Kim Butts Pauly's Lab

MRgFUS of Painful Bone Metastases

With ultrasound, we can ablate the periosteum, or the nerves that are responsible for pain in bone metastases. In these images, we see a) T2 hyperintense permeative tumor in the bone, b) multiple sonications (green oval) resulting in deposition of thermal dose (blue) along the targeted bone contour, and c) subtracted contrast enhanced image showing lack of perfusion of the treated bone surface, which is an immediate post-procedural indicator of successful ablation of the periosteal nerves and predicts subsequent pain relief. In this case, some of the cancer within the bone was also treated.

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We are developing ways to image the bone with MRI so that we can have a real-time evaluation of the bone on treatment day. Normal subject UTE-MR images (normalized subtraction images) demonstrating cortical bone in the scapula purple_arrow, ribs yellow_arrow, humerus orange_arrow,clavicle green_arrow, femur red_arrow, and ilium blue_arrow, common sites for bone metastases.

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Relevant Publications

Hurwitz MD, Ghanouni P, Kanaev SV, Iozeffi D, Gianfelice D, Fennessy FM, Kuten A, Meyer JE, LeBlang SD, Roberts A, Choi J, Larner JM, Napoli A, Turkevich VG, Inbar Y, Tempany CM, Pfeffer RM., Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. J Natl Cancer Inst. 2014 Apr 23;106(5).PMID: 24760791 PMCID: PMC4112926

Huisman M, ter Haar G, Napoli A, Hananel A, Ghanouni P, Lövey G, Nijenhuis RJ, van den Bosch MA, Rieke V, Majumdar S, Marchetti L, Pfeffer RM, Hurwitz MD.International consensus on use of focused ultrasound for painful bone metastases: Current status and future directions. Int J Hyperthermia. 2015 May;31(3):251-9. Epub 2015 Feb 13. Review. PMID: 25677840

Johnson EM, Vyas U, Ghanouni P, Butts Pauly K, Pauly JM, Improved Cortical Bone Specificity in UTE MR Imaging, MRM, 2016 Mar 12 [Epub] PMID: 26972442

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