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Background: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) uses intraoperative temperature mapping and thermal damage estimates to guide ablations of intracranial targets. In select cases, signal artifact presents at the target site and impairs intraprocedural decision-making by obscuring the visualization of both temperature imaging and the thermal damage estimate calculation. To date, the etiology and impact of signal artifact are unknown. However, user-selected MRgLITT software settings may play a role in generating artifact., Objective: To assess the effect of the thresholding feature in MRgLITT software on signal artifact generation during intracranial ablations., Methods: Ablations were performed with the Visualase MRI-guided Laser Ablation System (Medtronic). For each LITT procedure, raw thermal data were extracted at a reference threshold of 40 and reprocessed at 5 additional threshold values ranging from 35 to 60. Artifact growth rates relative to threshold values were derived using simple linear regressions and then assessed within the context of laser power and duration using Pearson correlations., Results: A total of 33 patients were included, with 28 artifact-containing and 5 artifact-free cases. For artifact-containing cases, a 13% increase in artifact area occurred for every 1-point increase in threshold (R2 > 0.99). Artifact growth rates were not correlated with laser power (r = 0.15, P = .44) or duration (r = 0.0049, P = .98). One of the 5 artifact-free cases developed artifact at a threshold of 60., Conclusion: Artifact generation is likely multifactorial involving tissue properties and software settings. Operators can minimize software-introduced artifact by reducing threshold values., (Copyright © Congress of Neurological Surgeons 2021. All rights reserved.)

Background: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive procedure that utilizes intraoperative magnetic resonance thermal imaging (MRTI) to generate a thermal damage estimate (TDE) of the ablative area. In select cases, the MRTI contains a signal artifact or defect that distorts the ablative region. No study has attempted to characterize this artifact., Objective: To characterize MRTI signal the artifact in select cases to better understand its potential relevance and impact on the ablation procedure., Methods: All ablations were performed using the Visualase magnetic resonance imaging-guided laser ablation system (Medtronic). Patients were included if the MRTI contained signal artifact that distorted the ablative region during the first thermal dose delivered. Ablation artifact was quantified using MATLAB version R2018a (Mathworks Inc, Natick, Massachusetts)., Results: A total of 116 patients undergoing MRgLITT for various surgical indications were examined. MRTI artifact was observed in 37.0% of cases overall. Incidence of artifact was greater at higher powers (P < .001) and with longer ablation times (P = .024), though artifact size did not correlate with laser power or ablation duration., Conclusion: MRTI signal artifact is common during LITT. Higher powers and longer ablation times result in greater incidence of ablation artifact, though artifact size is not correlated with power or duration. Future studies should aim to evaluate effects of artifact on postoperative imaging and, most notably, patient outcomes., (Copyright © 2020 by the Congress of Neurological Surgeons.)

Background: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive procedure that utilizes intraoperative magnetic resonance thermal imaging (MRTI) to generate a thermal damage estimate (TDE) of the ablative area. In select cases, the MRTI contains a signal artifact or defect that distorts the ablative region. No study has considered the impact of this artifact on TDE accuracy., Objective: To determine the effect of intraoperative MRTI signal artifact on postoperative magnetic resonance imaging (MRI)-predicted ablative area., Methods: All ablations were performed using the Visualase MRI-Guided Laser Ablation System (Medtronic). Patients were grouped based on whether the intraoperative MRTI contained signal artifact that distorted the ablative region. Cross-sectional area of the ablative lesion from the MRI image was measured, and the difference between intraoperative TDE and postoperative MRI cross-sectional area was calculated and compared between groups with and without intraoperative MRTI artifact., Results: A total of 91 patients undergoing MRgLITT for various surgical indications were examined. MRTI artifact was observed in 43.9% of cases overall. The mean absolute difference between TDE and the postoperative MRI cross-sectional area was 94.8 mm2 (SEM = 11.6) in the group with intraoperative MRTI artifact and 54.4 mm2 (SEM = 5.5) in the nonartifact group., Conclusion: MRTI signal artifact is common during LITT. The presence of signal artifact during intraoperative MRTI results in higher variation between intraoperative TDE and postoperative MRI cross-sectional ablative area. In cases in which intraoperative MRTI artifact is observed, there may be a larger degree of variation between observed intraoperative TDE and measured postoperative MRTI ablative area., (Copyright © 2019 by the Congress of Neurological Surgeons.)