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Cancers
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MR Guidance for Real-Time Interventions in Oncology
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MR Guidance for Real-Time Interventions in Oncology

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 22804

Special Issue Editors

Prof. Dr. Margarethus M. Paulides

E-Mail Website
Guest Editor
1. Center of Care & Cure Technology Eindhoven, Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
2. Department of Radiation Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
Interests: RF hyperthermia therapy; thermal therapy; electromagnetic dosimetry; electromagnetic modelling; thermal modelling; MRI; magnetic resonance thermometry; MR-guided therapy
Dr. Desmond Teck Beng Yeo

E-Mail Website
Guest Editor
Biology and Applied Physics Department, General Electric Global Research, Niskayuna, NY 12309, USA
Interests: MR thermometry; focused ultrasound; RF hyperthermia; electromagnetic modelling; cross-modality intervention guidance; MR-guided interventions; MRI sub-systems, image reconstruction; image registration

Special Issue Information

Dear Colleagues,

The use of magnetic resonance imaging (MRI) to improve precision and accuracy of real-time interventional and therapeutic procedures in oncology is a thriving field. This is largely due to the excellent soft-tissue contrast provided by MRI compared to other imaging modalities. In addition to anatomical information, different MRI contrast types can also yield information about vascular function, perfusion, physiology, and microstructure in one imaging session. This information can be combined to improve tumor detection, delineation, and characterization for treatment planning and therapy response monitoring. The information can also be fused with fast MRI techniques to monitor treatment in real-time to improve safety and efficacy, e.g., delineated tumor overlaid on MR thermometry maps in ablation and hyperthermia therapies. The combination of MRI with fast imaging modalities that present a friendlier interventional environment is also an active area of research. These hybrid-modality approaches seek to leverage the exquisite soft tissue contrast of MRI while ameliorating the challenges of MRI in real-time interventions, e.g., static/time-varying magnetic fields, temporal resolution. This Special Issue will focus on all aspects of MRI techniques and cross-modality technologies (MRI must be one of them) that improve the precision, accuracy or procedure time of real-time image-guided interventions.

Dr. Margarethus M. Paulides
Dr. Desmond Teck Beng Yeo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • real-time imaging guidance
  • cross-modality imaging
  • thermal therapy
  • biopsy
  • MR-guided interventions
  • MR thermometry
  • image-guided drug delivery

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Published Papers (6 papers)

