for real-time monitoring with the PRF method are discussed. Special attention is paid to acquisition and reconstruction methods for reducing temperature measurement artifacts introduced by tissue motion, which is often unavoidable during in vivo applications.

View details for DOI 10.1002/jmri.21265

View details for Web of Science ID 000252909100014

View details for PubMedID 18219673
Magnetic resonance-guided high-intensity ultrasound ablation of the prostate. Topics in magnetic resonance imaging Pauly, K. B., Diederich, C. J., Rieke, V., Bouley, D., Chen, J., Nau, W. H., Ross, A. B., Kinsey, A. M., Sommer, G. 2006; 17 (3): 195-207
Abstract

This paper describes our work in developing techniques and devices for magnetic resonance (MR)-guided high-intensity ultrasound ablation of the prostate and includes review of relevant literature.Catheter-based high-intensity ultrasound applicators, in interstitial and transurethral configurations, were developed to be used under MR guidance. Magnetic resonance thermometry and the relevant characteristics and artifacts were evaluated during in vivo thermal ablation of the prostate in 10 animals. Contrast-enhanced MR imaging (MRI) and diffusion-weighted MRI were used to assess tissue damage and compared with histology.During evaluation of these applicators, MR thermometry was used to monitor the temperature distributions in the prostate in real time. Magnetic resonance-derived maximum temperature thresholds of 52 degrees C and thermal dose thresholds of 240 minutes were used to control the extent of treatment and qualitatively correlated well with posttreatment imaging studies and histology. The directional transurethral devices are selective in their ability to target well-defined regions of the prostate gland and can be rotated in discrete steps to conform treatment to prescribed boundaries. The curvilinear applicator is the most precise of these directional techniques. Multisectored transurethral applicators, with dynamic angular control of heating and no rotation requirements, offer a fast and less complex means of treatment with less selective contouring.The catheter-based ultrasound devices can produce spatially selective regions of thermal destruction in prostate. The MR thermal imaging and thermal dose maps, obtained in multiple slices through the target volume, are useful for controlling therapy delivery (rotation, power levels, duration). Contrast-enhanced T1-weighted MRI and diffusion-weighted imaging are useful tools for assessing treatment.

View details for PubMedID 17414077
Toward Volumetric MR Thermometry With the MASTER Sequence IEEE TRANSACTIONS ON MEDICAL IMAGING Marx, M., Plata, J., Pauly, K. B. 2015; 34 (1): 148-155
Abstract

MR temperature monitoring is an indispensable tool for high intensity focused ultrasound. In this paper, a new technique known as MASTER (multiple adjacent slice thermometry with excitation refocusing) is presented which improves the speed and accuracy of multiple-slice MR thermometry. Defocusing the magnetization after exciting a slice allows for multiple slices to be excited concurrently and stored in k-space. The magnetization from each excitation is then refocused and read in sequence. This approach increases TE for each slice, greatly improving temperature SNR as compared to conventional slice interleaving. Gradient sequence design optimization is required to minimize diffusion losses while maintaining high sequence efficiency. Flexibility in selecting position, update rate, accuracy, and voxel size for each slice independently allows for freedom in design to fit different application needs. Results are shown in phantom and in vivo validating the feasibility of the sequence, and comparing it to interleaved GRE. Sample design curves are presented that contrast the MASTER design space with that of interleaved GRE thermometry.

View details for DOI 10.1109/TMI.2014.2349912

View details for Web of Science ID 000346975900015
MR-acoustic radiation force imaging (MR-ARFI) and susceptibility weighted imaging (SWI) to visualize calcifications in ex vivo swine brain JOURNAL OF MAGNETIC RESONANCE IMAGING Bitton, R. R., Butts, K. R. 2014; 39 (5): 1294-1300
Abstract

To present the use of MR-acoustic radiation force imaging (MR-ARFI) and susceptibility weighted imaging (SWI) to visualize calcifications in ex vivo brain tissue as a planning indicator for MR-guided focused ultrasound (MRgFUS).Calcifications were implanted in ex vivo swine brain and imaged using SWI, MR-ARFI, and computed tomography (CT). SWI-filtered phase images used 3D gradient recalled echo (GRE) images with a Fourier-based unwrapping algorithm. The MR-ARFI pulse sequence used a 2DFT spin-echo with repeated bipolar encoding gradients in the direction of the longitudinal ultrasound beam. MR-ARFI interrogations scanned a subregion (14 × 10 × 12 mm) of the brain surrounding the calcification. They were combined into a single displacement weighted map, using the sum of squares method. Calcification size estimates were based on image profiles plotted along the ±x and ±z direction, at the full-width half-maximum.Both MR-ARFI and SWI were able to visualize the calcifications. The contrast ratio was 150 for CT, 12 for SWI, and 12 for MR-ARFI. Profile measures were 1.35 × 1.28 mm on CT, 1.24 × 1.73 mm on SWI, and 2.45 × 3.02 mm on MR-ARFI. MR-ARFI displacement showed a linear increase with acoustic power (20-80W), and also increased with calcification size.The use of SWI-filtered phase and MR-ARFI have the potential to provide a clinical indicator of calcification relevance in the planning of a transcranial MRgFUS treatment.J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.

View details for DOI 10.1002/jmri.24255

View details for Web of Science ID 000333984700028

View details for PubMedID 24123504
Transcranial phase aberration correction using beam simulations and MR- ARFI MEDICAL PHYSICS Vyas, U., Kaye, E., Pauly, K. B. 2014; 41 (3)
Abstract

Transcranial magnetic resonance-guided focused ultrasound surgery is a noninvasive technique for causing selective tissue necrosis. Variations in density, thickness, and shape of the skull cause aberrations in the location and shape of the focal zone. In this paper, the authors propose a hybrid simulation-MR-ARFI technique to achieve aberration correction for transcranial MR-guided focused ultrasound surgery. The technique uses ultrasound beam propagation simulations with MR Acoustic Radiation Force Imaging (MR-ARFI) to correct skull-caused phase aberrations.Skull-based numerical aberrations were obtained from a MR-guided focused ultrasound patient treatment and were added to all elements of the InSightec conformal bone focused ultrasound surgery transducer during transmission. In the first experiment, the 1024 aberrations derived from a human skull were condensed into 16 aberrations by averaging over the transducer area of 64 elements. In the second experiment, all 1024 aberrations were applied to the transducer. The aberrated MR-ARFI images were used in the hybrid simulation-MR-ARFI technique to find 16 estimated aberrations. These estimated aberrations were subtracted from the original aberrations to result in the corrected images. Each aberration experiment (16-aberration and 1024-aberration) was repeated three times.The corrected MR-ARFI image was compared to the aberrated image and the ideal image (image with zero aberrations) for each experiment. The hybrid simulation-MR-ARFI technique resulted in an average increase in focal MR-ARFI phase of 44% for the 16-aberration case and 52% for the 1024-aberration case, and recovered 83% and 39% of the ideal MR-ARFI phase for the 16-aberrations and 1024-aberration case, respectively.Using one MR-ARFI image and noa priori information about the applied phase aberrations, the hybrid simulation-MR-ARFI technique improved the maximum MR-ARFI phase of the beam's focus.

View details for DOI 10.1118/1.4865778

View details for Web of Science ID 000332485600038

View details for PubMedID 24593740
Investigating the Feasibility of Rapid MRI for Image-Guided Motion Management in Lung Cancer Radiotherapy BIOMED RESEARCH INTERNATIONAL Sawant, A., Keall, P., Pauly, K. B., Alley, M., Vasanawala, S., Loo, B. W., Hinkle, J., Joshi, S. 2014
View details for DOI 10.1155/2014/485067

View details for Web of Science ID 000330472600001
Comparison of Temperature Processing Methods for Monitoring Focused Ultrasound Ablation in the Brain JOURNAL OF MAGNETIC RESONANCE IMAGING Rieke, V., Instrella, R., Rosenberg, J., Grissom, W., Werner, B., Martin, E., Pauly, K. B. 2013; 38 (6): 1462-1471
Abstract

To investigate the performance of different reconstruction methods for monitoring temperature changes during transcranial magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS).Four different temperature reconstruction methods were compared in volunteers (without heating) and patients undergoing transcranial MRgFUS: single baseline subtraction, multibaseline subtraction, hybrid single baseline/referenceless reconstruction, and hybrid multibaseline/referenceless reconstruction. Absolute temperature error and temporal temperature uncertainty of the different reconstruction methods were analyzed and compared.Absolute temperature errors and temporal temperature uncertainty were highest with single baseline subtraction and lowest with hybrid multibaseline/referenceless reconstruction in all areas of the brain. Pulsation of the brain and susceptibility changes from tongue motion or swallowing caused substantial temperature errors when single or multibaseline subtraction was used, which were much reduced when the referenceless component was added to the reconstruction.Hybrid multibaseline/referenceless thermometry accurately measures temperature changes in the brain with fewer artifacts and errors due to motion than pure baseline subtraction methods.

View details for DOI 10.1002/jmri.24117

View details for Web of Science ID 000327756800019

View details for PubMedID 23559437
Improved Sleep MRI at 3 Tesla in Patients With Obstructive Sleep Apnea JOURNAL OF MAGNETIC RESONANCE IMAGING Shin, L. K., Holbrook, A. B., Capasso, R., Kushida, C. A., Powell, N. B., Fischbein, N. J., Pauly, K. B. 2013; 38 (5): 1261-1266
Abstract

PURPOSE: To describe a real-time MR imaging platform for synchronous, multi-planar visualization of upper airway collapse in obstructive sleep apnea at 3 Tesla (T) to promote natural sleep with an emphasis on lateral wall visualization. MATERIALS AND METHODS: A real-time imaging platform was configured for sleep MR imaging which used a cartesian, partial k-space gradient-echo sequence with an inherent temporal resolution of 3 independent slices every 2 s. Combinations of axial, mid-sagittal, and coronal scan planes were acquired. The system was tested in five subjects with polysomnography-proven obstructive sleep apnea during sleep, with synchronous acquisition of respiratory effort and combined oral-nasal airflow data. RESULTS: Sleep was initiated and maintained to allow demonstration of sleep-induced, upper airway collapse as illustrated in two subjects when using a real-time, sleep MR imaging platform at 3T. Lateral wall collapse could not be visualized on mid-sagittal imaging alone and was best characterized on multiplanar coronal and axial imaging planes. CONCLUSION: Our dedicated sleep MR imaging platform permitted an acoustic environment of constant "white noise" which was conducive to sleep onset and sleep maintenance in obstructive sleep apnea patients at 3T. Apneic episodes, specifically the lateral walls, were more accurately characterized with synchronous, multiplanar acquisitions. J. Magn. Reson. Imaging 2013;. © 2013 Wiley Periodicals, Inc.

View details for DOI 10.1002/jmri.24029

View details for Web of Science ID 000326146900033

View details for PubMedID 23390078
Applicators for Magnetic Resonance-Guided Ultrasonic Ablation of Benign Prostatic Hyperplasia INVESTIGATIVE RADIOLOGY Sommer, G., Pauly, K. B., Holbrook, A., Plata, J., Daniel, B., Bouley, D., Gill, H., Prakash, P., Salgaonkar, V., Jones, P., Diederich, C. 2013; 48 (6): 387-394
Abstract

The aims of this study were to evaluate in a canine model applicators designed for ablation of human benign prostatic hyperplasia (BPH) in vivo under magnetic resonance imaging (MRI) guidance, including magnetic resonance thermal imaging (MRTI), determine the ability of MRI techniques to visualize ablative changes in prostate, and evaluate the acute and longer term histologic appearances of prostate tissue ablated during these studies.An MRI-compatible transurethral device incorporating a tubular transducer array with dual 120° sectors was used to ablate canine prostate tissue in vivo, in zones similar to regions of human BPH (enlarged transition zones). Magnetic resonance thermal imaging was used for monitoring of ablation in a 3-T environment, and postablation MRIs were performed to determine the visibility of ablated regions. Three canine prostates were ablated in acute studies, and 2 animals were rescanned before killing at 31 days postablation. Acute and chronic appearances of ablated prostate tissue were evaluated histologically and were correlated with the MRTI and postablation MRI scans.It was possible to ablate regions similar in size to enlarged transition zone in human BPH in 6 to 18 minutes. Regions of acute ablation showed a central "heat-fixed" region surrounded by a region of more obvious necrosis with complete disruption of tissue architecture. After 31 days, ablated regions demonstrated complete apparent resorption of ablated tissue with formation of cystic regions containing fluid. The inherent cooling of the urethra using the technique resulted in complete urethral preservation in all cases.Prostatic ablation of zones of size and shape corresponding to human BPH is possible using appropriate transurethral applicators using MRTI, and ablated tissue may be depicted clearly in contrast-enhanced magnetic resonance images. The ability accurately to monitor prostate tissue heating, the apparent resorption of ablated regions over 1 month, and the inherent urethral preservation suggest that the magnetic resonance-guided techniques described are highly promising for the in vivo ablation of symptomatic human BPH.

View details for DOI 10.1097/RLI.0b013e31827fe91e

View details for Web of Science ID 000318681600005

View details for PubMedID 23462673
Focal ablation of prostate cancer: four roles for magnetic resonance imaging guidance CANADIAN JOURNAL OF UROLOGY Sommer, G., Bouley, D., Gill, H., Daniel, B., Pauly, K. B., Diederich, C. 2013; 20 (2): 6672-6681
Abstract

There is currently a great deal of interest in the possible use of focal therapies for prostate cancer, since such treatments offer the prospect for control or cure of the primary disease with minimal side effects. Many forms of thermal therapy have been proposed for focal ablation of prostate cancer, including laser, high intensity ultrasound and cryotherapy. This review will demonstrate the important roles that magnetic resonance imaging (MRI) guidance can offer to such focal ablation, focusing on the use of high intensity ultrasonic applicators as an example of one promising technique.Transurethral and interstitial high intensity ultrasonic applicators, designed specifically for ablation of prostate tissue were tested extensively in vivo in a canine model. The roles of MRI in positioning the devices, monitoring prostate ablation, and depicting ablated tissue were assessed using appropriate MRI sequences.MRI guidance provides a very effective tool for the positioning of ablative devices in the prostate, and thermal monitoring successfully predicted ablation of prostate tissue when a threshold of 52 ºC was achieved. Contrast enhanced MRI accurately depicted the distribution of ablated prostate tissue, which is resorbed at 30 days.Guidance of thermal therapies for focal ablation of prostate cancer will likely prove critically dependent on MRI functioning in four separate roles. Our studies indicate that in three roles: device positioning; thermal monitoring of prostate ablation; and depiction of ablated prostate tissue, MR techniques are highly accurate and likely to be of great benefit in focal prostate cancer ablation. A fourth critical role, identification of cancer within the gland for targeting of thermal therapy, is more problematic at present, but will likely become practical with further technological advances.

View details for Web of Science ID 000317811000002

View details for PubMedID 23587506
Adapting MRI acoustic radiation force imaging for in vivo human brain focused ultrasound applications MAGNETIC RESONANCE IN MEDICINE Kaye, E. A., Pauly, K. B. 2013; 69 (3): 724-733
Abstract

A variety of magnetic resonance imaging acoustic radiation force imaging (MR-ARFI) pulse sequences as the means for image guidance of focused ultrasound therapy have been recently developed and tested ex vivo and in animal models. To successfully translate MR-ARFI guidance into human applications, ensuring that MR-ARFI provides satisfactory image quality in the presence of patient motion and deposits safe amount of ultrasound energy during image acquisition is necessary. The first aim of this work was to study the effect of motion on in vivo displacement images of the brain obtained with 2D Fourier transform spin echo MR-ARFI. Repeated bipolar displacement encoding configuration was shown less sensitive to organ motion. The optimal signal-to-noise ratio of displacement images was found for the duration of encoding gradients of 12 ms. The second aim was to further optimize the displacement signal-to-noise ratio for a particular tissue type by setting the time offset between the ultrasound emission and encoding based on the tissue response to acoustic radiation force. A method for measuring tissue response noninvasively was demonstrated. Finally, a new method for simultaneous monitoring of tissue heating during MR-ARFI acquisition was presented to enable timely adjustment of the ultrasound energy aimed at ensuring the safety of the MR-ARFI acquisition.

View details for DOI 10.1002/mrm.24308

View details for Web of Science ID 000315331300014

View details for PubMedID 22555751
A novel approach for global noise reduction in resting-state fMRI: APPLECOR NEUROIMAGE Marx, M., Pauly, K. B., Chang, C. 2013; 64: 19-31
Abstract

Noise in fMRI recordings creates uncertainty when mapping functional networks in the brain. Non-neural physiological processes can introduce correlated noise across much of the brain, altering the apparent strength and extent of intrinsic networks. In this work, a new data-driven noise correction, termed "APPLECOR" (for Affine Parameterization of Physiological Large-scale Error Correction), is introduced. APPLECOR models spatially-common physiological noise as the linear combination of an additive term and a mean-dependent multiplicative term, and then estimates and removes these components. APPLECOR is shown to achieve greater consistency of the default mode network across time and across subjects than was achieved using global mean regression, respiratory volume and heart rate correction (RVHRCOR (Chang et al., 2009)), or no correction. Combining APPLECOR with RVHRCOR regressors attained greater consistency than either correction alone. Use of the proposed noise-reduction approach may help to better identify and delineate the structure of resting state networks.

View details for DOI 10.1016/j.neuroimage.2012.09.040

View details for Web of Science ID 000312504200003

View details for PubMedID 23022327
Application of Zernike polynomials towards accelerated adaptive focusing of transcranial high intensity focused ultrasound MEDICAL PHYSICS Kaye, E. A., Hertzberg, Y., Marx, M., Werner, B., Navon, G., Levoy, M., Pauly, K. B. 2012; 39 (10): 6254-6263
Abstract

To study the phase aberrations produced by human skulls during transcranial magnetic resonance imaging guided focused ultrasound surgery (MRgFUS), to demonstrate the potential of Zernike polynomials (ZPs) to accelerate the adaptive focusing process, and to investigate the benefits of using phase corrections obtained in previous studies to provide the initial guess for correction of a new data set.The five phase aberration data sets, analyzed here, were calculated based on preoperative computerized tomography (CT) images of the head obtained during previous transcranial MRgFUS treatments performed using a clinical prototype hemispherical transducer. The noniterative adaptive focusing algorithm [Larrat et al., "MR-guided adaptive focusing of ultrasound," IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57(8), 1734-1747 (2010)] was modified by replacing Hadamard encoding with Zernike encoding. The algorithm was tested in simulations to correct the patients' phase aberrations. MR acoustic radiation force imaging (MR-ARFI) was used to visualize the effect of the phase aberration correction on the focusing of a hemispherical transducer. In addition, two methods for constructing initial phase correction estimate based on previous patient's data were investigated. The benefits of the initial estimates in the Zernike-based algorithm were analyzed by measuring their effect on the ultrasound intensity at the focus and on the number of ZP modes necessary to achieve 90% of the intensity of the nonaberrated case.Covariance of the pairs of the phase aberrations data sets showed high correlation between aberration data of several patients and suggested that subgroups can be based on level of correlation. Simulation of the Zernike-based algorithm demonstrated the overall greater correction effectiveness of the low modes of ZPs. The focal intensity achieves 90% of nonaberrated intensity using fewer than 170 modes of ZPs. The initial estimates based on using the average of the phase aberration data from the individual subgroups of subjects was shown to increase the intensity at the focal spot for the five subjects.The application of ZPs to phase aberration correction was shown to be beneficial for adaptive focusing of transcranial ultrasound. The skull-based phase aberrations were found to be well approximated by the number of ZP modes representing only a fraction of the number of elements in the hemispherical transducer. Implementing the initial phase aberration estimate together with Zernike-based algorithm can be used to improve the robustness and can potentially greatly increase the viability of MR-ARFI-based focusing for a clinical transcranial MRgFUS therapy.

