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IntroductionInterventional cardiac MRI in the context of the treatment of cardiac arrhythmia requires submillimeter image resolution to precisely characterize the cardiac substrate and guide the catheter-based ablation procedure in real-time. Conventional MRI receiver coils positioned on the thorax provide insufficient signal-to-noise ratio (SNR) and spatial selectivity to satisfy these constraints.MethodsA small circular MRI receiver coil was developed and evaluated under different experimental conditions, including high-resolution MRI anatomical and thermometric imaging at 1.5 T. From the perspective of developing a therapeutic MR-compatible catheter equipped with a receiver coil, we also propose alternative remote active detuning techniques of the receiver coil using one or two cables. Theoretical details are presented, as well as simulations and experimental validation.ResultsAnatomical images of the left ventricle at 170 µm in-plane resolution are provided on ex vivo beating heart from swine using a 2 cm circular receiver coil. Taking advantage of the increase of SNR at its vicinity (up to 35 fold compared to conventional receiver coils), real-time MR-temperature imaging can reach an uncertainty below 0.1°C at the submillimetric spatial resolution. Remote active detuning using two cables has similar decoupling efficiency to conventional on-site decoupling, at the cost of an acceptable decrease in the resulting SNR.DiscussionThis study shows the potential of small dimension surface coils for minimally invasive therapy of cardiac arrhythmia intraoperatively guided by MRI. The proposed remote decoupling approaches may simplify the construction process and reduce the cost of such single-use devices.

Cardiac MR thermometry shows promise for real-time guidance of radiofrequency ablation of cardiac arrhythmias. This technique uses ECG triggering, which can be unreliable in this situation. A prospective cardiac triggering method was developed for MR thermometry using the active tracking (AT) signal measured from catheter microcoils. In the proposed AT-based cardiac triggering (AT-trig) sequence, AT modules were repeatedly acquired to measure the catheter motion until a cardiac trigger was identified to start cardiac MR thermometry using single-shot echo-planar imaging. The AT signal was bandpass filtered to extract the motion induced by the beating heart, and cardiac triggers were defined as the extremum (peak or valley) of the filtered AT signal. AT-trig was evaluated in a beating heart phantom and in vivo in the left ventricle of a swine during temperature stability experiments (6 locations) and during one ablation. Stability was defined as the standard deviation over time. In the phantom, AT-trig enabled triggering of MR thermometry and resulted in higher temperature stability than an untriggered sequence. In all in vivo experiments, AT-trig intervals matched ECG-derived RR intervals. Mis-triggers were observed in 1/12 AT-trig stability experiments. Comparable stability of MR thermometry was achieved using peak AT-trig (1.0 ± 0.4°C), valley AT-trig (1.1 ± 0.5°C), and ECG triggering (0.9 ± 0.4°C). These experiments show that continuously acquired AT signal for prospective cardiac triggering is feasible. MR thermometry with AT-trig leads to comparable temperature stability as with conventional ECG triggering. AT-trig could serve as an alternative cardiac triggering strategy in situations where ECG triggering is not effective.

• Practical measures to achieve robust real-time MR thermometry during clinical hepatic microwave ablations are described. • Quality Assurance protocol was developed ensuring consistent high quality imaging during MR-guided microwave procedures. • Imaging protocol was modified to account for respiratory movement and reduce respiratory motion artifact. • These measures consistently reduced image noise and artifacts improving safety and effectiveness of microwave treatments. Practical non-invasive equipment modifications and effective acquisition methods to achieve robust and reliable real-time MR thermometry for monitoring of clinical hepatic microwave ablations were implemented. These included selection of the microwave generator location (inside versus outside the MR scan room), the number of radiofrequency chokes added to the microwave generator's coaxial lines, and the use of copper wool to maximize their electrical grounding. Signal-to-noise ratio (SNR) of MR thermometry images of a small fluid-filled phantom acquired during activation of microwave antenna were used to evaluate image quality as a function of each modification. SNR measurements corresponding to both locations of the microwave generator were comparable and so it was located outside the MR scan room. For this location, addition of one RF choke on the power and four chokes on the sensor coaxial lines was found to be optimal, corresponding to a 68% increase in SNR. Furthermore, image quality strongly depended on the proper electrical grounding of the power and sensor lines. SNR ratio (relative to SNR of baseline images) during activation of microwave generator was found to be 0.49 ± 0.28 without adequate grounding, and 0.88 ± 0.08 with adequate grounding (p = 0.002, Student's t -test). These SNR measurements were sufficiently sensitive to detect issues related to equipment performance and hence formed part of the quality assurance testing performed prior to each clinical treatment. Incorporating these non-invasive approaches resulted in significant improvements to image quality and, importantly while maintaining the clinical integrity of the microwave system which is of paramount importance in a highly regulated healthcare environment. [ABSTRACT FROM AUTHOR]

