Patent Publication Number: US-5291890-A

Title: Magnetic resonance surgery using heat waves produced with focussed ultrasound

Description:
BACKGROUND OF THE INVENTION 
     The present invention relates to surgery performed by local heating guided by magnetic resonance (MR) imaging methods of imaging, and more particularly to surgery performed by pulsed local heating guided by magnetic resonance (MR) imaging. 
     Conventional Magnetic Resonance Imaging (MRI) provides the radiologist with cross sectional views of the anatomy for diagnosis of pathology. MRI provides excellent contrast between different tissues and s useful in planning surgical procedures. A tumor is much more visible in an MR image than as seen in actual surgery because tumor and normal tissues often look similar in surgery. The tumor can also be obscured by blood during surgery. Researchers at Brigham and Womens Hospital, Boston, MA have proposed treatment of deep lying tumors by laser surgery. F. A. Jolesz, A. R. Bleire, P. Jakob, P. W. Ruenzel, K. Huttl, G. J. Jako, &#34;MR Imaging of Laser-Tissue Interactions&#34;, Radiology 168:249 (1989). Thus, in the case of brain tumors, the patient is first scanned in an MRI system to locate the tumor and plan a safe trajectory between the entry and target points. This can be accomplished by a MRI device employing fast scan apparatus such as U.S. Pat. Nos. 4,961,054 Gradient Current Speed-up Circuit for High-speed NMR Imaging System by John N. Park, Otward M. Mueller, and Peter B. Roemer, issued Oct. 2, 1990,  or 5,017,871 Gradient Current Speed-up Circuit for High-speed NMR Imaging System, by Otward M. Mueller, and Peter B. Roemer, issued May 21, 1991 both assigned to the present assignee and hereby incorporated by reference. A small burr hole is drilled in the skull and a hollow needle containing an optical fiber is then inserted into the tumor. The patient is then placed back into the MRI system to view the region heated by the laser using a temperature sensitive pulse sequence. Temperature Sensitive pulse sequence is described in U.S. Pat. No. 4,914,608 In-vivo Method for Determining and Imaging Temperature of an Object/Subject from Diffusion Coefficients Obtained by Nuclear Magnetic Resonance, Denis LeBihan, Jose Delannoy, and Ronald L. Levin issued April 3, 1990 and hereby incorporated by reference. Experiments on animals show that a heated zone above a critical temperature destroys tissue. This zone increases in size with time as the heat is applied to reach a steady state or both temperature and heat flow. If the maximum temperature is limited to 100 deg. C., then the laser heated zone, the area exceeding a critical temperature causing destruction of tissue, approaches 1 centimeter in diameter. It is difficult to predict the heated zone geometry because the heat flow depends on the profusion of blood as well as the tissue thermal properties. 
     Tumors have been selectively destroyed in cancer patients using focussed ultrasound heating at the University of Arizona, B. E. Billard, K. Hynynen and P. B. Roemer Effects of Physical Parameters on High Temperature Ultrasound Hyperthermia Ultrasound in Med. &amp; Biol. Vol. 16, No. 4, pp. 409-420, 1990 hereby incorporated by reference. Billard et al. disclosed that the control of heat was improved by using short laser pulses where the effect of blood perfusion is negligible. However, since they did not image the temperature distribution, it was difficult to hit small, deep laying targets. 
     It would be beneficial to be able to accurately localize heat to selectively kill or destroy tumor tissue without damage to surrounding healthy tissue. 
     OBJECTS OF THE INVENTION 
     It is an object of the present invention to selectively destroy tumors accurately with a non-invasive procedure employing the use of magnetic resonance imaging, and focussed ultrasound. 