View details for DOI 10.1118/1.4752085

View details for Web of Science ID 000310101900044

View details for PubMedID 23039661
Toward MR-guided high intensity focused ultrasound for presurgical localization: Focused ultrasound lesions in cadaveric breast tissue JOURNAL OF MAGNETIC RESONANCE IMAGING Bitton, R. R., Kaye, E., Dirbas, F. M., Daniel, B. L., Pauly, K. B. 2012; 35 (5): 1089-1097
Abstract

To investigate magnetic resonance image-guided high intensity focused ultrasound (MR-HIFU) as a surgical guide for nonpalpable breast tumors by assessing the palpability of MR-HIFU-created lesions in ex vivo cadaveric breast tissue.MR-HIFU ablations spaced 5 mm apart were made in 18 locations using the ExAblate2000 system. Ablations formed a square perimeter in mixed adipose and fibroglandular tissue. Ablation was monitored using T1-weighted fast spin echo images. MR-acoustic radiation force impulse (MR-ARFI) was used to remotely palpate each ablation location, measuring tissue displacement before and after thermal sonications. Displacement profiles centered at each ablation spot were plotted for comparison. The cadaveric breast was manually palpated to assess stiffness of ablated lesions and dissected for gross examination. This study was repeated on three cadaveric breasts.MR-ARFI showed a collective postablation reduction in peak displacement of 54.8% ([4.41 ± 1.48] ?m pre, [1.99 ± 0.82] ?m post), and shear wave velocity increase of 65.5% ([10.69 ± 1.60] mm pre, [16.33 ± 3.10] mm post), suggesting tissue became stiffer after the ablation. Manual palpation and dissection of the breast showed increased palpability, a darkening of ablation perimeter, and individual ablations were visible in mixed adipose/fibroglandular tissue.The results of this preliminary study show MR-HIFU has the ability to create palpable lesions in ex vivo cadaveric breast tissue, and may potentially be used to preoperatively localize nonpalpable breast tumors.

View details for DOI 10.1002/jmri.23529

View details for Web of Science ID 000302721800011

View details for PubMedID 22170814
Rapid HIFU autofocusing using the entire MR-ARFI image 12TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Grissom, W. A., Kaye, E., Pauly, K. B., Zur, Y., Yeo, D., Medan, Y., Davis, C. 2012; 1503: 162-167
View details for DOI 10.1063/1.4769936

View details for Web of Science ID 000312416000030
Transcranial Phase Aberration Correction Using Beam Simulations and MR-ARFI 12TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Vyas, U., Kaye, E., Pauly, K. B. 2012; 1503: 185-190
View details for DOI 10.1063/1.4769941

View details for Web of Science ID 000312416000035
MRI of Frozen Tissue Demonstrates a Phase Shift MAGNETIC RESONANCE IN MEDICINE Lu, A., Daniel, B. L., Kaye, E., Pauly, K. B. 2011; 66 (6): 1582-1589
Abstract

While temperature mapping is desired during cryosurgery for prostate cancer treatment, an effective approach for this purpose is still needed. We have demonstrated a phase shift with temperature in our in vivo canine experiments and ex vivo tissue sample experiments within the frozen tissue. The phase shift is much larger (~0.7 °/°C with an echo time of 0.1 ms at 0.5 T) in magnitude than that predicted by conventional proton resonant frequency shift (0.008 °/°C). It shows little dependence on the echo times used and thus is not due to a frequency change, although frequency-dependent phase shift has been observed near the frozen tissue. This phase shift varies monotonically with temperature within the frozen tissue and therefore may be potentially used as a novel temperature mapping approach in cryoablation applications.

View details for DOI 10.1002/mrm.22953

View details for Web of Science ID 000297285000012

View details for PubMedID 21630347
MR Imaging-guided Cryoablation for the Treatment of Benign Prostatic Hyperplasia JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Ghanouni, P., Gill, H., Kaye, E., Pauly, K. B., Daniel, B. 2011; 22 (10): 1427-1430
Abstract

A patient with benign prostatic hyperplasia presented with chronic lower urinary tract symptoms despite prior surgery and continued medical therapy. Using a magnetic resonance imaging-guided transperineal approach, two cryoprobes were placed into the transition zone of the prostate gland, and two cryoablation freeze-thaw cycles were performed. At 10 weeks after treatment, the frequency of nocturia had decreased from once every 1.5 hours to once per night, urinary peak flow rates had increased from 5.1 mL/s to 10.3 mL/s, and postvoid residual urinary bladder volume had decreased from 187 mL to 58 mL. Improved flow rates and symptoms remained stable 16 weeks after treatment.

View details for DOI 10.1016/j.jvir.2011.08.010

View details for Web of Science ID 000295708400013

View details for PubMedID 21961982
Metal-Induced Artifacts in MRI AMERICAN JOURNAL OF ROENTGENOLOGY Hargreaves, B. A., Worters, P. W., Pauly, K. B., Pauly, J. M., Koch, K. M., Gold, G. E. 2011; 197 (3): 547-555
Abstract

The purpose of this article is to review some of the basic principles of imaging and how metal-induced susceptibility artifacts originate in MR images. We will describe common ways to reduce or modify artifacts using readily available imaging techniques, and we will discuss some advanced methods to correct readout-direction and slice-direction artifacts.The presence of metallic implants in MRI can cause substantial image artifacts, including signal loss, failure of fat suppression, geometric distortion, and bright pile-up artifacts. These cause large resonant frequency changes and failure of many MRI mechanisms. Careful parameter and pulse sequence selections can avoid or reduce artifacts, although more advanced imaging methods offer further imaging improvements.

View details for DOI 10.2214/AJR.11.7364

View details for Web of Science ID 000294165600037

View details for PubMedID 21862795
Slice Encoding for Metal Artifact Correction With Noise Reduction MAGNETIC RESONANCE IN MEDICINE Lu, W., Pauly, K. B., Gold, G. E., Pauly, J. M., Hargreaves, B. A. 2011; 65 (5): 1352-1357
Abstract

Magnetic resonance imaging (MRI) near metallic implants is often hampered by severe metal artifacts. To obtain distortion-free MR images near metallic implants, SEMAC (Slice Encoding for Metal Artifact Correction) corrects metal artifacts via robust encoding of excited slices against metal-induced field inhomogeneities, followed by combining the data resolved from multiple SEMAC-encoded slices. However, as many of the resolved data elements only contain noise, SEMAC-corrected images can suffer from relatively low signal-to-noise ratio. Improving the signal-to-noise ratio of SEMAC-corrected images is essential to enable SEMAC in routine clinical studies. In this work, a new reconstruction procedure is proposed to reduce noise in SEMAC-corrected images. A singular value decomposition denoising step is first applied to suppress quadrature noise in multi-coil SEMAC-encoded slices. Subsequently, the singular value decomposition-denoised data are selectively included in the correction of through-plane distortions. The experimental results demonstrate that the proposed reconstruction procedure significantly improves the SNR without compromising the correction of metal artifacts.

View details for DOI 10.1002/mrm.22796

View details for Web of Science ID 000289760800018

View details for PubMedID 21287596
Rapid MR-ARFI Method for Focal Spot Localization During Focused Ultrasound Therapy MAGNETIC RESONANCE IN MEDICINE Kaye, E. A., Chen, J., Pauly, K. B. 2011; 65 (3): 738-743
Abstract

MR-guided focused ultrasound (FUS) is a noninvasive therapy for treating various pathologies. MR-based acoustic radiation force imaging (MR-ARFI) measures tissue displacement in the focal spot due to acoustic radiation force. MR-ARFI also provides feedback for adaptive focusing algorithms that could correct for phase aberrations caused by the skull during brain treatments. This work developed a single-shot echo-planar imaging-based MR-ARFI method that reduces scan time and ultrasound energy deposition. The new method was implemented and tested in a phantom and ex vivo brain tissue. The effect of the phase aberrations on the ultrasound focusing was studied using displacement maps obtained with echo-planar imaging and two-dimensional spin-warp MR-ARFI. The results show that displacement in the focal spot can be rapidly imaged using echo-planar imaging-based MR-ARFI with high signal-to-noise ratio efficiency and without any measurable tissue heating. Echo-planar imaging-based displacement images also demonstrate sufficient sensitivity to phase aberrations and can serve as rapid feedback for adaptive focusing in brain treatments and other applications.

View details for DOI 10.1002/mrm.22662

View details for Web of Science ID 000287929800016

View details for PubMedID 21337406
MR-Guided Unfocused Ultrasound Disruption of the Rat Blood-Brain Barrier 10TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND (ISTU 2010) Townsend, K. A., King, R. L., Zaharchuk, G., Pauly, K. B. 2011; 1359: 356-360
View details for DOI 10.1063/1.3607933

View details for Web of Science ID 000295944900059
Reweighted l(1) Referenceless PRF Shift Thermometry MAGNETIC RESONANCE IN MEDICINE Grissom, W. A., Lustig, M., Holbrook, A. B., Rieke, V., Pauly, J. M., Butts-Pauly, K. 2010; 64 (4): 1068-1077
Abstract

Temperature estimation in proton resonance frequency (PRF) shift MR thermometry requires a reference, or pretreatment, phase image that is subtracted from image phase during thermal treatment to yield a phase difference image proportional to temperature change. Referenceless thermometry methods derive a reference phase image from the treatment image itself by assuming that in the absence of a hot spot, the image phase can be accurately represented in a smooth (usually low order polynomial) basis. By masking the hot spot out of a least squares (?(2)) regression, the reference phase image's coefficients on the polynomial basis are estimated and a reference image is derived by evaluating the polynomial inside the hot spot area. Referenceless methods are therefore insensitive to motion and bulk main field shifts, however, currently these methods require user interaction or sophisticated tracking to ensure that the hot spot is masked out of the polynomial regression. This article introduces an approach to reference PRF shift thermometry that uses reweighted ?(1) regression, a form of robust regression, to obtain background phase coefficients without hot spot tracking and masking. The method is compared to conventional referenceless thermometry, and demonstrated experimentally in monitoring HIFU heating in a phantom and canine prostate, as well as in a healthy human liver.

View details for DOI 10.1002/mrm.22502

View details for Web of Science ID 000282477100015

View details for PubMedID 20564600
Magnetic Resonance Imaging Near Metal Implants JOURNAL OF MAGNETIC RESONANCE IMAGING Koch, K. M., Hargreaves, B. A., Pauly, K. B., Chen, W., Gold, G. E., King, K. F. 2010; 32 (4): 773-787
Abstract

The desire to apply magnetic resonance imaging (MRI) techniques in the vicinity of embedded metallic hardware is increasing. The soft-tissue contrast available with MR techniques is advantageous in diagnosing complications near an increasing variety of MR-safe metallic hardware. Near such hardware, the spatial encoding mechanisms utilized in conventional MRI methods are often severely compromised. Mitigating these encoding difficulties has been the focus of numerous research investigations over the past two decades. Such approaches include view-angle tilting, short echo-time projection reconstruction acquisitions, single-point imaging, prepolarized MRI, and postprocessing image correction. Various technical advances have also enabled the recent development of two alternative approaches that have shown promising clinical potential. Here, the physical principals and proposed solutions to the problem of MRI near embedded metal are discussed.

View details for DOI 10.1002/jmri.22313

View details for Web of Science ID 000282764800002

View details for PubMedID 20882607
T-2 relaxation times of C-13 metabolites in a rat hepatocellular carcinoma model measured in vivo using C-13-MRS of hyperpolarized [1-C-13]pyruvate NMR IN BIOMEDICINE Yen, Y., Le Roux, P., Mayer, D., King, R., Spielman, D., Tropp, J., Pauly, K. B., Pfefferbaum, A., Vasanawala, S., Hurd, R. 2010; 23 (4): 414-423
Abstract

A single-voxel Carr-Purcell-Meibloom-Gill sequence was developed to measure localized T(2) relaxation times of (13)C-labeled metabolites in vivo for the first time. Following hyperpolarized [1-(13)C]pyruvate injections, pyruvate and its metabolic products, alanine and lactate, were observed in the liver of five rats with hepatocellular carcinoma and five healthy control rats. The T(2) relaxation times of alanine and lactate were both significantly longer in HCC tumors than in normal livers (p?
View details for DOI 10.1002/nbm.1481

View details for Web of Science ID 000277525800011

View details for PubMedID 20175135
Optimization of Encoding Gradients for MR-ARFI MAGNETIC RESONANCE IN MEDICINE Chen, J., Watkins, R., Pauly, K. B. 2010; 63 (4): 1050-1058
Abstract

MR acoustic radiation force imaging provides a promising method to monitor therapeutic ultrasound treatments. By measuring the displacement induced by the acoustic radiation force, MR acoustic radiation force imaging can locate the focal spot, without a significant temperature rise. In this work, the encoding gradient for MR acoustic radiation force imaging is optimized to achieve an enhanced accuracy and precision of the displacement measurement. By analyzing the sources of artifacts, bulk motion and eddy currents are shown to introduce errors to the measurement, and heavy diffusion-weighting is shown to result in noisy displacement maps. To eliminate these problems, a new encoding scheme is proposed, which utilizes a pair of bipolar gradients. Improved precision is achieved with robustness against bulk motion and background phase distortion, and improved accuracy is achieved with reduced diffusion-weighting and optimized encoding pulse width. The experiment result shows that the signal-to-noise ratio can be enhanced by more than 2-fold. These significant improvements are obtained at no cost of scan time or encoding sensitivity, enabling the detection of a displacement less than 0.l microm in a gel phantom with MR acoustic radiation force imaging.

View details for DOI 10.1002/mrm.22299

View details for Web of Science ID 000276064300023

View details for PubMedID 20373406
Accelerated Slice Encoding for Metal Artifact Correction JOURNAL OF MAGNETIC RESONANCE IMAGING Hargreaves, B. A., Chen, W., Lu, W., Alley, M. T., Gold, G. E., Brau, A. C., Pauly, J. M., Pauly, K. B. 2010; 31 (4): 987-996
Abstract

To demonstrate accelerated imaging with both artifact reduction and different contrast mechanisms near metallic implants.Slice-encoding for metal artifact correction (SEMAC) is a modified spin echo sequence that uses view-angle tilting and slice-direction phase encoding to correct both in-plane and through-plane artifacts. Standard spin echo trains and short-TI inversion recovery (STIR) allow efficient PD-weighted imaging with optional fat suppression. A completely linear reconstruction allows incorporation of parallel imaging and partial Fourier imaging. The signal-to-noise ratio (SNR) effects of all reconstructions were quantified in one subject. Ten subjects with different metallic implants were scanned using SEMAC protocols, all with scan times below 11 minutes, as well as with standard spin echo methods.The SNR using standard acceleration techniques is unaffected by the linear SEMAC reconstruction. In all cases with implants, accelerated SEMAC significantly reduced artifacts compared with standard imaging techniques, with no additional artifacts from acceleration techniques. The use of different contrast mechanisms allowed differentiation of fluid from other structures in several subjects.SEMAC imaging can be combined with standard echo-train imaging, parallel imaging, partial-Fourier imaging, and inversion recovery techniques to offer flexible image contrast with a dramatic reduction of metal-induced artifacts in scan times under 11 minutes.

View details for DOI 10.1002/jmri.22112

View details for Web of Science ID 000276328200026

View details for PubMedID 20373445
Consistency of Signal Intensity and T2*in Frozen Ex Vivo Heart Muscle, Kidney, and Liver Tissue JOURNAL OF MAGNETIC RESONANCE IMAGING Kaye, E. A., Josan, S., Lu, A., Rosenberg, J., Daniel, B. L., Pauly, K. B. 2010; 31 (3): 719-724
Abstract

To investigate tissue dependence of the MRI-based thermometry in frozen tissue by quantification and comparison of signal intensity and T2* of ex vivo frozen tissue of three different types: heart muscle, kidney, and liver.Tissue samples were frozen and imaged on a 0.5 Tesla MRI scanner with ultrashort echo time (UTE) sequence. Signal intensity and T2* were determined as the temperature of the tissue samples was decreased from room temperature to approximately -40 degrees C. Statistical analysis was performed for (-20 degrees C, -5 degrees C) temperature interval.The findings of this study demonstrate that signal intensity and T2* are consistent across three types of tissue for (-20 degrees C, -5 degrees C) temperature interval.Both parameters can be used to calculate a single temperature calibration curve for all three types of tissue and potentially in the future serve as a foundation for tissue-independent MRI-based thermometry.

View details for DOI 10.1002/jmri.22029

View details for Web of Science ID 000275385900026

View details for PubMedID 20187218
Real-Time MR Thermometry for Monitoring HIFU Ablations of the Liver MAGNETIC RESONANCE IN MEDICINE Holbrook, A. B., Santos, J. M., Kaye, E., Rieke, V., Pauly, K. B. 2010; 63 (2): 365-373
Abstract

A high-resolution and high-speed pulse sequence is presented for monitoring high-intensity focused ultrasound ablations in the liver in the presence of motion. The sequence utilizes polynomial-order phase saturation bands to perform outer volume suppression, followed by spatial-spectral excitation and three readout segmented echo-planar imaging interleaves. Images are processed with referenceless thermometry to create temperature-rise images every frame. The sequence and reconstruction were implemented in RTHawk and used to image stationary and moving sonications in a polyacrylamide gel phantom (62.4 acoustic W, 50 sec, 550 kHz). Temperature-rise images were compared between moving and stationary experiments. Heating spots and corresponding temperature-rise plots matched very well. The stationary sonication had a temperature standard deviation of 0.15 degrees C compared to values of 0.28 degrees C and 0.43 degrees C measured for two manually moved sonications at different velocities. Moving the phantom (while not heating) with respect to the transducer did not cause false temperature rises, despite susceptibility changes. The system was tested on nonheated livers of five normal volunteers. The mean temperature rise was -0.05 degrees C, with a standard deviation of 1.48 degrees C. This standard deviation is acceptable for monitoring high-intensity focused ultrasound ablations, suggesting real-time imaging of moving high-intensity focused ultrasound sonications can be clinically possible.

