Prof. Dr. med. Thomas Kahn
Interventional MRI: Predicting the Future
(Dienstag, 15.15 Uhr, Schinkelsaal)
Interventional MRI is currently still not mainstream but some applications have become widely accepted.
More than 150 MRI units have been installed worldwide for intraoperative use in neurosurgery. At practically all field strengths, neuronavigation concepts using information from examinations like functional MRI and diffusion tensor imaging have been successfully integrated into the operating theater. This has led to improved radicality in brain tumor resection and better survival. Minimally invasive cranial applications such as biopsies, catheter placements and deep brain stimulation have been successfully introduced.
Breast and prostate biopsies and related interventions have demonstrated a clear benefit for the patient. More than 6,000 women with uterine fibroids have already been treated with focused ultrasound. There is also some limited FUS experience in breast and prostate tumors as well as brain and bone metastases. The technique has received FDA clearance for the treatment of chronic neuropathic pain and essential tremor. It can be used for the opening of the blood-brain barrier and targeted delivery of drugs as well.
Thermal therapy modalities based on radiofrequency, microwave, laser or cryo application are widely used today but most of the procedures are performed under CT or ultrasound guidance. Vascular applications have not yet become widely accepted with the exception of some clinical experience in the heart and with low-flow vascular malformations.
Predicting the future is generally difficult, in particular, in the field of high-tech medicine. My belief is that neurosurgical applications will play an important if not increasing role in the future. Thermal therapies might see a shift from CT and US guidance towards MRI when procedures are fast and simple enough, and thermal mapping turns out to improve patient outcomes. Hybrid applications combining X-ray or US with MRI are also likely to increase.
Molecular applications have also shown some great potential, for example in the delivery and tracking of cellular therapeutics (stem cells or Langerhans islet cells) or drugs, labelling of signal molecules (e. g. ligands or antibodies) as well as the visualization and induction (by focused ultrasound) of gene expression.
Magnetic particle imaging (MPI) may play a role in cardiovascular applications. It has the advantages of high temporal resolution and unobstructed access to the patient using single-sided scanners that are currently under development.
Prof. Dr. Thomas Kahn
Department of Diagnostic and Interventional Radiology, University of Leipzig