     It is another object of the present invention to selectively destroy tumors accurately with a small degree of invasiveness employing the use of magnetic resonance imaging, and a pulsed laser. 
     SUMMARY OF THE INVENTION 
     Pulsed heat is used to selectively destroy tumor tissue of a patient with a minimum amount of surgery. Magnetic resonance (MR) imaging is employed to provide to a surgeon performing the procedure images of a region within the patient being heated, such region including the tumor tissue. A series of fast scan MR images are used to monitor the temperature with a diffusion sensitive pulse sequence. The pulsed heat is received by the tumor tissue in the form of coherent optical energy produced by a laser and guided through optical fiber to a hollow needle placed into the tumor. Another embodiment employs a focussed ultrasound transducer as the heat source with the heat concentrated at a focal point. The heat is localized by adjusting the frequency of the pulses, since an oscillating point heat source creates a heat wave that decays exponentially with distance from the source with a decay rate determined only by the frequency. The needle or focal point is positioned by a mechanical guide under the control of the surgeon. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The features of the invention believed to be novel are set forth with particularity in the appended claims. The invention itself, however, both as to organization and method of operation, together with further objects and advantages thereof, may best be understood by reference to the following description taken in conjunction with the accompanying drawing in which: 
     FIG. 1 is a logarithmic graph of Frequency vs. heat Penetration Depth of a pulsed heat means according to the present invention. 
     FIG. 2 is a schematic block diagram of one embodiment of the present invention. 
     FIG. 3. is a partial perspective view of a patient positioned for surgery within the bore of the magnets of one embodiment of the present invention employing a laser source and fiber optics. 
     FIG. 4. is a partial view of a patient positioned for surgery within the bore of the magnets of another embodiment of the present invention employing a focussed ultrasound source. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     By employing the present invention, tumor tissue in a patient can be selectively destroyed by localized heating without affecting the surrounding healthy tissue. A method of selectively heating material such as diamond is disclosed in Thermal Diffusity of Isotopically Enriched  C  Diamond by T. R. Anthony, W. F. Banholzer, and J. F. Fleischer Phys. Rev. B Vol. 42, No. 2 Jul. 15, 1990 hereby incorporated by reference. The source of the heat may be either a focussed ultrasound transducer or a laser source routed to the tumor tissue through an optical fiber. The heat is applied to the tumor tissue in a pulsed or oscillating fashion. This oscillation creates a heat wave either at the tip of the optical fiber or at the focus point of the transducer. The pulsed heat is produced by a source driven in accordance with a sinusoidal component and a constant component, and thus varies sinusoidally. Although the sinusoidal component of the applied heat would imply a negative heating or heat withdrawal, the constant heat term added to the sinusoidal component keeps the heat flow positive. However, the constant heating from a point source steadily adds to the background thermal distribution. The temperature distribution T may be expressed as T(r, t) with r being the radius from the center of the point of application, and t being time. The temperature distribution satisfies the diffusion equation: 
     