View details for DOI 10.1002/mrm.22206

View details for Web of Science ID 000273995200013

View details for PubMedID 19950255
Clinical feasibility of a magnetic resonance tracking system to guide the position of the scan plane during physiologic joint motion RADIOLOGIA MEDICA Vandevenne, J., Pearle, A., Lang, P., Pauly, K. B., Bergman, G. 2010; 115 (1): 133-140
Abstract

Unrestricted physiologic joint motion results in multidirectional displacement of the anatomic structures. When performing real-time magnetic resonance (MR) imaging of such a joint motion, continuous adjustment of the scan plane position may be required. The purpose of this study was to evaluate the clinical feasibility of a method to guide the scan plane position during dynamic-motion MR imaging of freely moving joints.The location of a small tracker device (dedicated hardware) placed on the patient's skin overlying a joint was determined by an ultrashort MR sequence and used to automatically adjust the scan plane position prior to each dynamic-motion MR image. Using a vertically open MR unit, this MR tracking system was applied in ten dynamic-motion MR examinations to evaluate flexion/extension manoeuvres in the weight-bearing knee joint, and in ten dynamic-motion MR examinations of the shoulder joint to evaluate manoeuvres such as internal/external rotation of the humerus, stress testing of the glenohumeral joint and abduction/adduction manoeuvres. Average number of manoeuvre repetitions, total number of images and percentage of useful images per manoeuvre were calculated. Imaging time per scan plane for each manoeuvre was recorded.Average repetition of manoeuvres varied between 1.6 and 5.8, with an average number of 7 to 18 images per manoeuvre. Average percentage of useful images varied between 61% and 89%. Total imaging time per scan plane ranged between 1 min 10 s and 4 min 51 s.The MR tracking system to guide the slice position for each consecutive dynamic-motion MR image of the freely but slowly moving shoulder or knee joint was feasible for clinical use, providing a high percentage of useful images for each manoeuvre within a clinically acceptable time frame.

View details for DOI 10.1007/s11547-009-0485-4

View details for Web of Science ID 000274915400011

View details for PubMedID 20041313
Capacitive Micromachined Ultrasonic Transducers for Therapeutic Ultrasound Applications IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING Wong, S. H., Kupnik, M., Watkins, R. D., Butts-Pauly, K., Khuri-Yakub, B. T. 2010; 57 (1): 114-123
Abstract

Therapeutic ultrasound guided by MRI is a noninvasive treatment that potentially reduces mortality, lowers medical costs, and widens accessibility of treatments for patients. Recent developments in the design and fabrication of capacitive micromachined ultrasonic transducers (CMUTs) have made them competitive with piezoelectric transducers for use in therapeutic ultrasound applications. In this paper, we present the first designs and prototypes of an eight-element, concentric-ring, CMUT array to treat upper abdominal cancers. This array was simulated and designed to focus 30-50 mm into tissue, and ablate a 2- to 3-cm-diameter tumor within 1 h. Assuming a surface acoustic output pressure of 1 MPa peak-to-peak (8.5 W/cm (2)) at 2.5 MHz, we simulated an array that produced a focal intensity of 680 W/cm (2) when focusing to 35 mm. CMUT cells were then designed to meet these frequency and surface acoustic intensity specifications. These cell designs were fabricated as 2.5 mm x 2.5 mm test transducers and used to verify our models. The test transducers were shown to operate at 2.5 MHz with an output pressure of 1.4 MPa peak-to-peak (16.3 W/cm (2)). With this CMUT cell design, we fabricated a full eight-element array. Due to yield issues, we only developed electronics to focus the four center elements of the array. The beam profile of the measured array deviated from the simulated one because of the crosstalk effects; the beamwidth matched within 10% and sidelobes increased by two times, which caused the measured gain to be 16.6 compared to 27.4.

View details for DOI 10.1109/TBME.2009.2026909

View details for Web of Science ID 000273565600018

View details for PubMedID 19628448
Rapid MR-ARFI method for focal spot localization during focused ultrasound treatments 9TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Kaye, E., Chen, J., Pauly, K. B. 2010; 1215: 247-250
View details for Web of Science ID 000280794100056
Effect of the Rat Skull On Focused US, as Measured by MR Thermometry 9TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND King, R., Rieke, V., Pauly, K. B. 2010; 1215: 387-390
View details for Web of Science ID 000280794100088
Alternative Focal Spot Geometry for More Efficient HIFU Treatment Assessment 9TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Kaye, E., Chen, J., Medan, Y., Pauly, K. B. 2010; 1215: 256-259
View details for Web of Science ID 000280794100058
Maximum Linear-Phase Spectral-Spatial Radiofrequency Pulses for Fat-Suppressed Proton Resonance Frequency-Shift MR Thermometry MAGNETIC RESONANCE IN MEDICINE Grissom, W. A., Kerr, A. B., Holbrook, A. B., Pauly, J. M., Butts-Pauly, K. 2009; 62 (5): 1242-1250
Abstract

Conventional spectral-spatial pulses used for water-selective excitation in proton resonance frequency-shift MR thermometry require increased sequence length compared to shorter wideband pulses. This is because spectral-spatial pulses are longer than wideband pulses, and the echo time period starts midway through them. Therefore, for a fixed echo time, one must increase sequence length to accommodate conventional spectral-spatial pulses in proton resonance frequency-shift thermometry. We introduce improved water-selective spectral-spatial pulses for which the echo time period starts near the beginning of excitation. Instead of requiring increased sequence length, these pulses extend into the long echo time periods common to PRF sequences. The new pulses therefore alleviate the traditional tradeoff between sequence length and fat suppression. We experimentally demonstrate an 11% improvement in frame rate in a proton resonance frequency imaging sequence compared to conventional spectral-spatial excitation. We also introduce a novel spectral-spatial pulse design technique that is a hybrid of previous model- and filter-based techniques and that inherits advantages from both. We experimentally validate the pulses' performance in suppressing lipid signal and in reducing sequence length compared to conventional spectral-spatial pulses.

View details for DOI 10.1002/mrm.22118

View details for Web of Science ID 000271431200018

View details for PubMedID 19780177
3.0-T MR-Guided Focused Ultrasound for Preoperative Localization of Nonpalpable Breast Lesions: An Initial Experimental Ex Vivo Study JOURNAL OF MAGNETIC RESONANCE IMAGING Schmitz, A. C., Van den Bosch, M. A., Rieke, V., Dirbas, F. M., Pauly, K. B., Mali, W. P., Daniel, B. L. 2009; 30 (4): 884-889
Abstract

To compare the accuracy of magnetic resonance-guided focused ultrasound (MRgFUS) with MR-guided needle-wire placement (MRgNW) for the preoperative localization of nonpalpable breast lesions.In this experimental ex vivo study, 15 turkey breasts were used. In each breast phantom an artificial nonpalpable "tumor" was created by injecting an aqueous gel containing gadolinium. MRgFUS (n = 7) was performed with the ExAblate 2000 system (InSightec). With MRgFUS the ablated tissue changes in color and increases in stiffness. A rim of palpable and visible ablations was created around the tumor to localize the tumor and facilitate excision. MRgNW (n = 8) was performed by MR-guided placement of an MR-compatible needle-wire centrally in the tumor. After surgical excision of the tumor, MR images were used to evaluate tumor-free margins (negative/positive), minimum tumor-free margin (mm), and excised tissue volume (cm(3)).With MRgFUS localization no positive margins were found after excision (0%). With MRgNW two excision specimens (25%) had positive margins (P = 0.48). Mean minimum tumor-free margin (+/-SD) with MRgFUS was significantly larger (5.5 +/- 2.4 mm) than with MRgNW (0.9 +/- 1.4 mm) (P < 0.001). Mean volume +/- SD of excised tissue did not differ between MRgFUS and MRgNW localization, ie, 44.0 +/- 9.4 cm(3) and 39.5 +/- 10.7 cm(3) (P = 0.3).The results of this experimental ex vivo study indicate that MRgFUS can potentially be used to localize nonpalpable breast lesions in vivo.

View details for DOI 10.1002/jmri.21896

View details for Web of Science ID 000270522900026

View details for PubMedID 19787736
SEMAC: Slice Encoding for Metal Artifact Correction in MRI MAGNETIC RESONANCE IN MEDICINE Lu, W., Pauly, K. B., Gold, G. E., Pauly, J. M., Hargreaves, B. A. 2009; 62 (1): 66-76
Abstract

Magnetic resonance imaging (MRI) near metallic implants remains an unmet need because of severe artifacts, which mainly stem from large metal-induced field inhomogeneities. This work addresses MRI near metallic implants with an innovative imaging technique called "Slice Encoding for Metal Artifact Correction" (SEMAC). The SEMAC technique corrects metal artifacts via robust encoding of each excited slice against metal-induced field inhomogeneities. The robust slice encoding is achieved by extending a view-angle-tilting (VAT) spin-echo sequence with additional z-phase encoding. Although the VAT compensation gradient suppresses most in-plane distortions, the z-phase encoding fully resolves distorted excitation profiles that cause through-plane distortions. By positioning all spins in a region-of-interest to their actual spatial locations, the through-plane distortions can be corrected by summing up the resolved spins in each voxel. The SEMAC technique does not require additional hardware and can be deployed to the large installed base of whole-body MRI systems. The efficacy of the SEMAC technique in eliminating metal-induced distortions with feasible scan times is validated in phantom and in vivo spine and knee studies.

View details for DOI 10.1002/mrm.21967

View details for Web of Science ID 000267404300008

View details for PubMedID 19267347
MRI-Guided Cryoablation: In Vivo Assessment of Focal Canine Prostate Cryolesions JOURNAL OF MAGNETIC RESONANCE IMAGING Josan, S., Bouley, D. M., van den Bosch, M., Daniel, B. L., Pauly, K. B. 2009; 30 (1): 169-176
Abstract

To analyze the appearance of acute and chronic canine prostate cryolesions on T1-weighted (T1w) and T2-weighted (T2w) magnetic resonance imaging (MRI) and compare them with contrast-enhanced (CE) MRI and histology for a variety of freezing protocols.Three different freezing protocols were used in canine prostate cryoablation experiments. Six acute and seven chronic (survival times ranging between 4-53 days) experiments were performed. The change in T2w signal intensity was correlated with freezing protocol parameters. The lesion area on T2w MRI was compared to CE-MRI. Histopathologic evaluation of the cryolesions was performed and visually compared to the appearance on MRI.The T2w signal increased from pre- to postfreeze at the site of the cryolesion, and the enhancement was higher for smaller freeze area and duration. The T2w lesion area was between the CE nonperfused area and the hyperenhancing CE rim. The appearance of the lesion on T1w and T2w imaging over time correlated with outcome on pathology.T1w and T2w MRI can potentially be used to assess cryolesions and to monitor tissue response over time following cryoablation.

View details for DOI 10.1002/jmri.21827

View details for Web of Science ID 000267452600021

View details for PubMedID 19557805
Changes in Posterior Lumbar Disk Contour Abnormality with Flexion-Extension Movement in Subjects with Low Back Pain and Degenerative Disk Disease PM&R Lee, S., Lee, J., Butts, K., Carragee, E., Fredericson, M. 2009; 1 (6): 541-546
Abstract

To determine whether posterior lumbar disk contour dimensions differ in the flexed seated, upright seated, and extended seated positions.Two subgroups of subjects with degenerative disk disease were compared: those with central posterior disk bulge (at L4-5 or L5-S1 levels) and those with a dark nucleus pulposus without posterior disk bulge (L3-4, L4-5, and/or L5-S1 levels).Academic medical center.Eight subjects with a central disk bulge and 9 subjects with a dark nucleus pulposus on magnetic resonance imaging.Not applicable.Quantitative comparisons of posterior disk contour between neutral, flexed, and extended sitting positions.Of 8 subjects with central disk bulge, spinal flexion (from the neutral position) produced a decreased disk contour in all subjects, whereas spinal extension (from the neutral position) produced an increased disk contour in 6 subjects, a decreased disk contour in 1 subject, and no measurable change in 1 subject. Changes in posterior disk contour in subjects with a dark nucleus pulposus were variable. Approximately half increased and half decreased, but no relation to position was determined.The results of this pilot study suggest a consistent pattern of decreased posterior disk contour with spinal flexion and increased posterior disk contour with spinal extension in subjects with central disk bulge, but not in those with a dark nucleus pulposus.

View details for DOI 10.1016/j.pmrj.2009.03.014

View details for Web of Science ID 000208411600006
Double Half RF Pulses for Reduced Sensitivity to Eddy Currents in UTE Imaging MAGNETIC RESONANCE IN MEDICINE Josan, S., Pauly, J. M., Daniel, B. L., Pauly, K. B. 2009; 61 (5): 1083-1089
Abstract

Ultrashort echo time imaging with half RF pulse excitation is challenging as eddy currents induced by the slice-select gradient distort the half pulse slice profile. This work presents two pulses with T(2)-dependent slice profiles that are less sensitive to eddy currents. The double half pulse improves the slice selectivity for long T(2) components, while the inverted double half pulse suppresses the unwanted long T(2) signal. Thus, both approaches prevent imperfect cancellation of out-of-slice signal from contaminating the desired slice. Experimental results demonstrate substantially improved slice selectivity and R(2)* quantitation accuracy with these pulses. These pulses are effective in making short T(2) imaging and quantitation less sensitive to eddy currents and provide an alternative to time-consuming gradient characterization.

View details for DOI 10.1002/mrm.21879

View details for Web of Science ID 000265566000010

View details for PubMedID 19235919
Improved Half RF Slice Selectivity in the Presence of Eddy Currents with Out-of-Slice Saturation MAGNETIC RESONANCE IN MEDICINE Josan, S., Kaye, E., Pauly, J. M., Daniel, B. L., Pauly, K. B. 2009; 61 (5): 1090-1095
Abstract

Ultrashort echo time imaging with half RF pulse excitation is sensitive to eddy currents induced by the slice-select gradient that distorts the half pulse slice profile. This work demonstrates improvements in the half pulse profile by using spatial saturation on both sides of the imaged slice to suppress the out-of-slice magnetization. This effectively improves the selectivity of the half pulse excitation profile. A quadratic phase RF pulse with high bandwidth and selectivity was used to achieve a wide saturation band with sharp edges. Experimental results demonstrate substantially improved slice selectivity and R(2)* quantitation accuracy obtained with the out-of-slice saturation. This approach is effective in making short T(2) imaging and quantitation with half pulses less sensitive to eddy currents.

View details for DOI 10.1002/mrm.21914

View details for Web of Science ID 000265566000011

View details for PubMedID 19319972
MR Imaging-guided Percutaneous Cryoablation of the Prostate in an Animal Model: In Vivo Imaging of Cryoablation-induced Tissue Necrosis with Immediate Histopathologic Correlation JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY van den Bosch, M. A., Josan, S., Bouley, D. M., Chen, J., Gill, H., Rieke, V., Butts-Pauly, K., Daniel, B. L. 2009; 20 (2): 252-258
Abstract

To evaluate the feasibility of magnetic resonance (MR) imaging-guided percutaneous cryoablation of normal canine prostates and to identify MR imaging features that accurately predict the area of tissue damage at a microscopic level.Six adult male mixed-breed dogs were anesthetized, intubated, and placed in a 0.5-T open MR imaging system. A receive-only endorectal coil was placed, and prostate location and depth were determined on T1-weighted fast spin-echo (FSE) MR imaging. After placement of cryoprobes and temperature sensors, three freezing protocols were used to ablate prostate tissue. Ice ball formation was monitored with T1-weighted FSE imaging. Tissue necrosis area was assessed with contrast-enhanced weighted MR imaging and compared with histopathologic findings.A total of 12 cryolesions (mean size, 1.2 cm) were bilaterally created in six prostates. Ice ball formation was oval and signal-free on T1-weighted FSE sequences in all cases. Postprocedural contrast-enhanced MR imaging typically showed a nonenhancing area of low signal intensity centrally located within the frozen area, surrounded by a bright enhancing rim in all cases. On histopathologic examination, two distinct zones were identified within cryolesions. Centrally, a necrotic zone with complete cellular destruction and hemorrhage was found. Between this necrotic zone and normal glandular tissue, a zone of fragmented and intact glands, interstitial edema, and rare acute inflammatory cells was seen. Correlation between nonenhancement on contrast-enhanced weighted MR images and tissue necrosis on pathologic examination was consistent within all six dogs.MR imaging-guided cryoablation of the prostate is technically feasible. The nonenhancing area on postablation contrast-enhanced weighted MR imaging accurately predicts the area of cryoablation-induced tissue necrosis on pathologic analysis.

View details for DOI 10.1016/j.jvir.2008.10.030

View details for Web of Science ID 000263075000014

View details for PubMedID 19091600
Fast Referenceless PRF Thermometry Using Spatially Saturated, Spatial-spectrally Excited Flyback EPI. 8TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Holbrook, A. B., Kaye, E., Santos, J. M., Rieke, V., Pauly, K. B. 2009; 1113: 223-227
View details for Web of Science ID 000266425300042
Optimization of Encoding Gradients for Magnetic Resonance Acoustic Radiation Force Imaging 8TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Chen, J., Watkins, R., Pauly, K. B. 2009; 1113: 275-278
View details for Web of Science ID 000266425300053
The Feasibility of HIFU Liver Ablation Through the Ribcage and Cartilage in a Rodent Model 8TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND King, R., Rieke, V., Pauly, K. B. 2009; 1113: 149-153
View details for Web of Science ID 000266425300028
MR-guidance of HIFU Therapy Pauly, K. B., Rieke, V., Holbrook, A. B., Grissom, W., Chen, J., Kaye, E. IEEE. 2009: 141-144
Abstract

MR guidance of high intensity focused ultrasound is evolving with each new application. In this paper we describe ongoing research in the MR-guidance aspect of MR-guided focused ultrasound. The structure is divided into the pretreatment/setup phase of the procedure, MR thermometry for monitoring the actual treatment, and methods for assessment and follow-up.

View details for Web of Science ID 000280543600037

View details for PubMedID 19964927
Catheter-Based Ultrasound for 3D Control of Thermal Therapy 8TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Diederich, C., Chen, X., Wootton, J., Juang, T., Nau, W. H., Kinsey, A., Hsu, I., Rieke, V., Pauly, K. B., Sommer, G., Bouley, D. 2009; 1113: 318-322
View details for Web of Science ID 000266425300061
Progress in Development of HIFU CMUTs for use under MR-guidance 8TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Wong, S. H., Watkins, R. D., Kupnik, M., Pauly, K. B., Khuri-Yakub, B. T. 2009; 1113: 327-331
View details for Web of Science ID 000266425300063
REGULARIZED REFERENCELESS TEMPERATURE ESTIMATION IN PRF-SHIFT MR THERMOMETRY 2009 IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING: FROM NANO TO MACRO, VOLS 1 AND 2 Grissom, W., Pauly, K. B., Lustig, M., Rieke, V., Pauly, J., McDannold, N. 2009: 1235-1238
View details for Web of Science ID 000270678400316
All-in-one magnetic resonance arthrography of the shoulder in a vertically open magnetic resonance unit ACTA RADIOLOGICA Vandevenne, J. E., Vanhoenacker, F., Beaulieu, C. F., Bergman, A. G., Pauly, K. B., Dillingham, M. F., Lang, P. K. 2008; 49 (8): 918-927
Abstract

Magnetic resonance (MR) arthrography frequently involves joint injection under imaging guidance followed by MR imaging in static positions.To evaluate if MR arthrography of the shoulder joint can be performed in a comprehensive fashion combining the MR-guided injection procedure, static MR imaging, and dynamic motion MR imaging in a single test.Twenty-three shoulder joints were injected with Gd-DTPA2- under MR guidance. Static MR imaging was performed and included a three-point Dixon method to achieve water-selective images. Dynamic motion MR imaging with and without applying pressure to the upper arm was used to evaluate glenohumeral joint instability. In 10 cases, surgical correlation was available.The all-in-one MR arthrography technique was successful in all patients, and took an average time of 65 min. All but one glenohumeral injection procedure were performed with a single needle pass, and no complications were observed. Out of eight labrum tears seen with static MR imaging, seven were confirmed at surgery. In 10 cases, dynamic motion MR imaging correlated well with the surgeon's intraoperative evaluation for presence and direction of instability.MR arthrography of the shoulder joint using a vertically open magnet can be performed as a single comprehensive test, including the injection and the static and dynamic motion MR imaging. Good diagnostic accuracy for intraarticular lesions and glenohumeral instability was found in a small sample.