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Research

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15 pages, 14330 KiB  
Article
MRI-Guided Online Adaptive Stereotactic Body Radiation Therapy of Liver and Pancreas Tumors on an MR-Linac System
by Teo Stanescu, Andrea Shessel, Cathy Carpino-Rocca, Edward Taylor, Oleksii Semeniuk, Winnie Li, Aisling Barry, Jelena Lukovic, Laura Dawson and Ali Hosni
Cancers 2022, 14(3), 716; https://doi.org/10.3390/cancers14030716 - 30 Jan 2022
Cited by 24 | Viewed by 4951
Abstract
Purpose: To describe a comprehensive workflow for MRI-guided online adaptive stereotactic body radiation therapy (SBRT) specific to upper gastrointestinal cancer patients with abdominal compression on a 1.5T MR-Linac system. Additionally, we discuss the workflow’s clinical feasibility and early experience in the case of [...] Read more.
Purpose: To describe a comprehensive workflow for MRI-guided online adaptive stereotactic body radiation therapy (SBRT) specific to upper gastrointestinal cancer patients with abdominal compression on a 1.5T MR-Linac system. Additionally, we discuss the workflow’s clinical feasibility and early experience in the case of 16 liver and pancreas patients. Methods: Eleven patients with liver cancer and five patients with pancreas cancer were treated with online adaptive MRI-guidance under abdominal compression. Two liver patients received single-fraction treatments; the remainder plus all pancreas cancer patients received five fractions. A total of 65 treatment sessions were investigated to provide analytics relevant to the online adaptive processes. The quantification of target and organ motion as well as definition and validation of internal target volume (ITV) margins were performed via multi-contrast imaging provided by three different 2D cine sequences. The plan generation was driven by full re-optimization strategies and using T2-weighted 3D image series acquired by means of a respiratory-triggered exhale phase or a time-averaged imaging protocol. As a pre-requisite for the clinical development of the procedure, the image quality was thoroughly investigated via phantom measurements and numerical simulations specific to upper abdominal sites. The delivery of the online adaptive treatments was facilitated by real-time monitoring with 2D cine imaging. Results: Liver 1-fraction and 5-fraction online adaptive session time were on average 80 and 67.5 min, respectively. The total session length varied between 70–90 min for a single fraction and 55–90 min for five fractions. The pancreas sessions were 54–85 min long with an average session time of 68.2 min. Target visualization on the 2D cine image data varied per patient, with at least one of the 2D cine sequences providing sufficient contrast to confidently identify its location and confirm reproducibility of ITV margins. The mean/range of absolute and relative dose values for all treatment sessions evaluated with ArcCheck were 90.6/80.9–96.1% and 99/95.4–100%, respectively. Conclusion: MR-guidance is feasible for liver and pancreas tumors when abdominal compression is used to reduce organ motion, improve imaging quality, and achieve a robust intra- and inter-fraction patient setup. However, the treatment length is significantly longer than for the conventional linac, and patient compliance is paramount for the successful completion of the treatment. Opportunities for reducing the online adaptive session time should be explored. As the next steps, dose-of-the-day and dose accumulation analysis and tools are needed to enhance the workflow and to help further refine the online re-planning processes. Full article
(This article belongs to the Special Issue MR Guidance for Real-Time Interventions in Oncology)
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11 pages, 1464 KiB  
Article
Heat Modulation of Intrinsic MR Contrasts for Tumor Characterization
by Matthew Tarasek, Oguz Akin, Jeannette Roberts, Thomas Foo and Desmond Yeo
Cancers 2022, 14(2), 405; https://doi.org/10.3390/cancers14020405 - 14 Jan 2022
Viewed by 1876
Abstract
(1) Background: The longitudinal relaxation time (T1), transverse relaxation time (T2), water proton chemical shift (CS), and apparent diffusion coefficient (ADC) are MR quantities that change with temperature. In this work, we investigate heat-induced intrinsic MR contrast types to [...] Read more.
(1) Background: The longitudinal relaxation time (T1), transverse relaxation time (T2), water proton chemical shift (CS), and apparent diffusion coefficient (ADC) are MR quantities that change with temperature. In this work, we investigate heat-induced intrinsic MR contrast types to add salient information to conventional MR imaging to improve tumor characterization. (2) Methods: Imaging tests were performed in vivo using different rat tumor models. The rats were cooled/heated to steady-state temperatures from 26–36 °C and quantitative measurements of T1, T2, and ADC were obtained. Temperature maps were measured using the proton resonance frequency shift (PRFS) method during the heating and cooling cycles. (3) Results: All tissue samples show repeatable relaxation parameter measurement over a range of 26–36 °C. Most notably, we observed a more than 3.3% change in T1/°C in breast adenocarcinoma tumors compared to a 1% change in benign breast fibroadenoma lesions. In addition, we note distinct values of T2/°C change for rat prostate carcinoma cells compared to benign tissue. (4) Conclusion: These findings suggest the possibility of improving MR imaging visualization and characterization of tissue with heat-induced contrast types. Specifically, these results suggest that the temporal thermal responses of heat-sensitive MR imaging contrast mechanisms in different tissue types contain information for improved (i) characterization of tumor/tissue boundaries for diagnostic and therapy purposes, and (ii) characterization of salient behavior of tissues, e.g., malignant versus benign tumors. Full article
(This article belongs to the Special Issue MR Guidance for Real-Time Interventions in Oncology)
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13 pages, 2223 KiB  
Article
Experimental Validation of the MRcollar: An MR Compatible Applicator for Deep Heating in the Head and Neck Region
by Kemal Sumser, Tomas Drizdal, Gennaro G. Bellizzi, Juan A. Hernandez-Tamames, Gerard C. van Rhoon and Margarethus Marius Paulides
Cancers 2021, 13(22), 5617; https://doi.org/10.3390/cancers13225617 - 10 Nov 2021
Cited by 5 | Viewed by 2085
Abstract
