Iversen Marta M, Kline Michelle, Smith Emily A, Payne Allison, Shah Lubdha M, Rieke Viola
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
Int J Hyperthermia. 2025 Dec;42(1):2500487. doi: 10.1080/02656736.2025.2500487. Epub 2025 May 13.
BACKGROUND: Chronic neck pain due to cervical facet joint degenerative disease is a leading cause of disability. Denervation of the facet joint capsule with magnetic resonance-guided focused ultrasound (MRgFUS) ablation could provide a noninvasive treatment option. Our study investigates the safety and feasibility of targeting the cervical facet joints with two clinical transducers. METHODS: We simulated MRgFUS treatments in the cervical spine of six individuals using models from MR datasets segmented into eight tissue types. We determined the feasibility of targeting the facet joints in every cervical vertebral level at different trajectories for two 1 MHz clinical transducers. Using acoustic (hybrid angular spectrum method) and thermal (Pennes' bioheat equation) simulations, we determined the feasibility of reaching ablative temperatures at the targets while avoiding thermal damage in off-target locations. RESULTS: Both simulated transducers produce ablative or near-ablative temperatures at the target while maintaining tissue safety in off-target locations. We quantified the tissue temperature during a 20-second sonication at the target and in important surrounding structures including the spinal nerves, the spinal cord, surrounding CSF, and the major cervical arteries. Temperatures in critical structures demonstrated a less than 3 °C temperature rise, which is well within the level for tissue safety. Ablative thermal doses were achieved at the target (>240 CEM at 43 °C). CONCLUSION: This simulation study demonstrates the feasibility and safety of targeting cervical facet joint capsules with clinically available MRgFUS transducers. Integrating these transducers into an MRgFUS device introduces a novel noninvasive modality to treat cervical neck pain.
背景:颈椎小关节退变疾病所致的慢性颈部疼痛是导致残疾的主要原因。磁共振引导聚焦超声(MRgFUS)消融小关节囊去神经支配可为其提供一种非侵入性治疗选择。我们的研究调查了使用两种临床换能器靶向颈椎小关节的安全性和可行性。 方法:我们使用从MR数据集中分割成八种组织类型的模型,在六名个体的颈椎中模拟MRgFUS治疗。我们确定了两种1MHz临床换能器在不同轨迹下针对每个颈椎水平小关节的可行性。通过声学(混合角谱法)和热学(彭斯生物热方程)模拟,我们确定了在靶区达到消融温度同时避免非靶区热损伤的可行性。 结果:两种模拟换能器均在靶区产生消融或接近消融的温度,同时在非靶区保持组织安全。我们对靶区以及包括脊神经、脊髓、周围脑脊液和主要颈动脉在内的重要周围结构在20秒超声处理期间的组织温度进行了量化。关键结构的温度升高小于3°C,这完全在组织安全范围内。靶区实现了消融热剂量(43°C时>240 CEM)。 结论:这项模拟研究证明了使用临床可用的MRgFUS换能器靶向颈椎小关节囊的可行性和安全性。将这些换能器集成到MRgFUS设备中引入了一种治疗颈部疼痛的新型非侵入性方法。
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