View details for DOI 10.1080/02841850802291242

View details for Web of Science ID 000260046200011

View details for PubMedID 18651257
Evaluation of wafer bonded CMUTs with rectangular membranes featuring high fill factor IEEE TRANSACTIONS ON ULTRASONICS FERROELECTRICS AND FREQUENCY CONTROL Wong, S. H., Kupnik, M., Zhuang, X., Lin, D., Butts-Pauly, K., Khuri-Yakub, B. T. 2008; 55 (9): 2053-2065
Abstract

Increasing fill factor is one design approach used to increase average output displacement, output pressure, and sensitivity of capacitive micromachined ultrasonic transducers (CMUTs). For rectangular cells, the cell-to-cell spacing and the aspect ratio determine the fill factor. In this paper, we explore the effects of these parameters on performance, in particular the nonuniformity of collapse voltage between neighboring cells and presence of higher order modes in air or immersed operation. We used a white light interferometer to measure nonuniformity in deflection between neighboring cells. We found that reducing the cell-to-cell spacing could cause bending of the center support post, which amplifies nonuniformities in collapse voltage to 18.4% between neighboring cells. Using a 2-D finite element model (FEM), we found that for our designs, increasing the support post width to 1.67 times the membrane thickness alleviated the post bending problem. Using impedance and interferometer measurements to observe the effects of aspect ratio on higher order modes, we found that the (1,3) modal frequency approached the (1,1) modal frequency as the aspect ratio of the rectangles increased. In air operation, under continuous wave (CW) excitation at the center frequency, the rectangular cells behaved in the (1,1) mode. In immersion, because of dispersive guided modes, these cells operated in a higher order mode when excited with a CW signal at the center frequency. This contributed to a loss of output pressure; for this reason our rectangular design was unsuitable for CW operation in immersion.

View details for DOI 10.1109/TUFFC.897

View details for Web of Science ID 000258912800020

View details for PubMedID 18986902
Improved slice selection for R2*mapping during cryoablation with eddy current compensation JOURNAL OF MAGNETIC RESONANCE IMAGING Lu, A., Daniel, B. L., Pauly, J. M., Pauly, K. B. 2008; 28 (1): 190-198
Abstract

To improve the slice profile and image quality of R2* mapping in the iceball during cryoablation with ultrashort echo time (UTE) imaging by compensating for eddy currents induced by the selective gradient when half-pulse radiofrequency (RF) excitation is employed to achieve UTEs.A method to measure both B0 and linear eddy currents simultaneously is first presented. This is done with a least-square fitting process on calibration data collected on a phantom. Eddy currents during excitation are compensated by redesigning the RF pulse and the selective gradient accordingly, while that resultant from the readout gradient are compensated for during image reconstruction. In vivo data were obtained continuously during the cryoablation experiments to calculate the R2* values in the iceball and to correlate them with the freezing process.Image quality degradation due to eddy currents is significantly reduced with the proposed approaches. R2* maps of iceball throughout the cryoablation experiments were achieved with improved quality.The proposed approaches are effective for compensating eddy currents during half-pulse RF excitation as well as readout. TEs as short as 100 microsec were obtained, allowing R2* maps to be obtained from frozen tissues with improved quality.

View details for DOI 10.1002/jmri.21396

View details for Web of Science ID 000257865800025

View details for PubMedID 18581340
Monitoring prostate thermal therapy with diffusion-weighted MRI MAGNETIC RESONANCE IN MEDICINE Chen, J., Daniel, B. L., Diederich, C. J., Bouley, D. M., Van den Bosch, M. A., Kinsey, A. M., Sommer, G., Pauly, K. B. 2008; 59 (6): 1365-1372
Abstract

For MR-guided minimally invasive therapies, it is important to have a repeatable and reliable tissue viability evaluation method. The use of diffusion-weighted MRI (DWI) to evaluate tissue damage was assessed in 19 canine prostates with cryoablation or high-intensity ultrasound (HIU) ablation. The apparent diffusion coefficient (ADC) trace value was measured in the treated tissue immediately upon the procedure and on the posttreatment follow-up. For the acute lesions, the ADC value decreased to (1.05+/-0.25)x10(-3) mm2/s, as compared to (1.64+/-0.24)x10(-3) mm2/s before the treatment. There was no statistical difference between previously frozen or previously ultrasound-heated lesions in terms of the 36% ADC reduction (P=0.66). The ADC decrease occurred early during the course of the treatment, which appears to complicate DWI-based thermometry. Over time, the ADC value increased as the tissue recovered and regenerated. This study shows that DWI could be a promising method to monitor prostate thermal therapies and to provide insight on tissue damage and tissue remodeling after injury.

View details for DOI 10.1002/mrm.21589

View details for Web of Science ID 000256266400019

View details for PubMedID 18506801
Transurethral ultrasound applicators with dynamic multi-sector control for prostate thermal therapy: In vivo evaluation under MR guidance MEDICAL PHYSICS Kinsey, A. M., Diederich, C. J., Rieke, V., Nau, W. H., Pauly, K. B., Bouley, D., Sommer, G. 2008; 35 (5): 2081-2093
Abstract

The purpose of this study was to explore the feasibility and performance of a multi-sectored tubular array transurethral ultrasound applicator for prostate thermal therapy, with potential to provide dynamic angular and length control of heating under MR guidance without mechanical movement of the applicator. Test configurations were fabricated, incorporating a linear array of two multi-sectored tubular transducers (7.8-8.4 MHz, 3 mm OD, 6 mm length), with three 120 degrees independent active sectors per tube. A flexible delivery catheter facilitated water cooling (100 ml min(-1)) within an expandable urethral balloon (35 mm long x 10 mm diameter). An integrated positioning hub allows for rotating and translating the transducer assembly within the urethral balloon for final targeting prior to therapy delivery. Rotational beam plots indicate approximately 90 degrees-100 degrees acoustic output patterns from each 120 degrees transducer sector, negligible coupling between sectors, and acoustic efficiencies between 41% and 53%. Experiments were performed within in vivo canine prostate (n = 3), with real-time MR temperature monitoring in either the axial or coronal planes to facilitate control of the heating profiles and provide thermal dosimetry for performance assessment. Gross inspection of serial sections of treated prostate, exposed to TTC (triphenyl tetrazolium chloride) tissue viability stain, allowed for direct assessment of the extent of thermal coagulation. These devices created large contiguous thermal lesions (defined by 52 degrees C maximum temperature, t43 = 240 min thermal dose contours, and TTC tissue sections) that extended radially from the applicator toward the border of the prostate (approximately15 mm) during a short power application (approximately 8-16 W per active sector, 8-15 min), with approximately 200 degrees or 360 degrees sector coagulation demonstrated depending upon the activation scheme. Analysis of transient temperature profiles indicated progression of lethal temperature and thermal dose contours initially centered on each sector that coalesced within approximately 5 min to produce uniform and contiguous zones of thermal destruction between sectors, with smooth outer boundaries and continued radial propagation in time. The dimension of the coagulation zone along the applicator was well-defined by positioning and active array length. Although not as precise as rotating planar and curvilinear devices currently under development for MR-guided procedures, advantages of these multi-sectored transurethral applicators include a flexible delivery catheter and that mechanical manipulation of the device using rotational motors is not required during therapy. This multi-sectored tubular array transurethral ultrasound technology has demonstrated potential for relatively fast and reasonably conformal targeting of prostate volumes suitable for the minimally invasive treatment of BPH and cancer under MR guidance, with further development warranted.

View details for DOI 10.1118/1.2900131

View details for Web of Science ID 000255456500049

View details for PubMedID 18561684
Feasibility of MR-temperature mapping of ultrasonic heating from a CMUT IEEE TRANSACTIONS ON ULTRASONICS FERROELECTRICS AND FREQUENCY CONTROL Wong, S. H., Watkins, R. D., Kupnik, M., Pauly, K. B., Khuri-Yakub, B. T. 2008; 55 (4): 811-818
Abstract

In the last decade, high intensity focused ultrasound (HIFU) has gained popularity as a minimally invasive and noninvasive therapeutic tool for treatment of cancers, arrhythmias, and other medical conditions. HIFU therapy is often guided by magnetic resonance imaging (MRI), which provides anatomical images for therapeutic device placement, temperature maps for treatment guidance, and postoperative evaluation of the region of interest. While piezoelectric transducers are dominantly used for MR-guided HIFU, capacitive micromachined ultrasonic transducers (CMUTs) show competitive advantages, such as ease of fabrication, integration with electronics, improved efficiency, and reduction of self-heating. In this paper, we will show our first results of an unfocused CMUT transducer monitored by MR-temperature maps. This 2.51 mm by 2.32 mm, unfocused CMUT heated a HIFU phantom by 14 degrees C in 2.5 min. This temperature rise was successfully monitored by MR thermometry in a 3.0 T General Electric scanner.

View details for DOI 10.1109/TUFFC.2008.71.5

View details for Web of Science ID 000254783100007

View details for PubMedID 18467225
Echo combination to reduce proton resonance frequency (PRF) thermometry errors from fat JOURNAL OF MAGNETIC RESONANCE IMAGING Rieke, V., Pauly, K. B. 2008; 27 (3): 673-677
Abstract

To validate echo combination as a means to reduce errors caused by fat in temperature measurements with the proton resonance frequency (PRF) shift method.Computer simulations were performed to study the behavior of temperature measurement errors introduced by fat as a function of echo time. Error reduction by combining temperature images acquired at different echo times was investigated. For experimental verification, three echoes were acquired in a refocused gradient echo acquisition. Temperature images were reconstructed with the PRF shift method for the three echoes and then combined in a weighted average. Temperature measurement errors in the combined image and the individual echoes were compared for pure water and different fractions of fat in a computer simulation and for a phantom containing a homogenous mixture with 20% fat in an MR experiment.In both simulation and MR measurement, the presence of fat caused severe temperature underestimation or overestimation in the individual echoes. The errors were substantially reduced after echo combination. Residual errors were about 0.3 degrees C for 10% fat and 1 degrees C for 20% fat.Echo combination substantially reduces temperature measurement errors caused by small fractions of fat. This technique then eliminates the need for fat suppression in tissues such as the liver.

View details for DOI 10.1002/jmri.21238

View details for Web of Science ID 000253949300035

View details for PubMedID 18064715
Design, performance, and applications of a hybrid X-Ray/MR system for interventional guidance PROCEEDINGS OF THE IEEE Fahrig, R., Ganguly, A., Lillaney, P., Bracken, J., Rowlands, J. A., Wen, Z., Yu, H., Rieke, V., Santos, J. M., Pauly, K. B., Sze, D. Y., Frisoli, J. K., Daniel, B. L., Pelc, N. J. 2008; 96 (3): 468-480
View details for DOI 10.1109/JPROC.2007.913506

View details for Web of Science ID 000253299600007
MRI-guided radiofrequency ablation of breast cancer: Preliminary clinical experience JOURNAL OF MAGNETIC RESONANCE IMAGING van den Bosch, M., Daniel, B., Rieke, V., Butts-Pauly, K., Kermit, E., Jeffrey, S. 2008; 27 (1): 204-208
Abstract

This study was designed to demonstrate the feasibility of MRI-guided radiofrequency ablation (RFA) of breast cancer. A total of three women diagnosed with invasive ductal breast cancer were treated with percutaneous MRI-guided RFA, according to a treat and resect protocol, in our hospital. RFA procedures were performed in an open 0.5T Signa-SP imager allowing direct patient access and real-time monitoring of the procedure. In all patients ablation was performed with a 15-gauge insulated MRI-compatible multiple needle probe. MRI thermometry and contrast-enhanced postablation MRI were used to evaluate the ablation process. Patients underwent lumpectomy within a week of the RFA procedure. Histopathology confirmed successful (100%) tumor ablation in one patient, and partial tumor destruction (33% and 50%, respectively) in two patients. Challenges of MRI-guided breast RFA that need to be solved to facilitate progress of the technique toward clinical practice are discussed.

View details for DOI 10.1002/jmri.21190

View details for Web of Science ID 000252104100029

View details for PubMedID 18050333
Progress in CMUTs for HIFU ablation of upper abdominal cancer 2008 IEEE ULTRASONICS SYMPOSIUM, VOLS 1-4 AND APPENDIX Wong, S. H., Kupnik, M., Khuri-Yakub, B. T., Watkins, R. D., Pauly, K. B. 2008: 2068-2071
View details for Web of Science ID 000268845801102
REDUCTION OF METAL ARTEFACTS IN MUSCULOSKELETAL MR IMAGING JBR-BTR Vandevenne, J. E., Vanhoenacker, F. M., Parizel, R. M., Pauly, K. B., Lang, P. K. 2007; 90 (5): 345-349
Abstract

The purpose of this article is to present a educational overview of practical tips to deal with metal artefacts in clinical musculoskeletal MRI. A brief theoretical explanation to understand the cause of metal artefacts is provided followed by a discussion on parameters to reduce these metal artefacts. Effects of adjustable parameters are demonstrated both in a volunteer with a titanium screw and a saline bag attached to the shoulder and in a in vitro experiment. These parameters include positioning of the patient with the long axis of metallic hardware parallel to B0, use of fast spin echo sequences, use of inversion recovery fat suppression, swapping phase and frequency encoding direction, use of view angle tilting, increasing the read-out bandwidth, and decreasing voxel size.

View details for Web of Science ID 000260089300008

View details for PubMedID 18085188
MRI-guided thermal ablation therapy: Model and parameter estimates to predict cell death from MR thermometry images ANNALS OF BIOMEDICAL ENGINEERING Breen, M. S., Breen, M., Butts, K., Chen, L., Saidel, G. M., Wilson, D. L. 2007; 35 (8): 1391-1403
Abstract

Solid tumors and other pathologies can be treated using laser thermal ablation under interventional magnetic resonance imaging (iMRI) guidance. A model was developed to predict cell death from magnetic resonance (MR) thermometry measurements based on the temperature-time history, and validated using in vivo rabbit brain data. To align post-ablation T2-weighted spin-echo MR lesion images to gradient-echo MR images, from which temperature is derived, a registration method was used that aligned fiducials placed near the thermal lesion. The outer boundary of the hyperintense rim in the post-ablation MR lesion image was used as the boundary for cell death, as verified from histology. Model parameters were simultaneously estimated using an iterative optimization algorithm applied to every interesting voxel in 328 images from multiple experiments having various temperature histories. For a necrotic region of 766 voxels across all lesions, the model provided a voxel specificity and sensitivity of 98.1 and 78.5%, respectively. Mislabeled voxels were typically within one voxel from the segmented necrotic boundary with median distances of 0.77 and 0.22 mm for false positives (FP) and false negatives (FN), respectively. As compared to the critical temperature cell death model and the generalized Arrhenius model, our model typically predicted fewer FP and FN. This is good evidence that iMRI temperature maps can be used with our model to predict therapeutic regions in real-time during treatment.

View details for DOI 10.1007/s10439-007-9300-3

View details for Web of Science ID 000248054500009

View details for PubMedID 17436111
Quantitative evaluation of the relaxivity effects of iodine on Gd-DTPA enhanced MR arthrography JOURNAL OF MAGNETIC RESONANCE IMAGING Ganguly, A., Gold, G. E., Pauly, K. B., Mayer, D., Moseley, M. M., Pelc, N. J., Fahrig, R. 2007; 25 (6): 1219-1225
Abstract

To quantify the effect of iodine on the gadolinium (Gd) contrast-enhanced signal in MR arthrography.Saline solutions of Gd contrast agent (0-1 mmol/liter) were mixed with iodinated contrast agent (0-185 mmol/liter). The T1 and T2 relaxation constants of these solutions were measured at 1.5T. Different types of commonly used iodinated contrast agents as well as sodium iodide (NaI) solutions were also analyzed.Iodine caused significant T2 shortening and some T1 shortening in Gd contrast solutions. Both contrast agents independently obeyed the standard relaxation relation, and their mixture obeyed a modified version of this relation. The side chains in various iodine molecules and their viscosities affected the relaxation properties differently. For various spin-echo (SE) sequences, the signal from synovial fluid containing different concentrations of the two contrast agents was calculated. The T2-weighted signal appeared to be most affected by the increase in iodine concentrations. In the absence of Gd contrast, all SE sequences showed an initial increase in signal from iodine contrast.A generalized relation for the relaxivities of Gd contrast in the presence of iodine was established. The side chains of iodine contrast were found to alter the relaxivities of Gd contrast. Imaging with proton density (PD)-weighted SE with only iodine contrast agent was found to be feasible.

View details for DOI 10.1002/jmri.20934

View details for Web of Science ID 000246824100017

View details for PubMedID 17520728
Referenceless MR thermometry for monitoring thermal ablation in the prostate IEEE TRANSACTIONS ON MEDICAL IMAGING Rieke, V., Kinsey, A. M., Ross, A. B., Nau, W. H., Diederich, C. J., Sommer, G., Pauly, K. B. 2007; 26 (6): 813-821
Abstract

Referenceless proton resonance frequency (PRF) shift thermometry provides a means to measure temperature changes during minimally invasive thermotherapy that is inherently robust to motion and tissue displacement. However, if the referenceless method is used to determine temperature changes during prostate ablation, phase gaps between water and fat in image regions used to determine the background phase can confound the phase estimation. We demonstrate an extension to referenceless thermometry which eliminates this problem by allowing background phase estimation in the presence of phase discontinuities between aqueous and fatty tissue. In this method, images are acquired with a multiecho sequence and binary water and fat maps are generated from a Dixon reconstruction. For the background phase estimation, water and fat regions are treated separately and the phase offset between the two tissue types is determined. The method is demonstrated feasibile in phantoms and during in vivo thermal ablation of canine prostate.