Clinical effectiveness of hyperthermia treatments, in which tumor tissue is artificially heated to 40–44 °C for 60–90 min, can be hampered by a lack of accurate temperature monitoring. The need for noninvasive temperature monitoring in the head and neck region (H&N) and the [...] Read more.
Clinical effectiveness of hyperthermia treatments, in which tumor tissue is artificially heated to 40–44 °C for 60–90 min, can be hampered by a lack of accurate temperature monitoring. The need for noninvasive temperature monitoring in the head and neck region (H&N) and the potential of MR thermometry prompt us to design an MR compatible hyperthermia applicator: the MRcollar. In this work, we validate the design, numerical model, and MR performance of the MRcollar. The MRcollar antennas have low reflection coefficients (<−15 dB) and the intended low interaction between the individual antenna modules (<−32 dB). A 10 °C increase in 3 min was reached in a muscle-equivalent phantom, such that the specifications from the European Society for Hyperthermic Oncology were easily reached. The MRcollar had a minimal effect on MR image quality and a five-fold improvement in SNR was achieved using the integrated coils of the MRcollar, compared to the body coil. The feasibility of using the MRcollar in an MR environment was shown by a synchronous heating experiment. The match between the predicted SAR and measured SAR using MR thermometry satisfied the gamma criteria [distance-to-agreement = 5 mm, dose-difference = 7%]. All experiments combined show that the MRcollar delivers on the needs for MR—hyperthermia in the H&N and is ready for in vivo investigation. Full article
(This article belongs to the Special Issue MR Guidance for Real-Time Interventions in Oncology)
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17 pages, 3249 KiB  
Article
MR Thermometry Accuracy and Prospective Imaging-Based Patient Selection in MR-Guided Hyperthermia Treatment for Locally Advanced Cervical Cancer
by Iva VilasBoas-Ribeiro, Sergio Curto, Gerard C. van Rhoon, Martine Franckena and Margarethus M. Paulides
Cancers 2021, 13(14), 3503; https://doi.org/10.3390/cancers13143503 - 13 Jul 2021
Cited by 13 | Viewed by 3874
Abstract
The efficacy of a hyperthermia treatment depends on the delivery of well-controlled heating; hence, accurate temperature monitoring is essential for ensuring effective treatment. For deep pelvic hyperthermia, there are no comprehensive and systematic reports on MR thermometry. Moreover, data inclusion generally lacks objective [...] Read more.
The efficacy of a hyperthermia treatment depends on the delivery of well-controlled heating; hence, accurate temperature monitoring is essential for ensuring effective treatment. For deep pelvic hyperthermia, there are no comprehensive and systematic reports on MR thermometry. Moreover, data inclusion generally lacks objective selection criteria leading to a high probability of bias when comparing results. Herein, we studied whether imaging-based data inclusion predicts accuracy and could serve as a tool for prospective patient selection. The accuracy of the MR thermometry in patients with locally advanced cervical cancer was benchmarked against intraluminal temperature. We found that gastrointestinal air motion at the start of the treatment, quantified by the Jaccard similarity coefficient, was a good predictor for MR thermometry accuracy. The results for the group that was selected for low gastrointestinal air motion improved compared to the results for all patients by 50% (accuracy), 26% (precision), and 80% (bias). We found an average MR thermometry accuracy of 2.0 °C when all patients were considered and 1.0 °C for the selected group. These results serve as the basis for comprehensive benchmarking of novel technologies. The Jaccard similarity coefficient also has good potential to prospectively determine in which patients the MR thermometry will be valuable. Full article
(This article belongs to the Special Issue MR Guidance for Real-Time Interventions in Oncology)
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11 pages, 1423 KiB  
Article
Feasibility and Early Clinical Experience of Online Adaptive MR-Guided Radiotherapy of Liver Tumors
by Paul Rogowski, Rieke von Bestenbostel, Franziska Walter, Katrin Straub, Lukas Nierer, Christopher Kurz, Guillaume Landry, Michael Reiner, Christoph Josef Auernhammer, Claus Belka, Maximilian Niyazi and Stefanie Corradini
Cancers 2021, 13(7), 1523; https://doi.org/10.3390/cancers13071523 - 26 Mar 2021
Cited by 41 | Viewed by 3869
Abstract
Purpose: To assess the feasibility and early results of online adaptive MR-guided radiotherapy (oMRgRT) of liver tumors. Methods: We retrospectively examined consecutive patients with primary or secondary liver lesions treated at our institution using a 0.35T hybrid MR-Linac (Viewray Inc., Mountain View, CA, [...] Read more.
Purpose: To assess the feasibility and early results of online adaptive MR-guided radiotherapy (oMRgRT) of liver tumors. Methods: We retrospectively examined consecutive patients with primary or secondary liver lesions treated at our institution using a 0.35T hybrid MR-Linac (Viewray Inc., Mountain View, CA, USA). Online-adaptive treatment planning was used to account for interfractional anatomical changes, and real-time intrafractional motion management using online 2D cine MRI was performed using a respiratory gating approach. Treatment response and toxicity were assessed during follow-up. Results: Eleven patients and a total of 15 lesions were evaluated. Histologies included cholangiocarcinomas and metastases of neuroendocrine tumors, colorectal carcinomas, sarcomas and a gastrointestinal stroma tumor. The median BED10 of the PTV prescription doses was 84.4 Gy (range 59.5–112.5 Gy) applied in 3–5 fractions and the mean GTV BED10 was in median 147.9 Gy (range 71.7–200.5 Gy). Online plan adaptation was performed in 98% of fractions. The median overall treatment duration was 53 min. The treatment was feasible and successfully completed in all patients. After a median follow-up of five months, no local failure occurred and no ≥ grade two toxicity was observed. OMRgRT resulted in better PTV coverage and fewer OAR constraint violations. Conclusion: Early results of MR-linac based oMRgRT for the primary and secondary liver tumors are promising. The treatment was feasible in all cases and well tolerated with minimal toxicity. The technique should be compared to conventional SBRT in further studies to assess the advantages of the technique. Full article
(This article belongs to the Special Issue MR Guidance for Real-Time Interventions in Oncology)
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Review