         D∇.sup.2 T(r,t)+dT(r,t)/dt=Q(r,t)/ρc          (1) 
    
     where ω is an angular frequency, ρ is the density of the heated tissue, c is the specific of the heated tissue and D is the thermal diffusity of the heated tissue. In the case of a periodic point heat source of amplitude Q 0  at the origin r=0, the heat flow becomes: 
     
         D∇.sup.2 T(r,t)+dT(r,t)/dt=(Q.sub.0 /ρc)Cos(ωt)δ(r)(2) 
    
     with frequency f=ω/2π. A radially symmetric solution is of the form: 
     
         T(r,t)=Q/ρcExp[-kr]cos(ωt-kr)/r                  (3) 
    
     where k=Sqrt[ω/2D], and D is the thermal diffusity. The wavelength L=2π/k of heat waves depends on the thermal diffusivity D and frequency f, so that 
     
         T(r,t)=Q/ρcExp[-kr]cos(2πft-kr)/r                   (4) 
    
     The heat from an oscillating point source decays exponentially with a characteristic distance 1/k as shown in H. S. Carlsow and J. C. Jaeger Conduction of Heat in Solids 2nd Edition, Oxford, Clarendon Press, 1959 at pages 64-70 hereby incorporated by reference. The heat decay is given by: ##EQU1## 
     The frequency of the oscillating point source is controlled to vary the size of the heated region. The size of the heated region can be seen with the use of a Magnetic Resonant (MR) imaging system employing a temperature sensitive MR pulse sequence. The MR imaging system also creates an image of the tissue intended to be destroyed. By varying the frequency of the oscillating point source, the surgeon can selectively destroy a small region of tissue, thus performing non-invasive micro surgery. The operator of the apparatus, such as a surgeon, can adjust the placement of the oscillating point source and the size of tissue destroyed while monitoring the images of the heated tissue and the tumor. In an alternative embodiment, the frequency of the oscillating source and the placement of the oscillating point source of heat are under the control of a mechanical guide responsive to the MR temperature sensitive fast scan imaging system. 
     Consider heat applied at a point by either a laser fiber or focussed ultrasound transducer. The heat may be applied over a spot of up to 1 mm. in radius because of the laser optical absorption or diffraction limit of focussed ultrasound. The thermal diffusivity D of tissue is similar to that of water, which is 0.0015 cm 2  /sec. The penetration depth for a given frequency f is tabulated below 
     
                       TABLE 1                                                     
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FREQUENCY (Hz) PENETRATION DEPTH (mm)                                     
______________________________________                                    
0.001          6.9                                                        
0.01           2.2                                                        
0.1            0.69                                                       
1              0.22                                                       
10             .069                                                       
______________________________________                                    
 
    
     The temperature profile decays exponentially with distance from the oscillating heat source with a penetration depth that, as evident from Table 1, depends on the frequency. FIG. 1 is a logerithmic graph of Frequency vs. Penetration Depth. 
     A schematic block diagram of the magnetic resonance surgery system is shown in FIG. 2. A magnet 10 provides a uniform field for nuclear magnetic resonance imaging using both gradient coils 20 and radiofrequency (RF) coils 30 to detect the resonance of protons in the patient. A pulse sequence is applied to the coils by gradient amplifier 40 and RF power source 50 to the coils to acquire temperature sensitive images rapidly during surgery. Operator&#39;s console 60 is used to control the imaging. A mechanical guide 70 positions the laser fiber or ultrasound transducer 80. Raw data is sent from receiver 90 to a surgical planning and control workstation 100 that displays images 110 to the surgeon and enables him to guide the heat source by means of a three-dimensional (3D) pointing device 120 such as a track ball or a mouse. 
     As shown in FIG. 3, a patient 200 lies on a table 210 that moves into the bore of a two part magnet 260, 270. A laser fiber 230 is inserted into the patient with a hollow needle 240 guided by a mechanical positioning device 250 such as a hydraulic positioner. The trajectory is computed from a set of images of the patient taken during surgery planning. A safe trajectory from the entry point to the target does not intersect critical anatomy such as large blood vessels. Heat is applied to tumor tissue 280 by periodically pulsing the laser through laser fiber 230 (i.e., a fiber optic material) to selectively destroy tumor 280 while the operator views a temperature sensitive magnetic resonance image. More than one needle may be required to remove an irregular shaped tumor. 
     An alternative embodiment (not shown) may employ a heat source that creates heat over a line segment instead of a point. 
     As shown in FIG. 4, patient 200 is placed on a table 310 designed to accommodate a focussed ultrasound transducer 330 in a water bath 320. The ultrasound transducer 330 can be moved inside the bore of magnets 260, 270 to focus on different locations within patient 200. Ultrasound transducer 330 is focussed onto the tumor tissue 280, avoiding bone or air in the path of the ultrasound beam, and pulsed to selectively heat tumor tissue 280 at the focal point of the ultrasound transducer. The ultrasound transducer is moved while the surgeon views cross sectional temperature sensitive images. 
     While several presently preferred embodiments of the invention have been described in detail herein, many modifications and variations will now become apparent to those skilled in the art. It is, therefore, to be understood that the appended claims are intended to cover all such modifications and variations as fall within the true spirit of the invention.