View details for DOI 10.1109/TMI.2007.892647

View details for Web of Science ID 000247016400006

View details for PubMedID 17679332
Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI BMC MUSCULOSKELETAL DISORDERS Kulig, K., Powers, C. M., Landel, R. F., Chen, H., Fredericson, M., Guillet, M., Butts, K. 2007; 8
Abstract

Altered spinal mobility is thought to be related to current or past episodes of low back pain; however evidence of that relationship in younger subjects has not been established. The purpose of this study was to compare lumbar segmental mobility in asymptomatic and symptomatic subjects during posterior to anterior (PA) manual spinal mobilization and a self-initiated prone press-up (PU) maneuver. We hypothesized that persons with central low back pain would have an altered lumbar segmental mobility pattern compared to those without pain.Forty-five individuals (age 32.1 +/- 8.5) with non-specific low back pain and 20 persons (age 31.1 +/- 7.0) without low back pain participated. Each subject underwent dynamic imaging of the lumbar spine during a PA mobilization procedure and while performing a PU. Segmental motion was quantified as the change in the intervertebral angle between the resting and end-range vertebral positions.The symptomatic group had a larger percentage of subjects with evidence of single level segmental hypermobility than the asymptomatic group during the PA (40.0% vs. 5%) and PU (26.7% vs. 15%) procedures. Single lumbar motion-segment analysis revealed hyper-mobility in symptomatic subjects at L5 - S1 (Chi-square = 10.0, p < or = 0.01) and L4 - L5 (Chi-square = 4.18, p < or = 0.05) during the PA test.Persons with non-specific low back pain have a tendency to demonstrate single level lumbar segmental hypermobility when compared to age specific asymptomatic subjects.

View details for DOI 10.1186/1471-2474-8-8

View details for Web of Science ID 000244076100001

View details for PubMedID 17261197
Design of HIFUCMUT arrays for treatment of liver and renal cancer 6TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Wong, S. H., Ergun, A. S., Yaralioglu, G. G., Oralkan, O., Kupnik, M., Pauly, K. B., Khuri-Yakub, B. T. 2007; 911: 54-60
View details for Web of Science ID 000247342200009
Referenceless PRF thermometry with multi-echo processing to monitor prostate ablation 6TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Rieke, V., Kinsey, A. M., Nau, W. H., Diederich, C. J., Sommer, G., Pauly, K. B. 2007; 911: 272-277
View details for Web of Science ID 000247342200042
Fast conformal thermal ablation in the prostate with transurethral multi-sectored ultrasound devices and MR guidance 6TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Kinsey, A. M., Diederich, C. J., Nau, W. H., Ross, A. B., Pauly, K. B., Rieke, V., Sommer, G. 2007; 911: 400-404
View details for Web of Science ID 000247342200062
Segmentation of costal cartilage in abdominal CT data using watershed markers 6TH INTERNATIONAL SYMPOSIUM ON THERAPEUTIC ULTRASOUND Holbrook, A. B., Pauly, K. B. 2007; 911: 226-231
View details for Web of Science ID 000247342200035
Multisectored interstitial ultrasound applicators for dynamic angular control of thermal therapy MEDICAL PHYSICS Kinsey, A. M., Diederich, C. J., Tyreus, P. D., Nau, W. H., Rieke, V., Pauly, K. B. 2006; 33 (5): 1352-1363
Abstract

Dynamic angular control of thermal ablation and hyperthermia therapy with current interstitial heating technology is limited in capability, and often relies upon nonadjustable angular power deposition patterns and/or mechanical manipulation of the heating device. The objective of this study was to investigate the potential of multisectored tubular interstitial ultrasound devices to provide control of the angular heating distribution without device manipulation. Multisectored tubular transducers with independent sector power control were incorporated into modified versions of internally cooled (1.9 mm OD) and catheter-cooled (2.4 mm OD) interstitial ultrasound applicators in this work. The heating capabilities of these multisectored devices were evaluated by measurements of acoustic output properties, measurements of thermal lesions produced in ex vivo tissue samples, biothermal simulations of thermal ablation and hyperthermia treatments, and MR temperature imaging of ex vivo and in vivo experiments. Acoustic beam measurements of each applicator type displayed a 35 degrees -40 degrees acoustic dead zone between each independent sector, with negligible mechanical or electrical coupling. Thermal lesions produced in ex vivo liver tissue with one, two, or three sectors activated ranged from 13-18 mm in radius with contiguous zones of coagulation between active sectors. The simulations demonstrated the degree of angular control possible by using variable power levels applied to each sector, variable duration of applied constant power to individual sectors, respectively, or a multipoint temperature controller to vary the power applied to each sector. Despite the acoustic dead zone between sectors, the simulations also showed that the variance from the maximum lesion radius with three elements activated is within 4%-13% for tissue perfusions from 1-10 kg m(-3) s(-1). Simulations of hyperthermia with maximum tissue temperatures of 45 degrees C and 48 degrees C displayed radial penetration up to 2 cm of the 40 degrees C steady-state contour. Thermal characterizations of trisectored applicators in ex vivo and in vivo muscle, using real-time MR thermal imaging, reinforced angular controllability and negligible radial variance of the heating pattern from the applicators, demonstrated effective heating penetration, and displayed MR compatibility. The multisectored interstitial ultrasound applicators developed in this study demonstrated a significant degree of dynamic angular control of a heating pattern without device manipulation, while maintaining heat penetration consistent with previously reported results from other interstitial ultrasound applicators.

View details for DOI 10.1118/1.2184443

View details for Web of Science ID 000237673600019

View details for PubMedID 16752571
In vivo porcine liver radiofrequency ablation with simultaneous MR temperature imaging JOURNAL OF MAGNETIC RESONANCE IMAGING Vigen, K. K., Jarrard, J., Rieke, V., Frisoli, J., Daniel, B. L., Pauly, K. B. 2006; 23 (4): 578-584
Abstract

To demonstrate in vivo MR-guided temperature mapping during radiofrequency (RF) ablation of the liver with a commercially available RF generator modified to allow simultaneous RF treatment and MRI.A commercial RF generator was modified using passive filtering to allow the continuous application of the treatment current during MRI studies. A total of six ablations were performed with the device in vivo in three porcine livers, and imaging was concurrently performed using one of two different temperature mapping strategies.MR images acquired during RF ablation demonstrated no noticeable interference from the RF ablation device, which was operated at clinically relevant power levels. Temperature maps showed areas of heating that were consistent with the dimensions of the RF ablation probe, with some asymmetry (likely depending on the orientation of the probe and heat propagation effects), and some differences in heating-spot area stability depending on the specific temperature mapping strategy used. Lesions were visualized on post-ablation imaging and sectioning.The feasibility of performing RF ablation with a modified commercial RF generator simultaneously with MRI was demonstrated. Interference-free MR temperature maps were produced with both variable respiratory motion and mechanical ventilation, and showed the extent of heating as the ablation progressed.

View details for DOI 10.1002/jmri.20528

View details for Web of Science ID 000236577000022

View details for PubMedID 16508928
Investigation of proton density for measuring tissue temperature JOURNAL OF MAGNETIC RESONANCE IMAGING Chen, J., Daniel, B. L., Pauly, K. B. 2006; 23 (3): 430-437
Abstract

To examine the temperature dependence of the proton density (PD) in both adipose and muscle tissues, and the application of the PD as a thermometry parameter in breast tissues.Porcine fat samples and bovine muscle samples were successively heated to temperatures ranging from 30 degrees C to 76 degrees C and then cooled. They were then imaged with a dual-echo spin-echo sequence. T1 and T2 effects were carefully corrected from the images. The apparent PD (APD) in regions of interest (ROIs) and the sum of the APD in all pixels (Sum_APD) were measured and analyzed by linear regression.APD in adipose tissue is linear and reversible, and changes with a 0.3%/ degrees C to 0.45%/ degrees C temperature variation. The temperature coefficient of Sum_APD in adipose tissue is approximately 0.29%/ degrees C, as predicted from the Boltzmann distribution. However, the results in muscle tissue are more variable. There is an offset in both APD and Sum_APD between heating and cooling phases, as well as different temperature coefficients between these two phases.The Sum_APD in adipose tissue validates the 1/T dependence on temperature. The APD is a potentially useful parameter for fat thermometry; however, its application in muscle tissue requires further investigation.

View details for DOI 10.1002/jmri.20516

View details for Web of Science ID 000236058400025

View details for PubMedID 16463298
Dynamic angular control of thermal therapy with stationary multi-sectored tubular ultrasound applicators under MR temperature monitoring THERAPEUTIC ULTRASOUND Kinsey, A. M., Diederich, C. J., Nau, W. H., Ross, A. B., Pauly, K. B., Rieke, V., Sommer, G. 2006; 829: 455-459
View details for Web of Science ID 000238329700090
Assessment of MR thermometry during high intensity ultrasound ablation of the canine prostate THERAPEUTIC ULTRASOUND Pauly, K. B., Rieke, V., Pisani, L., Sommer, G., Bouley, D., Diederich, C., Ross, A., Nau, W., Kinsey, A., Dumoulin, C., Watkins, R. 2006; 829: 76-80
View details for Web of Science ID 000238329700015
Targeted prostate thermal therapy with catheter-based ultrasound devices and MR thermal monitoring THERAPEUTIC ULTRASOUND Diederich, C., Ross, A., Kinsey, A., Nau, W. H., Rieke, V., Pauly, K. B., Sommer, G. 2006; 829: 370-374
View details for Web of Science ID 000238329700073
Referenceless MR thermometry during canine prostate ablation THERAPEUTIC ULTRASOUND Rieke, V., Ross, A. B., Kinsey, A. M., Nau, W. H., Diederich, C. J., Sommer, G., Pauly, K. B. 2006; 829: 91-95
View details for Web of Science ID 000238329700018
Truly hybrid x-ray/MR imaging: Toward a streamlined clinical system ACADEMIC RADIOLOGY Ganguly, A., Wen, Z. F., Daniel, B. L., Butts, K., Kee, S. T., Rieke, V., Do, H. M., Pelc, N. J., Alley, M. T., Fahrig, R. 2005; 12 (9): 1167-1177
Abstract

We have installed an improved X-ray/MR (XMR) truly hybrid system with higher imaging signal-to-noise ratio (SNR) and versatility than our first prototype. In our XMR design, a fixed anode X-ray fluoroscopy system is positioned between the two donut-shaped magnetic poles of a 0.5T GE Signa-SP magnet (SP-XMR). This paper describes the methods for increased compatibility between the upgraded x-ray and MR systems that have helped improve patient management.A GE OEC 9800 system (GE OEC Salt Lake City, UT) was specially reconfigured for permitting X-ray fluoroscopy inside the interventional magnet. A higher power X-ray tube, a new permanent tube mounting system, automatic exposure control (AEC), remote controlled collimators, choice of multiple frame rates, DICOM image compatibility, magnetically shimmed X-ray detector, X-ray compatible MR coil, and better RF shielding are the highlights of the new system. A total of 23 clinical procedures have been conducted with SP-XMR guidance of which five were performed using the new system.The 70% increased power for fluoroscopy, and a new 6 times higher power single frame imaging mode, has improved imaging capability. The choice of multiple imaging frame rates, AEC, and collimator control allow reduction in X-ray exposure to the patient. The DICOM formatting has permitted easy transfer of clinical images over the hospital PACS network. The increased MR compatibility of the detector and the X-ray transparent MR coil has enabled faster switching between X-ray and MR imaging modes.The improvements introduced in our SP-XMR system have further streamlined X-ray/MR hybrid imaging. Additional clinical procedures could benefit from the new SP-XMR imaging.

View details for DOI 10.1016/j.acra.2005.03.076

View details for Web of Science ID 000231463500014

View details for PubMedID 16099685
In vivo MR thermometry of frozen tissue using R2* and signal intensity ACADEMIC RADIOLOGY Wansapura, J. P., Daniel, B. L., Vigen, K. K., Butts, K. 2005; 12 (9): 1080-1084
Abstract

Cryoablation is one of several minimally invasive treatments that may be suitable for a targeted treatment of prostate cancer. Because efficacy is improved when a sufficiently cold end temperature is reached, the purpose of this work was to demonstrate an image-based thermometry method that could provide temperature maps throughout the frozen tissue. In five in vivo canine prostate cryoablation experiments performed under magnetic resonance imaging guidance, two MR parameters were measured and correlated to temperature: R2* and changes in signal intensity. R2* is elevated approximately linearly as tissue temperature decreases below the freezing point, while the signal intensity decreases exponentially. In vivo temperature maps with isotherms at -5 degrees C, -15 degrees C, and -30 degrees C are demonstrated.

View details for DOI 10.1016/j.acra.2005.06.006

View details for Web of Science ID 000231463500003

View details for PubMedID 16112510
Effects of spatial and temporal resolution for MR image-guided thermal ablation of prostate with transurethral ultrasound JOURNAL OF MAGNETIC RESONANCE IMAGING Pisani, L. J., Ross, A. B., Diederich, C. J., Nau, W. H., Sommer, F. G., Glover, G. H., Butts, K. 2005; 22 (1): 109-118
Abstract

To describe approaches for determining optimal spatial and temporal resolutions for the proton resonance frequency shift method of quantitative magnetic resonance temperature imaging (MRTI) guidance of transurethral ultrasonic prostate ablation.Temperature distributions of two transurethral ultrasound applicators (90 degrees sectored tubular and planar arrays) for canine prostate ablation were measured via MRTI during in vivo sonication, and agree well with two-dimensional finite difference model simulations at various spatial resolutions. Measured temperature distributions establish the relevant signal-to-noise ratio (SNR) range for thermometry in an interventional MR scanner, and are reconstructed at different resolutions to compare resultant temperature measurements. Various temporal resolutions are calculated by averaging MRTI frames.When noise is added to simulated temperature distributions for tubular and planar applicators, the minimum root mean squared (RMS) error is achieved by reconstructing to pixel sizes of 1.9 and 1.7 mm, respectively. In in vivo measurements, low spatial resolution MRTI data are shown to reduce the noise without significantly affecting thermal dose calculations. Temporal resolution of 0.66 frames/minute leads to measurement errors of more than 12 degrees C during rapid heating.Optimizing MRTI pixel size entails balancing large pixel SNR gain with accuracy in representing underlying temperature distributions.

View details for DOI 10.1002/jmri.20339

View details for Web of Science ID 000230128900015

View details for PubMedID 15971190
Curvilinear transurethral ultrasound applicator for selective prostate thermal therapy MEDICAL PHYSICS Ross, A. B., Diederich, C. J., Nau, W. H., Rieke, V., Butts, R. K., Sommer, G., Gill, H., Bouley, D. M. 2005; 32 (6): 1555-1565
Abstract

Thermal therapy offers a minimally invasive option for treating benign prostatic hyperplasia (BPH) and localized prostate cancer. In this study we investigated a transurethral ultrasound applicator design utilizing curvilinear, or slightly focused, transducers to heat prostatic tissue rapidly and controllably. The applicator was constructed with two independently powered transducer segments operating at 6.5 MHz and measuring 3.5 mm x 10 mm with a 15 mm radius of curvature across the short axis. The curvilinear applicator was characterized by acoustic efficiency measurements, acoustic beam plots, biothermal simulations of human prostate, ex vivo heating trials in bovine liver, and in vivo heating trials in canine prostate (n=3). Each transducer segment was found to emit a narrow acoustic beam (max width <3 mm), which extended the length of the transducer, with deeper penetration than previously developed planar or sectored tubular transurethral ultrasound applicators. Acoustic and biothermal simulations of human prostate demonstrated three treatment schemes for the curvilinear applicator: single shot (10 W, 60 s) schemes to generate narrow ablation zones (13 x 4 mm, 52 degrees C at the lesion boundary), incremental rotation (10 W, 10 degrees/45 s) to generate larger sector-shaped ablation zones (16 mm x 180 degrees sector), and rotation with variable sonication times (10 W, 10 degrees/15-90 s) to conform the ablation zone to a predefined boundary (9-17 mm x 180 degrees sector, 13 min total treatment time). During in vivo canine prostate experiments, guided by MR temperature imaging, single shot sonications (6 W/transducer, 2-3 min) with the curvilinear applicator ablated 20 degree sections of tissue to the prostate boundary (9-15 mm). Multiple adjacent sonications ("sweeping") ablated large sections of the prostate (180 degrees) by using the MR temperature imaging to adjust the power (4-6.4 W/transducer) and sonication time (30-180 s) at each 10 degrees rotation such that the periphery of the prostate reached 52 degrees C before the next rotation. The conclusion of this study was that the curvilinear applicator produces a narrow and penetrating ultrasound beam that, when combined with image guidance, can provide a precise technique for ablating target regions with a contoured outer boundary, such as the prostate capsule, by rotating in small steps while dynamically adjusting the net applied electrical power and sonication time at each position.

View details for DOI 10.1118/1.1924314

View details for Web of Science ID 000229908600015

View details for PubMedID 16013714
X-ray compatible radiofrequency coil for magnetic resonance imaging MAGNETIC RESONANCE IN MEDICINE Rieke, V., GANGULY, A., Daniel, B. L., Scott, G., Pauly, J. M., Fahrig, R., Pelc, N. J., Butts, K. 2005; 53 (6): 1409-1414
Abstract

The range of RF coils that can be used in combined X-ray/MR (XMR) systems is limited because many conventional coils contain highly X-ray attenuating materials that are visible in the X-ray images and potentially obscure patient anatomy. In this study, an X-ray compatible coil design that has minimal X-ray attenuation in the field of view (FOV) of the X-ray image is presented. In this design, aluminum is used for the loop conductor and discrete elements of the coil are eliminated from the X-ray FOV. A surface coil and an abdominal phased array coil were built using the X-ray compatible design. X-ray attenuation and MR imaging properties of the coils were evaluated and compared to conventional coils. The X-ray compatible phased array coil was used to image patients during two interventional procedures in the XMR system. The X-ray compatible coils allowed for fluoroscopic X-ray image acquisition, without degradation by the coil, while maintaining excellent MR imaging qualities.

View details for DOI 10.1002/mrm.20494

View details for Web of Science ID 000229468200022

View details for PubMedID 15906285
MRI-guided interstitial ultrasound thermal therapy of the prostate: A feasibility study in the canine model MEDICAL PHYSICS Nau, W. H., Diederich, C. J., Ross, A. B., Butts, K., Rieke, V., Bouley, D. M., Gill, H., Daniel, B., Sommer, G. 2005; 32 (3): 733-743
Abstract

The feasibility of MRI-guided interstitial ultrasound thermal therapy of the prostate was evaluated in an in vivo canine prostate model. MRI compatible, multielement interstitial ultrasound applicators were developed using 1.5 mm diameter cylindrical piezoceramic transducers (7 to 8 MHz) sectored to provide 180 degrees of angular directional heating. Two in vivo experiments were performed in canine prostate. The first using two interstitial ultrasound applicators, the second using three ultrasound applicators in conjunction with rectal and urethral cooling. In both experiments, the applicators were inserted transperineally into the prostate with the energy directed ventrally, away from the rectum. Electrical power levels of 5-17 W per element (approximately 1.6-5.4 W acoustic output power) were applied for heating periods of 18 and 48 min. Phase-sensitive gradient-echo MR imaging was used to monitor the thermal treatment in real-time on a 0.5 T interventional MRI system. Contrast-enhanced T1-weighted images and vital-stained serial tissue sections were obtained to assess thermal damage and correlate to real-time thermal contour plots and calculated thermal doses. Results from these studies indicated a large volume of ablated (nonstained) tissue within the prostate, extending 1.2 to 2.0 cm from the applicators to the periphery of the gland, with the dorsal margin of coagulation well-defined by the applicator placement and directionality. The shape of the lesions correlated well to the hypointense regions visible in the contrast-enhanced T1-weighted images, and were also in good agreement with the contours of the 52 degrees C threshold temperature and t43 > 240 min. This study demonstrates the feasibility of using directional interstitial ultrasound in conjunction with MRI thermal imaging to monitor and possibly control thermal coagulation within a targeted tissue volume while potentially protecting surrounding tissue, such as rectum, from thermal damage.