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16 pages, 1915 KiB  
Review
Real-Time MRI-Guided Prostate Interventions
by Seyedeh Nina Masoom, Karthik M. Sundaram, Pejman Ghanouni, Jurgen Fütterer, Aytekin Oto, Raj Ayyagari, Preston Sprenkle, Jeffrey Weinreb and Sandeep Arora
Cancers 2022, 14(8), 1860; https://doi.org/10.3390/cancers14081860 - 7 Apr 2022
Cited by 11 | Viewed by 4672
Abstract
Prostate cancer (PCa) is the second most common cause of cancer death in males. Targeting MRI-visible lesions has led to an overall increase in the detection of clinically significant PCa compared to the prior practice of random ultrasound-guided biopsy of the prostate. Additionally, [...] Read more.
Prostate cancer (PCa) is the second most common cause of cancer death in males. Targeting MRI-visible lesions has led to an overall increase in the detection of clinically significant PCa compared to the prior practice of random ultrasound-guided biopsy of the prostate. Additionally, advances in MRI-guided minimally invasive focal treatments are providing new options for patients with PCa. This review summarizes the currently utilized real-time MRI-guided interventions for PCa diagnosis and treatment. Full article
(This article belongs to the Special Issue MR Guidance for Real-Time Interventions in Oncology)
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