State of Practice on Transcranial MR-Guided Focused Ultrasound: A Report from the ASNR Standards and Guidelines Committee and ACR Commission on Neuroradiology Workgroup

Bhavya R Shah; Jody Tanabe; John E Jordan; Drew Kern; Stephen C Harward; Fabricio S Feltrin; Padraig O'Suilliebhain; Vibhash D Sharma; Joseph A Maldjian; Alexandre Boutet; Raghav Mattay; Leo P Sugrue; Kazim Narsinh; Steven Hetts; Lubdha M Shah; Jason Druzgal; Vance T Lehman; Kendall Lee; Shekhar Khanpara; Shivanand Lad; Timothy J Kaufmann

doi:10.3174/ajnr.A8405

State of Practice on Transcranial MR-Guided Focused Ultrasound: A Report from the ASNR Standards and Guidelines Committee and ACR Commission on Neuroradiology Workgroup

AJNR Am J Neuroradiol. 2024 Nov 21. doi: 10.3174/ajnr.A8405. Online ahead of print.

Authors

Bhavya R Shah^{1

2

3

4}, Jody Tanabe^{5

6}, John E Jordan^{5

7

6}, Drew Kern⁸, Stephen C Harward⁹, Fabricio S Feltrin^{10

2

3}, Padraig O'Suilliebhain¹¹, Vibhash D Sharma¹¹, Joseph A Maldjian³, Alexandre Boutet¹², Raghav Mattay¹³, Leo P Sugrue¹³, Kazim Narsinh¹³, Steven Hetts^{5

14

13}, Lubdha M Shah^{5

14

15}, Jason Druzgal¹⁶, Vance T Lehman¹⁷, Kendall Lee¹⁸, Shekhar Khanpara¹⁹, Shivanand Lad⁹, Timothy J Kaufmann^{18

17}

Affiliations

¹ From the Transcranial Focused Ultrasound Laboratory (B.R.S., F.S.F.), University of Texas Southwestern Medical Center, Dallas, Texas [email protected].
² Neuroradiology and Neurointervention Section (B.R.S., F.S.F.), University of Texas Southwestern Medical Center, Dallas, Texas.
³ Department of Radiology (B.R.S., F.S.F., J.A.M.), University of Texas Southwestern Medical Center, Dallas, Texas.
⁴ Department of Neurological Surgery (B.R.S.), University of Texas Southwestern Medical Center, Dallas, Texas.
⁵ American Society of Neuroradiology Standards and Guidelines Committee (J.T., J.E.J., S.H., L.M.S.), Oak Brook, Illinois.
⁶ Department of Neuroradiology (J.T., J.E.J.), University of Colorado School of Medicine, Aurora, Colorado.
⁷ Providence Little Company of Mary Medical Center (J.E.J.), Torrance, Colorado.
⁸ Departments of Neurology and Neurosurgery (D.K.), University of Colorado School of Medicine, Aurora, Colorado.
⁹ Department of Neurosurgery (S.C.H., S.L.), Duke University Medical Center, Durham, North Carolina.
¹⁰ From the Transcranial Focused Ultrasound Laboratory (B.R.S., F.S.F.), University of Texas Southwestern Medical Center, Dallas, Texas.
¹¹ Department of Neurology (P.O., V.D.S.), Movement Disorder Section, University of Texas Southwestern Medical Center, Dallas, Texas.
¹² Department of Neuroradiology (A.B.), University of Toronto Medical Center, Toronto, Ontario, Canada.
¹³ Department of Radiology and Biomedical Imaging (R.M., L.P.S., K.N., S.H.), University of California San Francisco, San Francisco, California.
¹⁴ American College of Radiology Commission on Neuroradiology (S.H., L.M.S.), Reston, Virginia.
¹⁵ Department of Radiology (L.M.S.), University of Utah, Salt Lake City, Utah.
¹⁶ Department of Radiology (J.D.), University of Virginia, Charlottesville, Virginia.
¹⁷ Department of Radiology (V.T.L., T.J.K.), Mayo Clinic, Rochester, Minnesota.
¹⁸ Department of Neurosurgery (K.L., T.J.K.), Mayo Clinic, Rochester, Minnesota.
¹⁹ Department of Neuroradiology (S.K.), University of Texas MD Anderson Cancer Center, Houston, Texas.

PMID: 39572202
DOI: 10.3174/ajnr.A8405

Abstract

Transcranial focused ultrasound (FUS) is a versatile, MR-guided, incisionless intervention with diagnostic and therapeutic applications for neurologic and psychiatric diseases. It is currently FDA-approved as a thermoablative treatment of essential tremor and Parkinson disease. However, other applications of FUS including BBB opening for diagnostic and therapeutic applications, sonodynamic therapy, histotripsy, and low-intensity focused ultrasound neuromodulation are all in clinical trials. While FUS targeting for essential tremor and Parkinson disease has classically relied on an indirect, landmark-based approach, development of novel, advanced MR imaging techniques such as DTI tractography and fast gray matter acquisition T1 inversion recovery has the potential to improve individualized targeting and thus potentially enhance treatment response, decrease treatment times, and avoid adverse effects. As the technology advances and the number of clinical applications increases, the role of the neuroradiologist on a multidisciplinary team will be essential in pairing advanced structural and functional imaging to further this image-guided procedure via a precision medicine approach. This multi-institutional report, written by an experienced team of neuroradiologists, neurosurgeons, and neurologists, summarizes current practices, the use of advanced imaging techniques for transcranial MR-guided high-intensity FUS, recommendations for clinical implementation, and emerging clinical indications.