View details for DOI 10.1118/1.1861163

View details for Web of Science ID 000227910600010

View details for PubMedID 15839345
MR-guided transjugular intrahepatic portosystemic shunt creation with use of a hybrid radiography/MR system JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Kee, S. T., GANGULY, A., Daniel, B. L., Wen, Z. F., Butts, K., Shimikawa, A., Pelc, N. J., Fahrig, R., Dake, M. D. 2005; 16 (2): 227-234
Abstract

To evaluate the performance of a combined hybrid radiography/magnetic resonance (MR) unit to guide portal vein (PV) puncture during human transjugular intrahepatic portosystemic shunt (TIPS) creation.Fourteen patients undergoing TIPS creation were studied during standard clinical applications. Patients were anesthetized and then positioned in an open MR unit containing a flat-panel radiographic fluoroscopic unit. With use of a combination of fluoroscopy and MR imaging, the PV was accessed and the TIPS procedure was performed. A noncovered nitinol stent or a covered stent-graft was placed in the TIPS tract. Number of punctures required, total procedure time, fluoroscopy time, procedural success rate, complications, and ultrasonographic and clinical follow-up were recorded.Clinical success was obtained in 13 of 14 patients. In one patient, extrahepatic puncture of the PV occurred, resulting in hemorrhage and requiring placement of a covered stent to control the bleeding. The mean number of punctures required to access the PV was 2.6 +/- 1.7, and the total procedure time was 2.5 hours +/- 0.6. Mean fluoroscopy time was 22.3 minutes +/- 5.5. Results of clinical and ultrasonographic follow-up compare favorably to previously published reports.TIPS creation with a combination hybrid radiography/MR unit is feasible and may reduce the number of needle passes required and radiation exposure, with similar overall outcomes compared with studies reported in the literature.

View details for DOI 10.1097/01.RVI.0000143766.08029.6E

View details for Web of Science ID 000227710000009

View details for PubMedID 15713923
Reduction of blurring in view angle tilting MRI MAGNETIC RESONANCE IN MEDICINE Butts, K., Pauly, J. M., Gold, G. E. 2005; 53 (2): 418-424
Abstract

Magnetic resonance imaging (MRI) in the presence of metallic objects suffers from slice-selection errors and in-plane distortions. View angle tilting (VAT) corrects for in-plane distortions by adding a gradient on the slice-select axis during readout, but can suffer from image blurring. This work demonstrates that the major source of blurring is a slice profile modulation of the data, and proposes several solutions to prevent such blurring. Multiple high-bandwidth readouts are demonstrated to reduce the blurring while improving the signal-to-noise ratio (SNR) over a single high-bandwidth readout.

View details for DOI 10.1002/mrm.20375

View details for Web of Science ID 000226651100020

View details for PubMedID 15678535
Catheter-based ultrasound applicators for selective thermal ablation: progress towards MRI-guided applications in prostate INTERNATIONAL JOURNAL OF HYPERTHERMIA Diederich, C. J., Nau, W. H., Ross, A. B., Tyreus, P. D., Butts, K., Rieke, V., Sommer, G. 2004; 20 (7): 739-756
Abstract

High-temperature thermal therapy is emerging as a feasible treatment option for prostate cancer and benign prostatic hyperplasia. Previous investigations have demonstrated distinct advantages of catheter-based ultrasound technology over other heating modalities for thermal ablation therapies, with significant potential for better spatial control and faster heating times. The purpose of this study was to develop ultrasound devices and techniques specifically for treating prostate cancer in conjunction with magnetic resonance thermal imaging (MRTI) to monitor and control treatment progression. Directional transurethral applicators have been designed with arrays of sectored tubular (90 degrees active acoustic sector) or with narrow planar transducer segments and integrated with a flexible delivery catheter with a cooling balloon. This applicator can be rotated within the prostatic urethra to target specific regions during treatment. MRI compatible catheter-cooled interstitial ultrasound applicators with 180 degrees active acoustic sectors were developed specifically to treat the prostate. These applicators may be implanted through the perineum into the posterior portion of the prostate, with their heating energy directed away from the rectum. Both heating strategies were evaluated via biothermal simulations and in vivo experiments within canine prostate (n = 3). During the in vivo studies, MRTI was used to monitor treatment temperatures, cytotoxic thermal doses (t43 > 240 min) and corresponding maximum temperature thresholds (Tmax > 52 degrees C) within three imaging planes simultaneously. Urethral and endorectal cooling was employed with both treatment strategies to provide further protection of the urethral mucosa and rectum from thermal damage. Results using the transurethral applicators demonstrated that narrow zones of coagulation (approximately 30 degrees sector for planar, approximately 90 degrees for tubular), extending up to 20 mm from the urethra to the periphery of the prostate gland, could be produced within 10-15 min. Further, rotation of the applicator during treatment could be used to destroy larger regions in the prostate. Experiments using multiple interstitial directional applicators (approximately 180 degrees active sectors), implanted within the posterior margin of the prostate with the energy directed away from the rectum, produced contiguous zones of thermal coagulation which extended from the posterior prostate toward the anterior-lateral periphery of the gland. Both transurethral and interstitial treatment strategies demonstrated significant potential for thermal ablation of localized prostate cancer, particularly when MRTI is used to guide and assess treatment.

View details for DOI 10.1080/02656730410001721816

View details for Web of Science ID 000225135100006

View details for PubMedID 15675669
Referenceless PRF shift thermometry MAGNETIC RESONANCE IN MEDICINE Rieke, V., Vigen, K. K., Sommer, G., Daniel, B. L., Pauly, J. M., Butts, K. 2004; 51 (6): 1223-1231
Abstract

The proton resonance frequency (PRF) shift provides a means of measuring temperature changes during minimally invasive thermotherapy. However, conventional PRF thermometry relies on the subtraction of baseline images, which makes it sensitive to tissue motion and frequency drift during the course of treatment. In this study, a new method is presented that eliminates these problems by estimating the background phase from each acquired image phase. In this referenceless method, a polynomial is fit to the background phase outside the heated region in a weighted least-squares fit. Extrapolation of the polynomial to the heated region serves as the background phase estimate, which is then subtracted from the actual phase. The referenceless method is demonstrated on a phantom during laser heating, 0 degrees temperature rise images of in vivo human liver, interstitial laser ablation of porcine liver, and transurethral ultrasound ablation of canine prostate. A good correlation between temperature maps reconstructed with the referenceless and subtraction methods was found.

View details for DOI 10.1002/mrm.20090

View details for Web of Science ID 000221835900018

View details for PubMedID 15170843
Highly directional transurethral ultrasound applicators with rotational control for MRI-guided prostatic thermal therapy PHYSICS IN MEDICINE AND BIOLOGY Ross, A. B., Diederich, C. J., Nau, W. H., Gill, H., Bouley, D. M., Daniel, B., Rieke, V., Butts, R. K., Sommer, G. 2004; 49 (2): 189-204
Abstract

Transurethral ultrasound applicators with highly directional energy deposition and rotational control were investigated for precise treatment of benign prostatic hyperplasia (BPH) and adenocarcinoma of the prostate (CaP). Two types of catheter-based applicators were fabricated, using either 90 degrees sectored tubular (3.5 mm OD x 10 mm) or planar transducers (3.5 mm x 10 mm). They were constructed to be MRI compatible, minimally invasive and allow for manual rotation of the transducer array within a 10 mm cooling balloon. In vivo evaluations of the applicators were performed in canine prostates (n = 3) using MRI guidance (0.5 T interventional magnet). MR temperature imaging (MRTI) utilizing the proton resonance frequency shift method was used to acquire multiple-slice temperature overlays in real time for monitoring and guiding the thermal treatments. Post-treatment T1-weighted contrast-enhanced imaging and triphenyl tetrazolium chloride stained tissue sections were used to define regions of tissue coagulation. Single sonications with the 90 degrees tubular applicator (9-15 W, 12 min, 8 MHz) produced coagulated zones covering an 80 degrees wedge of the prostate extending from 1-2 mm outside the urethra to the outer boundary of the gland (16 mm radial coagulation). Single sonications with the planar applicator (15-20 W, 10 min, approximately 8 MHz) generated thermal lesions of approximately 30 degrees extending to the prostate boundary. Multiple sequential sonications (sweeping) of a planar applicator (12 W with eight rotations of 30 degrees each) demonstrated controllable coagulation of a 270 degrees contiguous section of the prostate extending to the capsule boundary. The feasibility of using highly directional transurethral ultrasound applicators with rotational capabilities to selectively coagulate regions of the prostate while monitoring and controlling the treatments with MRTI was demonstrated in this study.

View details for DOI 10.1088/0031-9155/49/2/0020

View details for Web of Science ID 000220421700002

View details for PubMedID 15083666
MRI-temperature mapping during ultrasound prostate ablation using fat for phase estimation. Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference Rieke, V., Ross, A. B., Nau, W. H., Diederich, C. J., Sommer, G., Butts, K. 2004; 4: 2500-2502
Abstract

Referenceless proton resonance frequency (PRF) shift thermometry provides a means to measure temperature changes during minimally invasive thermotherapy that is inherently robust to motion and tissue displacement. In this study, the method is expanded to allow background phase estimation from fatty tissue. A correction scheme for temperature map distortions caused by the ultrasound applicator is developed. The method is tested during thermal ablation of canine prostate using a directional transurethral ultrasound applicator.

View details for PubMedID 17270780
Triggered, navigated, multi-baseline method for proton resonance frequency temperature mapping with respiratory motion MAGNETIC RESONANCE IN MEDICINE Vigen, K. K., Daniel, B. L., Pauly, J. M., Butts, K. 2003; 50 (5): 1003-1010
Abstract

A technique is presented for the acquisition of temperature maps in the presence of variable respiratory motion using the proton resonance frequency (PRF) shift. The technique uses respiratory triggering, diaphragm position determination with a navigator echo, and the collection of multiple baseline images to generate temperature maps. Laser ablations were performed in an ex vivo liver phantom undergoing variable simulated respiratory motion and in vivo in four porcine livers, demonstrating a reduction of artifacts in the computed temperature maps compared with conventional single baseline techniques, both uncorrected and corrected for motion.

View details for DOI 10.1002/mrm.10608

View details for Web of Science ID 000186326400014

View details for PubMedID 14587011
First use of a truly-hybrid X-ray/MR imaging system for guidance of brain biopsy ACTA NEUROCHIRURGICA Fahrig, R., Heit, G., Wen, Z., Daniel, B. L., Butts, K., Pelc, N. J. 2003; 145 (11): 995-997
Abstract

The use of a new hybrid imaging system for guidance of a brain biopsy is described. The system combines the strengths of MRI (soft-tissue contrast, arbitrary plane selection) with those of x-ray fluoroscopy (high-resolution real-time projection images, clear portrayal of bony structures) and allows switching between the imaging modalities without moving the patient. The biopsy was carried out using x-ray guidance for direction of the needle through the foramen ovale and MR guidance to target the soft-tissue lesion. Appropriate samples were acquired. The system could be particularly effective for guidance of those cases where motion, swelling, resection and other intra-operative anatomical changes cannot be accounted for using traditional stereotactic-based imaging approaches.

View details for DOI 10.1007/s00701-003-0138-7

View details for Web of Science ID 000186686300020

View details for PubMedID 14628205
Pair of resonant fiducial markers for localization of endovascular catheters at all catheter orientations JOURNAL OF MAGNETIC RESONANCE IMAGING Kuehne, T., Fahrig, R., Butts, K. 2003; 17 (5): 620-624
Abstract

To test wireless resonance circuits (RC) to be used as fiducial marker of endovascular catheters during MR-guided interventions. Current markers loose their signal enhancement for certain catheter orientations. The purpose of this study was to test a marker setup which overcomes this orientation problem.The markers were constructed from a pair of two RCs. The RCs were individually tuned and the coil axes were oriented perpendicular to each other in order to decouple the two RCs. The markers were mounted on the tip of endovascular catheters and tested in vitro and in one porcine in vivo experiment.An intense MR signal at similar signal levels was noted at all catheter orientations. In the in vivo experiment the markers allowed for fast and reliable MR guidance of the catheters.A pair of two individually tuned and decoupled RCs is well suited for MR guidance of endovascular catheters.

View details for DOI 10.1002/jmri.10307

View details for Web of Science ID 000182630800015

View details for PubMedID 12720274
Diffusion-weighted MRI after cryosurgery of the canine prostate. Magnetic resonance imaging. Journal of magnetic resonance imaging : JMRI Butts, K., Daniel, B. L., Chen, L., Bouley, D. M., Wansapura, J., Maier, S. E., Dumoulin, C., Watkins, R. 2003; 17 (1): 131-135
Abstract

To evaluate the acute lesion created by cryosurgery with diffusion-weighted magnetic resonance imaging (DWI).The appearance of the acute cryolesion was evaluated in four canine prostates DWI after they were warmed to original body temperature. The prostates were excised, stained with triphenyl tetrazolium chloride (TTC), photographed, prepared for hematoxylin and eosin (H&E) staining, and examined under a light microscope.A marked decrease in apparent diffusion coefficient of 38% was evident in the center of the previously frozen tissue, but not in all of the previously frozen tissue. Histologic results confirm differences between the iceball core and the periphery of the iceball, which have markedly different imaging characteristics on DWI.The core of the previously frozen tissue has a reduced apparent diffusion coefficient (ADC) compared to the periphery of the previously frozen tissue and previously unfrozen tissue.

View details for PubMedID 12500282
Line scan diffusion imaging of the spine AMERICAN JOURNAL OF NEURORADIOLOGY Bammer, R., Herneth, A. M., Maier, S. E., Butts, K., Prokesch, R. W., Do, H. M., Atlas, S. W., Moseley, M. E. 2003; 24 (1): 5-12
Abstract

Recent findings suggest that diffusion-weighted imaging might be an important adjunct to the diagnostic workup of disease processes in the spine, but physiological motion and the challenging magnetic environment make it difficult to perform reliable quantitative diffusion measurements. Multi-section line scan diffusion imaging of the spine was implemented and evaluated to provide quantitative diffusion measurements of vertebral bodies and intervertebral disks.Line scan diffusion imaging of 12 healthy study participants and three patients with benign vertebral compression fractures was performed to assess the potential of line scan diffusion imaging of the spinal column. In a subgroup of six participants, multiple b-value (5-3005 s/mm(2)) images were obtained to test for multi-exponential signal decay.All images were diagnostic and of high quality. Mean diffusion values were (230 +/- 83) x 10(-6) mm(2)/s in the vertebral bodies, (1645 +/- 213) x 10(-6) mm(2)/s in the nuclei pulposi, (837 +/- 318) x 10(-6) mm(2)/s in the annuli fibrosi and ranged from 1019 x 10(-6) mm(2)/s to 1972 x 10(-6) mm(2)/s in benign compression fractures. The mean relative intra-participant variation of mean diffusivity among different vertebral segments (T10-L5) was 2.97%, whereas the relative difference in mean diffusivity among participants was 7.41% (P <.0001). The estimated measurement precision was <2%. A bi-exponential diffusion attenuation was found only in vertebral bodies.Line scan diffusion imaging is a robust and reliable method for imaging the spinal column. It does not suffer as strongly from susceptibility artifacts as does echo-planar imaging and is less susceptible to patient motion than are other multi-shot techniques. The different contributions from the water and fat fractions need to be considered in diffusion-weighted imaging of the vertebral bodies.

View details for Web of Science ID 000180962400004

View details for PubMedID 12533319
Dynamic magnetic resonance guided treatment of developmental dysplasia of the hip JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B Lincoln, T. L., Vandevenne, J. E., Rinsky, L. A., Butts, K., Lang, P. 2002; 11 (4): 279-283
Abstract

This study demonstrates the feasibility and advantages of near real-time, multiplanar, dynamic magnetic resonance image-assisted treatment of patients with developmental dysplasia of the hip. Pathoanatomy and dynamic blocks to reduction are visualized with anatomic clarity not otherwise possible. Continuous imaging allows accurate assessment and maintenance of optimum positioning throughout the casting procedure. Patient charges for this new technique are less than standard methods of treatment, and the child receives no ionizing radiation.

View details for Web of Science ID 000178875700002

View details for PubMedID 12370576
Study of laser ablation in the in vivo rabbit brain with MR thermometry JOURNAL OF MAGNETIC RESONANCE IMAGING Chen, L. L., Wansapura, J. P., Heit, G., Butts, K. 2002; 16 (2): 147-152
Abstract

To investigate the peak temperature and thermal dose (T(43)) as tissue damage indicators for thermal therapy.The proton resonant frequency (PRF) shift thermal coefficient was calibrated on six in vivo rabbit brains during interstitial laser ablation. The peak temperature and T(43) were correlated with the lesion boundary observed on T2-weighted spin-echo (SE) MRI at 4 hours post-heating in seven thermal lesions using direct MR measurement and analysis based on a binary discriminate model.The peak temperature and T(43) were 48.3 +/- 1.7 degrees C and 191 +/- 219 minutes, respectively, from the direct MR measurement. The values derived by the binary discriminate analysis were 47.8 +/- 2.2 degrees C and 28 +/- 41 minutes, respectively.Our results suggest that tissue damage in rabbit brain 4 hours after thermal ablation can be predicted reliably from a threshold temperature of approximately 48 degrees C.

View details for DOI 10.1002/jmri.10152

View details for Web of Science ID 000177083900004

View details for PubMedID 12203761
Truly hybrid interventional MR/x-ray system: Investigation of in vivo applications ACADEMIC RADIOLOGY Fahrig, R., Butts, K., Wen, Z. F., Saunders, R., Kee, S. T., Sze, D. Y., Daniel, B. L., Laerum, F., Pelc, N. J. 2001; 8 (12): 1200-1207
Abstract

The purpose of this study was to provide in vivo demonstrations of the functionality of a truly hybrid interventional x-ray/magnetic resonance (MR) system.A digital flat-panel x-ray system (1,024(2) array of 200 microm pixels, 30 frames per second) was integrated into an interventional 0.5-T magnet. The hybrid system is capable of MR and x-ray imaging of the same field of view without patient movement. Two intravascular procedures were performed in a 22-kg porcine model: placement of a transjugular intrahepatic portosystemic shunt (TIPS) (x-ray-guided catheterization of the hepatic vein, MR fluoroscopy-guided portal puncture, and x-ray-guided stent placement) and mock chemoembolization (x-ray-guided subselective catheterization of a renal artery branch and MR evaluation of perfused volume).The resolution and frame rate of the x-ray fluoroscopy images were sufficient to visualize and place devices, including nitinol guidewires (0.016-0.035-inch diameter) and stents and a 2.3-F catheter. Fifth-order branches of the renal artery could be seen. The quality of both real-time (3.5 frames per second) and standard MR images was not affected by the x-ray system. During MR-guided TIPS placement, the trocar and the portal vein could be easily visualized, allowing successful puncture from hepatic to portal vein.Switching back and forth between x-ray and MR imaging modalities without requiring movement of the patient was demonstrated. The integrated nature of the system could be especially beneficial when x-ray and MR image guidance are used iteratively.

