Treatment of Low-Flow Vascular Malformations of the Extremities Using MR-Guided High Intensity Focused Ultrasound: Preliminary Experience

Ghanouni, Pejman; Kishore, Sirish; Lungren, Matthew P.; Bitton, Rachelle; Chan, Lauren; Avedian, Raffi S.; Bazzocchi, Alberto; Pauly, Kim Butts; Napoli, Alessandro; Hovsepian, David M.

doi:10.1016/j.jvir.2017.06.002

Cited by 17 publications

(12 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ghanouni et al [ 12 ] presented results of MR-HIFU treatments of four patients with vascular malformations. The vascular malformations were located in the thigh or calf at an average focal depth of 14.9 cm.…”

Section: Case Presentationmentioning

confidence: 99%

“…Ghanouni et al [ 12 ] from Stanford University presented results of MR-HIFU ablation of slow-flow vascular malformations obtained in four patients during the 15th International Symposium of Therapeutic Ultrasound 2015 in Utrecht, The Netherlands. The average ratio of the non-perfused volume to the total tumor volume was 2.6 (range 0.75–7.4).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report

et al. 2015

View full text Add to dashboard Cite

IntroductionTherapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization. However, these techniques are invasive with possible complications and require hospitalization. We present a novel non-invasive technique, i.e., magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, for the treatment of a vascular malformation in a patient. This technique applies high-intensity sound waves transcutaneously to the body and is fully non-invasive. MRI guidance is the novel aspect of HIFU treatments and is used for exquisite delineation and localization of the lesion and accurate real-time temperature monitoring during tissue ablation. MR-HIFU is a well-established treatment option for uterine fibroids and is currently being investigated for, e.g., bone tumors, breast cancer, prostate cancer, and liver cancer. MR-HIFU of vascular malformations has not been a topic of research yet.Case descriptionVolumetric MR-HIFU ablation of a vascular malformation in the lower extremity of an 18-year-old male patient was performed. Temperatures of 62–80 °C were reached in the target lesion with sonications of 4 × 4 × 8 mm using powers of 200 W for <20 s. At 1-month follow-up, the patient reported qualitatively sustained reduction of pain and normal motor function. Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume. After 13 months, pain score was reduced to <2 after extreme exertion for several hours and to 0 for daily activities.Discussion and evaluationRadiofrequency ablation and cryoablation are minimally invasive techniques that have been tried on low-flow vascular malformations with inconsistent results. Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization. Since MR-HIFU is truly non-invasive, these risks are negligible.ConclusionsIn conclusion, we reported a successful non-invasive treatment of a vascular malformation with MR-HIFU in a clinical patient including long-term follow-up data for the first time. The patient reported qualitatively sustained pain reduction up to 13 months post treatment.

show abstract

Section: Case Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report

et al. 2015

View full text Add to dashboard Cite

show abstract

“…In contrast to applications in functional neurosurgery and neuro-oncology (5, 6) HIFU for intracranial vascular lesions is less studied and no investigation of brain AVM has been published. However, data from peripheral vascular ablation by focused ultrasound in both animal models and man is encouraging (7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Focused Ultrasound Ablation of an Arteriovenous Malformation Model

et al. 2021

View full text Add to dashboard Cite

Brain AVMs are rare but serious vascular lesions that often pose a management dilemma between the risk of various treatment modalities and uncertain natural history during observation. We describe preliminary data on the use of focused ultrasound as a novel therapeutic strategy. In an AVM model, one session of ultrasound gradually reduced flow through the lesion without inducing rupture. Due to its non-invasive yet immediate ablative effects, focused ultrasound may allow safer treatment of AVMs. However, further studies are needed to clarify its efficacy and side effect profile.

show abstract

“…Other work demonstrated that MRgFUS can effectively treat vascular malformations, with one study showing a statistically significant pain reduction (8.4 ± 1.5 to 1.6 ± 2.2; p = 0.004) and decreased tumor volume in five patients. 60…”

Section: Other Indicationsmentioning

confidence: 99%

Musculoskeletal Applications of Magnetic Resonance-Guided Focused Ultrasound

Bucknor

Baal

McGill

et al. 2021

Semin Musculoskelet Radiol

View full text Add to dashboard Cite

Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel noninvasive therapy that uses focused sound energy to thermally ablate focal pathology within the body. In the United States, MRgFUS is approved by the Food and Drug Administration for the treatment of uterine fibroids, palliation of painful bone metastases, and thalamotomy for the treatment of essential tremor. However, it has also demonstrated utility for the treatment of a wide range of additional musculoskeletal (MSK) conditions that currently are treated as off-label indications. Advantages of the technology include the lack of ionizing radiation, the completely noninvasive technique, and the precise targeting that offer unprecedented control of the delivery of the thermal dose, as well as real-time monitoring capability with MR thermometry. In this review, we describe the most common MSK applications of MRgFUS: palliation of bone metastases, treatment of osteoid osteomas, desmoid tumors, facet arthropathy, and other developing indications.

show abstract

Treatment of Low-Flow Vascular Malformations of the Extremities Using MR-Guided High Intensity Focused Ultrasound: Preliminary Experience

Cited by 17 publications

References 17 publications

Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report

Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report

Focused Ultrasound Ablation of an Arteriovenous Malformation Model

Musculoskeletal Applications of Magnetic Resonance-Guided Focused Ultrasound

Contact Info

Product

Resources

About