Focused ultrasound for treatment of bone tumours

MRI-guided focused ultrasound ablation of lumbar medial branch nerve: Feasibility and safety study in a swine model

“…When targeting the MB nerve using an extracorporeal FUS system, the cortical bone of the vertebral body and the transverse and superior articular processes are likely to serve as natural absorbers of ultrasound energy, preventing a significant portion of the far-field ultrasound beam from reaching the critical neural structures. Nonetheless, when using the clinical FUS system, which operates at a lower frequency of 1.35 MHz, an obvious concern is inadvertent damage of the spinal cord or exiting nerve root structures, which typically precludes the clinical application of MRgFUS in patients with spinal tumors [26]. In this work, the in vivo acute study demonstrated that the selected acoustic parameters and the targeting strategy did not damage the spinal cord and the lumbar nerve roots.…”

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

“…74 A recent article reviewed the clinical applications of FUS and provided a comprehensive overview of HIFU employment on bone tumours, describing background, results of clinical studies and suggesting future directions. 75 MRgFUS has been first proposed with a potential in pain palliation of bone metastases, for its good results in patients non-responding to radiotherapy while applying acoustic energy on the bone surface resulting in bone cortex heating, and indirectly ablating the adjacent periosteum-the most innervated component of mature bone tissue, and tumour tissue, and a major source of pain. 11,76 The bone is a common site for metastasis.…”

“…Major complications were reported in the ranges of 0%, 0-28% and 0-4% for primary benign, malignant and metastatic tumours, respectively. 75 Degenerative diseases Osteoarthritis (OA) is a common, disabling and costly disease. The predominant symptom is pain.…”

“…Overall, the data provide strong evidence that FUS is safe for treatment of bone metastases and primary benign lesions, whereas other applications are still under investigation. 75 Adverse events of extracorporeal USgHIFU therapy were also reported. 158,159 One last issue deserves special consideration: the use of contrast agents before HIFU treatment.…”

Heat and sound: focused ultrasound in the clinic

“…This is being used to cause neurolysis to palliate the pain caused by bone metastases [13,14]. More than 1000 such patients have now been treated [15].…”