View details for Web of Science ID 000172759200002

View details for PubMedID 11770916
Temperature mapping of frozen tissue using eddy current compensated half excitation RF pulses MAGNETIC RESONANCE IN MEDICINE Wansapura, J. P., Daniel, B. L., Pauly, J., Butts, K. 2001; 46 (5): 985-992
Abstract

Cryosurgery has been shown to be an effective therapy for prostate cancer. Temperature monitoring throughout the cryosurgical iceball could dramatically improve efficacy, since end temperatures of at least -40 degrees C are required. The results of this study indicate that MR thermometry based on tissue R(*)(2) has the potential to provide this information. Frozen tissue appears as a complete signal void on conventional MRI. Ultrashort echo times (TEs), achievable with half pulse excitation and a short spiral readout, allow frozen tissue to be imaged and MR characteristics to be measured. However, half pulse excitation is highly sensitive to eddy current distortions of the slice-select gradient. In this work, the effects of eddy currents on the half pulse technique are characterized and methods to overcome these effects are developed. The methods include: 1) eddy current compensated slice-select gradients, and 2) a correction for the phase shift between the first and second half excitations at the center of the slice. The effectiveness of these methods is demonstrated in R(*)(2) maps calculated within the frozen region during cryoablation.

View details for Web of Science ID 000171821100019

View details for PubMedID 11675651
Freehand iMRI-guided large-gauge core needle biopsy: A new minimally invasive technique for diagnosis of enhancing breast lesions Daniel, B. L., Birdwell, R. L., Butts, K., Nowels, K. W., Ikeda, D. M., Heiss, S. G., Cooper, C. R., Jeffrey, S. S., Dirbas, F. M., Herfkens, R. J. JOHN WILEY & SONS INC. 2001: 896-902
Abstract

The lack of reliable methods for minimally invasive biopsy of suspicious enhancing breast lesions has hindered the utilization of contrast-enhanced magnetic resonance imaging (MRI) for the detection and diagnosis of breast cancer. In this study, a freehand method was developed for large-gauge core needle biopsy (LCNB) guided by intraprocedural MRI (iMRI). Twenty-seven lesions in nineteen patients were biopsied using iMRI-guided LCNB without significant complications. Diagnostic tissue was obtained in all cases. Nineteen of the 27 lesions were subsequently surgically excised. Histopathologic analysis confirmed that iMRI-guided LCNB correctly distinguished benign lesions from malignancy in 18 of the 19 lesions. The histology revealed by core biopsy was partially discrepant with surgical biopsy in 2 of the other 19 lesions. Freehand iMRI-guided LCNB of enhancing breast lesions is promising. Larger studies are needed to determine the smallest lesion that can be sampled reliably and to precisely measure the accuracy of iMRI-guided LCNB as a minimally invasive tool to diagnose suspicious lesions found by breast MRI. J. Magn. Reson. Imaging 2001;13:896-902.

View details for Web of Science ID 000171296500013

View details for PubMedID 11382950
Dynamic MR imaging and stress testing in glenohumeral instability: Comparison with normal shoulders and clinical/surgical findings JOURNAL OF MAGNETIC RESONANCE IMAGING Hodge, D. K., Beaulieu, C. F., Thabit, G. H., Gold, G. E., Bergman, A. G., Butts, R. K., Dillingham, M. F., Herfkens, R. J. 2001; 13 (5): 748-756
Abstract

Our objectives were to test the hypotheses that: 1) during shoulder motion, glenohumeral alignment differs between asymptomatic shoulders and those with symptomatic instability; 2) during magnetic resonance (MR)-monitored physical exam or stress testing, glenohumeral alignment differs between asymptomatic shoulders and those with instability; and 3) glenohumeral translation during MR stress testing correlates with findings of shoulder instability by clinical exam and exam under anesthesia (EUA). Using an open-configuration 0.5 T MR imaging (MRI) system, we studied symptomatic shoulders in 11 subjects and compared them to their contralateral asymptomatic shoulders. Each shoulder was studied during abduction/adduction and internal/external rotation to determine the humeral head position on the glenoid. An examiner also performed the MR stress test on each shoulder by applying manual force on the humeral head during imaging. All shoulders were assigned an instability grade from the MR stress test, and this grade was correlated with: 1) clinical exam grade assigned during preoperative assessment by an orthopedic surgeon and 2) intraoperative instability grade by EUA immediately preceding arthroscopy. With dynamic abduction and internal/external rotation, the humeral head remained centered on the glenoid in 9 of 11 shoulders, but in two subjects there were dramatic demonstrations of subluxation. With stress testing, a trend toward more joint laxity was demonstrated in symptomatic than in asymptomatic joints (P = 0.11). MR grading of instability correlated directly with clinical grading in six cases and underestimated the degree of instability relative to clinical exam in the other cases. MR instability grading systematically underestimated instability compared with EUA in 7 of the 10 cases that underwent surgical repair. We concluded that dynamic MR evaluation of glenohumeral alignment did not demonstrate abnormalities in symptomatic shoulders in 8 of 10 patients, whereas 2 patients showed dramatic findings of subluxation. Manual stress testing during dynamic MR examination showed a strong correlation with clinical instability grading. Dynamic shoulder MR examination during stress testing could, with further validation, become a useful adjunct to shoulder instability evaluations. J. Magn. Reson. Imaging 2001;13:748-756.

View details for Web of Science ID 000171296300012

View details for PubMedID 11329197
A truly hybrid interventional MR/X-ray system: Feasibility demonstration Fahrig, R., Butts, K., Rowlands, J. A., Saunders, R., Stanton, J., Stevens, G. M., Daniel, B. L., Wen, Z. F., Ergun, D. L., Pelc, N. J. JOHN WILEY & SONS INC. 2001: 294-300
Abstract

A system enabling both x-ray fluoroscopy and MRI in a single exam, without requiring patient repositioning, would be a powerful tool for image-guided interventions. We studied the technical issues related to acquisition of x-ray images inside an open MRI system (GE Signa SP). The system includes a flat-panel x-ray detector (GE Medical Systems) placed under the patient bed, a fixed-anode x-ray tube overhead with the anode-cathode axis aligned with the main magnetic field and a high-frequency x-ray generator (Lunar Corp.). New challenges investigated related to: 1) deflection and defocusing of the electron beam of the x-ray tube; 2) proper functioning of the flat panel; 3) effects on B0 field homogeneity; and 4) additional RF noise in the MR images. We have acquired high-quality x-ray and MR images without repositioning the object using our hybrid system, which demonstrates the feasibility of this new configuration. Further work is required to ensure that the highest possible image quality is achieved with both MR and x-ray modalities.

View details for Web of Science ID 000171295900018

View details for PubMedID 11169837
Temperature quantitation and mapping of frozen tissue JOURNAL OF MAGNETIC RESONANCE IMAGING Butts, K., Sinclair, J., Daniel, B. L., Wansapura, J., Pauly, J. M. 2001; 13 (1): 99-104
Abstract

A method was developed for quantitating the temperature within frozen tissue with the magnetic resonance (MR) parameter R2*. The pulse sequence uses half-pulse excitation and a short spiral readout to achieve echo times as short as 0.2 msec. Fiber-optic temperature sensors were inserted into bovine liver tissue. The tissue was frozen at one end while being held warm at the other end. Once steady state was reached, the parameter R2* was measured. A linear dependence of R2* on temperature was demonstrated. R2* is independent of freeze number and of the orientation of the temperature gradient with respect to the main magnetic field. Feasibility in a canine prostate during cryosurgery is demonstrated. J. Magn. Reson. Imaging 2001;13:99-104.

View details for Web of Science ID 000171295800016

View details for PubMedID 11169810
MRI study of immediate cell viability in focused ultrasound lesions in the rabbit brain JOURNAL OF MAGNETIC RESONANCE IMAGING Chen, L., Bouley, D. M., Harris, B. T., Butts, K. 2001; 13 (1): 23-30
Abstract

The purpose of this study was to evaluate cell viability in MR imaged focused ultrasound (FUS) lesions using cell-viability staining with triphenyl tetrazolium chloride (TTC) and both light and electron microscopy. Ten paired ultrasonic lesions were created in 5 rabbit brains in vivo with an ultrasound beam of 1.5 MHz electrical power input to the transducer of 50 W and exposure duration of 15 seconds. T2-weighted fast spin-echo (FSE) MRI was performed to detect the FUS lesions in the brain 4 hours after treatment, after which the animals were immediately euthanized. Lesion sizes were measured on TTC-stained specimens, histological sections stained with hematoxylin and eosin (H&E), and T2-weighted MR images. The differences between the lesion diameters measured with the three methods were within the range of 0.1--0.7 mm. The lesion sizes measured from MRI correlated well with those seen from H&E sections. The measurements from MRI slightly overestimated lesion sizes on TTC-stained wet tissues by approximately one MRI pixel (0.31 mm). Electron microscopy demonstrated nuclear and cytoplasmic ultrastructural damage within the grey-white, non-TTC-stained lesion zone, whereas the TTC-stained normal tissue showed preservation of neuronal ultrastructure. Therefore, MR-imaged lesions represent a cell-death zone in rabbit brain 4 hours after FUS ablation, with slight overestimation by approximately one MRI pixel. J. Magn. Reson. Imaging 2001;13:23-30.

View details for Web of Science ID 000171295800005

View details for PubMedID 11169799
Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects. spine journal Fredericson, M., Lee, S. U., Welsh, J., Butts, K., Norbash, A., Carragee, E. J. 2001; 1 (1): 10-17
Abstract

No previous study has used magnetic resonance imaging (MRI) to evaluate changes of posterior disc bulging and intervertebral foraminal size in the normal spine with flexion-extension movement, comparing L4-5 versus L5-S1 intervertebral levels.To determine changes in posterior disc bulging and intervertebral foraminal size with flexion-extension movement, comparing L4-5 versus L5-S1 intervertebral levels.An in vivo study of magnetic resonance kinematics with spine flexion extension.Spines of three volunteers with no history of low back pain were scanned in neutral, flexion, and extension positions in a vertically open MRI system. MRI was repeated after 6 hours of normal activity and an additional 4 hours of heavy activity with a weighted vest. Posterior bulging of the intervertebral disc and the size of intervertebral foramen were measured at the L4-5 and L5-S1 levels.With spine flexion, posterior bulging of the discs increased at L4-5 in eight of nine measurements (three different spine-loading states for each of three subjects) and L5-S1 discs in six of nine measurements. In most cases, posterior bulging decreased with extension. No significant difference was noted in the degree of disc bulge between levels. Foraminal size at L4-5 increased with flexion and decreased with extension, and the extent of these changes was greater at the L4-5 level than at L5-S1.This pilot study demonstrates two distinct behavior characteristics of the normal spine with flexion-extension movement.

View details for PubMedID 14588361
The use of view angle tilting to reduce distortions in magnetic resonance imaging of cryosurgery MAGNETIC RESONANCE IMAGING Daniel, B. L., Butts, K. 2000; 18 (3): 281-286
Abstract

Susceptibility artifacts from magnetic resonance (MR)-compatible cryoprobes can distort MR images of iceballs. In this work, we investigate the ability of view angle tilting (VAT) to correct susceptibility induced distortions in MR images of cryosurgery. The efficacy of VAT was tested in an ex vivo bovine liver model of cryosurgery using MR-compatible cryoprobes. Artifacts on high bandwidth fast spin echo images of freezing obtained with and without VAT were compared with photographs of the actual iceball shape and size. In vivo imaging with VAT was demonstrated during percutaneous MR-guided cryosurgery of pig liver and brain. VAT was most successful in reducing probe and iceball distortions when the imaging plane was normal to the cryoprobe, and the cryoprobe was perpendicular to the main magnetic field of the scanner. VAT had the greatest benefit when used to correct MR images of freezing when the surface of the iceball was relatively near to the cryoprobe. For large iceballs, the artifact was small so the VAT correction was less important. We conclude that VAT significantly reduced distortions in the shape of the signal void corresponding to the extent of freezing visualized during MR-guided cryosurgery. This improved ability to visualize the exact location of the cryoprobe, as well as the precise shape of the iceball, particularly during initial freezing when the iceball is small, has potential to significantly improve the accuracy of MR-guided cryosurgery of small lesions, and the accuracy of MR-assisted temperature calculations that are based on precise imaging of the probe location, and boundary geometry of the iceball.

View details for Web of Science ID 000086585100008

View details for PubMedID 10745137
Glenohumeral relationships during physiologic shoulder motion and stress testing: Initial experience with open MR imaging and active imaging-plane registration RADIOLOGY Beaulieu, C. F., Hodge, D. K., Bergman, A. G., Butts, K., Daniel, B. L., Napper, C. L., Darrow, R. D., Dumoulin, C. L., Herfkens, R. J. 1999; 212 (3): 699-705
Abstract

To test the hypotheses that open dynamic magnetic resonance (MR) imaging can (a) be used to evaluate and define normal shoulder motion in active joint motion and muscle contraction and (b) be used in conjunction with physical examination.With an open-configuration, 0.5-T MR imaging system and active image-plane tracking, 10 shoulders were studied in five asymptomatic subjects to establish normal patterns of glenohumeral motion during abduction and adduction and internal and external rotation. Preliminary studies of physical examination during MR imaging, in which a physician examiner applied mechanical force to the humeral head, were also performed.During abduction and adduction and internal and external rotation maneuvers with active subjects muscle contraction, the humeral head remained precisely centered on the glenoid fossa in all asymptomatic subjects, which is in agreement with findings of previous radiographic studies. Application of force to the humeral head by an examiner was associated with as much as 6 mm of anterior translation and 13 mm of posterior translation.Dynamic MR imaging of the glenohumeral joint is possible over a wide range of physiologic motion in vertically open systems. Use of an MR tracking coil enabled accurate tracking of the anatomy of interest. These preliminary measurements of normal glenohumeral motion patterns begin to establish normal ranges of motion and constitute a necessary first step in characterizing pathologic motion in patients with common clinical problems such as instability and impingement.

View details for Web of Science ID 000082196600016

View details for PubMedID 10478235
Study of focused ultrasound tissue damage using MRI and histology JOURNAL OF MAGNETIC RESONANCE IMAGING Chen, L., Bouley, D., Yuh, E., D'Arceuil, H., Butts, K. 1999; 10 (2): 146-153
Abstract

This paper reports on an experimental study of in vivo tissue damage in the rabbit brain with focused ultrasound (FUS) using magnetic resonance imaging (MRI) and histopathological analysis. Ten ultrasonic lesions (tissue damage) were created in five rabbits using a focused ultrasound beam of 1.5 MHz, electrical power input to the transducer of 70-85 W, and an exposure duration of 15-20 seconds. T1- and T2-weighted fast spin-echo (FSE) and Fluid attenuated inversion recovery (FLAIR) sequences were used to detect the ultrasonic lesions after treatment. Imaging was performed for 4-8 hours after treatment, after which the animals were immediately sacrificed. Ultrasonic lesion diameter was measured on MRI and histological sections after correction for tissue shrinkage during the histological processing. The T1-weighted images showed lesions poorly, whereas both T2-weighted and FLAIR images showed lesions clearly. The lesion diameters on both T2 and FLAIR imaging correlated well with measurements from histology. The time delay before lesions appeared on T2-weighted imaging was 15 minutes to 1 hour, depending on the exposure location in the brain. J. Magn. Reson. Imaging 1999;10:146-153.

View details for Web of Science ID 000084567000006

View details for PubMedID 10441017
Joint motion in an open MR unit using MR tracking JOURNAL OF MAGNETIC RESONANCE IMAGING Pearle, A. D., Daniel, B. L., Bergman, A. G., Beaulieu, C. F., Lang, P., Dumoulin, C. L., Darrow, R. D., Norbash, A. M., Napper, C. L., Hurtak, W., Butts, K. 1999; 10 (1): 8-14
Abstract

A system for active scan plane guidance during kinematic magnetic resonance (MR) examination of joint motion was developed utilizing an external tracking coil and MR tracking software. In a phantom study and during upright, weight-bearing, physiologic knee flexion, the external tracking coil maintained the scan plane through desired structures. Thus, MR tracking provides a robust method to guide the scan plane during MR imaging of active joint motion.

View details for Web of Science ID 000081199600002

View details for PubMedID 10398972
MR-guided transjugular portosystemic shunt placement in a swine model JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Kee, S. T., Rhee, J. S., Butts, K., Daniel, B., Pauly, J., Kerr, A., O'Sullivan, G. J., Sze, D. Y., Razavi, M. K., Semba, C. P., Herfkens, R. J., Dake, M. D. 1999; 10 (5): 529-535
Abstract

To evaluate the performance of portal venous puncture with use of magnetic resonance (MR) guidance, and to place a transjugular intrahepatic portosystemic shunt (TIPS) in a swine model.A study of 12 swine was performed to evaluate the ability of interventional MR imaging to guide portal vein puncture and TIPS placement. Six swine had catheters placed in the right hepatic vein under C-arm fluoroscopy. A nitinol guide wire was left in the vein and the animals were then moved into an open configuration MR imaging unit. A TIPS needle set was used to puncture the portal vein using MR fluoroscopy. The animals were transferred to the C-arm, and venography confirmed portal vein puncture. A follow-up study was performed in six additional swine to place a TIPS using only MR imaging guidance. MR tracking was used to advance a catheter from the right atrium into the inferior vena cava. Puncture of the portal vein was performed and a nitinol stent was placed, bridging the hepatic parenchyma. MR venogram confirmed placement.Successful portal vein puncture was achieved in all animals. The number of punctures required decreased from 12 in the first animal to a single puncture in the last eight swine. A stent was successfully placed across the hepatic tract in all six swine.Real-time MR imaging proved to be a feasible method to guide portal vein puncture and TIPS placement in pigs.

View details for Web of Science ID 000084345500001
Management of biopsy needle artifacts: Techniques for RF-refocused MRI JOURNAL OF MAGNETIC RESONANCE IMAGING Butts, K., Pauly, J. M., Daniel, B. L., Kee, S., Norbash, A. M. 1999; 9 (4): 586-595
Abstract

Several methods were investigated to improve the depiction of biopsy needles in radiofrequency (RF)-refocused magnetic resonance imaging. Distortion correction is performed by the use of view angle tilting (VAT): a gradient is employed on the slice-select axis during readout. Needle conspicuity is increased by offsetting the gradient echo from the spin echo and by inverting the 90 degrees RF pulse slice-select gradient. VAT effectively re-registers in-plane shifts. Since this method changes the projection angle through the slice, some structures appear blurred, while other structures appear sharper. VAT does not correct errors in slice selection. Offsetting the spin echo from the gradient echo increases needle conspicuity but can result in a shift in the apparent location of the needle. Inverting the 90 degrees slice-select gradient effectively increases the needle conspicuity with no shift in the needle location. These methods provide an easy and interactive means to manipulate needle artifacts but should be used cautiously.