Introduction: Interventional cardiac MRI in the context of the treatment of cardiac arrhythmia requires submillimeter image resolution to precisely characterize the cardiac substrate and guide the catheter-based ablation procedure in real-time. Conventional MRI receiver coils positioned on the thorax provide insufficient signal-to-noise ratio (SNR) and spatial selectivity to satisfy these constraints., Methods: A small circular MRI receiver coil was developed and evaluated under different experimental conditions, including high-resolution MRI anatomical and thermometric imaging at 1.5 T. From the perspective of developing a therapeutic MR-compatible catheter equipped with a receiver coil, we also propose alternative remote active detuning techniques of the receiver coil using one or two cables. Theoretical details are presented, as well as simulations and experimental validation., Results: Anatomical images of the left ventricle at 170 µm in-plane resolution are provided on ex vivo beating heart from swine using a 2 cm circular receiver coil. Taking advantage of the increase of SNR at its vicinity (up to 35 fold compared to conventional receiver coils), real-time MR-temperature imaging can reach an uncertainty below 0.1°C at the submillimetric spatial resolution. Remote active detuning using two cables has similar decoupling efficiency to conventional on-site decoupling, at the cost of an acceptable decrease in the resulting SNR., Discussion: This study shows the potential of small dimension surface coils for minimally invasive therapy of cardiac arrhythmia intraoperatively guided by MRI. The proposed remote decoupling approaches may simplify the construction process and reduce the cost of such single-use devices., Competing Interests: MD did part of her Ph.D as an employee of Siemens Healthineers. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Marhabaie, Delcey, El Hamrani, Vaillant, Ginefri, Ozenne, Abell, Poirier-Quinot and Quesson.)

Purpose: To correlate the accumulated thermal dose (ATD) with lesion size in magnetic resonance (MR)‐guided focused ultrasound (MRgFUS) thalamotomy to help guide future clinical treatments. Materials and Methods: Thirty‐six patients with medication‐refractory essential tremor were treated using a commercial MRgFUS brain system (ExAblate 4000, InSightec) in a 3T MR scanner (MR750, GE Healthcare). Intraoperative MR‐thermometry was performed to measure the induced temperature and thermal dose distributions (thermal coefficient = −0.00909 ppm/°C). The ATD was calculated over multiple sonications with appropriate corrections for spatial‐shifting artifacts. The ATD profile sizes obtained for dose values of 17, 40, 100, 200, and 240 cumulative equivalent minutes at 43°C (CEM) were correlated with the corresponding lesion sizes measured via axial T1‐ and T2‐weighted MR images acquired 1 day post‐treatment. Results: Of a total of 232 included sonications, 83 required corrections for off‐resonance‐induced spatial‐shifting artifacts (correction range = [1.1,2.2] mm). The mean lesion sizes measured on T2‐weighted MR images (6.2 ± 1.3 mm, mean ± SD) were 15% larger than those measured on corresponding T1‐weighted MR images (5.3 ± 1.2 mm, mean ± SD). The ATD values that provided the best correlations with the measured lesion sizes on T2‐ and T1‐weighted MR images were 100 and 200 CEM, respectively. Conclusion: The ATD was correlated with lesion size measured 1 day following MRgFUS thalamotomy for essential tremor. These data provide useful information for predicting brain lesion size and determining treatment endpoints in future clinical MRgFUS procedures. [ABSTRACT FROM AUTHOR]

Proton resonance frequency shift-based magnetic resonance thermometry is a currently used technique for monitoring temperature during targeted thermal therapies. However, in order to provide temperature updates with very short latency times, fast MR acquisition schemes are usually employed, which in turn might lead to noisy temperature measurements. This will, in general, have a direct impact on therapy control and endpoint detection. In this paper, we address this problem through an improved non-local filtering technique applied on the temperature images. Compared with previous non-local filtering methods, the proposed approach considers not only spatial information but also exploits temporal redundancies. The method is fully automatic and designed to improve the precision of the temperature measurements while at the same time maintaining output accuracy. In addition, the implementation was optimized in order to ensure real-time availability of the temperature measurements while having a minimal impact on latency. The method was validated in three complementary experiments: a simulation, an ex-vivo and an in-vivo study. Compared to the original non-local means filter and two other previously employed temperature filtering methods, the proposed approach shows considerable improvement in both accuracy and precision of the filtered data. Together with the low computational demands of the numerical scheme, the proposed filtering technique shows great potential for improving temperature measurements during real-time MR thermometry dedicated to targeted thermal therapies. [ABSTRACT FROM PUBLISHER]

Laser ablation (LA) is a minimally invasive technique for the treatment of tumors as an alternative to surgical resection. The light absorbed by tissue is converted into heat, and causes irreversible cell damage when temperatures higher than 60 °C are reached. The knowledge in real time of temperature may be particularly beneficial for adjusting laser settings applied during treatment and to be notified in real time about its end-point. As a consequence, several techniques for temperature monitoring within the tissue have been investigated along the last decades. In the field of LA, particularly attractive are non-invasive methods. Among these techniques, thermometry based on the analysis of Magnetic Resonance Imaging (MR-thermometry) has gaining large acceptance in this field. MR-thermometry allows estimating the temperature variation thanks to the thermal dependence of several MRI parameters, among others the most promising are T 1 relaxation time, and proton resonance frequency shift. The aim of this study is to assess the sensitivity of MRI thermometry using three T 1 -weighted sequences (i.e., Inversion Recovery Turbo-FLASH, IRTF, Saturation Recovery Turbo-FLASH, SRTF, and FLASH) using an 1.5-T MR scanner on healthy swine pancreases undergoing LA. The reference temperature was measured by MRI-compatible fiber optic sensors (fiber Bragg grating sensors). The sensitivity of the proposed techniques was estimated and compared. The thermal sensitivity of the three sequences was −1.47 ± 0.08 °C −1 , −0.95 ± 0.05 °C −1 , and −0.56 ± 0.04 °C −1 for IRTF, SRTF and FLASH, respectively. Results show that the proposed technique may be adequate for temperature monitoring during LA. [ABSTRACT FROM AUTHOR]

Thin-film micro-coils are integrated with commercially available ablation catheters, for MR-thermometry during laser interstitial thermal therapies (LITTs). The coils are formed on a flexible polyimide substrate and consist of a two-turn electroplated copper inductor and integrated parallel plate capacitors for tuning and matching. Their performance was assessed during Nd:YAG laser ablations in a static phantom study carried out in a 3 T clinical scanner. Further moving phantom studies were performed to calculate errors due to motion. The temperature accuracy is improved by 1.5–10 times in a radius matching the dimensions of the lesions typically treated. Resolution of 1 mm can be maintained during motion by using short acquisition time sequences while the SNR remains sufficient for accurate MR-thermometry. The temperature error on a moving un-heated phantom under respiratory gating does not exceed 1 °C. This demonstration suggests a possible improvement of the overall control of MR-guided LITTs by local temperature monitoring. [ABSTRACT FROM AUTHOR]

Purpose: Flexible microcoils integrated with ablation catheters can improve the temperature accuracy during local MR-thermometry in Nd:YAG laser interstitial thermal therapies. Here, the authors are concerned with obtaining a preliminary confirmation of the clinical utility of the modified catheter. They investigate whether the thin-film substrate and copper tracks of the printed coil inductor affect the symmetry of the thermal profile, and hence of the lesion produced. Methods: Transmission spectroscopy in the near infrared was performed to test for the attenuation at 1064 nm through the 25 jum thick Kapton substrate of the microcoil. The radial transmission profile of an infrared high-power, light emitting diode with >80% normalized power at 1064 nm was measured through a cross section of the modified applicator to assess the impact of the copper inductor on the optical profile. The measurements were performed in air, as well as with the applicator surrounded by two types of scattering media; crystals of NaCl and a layer of liver-mimicking gel phantom. A numerical model based on Huygens-Fresnel principle and finite element simulations, using a commercially available package (COMSOL Multiphysics), were employed to compare with the optical measurements. The impact of the modified optical profile on the thermal symmetry was assessed by examining the high resolution microcoil derived thermal maps from a Nd:YAG laser ablation performed on a liver-mimicking gel phantom. Results: Less than 30% attenuation through the Kapton film was verified. Shadowing behind the copper tracks was observed in air and the measured radial irradiation correlated well with the diffraction pattern calculated numerically using the Huygens-Fresnel principle. Both optical experiments and simulations, demonstrate that shadowing is mitigated by the scattering properties of a turbid medium. The microcoil derived thermal maps at the end of a Nd:YAG laser ablation performed on a gel phantom in a 3 T scanner confirm that the modified irradiation pattern does not disrupt the thermal symmetry, even though, unlike tissue, the gel is minimally scattering. Conclusions: The results from this initial assessment indicate that microcoils can be safely integrated with ablation catheters and ensure that the complete necrosis of the liver tumor can still be achieved. [ABSTRACT FROM AUTHOR]

Cardiac MR thermometry shows promise for real-time guidance of radiofrequency ablation of cardiac arrhythmias. This technique uses ECG triggering, which can be unreliable in this situation. A prospective cardiac triggering method was developed for MR thermometry using the active tracking (AT) signal measured from catheter microcoils. In the proposed AT-based cardiac triggering (AT-trig) sequence, AT modules were repeatedly acquired to measure the catheter motion until a cardiac trigger was identified to start cardiac MR thermometry using single-shot echo-planar imaging. The AT signal was bandpass filtered to extract the motion induced by the beating heart, and cardiac triggers were defined as the extremum (peak or valley) of the filtered AT signal. AT-trig was evaluated in a beating heart phantom and in vivo in the left ventricle of a swine during temperature stability experiments (6 locations) and during one ablation. Stability was defined as the standard deviation over time. In the phantom, AT-trig enabled triggering of MR thermometry and resulted in higher temperature stability than an untriggered sequence. In all in vivo experiments, AT-trig intervals matched ECG-derived RR intervals. Mis-triggers were observed in 1/12 AT-trig stability experiments. Comparable stability of MR thermometry was achieved using peak AT-trig (1.0 ± 0.4°C), valley AT-trig (1.1 ± 0.5°C), and ECG triggering (0.9 ± 0.4°C). These experiments show that continuously acquired AT signal for prospective cardiac triggering is feasible. MR thermometry with AT-trig leads to comparable temperature stability as with conventional ECG triggering. AT-trig could serve as an alternative cardiac triggering strategy in situations where ECG triggering is not effective., Competing Interests: Author RMo was seconded to and RN was employed by Siemens Healthcare Ltd. RS and AK were employed by Siemens Healthcare GmbH. KE, JS, and TL were employed by Imricor Medical Systems. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mooiweer, Schneider, Krafft, Empanger, Stroup, Neofytou, Mukherjee, Williams, Lloyd, O'Neill, Razavi, Schaeffter, Neji and Roujol.)

Purpose: MR thermometry based on the proton resonance frequency shift (PRFS) is the most commonly used method for the monitoring of thermal therapies. As the chemical shift of water protons is temperature dependent, the local temperature variation (relative to an initial baseline) may be calculated from time-dependent phase changes in gradient-echo (GRE) MR images. Dynamic phase shift in GRE images is also produced by time-dependent changes in the magnetic bulk susceptibility of tissue. Gas bubbles (known as “white cavitation”) are frequently visualized near the RF electrode in ultrasonography-guided radio frequency ablation (RFA). This study aimed to investigate RFA-induced cavitation’s effects by using simultaneous ultrasonography and MRI, to both visualize the cavitation and quantify the subsequent magnetic susceptibility-mediated errors in concurrent PRFS MR-thermometry (MRT) as well as to propose a first-order correction for the latter errors. Methods: RF heating in saline gels and in ex vivo tissues was performed with MR-compatible bipolar and monopolar electrodes inside a 1.5 T MR clinical scanner. Ultrasonography simultaneous to PRFS MRT was achieved using a MR-compatible phased-array ultrasonic transducer. PRFS MRT was performed interleaved in three orthogonal planes and compared to measurements from fluoroptic sensors, under low and, respectively, high RFA power levels. Control experiments were performed to isolate the main source of errors in standard PRFS thermometry. Results: Ultrasonography, MRI and digital camera pictures clearly demonstrated generation of bubbles every time when operating the radio frequency equipment at therapeutic powers (>=30 W). Simultaneous bimodal (ultrasonography and MRI) monitoring of high power RF heating demonstrated a correlation between the onset of the PRFS-thermometry errors and the appearance of bubbles around the applicator. In an ex vivo study using a bipolar RF electrode under low power level (5 W), the MR measured temperature curves accurately matched the reference fluoroptic data. In similar ex vivo studies when applying higher RFA power levels (30 W), the correlation plots of MR thermometry versus fluoroptic data showed large errors in PRFS-derived temperature (up to 45 °C absolute deviation, positive or negative) depending not only on fluoroptic tip position but also on the RF electrode orientation relative to the B0 axis. Regions with apparent decrease in the PRFS-derived temperature maps as much as 30 °C below the initial baseline were visualized during RFA high power application. Ex vivo data were corrected assuming a Gaussian dynamic source of susceptibility, centered in the anode/cathode gap of the RF bipolar electrode. After correction, the temperature maps recovered the revolution symmetry pattern predicted by theory and matched the fluoroptic data within 4.5 °C mean offset. Conclusions: RFA induces dynamic changes in magnetic bulk susceptibility in biological tissue, resulting in large and spatially dependent errors of phase-subtraction-only PRFS MRT and unexploitable thermal dose maps. These thermometry artifacts were strongly correlated with the appearance of transient cavitation. A first-order dynamic model of susceptibility provided a useful method for minimizing these artifacts in phantom and ex vivo experiments. [ABSTRACT FROM AUTHOR]

• Deep learning is used for on-line correction of motion artifacts in MR-thermometry • A convolutional neural network (CNN) learns the apparent temperature perturbation • The proposed approach is evaluated on the liver of 12 healthy volunteers • The proposed method is evaluated on a heating experiment performed on a porcine liver • The proposed method is compared to two frequently employed multi-baseline strategies Real-time MR-imaging has been clinically adapted for monitoring thermal therapies since it can provide on-the-fly temperature maps simultaneously with anatomical information. However, proton resonance frequency based thermometry of moving targets remains challenging since temperature artifacts are induced by the respiratory as well as physiological motion. If left uncorrected, these artifacts lead to severe errors in temperature estimates and impair therapy guidance. In this study, we evaluated deep learning for on-line correction of motion related errors in abdominal MR-thermometry. For this, a convolutional neural network (CNN) was designed to learn the apparent temperature perturbation from images acquired during a preparative learning stage prior to hyperthermia. The input of the designed CNN is the most recent magnitude image and no surrogate of motion is needed. During the subsequent hyperthermia procedure, the recent magnitude image is used as an input for the CNN-model in order to generate an on-line correction for the current temperature map. The method's artifact suppression performance was evaluated on 12 free breathing volunteers and was found robust and artifact-free in all examined cases. Furthermore, thermometric precision and accuracy was assessed for in vivo ablation using high intensity focused ultrasound. All calculations involved at the different stages of the proposed workflow were designed to be compatible with the clinical time constraints of a therapeutic procedure. [ABSTRACT FROM AUTHOR]