View details for Web of Science ID 000080145000013

View details for PubMedID 10232519
Magnetic resonance imaging of frozen tissues: Temperature-dependent MR signal characteristics and relevance for MR monitoring of cryosurgery MAGNETIC RESONANCE IN MEDICINE Daniel, B. L., Butts, K., Block, W. F. 1999; 41 (3): 627-630
Abstract

Previously, the magnetic resonance (MR) imaging appearance of frozen tissues created during cryosurgery has been described as a signal void. In this work, very short echo times (1.2 msec) allowed MR signals from frozen tissues to be measured at temperatures down to -35 degrees C. Ex vivo bovine liver, muscle, adipose tissue, and water were imaged at steady-state temperatures from -78 degrees to +6 degrees C. Signal intensity, T2*, and T1 were measured using gradient-echo imaging. Signal intensity and T2* decrease monotonically with temperature. In the future, these MR parameters may be useful for mapping temperatures during cryosurgery.

View details for Web of Science ID 000079317800028

View details for PubMedID 10204889
Magnetic resonance imaging of knee cartilage repair. Topics in magnetic resonance imaging Gold, G. E., Bergman, A. G., Pauly, J. M., Lang, P., Butts, R. K., Beaulieu, C. F., Hargreaves, B., Frank, L., Boutin, R. D., Macovski, A., Resnick, D. 1998; 9 (6): 377-392
Abstract

Cartilage injury resulting in osteoarthritis is a frequent cause of disability in young people. Osteoarthritis, based on either cartilage injury or degeneration, is a leading cause of disability in the United States. Over the last several decades, much progress has been made in understanding cartilage injury and repair. Magnetic resonance (MR) imaging, with its unique ability to noninvasively image and characterize soft tissue, has shown promise in assessment of cartilage integrity. In addition to standard MR imaging methods, MR imaging contrast mechanisms under development may reveal detailed information regarding the physiology and morphology of cartilage. MR imaging will play a crucial role in assessing the success or failure of therapies for cartilage injury and degeneration.

View details for PubMedID 9894740
Breast cancer: Gadolinium-enhanced MR imaging with a 0.5-T open imager and three-point Dixon technique RADIOLOGY Daniel, B. L., Butts, K., Glover, G. H., Cooper, C., Herfkens, R. J. 1998; 207 (1): 183-190
Abstract

To investigate the three-point Dixon technique as a method for obtaining fat-nulled images of contrast material-enhancing breast lesions with a 0.5-T open magnetic resonance (MR) imager.Real and imaginary source images were obtained with an interleaved gradient-echo sequence with a repetition time of 550 msec and echo times of 12.8, 19.8, and 26.8 msec. Twenty-four to 28 sections were obtained in the sagittal plane with a 90 degrees flip angle, 256 x 192 matrix, 3-4.5-mm section thickness, and acquisition time of 10 minutes 54 seconds. A three-point Dixon reconstruction algorithm was used to generate water-specific, fat-specific, and combined images from the raw image data. Twelve breasts in 10 patients and one healthy volunteer were imaged.Three-point Dixon images were superior to extended two-point Dixon and fat-suppressed images and to images generated by means of subtraction of three-dimensional fast spoiled gradient-echo images obtained before contrast material injection from those obtained after.Three-point Dixon imaging provides a robust method for creating fat-nulled images of enhancing breast lesions in the 0.5-T open MR environment. Water-specific three-point Dixon images are successful in regions of B0 heterogeneity and are superior to fat-suppressed images. They are much less susceptible to motion artifact than are subtraction images.

View details for Web of Science ID 000072662500027

View details for PubMedID 9530315
Isotropic diffusion-weighted and spiral-navigated interleaved EPI for routine imaging of acute stroke MAGNETIC RESONANCE IN MEDICINE Butts, K., Pauly, J., deCrespigny, A., Moseley, M. 1997; 38 (5): 741-749
Abstract

An interleaved echo-planar imaging (EPI) technique is presented for the rapid acquisition of isotropic diffusion-weighted images of stroke patients. Sixteen isotropic diffusion-weighted images at three b values are acquired in less than 3 min. A spiral navigator echo is used to measure the constant and linear phase shifts across the head in both the x and y directions which result from motion during the isotropic diffusion- sensitizing gradients. The measured k-space errors are corrected during a gridding reconstruction. The gridding kernel has a constant width in kx and a variable width in ky which eliminates variable data-density ghosts. The resulting isotropic diffusion-weighted images have excellent lesion-to-normal brain contrast, very good spatial resolution, and little sensitivity to susceptibility effects in the base of the brain. Examples of diffusion-weighted images and ADC maps from several stroke patients are shown.

View details for Web of Science ID A1997YD91100009

View details for PubMedID 9358448
Diffusion-weighted interleaved echo-planar imaging with a pair of orthogonal navigator echoes MAGNETIC RESONANCE IN MEDICINE Butts, K., deCrespigny, A., Pauly, J. M., Moseley, M. 1996; 35 (5): 763-770
Abstract

This work describes a diffusion-weighted (DW) interleaved echo-planar imaging (IEPI) method for use on either conventional whole-body scanners or scanners equipped with high-speed gradient and receiver hardware. In combination with cardiac gating and motion correction with a pair of orthogonal navigator echoes, the presented method is time-efficient, compensates for patient motions, and is less sensitive to image distortions than single-shot methods. The motion-correction scheme consists of correction for constant and linear phase terms found from the orthogonal navigator echoes. The correction for the linear phase term in the phase-encode direction includes gridding the data to the Cartesian grid. The DW IEPI was used to image a phantom rotating about the slice-select direction, and motion correction was performed to eliminate ghost artifacts arising from motion in either the readout- or phase-encoding directions. DW IEPI with motion correction was performed on a normal volunteer and on a patient with a 26-day-old region of ischemia over much of the right hemisphere.

View details for Web of Science ID A1996UJ17500017

View details for PubMedID 8722828
Clinical aspects of DWI NMR IN BIOMEDICINE Moseley, M. E., Butts, K., Yenari, M. A., Marks, M., deCrespigny, A. 1995; 8 (7-8): 387-396
Abstract

Diffusion-weighted MR imaging (DWI) is capable of imaging ischemia-induced changes in water protons in either animal or man. Technical developments are described that allow the routine clinical utility of DWI in a stroke setting to provide objective criteria beyond the neurological exam by which the pathophysiology of stroke can be evaluated. To date, DWI has provided unique information concerning detection and evaluation of acute, symptomatic lesions from older, chronic strokes, detection and localization of small deep infarcts and reversible ischemic neurologic deficits and transient ischemia. Clinical DWI studies suggest that the temporal behaviour of ADC can critically improve the evaluation of clinical ischemia.

View details for Web of Science ID A1995UL58700011

View details for PubMedID 8739275
MR-IMAGING OF THE ABDOMEN WITH A PHASED-ARRAY MULTICOIL - PROSPECTIVE CLINICAL-EVALUATION Campeau, N. G., Johnson, C. D., Felmlee, J. P., Rydberg, J. N., Butts, R. K., Ehman, R. L., Riederer, S. J. RADIOLOGICAL SOC NORTH AMERICA. 1995: 769-776
Abstract

To prospectively compare use of a phased-array multicoil and a conventional body coil in abdominal MR imaging.Thirteen patients (seven men, six women; mean age, 55 years) underwent imaging with a phased-array multicoil and with a conventional body coil. Four pulse sequences were used: T2-weighted spin echo (SE), magnetization-prepared gradient-recalled echo (GRE), breath-hold fast SE, and echo planar (EP).Lesion detection improved the most on fast SE, multicoil-acquired images. Signal-to-noise ratio (S/N) increased 64% with fast SE (P = .0005) and EP (P < .0109) sequences. Contrast-to-noise ratio (C/N) doubled (P < .05) with T2-weighted SE sequences. Lesion conspicuity improved on multicoil-acquired images with all fast sequences (magnetization-prepared GRE, P = .015; fast SE, P = .002; EP imaging, P = .013). There was little difference in respiratory and vascular artifact. Depiction of most abdominal structures improved (P < .01).Use of the phased-array multicoil provides better MR images of the abdomen than does use of a conventional body coil.

View details for Web of Science ID A1995QZ80200035

View details for PubMedID 7754009
DUAL-ECHO INTERLEAVED ECHO-PLANAR IMAGING OF THE BRAIN MAGNETIC RESONANCE IN MEDICINE Slavin, G. S., Butts, K., Rydberg, J. N., Jack, C. R., Riederer, S. J. 1995; 33 (2): 264-270
Abstract

An interleaved echo-planar imaging (EPI) technique is described that provides images from 20 sections of the brain at two echo times (27 and 84 ms) in 1:05. Six echoes per image per repetition are collected in 24 repetitions of the pulse sequence. MR images of the brain obtained from five volunteers using the dual-echo EPI sequence, fast spin-echo (FSE), and conventional dual-echo spin-echo were evaluated qualitatively for diagnostic use and quantitatively for relative signal-to-noise ratio (SNR), contrast, and contrast-to-noise ratios (CNR).

View details for Web of Science ID A1995QE69200017

View details for PubMedID 7707919
THE EFFECT OF RESPIRATION ON THE CONTRAST AND SHARPNESS OF LIVER-LESIONS IN MRI MAGNETIC RESONANCE IN MEDICINE Butts, K., Riederer, S. J., Ehman, R. L. 1995; 33 (1): 1-7
Abstract

This work demonstrates the effects of through-plane motion due to respiration on contrast and sharpness of liver lesions in MRI. The effects of slice coverage with and without such respiratory motion is also reported. This work is comprised of two parts: a theoretical prediction of liver-lesion contrast and blur with and without respiration and an experimental validation using gel phantoms of the predicted results. Both theory and experiment show a loss of contrast, increasing with amplitude of the peak-to-peak motion. The loss of contrast for a 5-mm lesion at normal respiration of 15 mm peak-to-peak superior-inferior motion is approximately 10% with a low order sorted respiratory ordered phase encoding acquisition and approximately 50% for an unsorted acquisition. Lesion blur is greatest for the low order sorted acquisition while the unsorted and high sort acquisitions maintain edge definition. Breath-hold imaging is potentially superior to nonbreath-hold imaging in liver lesion contrast and edge definition, but is more sensitive to inadequate slice coverage.

View details for Web of Science ID A1995PZ80800001

View details for PubMedID 7891521
IMAGING OF CEREBRAL ACTIVATION AT 1.5-T - OPTIMIZING A TECHNIQUE FOR CONVENTIONAL HARDWARE RADIOLOGY Thompson, R. M., Jack, C. R., Butts, K., Hanson, D. P., Riederer, S. J., Ehman, R. L., HYNES, R. W., Hangiandreou, N. J. 1994; 190 (3): 873-877
Abstract

To empirically optimize a two-dimensional magnetic resonance (MR) imaging technique for detecting changes in signal intensity during cerebral activation with a standard clinical imager.Visual activation experiments were performed while imaging parameters were manipulated in a serial fashion, to test their effect on the percentage change in signal intensity (PCSI). The parameters tested were section thickness, echo time (TE), field of view (FOV), flip angle, radio-frequency (RF) spoiling, number of readout points, and number of signals averaged.The PCSI for visual activation experiments was typically in the 1%-5% range. The best results were achieved with a small section thickness, long TE, and large FOV. Variations in other acquisition parameters had a negligible influence on the PCSI.Good results can be obtained at functional MR imaging with standard 1.5-T hardware. Markedly improved results can be obtained by optimizing several key variables, namely, section thickness, TE, and FOV.

View details for Web of Science ID A1994MX69800049

View details for PubMedID 8115643
SENSORY-MOTOR CORTEX - CORRELATION OF PRESURGICAL MAPPING WITH FUNCTIONAL MR-IMAGING AND INVASIVE CORTICAL MAPPING RADIOLOGY Jack, C. R., Thompson, R. M., Butts, R. K., Sharbrough, F. W., Kelly, P. J., Hanson, D. P., Riederer, S. J., Ehman, R. L., Hangiandreou, N. J., Cascino, G. D. 1994; 190 (1): 85-92
Abstract

To describe a clinically useful application of functional magnetic resonance (MR) imaging--presurgical mapping of the sensory motor cortex--and to validate the results with established physiologic techniques.Functional MR mapping of the sensory motor cortex was performed in two women, aged 24 and 38 years. Both had intractable, simple partial motor seizures due to tumors located in or near the sensory motor cortex. They subsequently underwent invasive cortical mapping--direct cortical stimulation and/or sensory-evoked-potential recording--to localize the affected sensory motor area prior to tumor resection.In both patients, the functional MR study demonstrated task activation of the sensory motor cortex. In both cases, results of cortical functional mapping with invasive techniques matched those obtained with functional MR imaging.Presurgical mapping of the sensory motor cortex is a potentially useful clinical application of functional MR imaging.

View details for Web of Science ID A1994MW25300019

View details for PubMedID 8259434
INTERLEAVED ECHO-PLANAR IMAGING ON A STANDARD MRI SYSTEM MAGNETIC RESONANCE IN MEDICINE Butts, K., Riederer, S. J., Ehman, R. L., Thompson, R. M., Jack, C. R. 1994; 31 (1): 67-72
Abstract

This work describes an interleaved echo planar imaging (EPI) method for use on a standard whole body scanner. The data acquisition is divided into two to eight repetitions rather than one to two, as implemented by dedicated EPI systems. Interleaving allows the use of a lower sampling bandwidth with a significant increase in signal-to-noise. The method also has the advantages of relative ease of implementation, no need for postprocessing to remove image distortion, and no need for shimming on a case-by-case basis. The interleaved EPI method was applied to two applications ideally suited to EPI: breathhold T2-weighted abdominal imaging and functional imaging. In vivo liver-lesion contrast as measured in a 35-patient study showed increased contrast for the interleaved EPI by an average factor of 1.21 (+/- 0.34) over conventional spin-echo imaging. CNR measurements showed the EPI to be comparable with conventional spin echo with a relative factor of 1.00 (+/- 0.36). Functional imaging with an eight-shot interleaved EPI sequence provided 128 x 128 images of cerebral activation during bilateral finger tapping.

View details for Web of Science ID A1994MP54200010

View details for PubMedID 8121272
ECHO-PLANAR IMAGING OF THE LIVER WITH A STANDARD MR-IMAGING SYSTEM RADIOLOGY Butts, K., Riederer, S. J., Ehman, R. L., Felmlee, J. P., Grimm, R. C. 1993; 189 (1): 259-264
Abstract

A multisection, whole-body echo-planar imaging (EPI) sequence was developed to obtain T2-weighted images of the liver in one 18-second breath hold with a standard magnetic resonance (MR) imaging system.This capability was achieved by dividing the data acquisition period into eight interleaved segments rather than one or two as implemented previously with EPI systems having high-power gradient subsystems.The interleaved echo-planar images had excellent depiction of anatomy and no identifiable respiratory artifact. In 26 lesions in 12 patients, the eight-shot echo-planar images (2,000/66 [repetition time msec/echo time msec]) had superior contrast compared with conventional T2-weighted spin-echo (SE) images (2,500/60) by an average factor of 1.22 +/- 0.31 (standard deviation) and an average contrast-to-noise ratio relative to conventional T2-weighted SE images of 0.85 +/- 0.22.With a conventional MR imaging system, breath-hold T2-weighted echo-planar images of the liver are comparable in diagnostic quality to conventional T2-weighted SE images.

View details for Web of Science ID A1993LY02300051

View details for PubMedID 8396785
PHASE-VELOCITY MAPPING WITH A REAL-TIME LINE SCAN TECHNIQUE MAGNETIC RESONANCE IN MEDICINE Butts, K., Hangiandreou, N. J., Riederer, S. J. 1993; 29 (1): 134-138
Abstract

A real-time, 20-Hz, one-dimensional MR velocity imaging technique is described. A two-dimensional RF pulse excites a 3-cm diameter column. Velocity maps are formed from the phase difference between successive flow encoded and compensated acquisitions. A three-point subtraction variation provides reduced sensitivity to static spins.

View details for Web of Science ID A1993KJ34900023

View details for PubMedID 8419735
ANALYSIS OF FLOW EFFECTS IN ECHO-PLANAR IMAGING JOURNAL OF MAGNETIC RESONANCE IMAGING Butts, K., Riederer, S. J. 1992; 2 (3): 285-293
Abstract

The effects on the phase of spins moving during echo-planar imaging (EPI) acquisition were studied. Standard single-shot and interleaved multishot blipped EPI acquisitions were considered, assuming either high gradient strength and slew rates or standard gradient strength and slew rates. A spiral k-space trajectory was also considered. Flow components in the section-select and phase- and frequency-encoding directions were analyzed separately. While the effect of flow in the section-select direction is identical to that in a standard two-dimensional Fourier transform (2DFT) acquisition, flow in the phase- or frequency-encoding directions can have substantial effects on the image, different from that in 2DFT imaging. The magnitude of these effects, which include displacement, distortion, and/or ghosting of vascular structures, is analyzed and predicted for a given velocity and direction of flow, the specific acquisition sequence, and the strength and slew rate of the gradients. For example, 50-cm/sec flow along the phase-encoding direction can cause a blurring of 1.25 cm full width at half maximum for blipped EPI with high-strength gradients, assuming a 40-cm field of view and 64 x 64 matrix.

View details for Web of Science ID A1992HV08100005

View details for PubMedID 1627863
T2-WEIGHTED SPIN-ECHO PULSE SEQUENCE WITH VARIABLE REPETITION AND ECHO TIMES FOR REDUCTION OF MR IMAGE ACQUISITION TIME RADIOLOGY Butts, R. K., Farzaneh, F., Riederer, S. J., Rydberg, J. N., Grimm, R. C. 1991; 180 (2): 551-556
Abstract

Use of intraacquisition modification of pulse-sequence parameters to reduce acquisition time for conventional T2-weighted spin-echo images was evaluated. With this technique (variable-rate spin-echo pulse sequence), the repetition time and echo time (TR msec/TE msec) were reduced during imaging as a function of the phase-encoding view. To maintain T2-based contrast, TR and TE for the low-spatial-frequency views were left at their prescribed values (eg, 2,000/80). TR and TE for the high-spatial-frequency views were progressively reduced during imaging (eg, to 1,000/20). Acquisition time was reduced by as much as 25%. In one pulse sequence, the duration of multisection imaging nominally performed at TR 2,000 and with 256 phase-encoding views was reduced from 9 minutes 30 seconds to 6 minutes 30 seconds. In all sequences, edges and small structures were enhanced, and T2 contrast was somewhat decreased in high spatial frequencies. Filtering of the raw data before reconstruction can suppress these effects and provide a net increase in contrast-to-noise ratio.

View details for Web of Science ID A1991FW93300051

View details for PubMedID 2068326

Professor of Radiology (General Radiology) and, by courtesy, of Bioengineering and of Electrical Engineering

Bio

Academic Appointments

Administrative Appointments

Honors & Awards

Boards, Advisory Committees, Professional Organizations

Professional Education

Contact

Links

Research & Scholarship

Current Research and Scholarly Interests

Teaching

2016-17 Courses

2015-16 Courses

2014-15 Courses

2013-14 Courses

Stanford Advisees

Graduate and Fellowship Programs

Publications

All Publications

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract