PMC4696245_01
Contrast enhanced scans (axial view in a, c, e and sagittal view in b, d, f) several months prior to treatment (a, b), directly after treatment showing a non-perfused volume (c, d), and at 3 months follow-up showing a reduction in size of the malformation (e, f)
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Fig1
TSE spectral presaturation with inversion recovery (SPIR), Fig. 1a, b), and a digital subtraction angiogram (MRA) (Fig. 2). The lesion had a volume of 1.9 mL. When comparing the pre- and post-treatment contrast-enhanced scans, the targeted region within the vascular malformation showed no enhancement after treatment (Fig. 1c, d). At 3-month follow-up, a contrast-enhanced scan (T1 SPIR) was performed (Fig. 1e, f), which showed a decrease in volume of the lesion of >30 % (rest volume of 1.3 mL, software Osirix, Pixmeo, Switzerland). The part of the vascular malformation that was targeted with HIFU showed a large decrease in size, whilst the part adjacent to the nerves and main vessels, which was not targeted, was still intact (Fig. 1e, f).
Set-up of the HIFU including the device for active skin cooling, which is integrated in the MR scanner (a). Temperature measurement during HIFU treatment. b Coronal and (c) sagittal views
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Fig3
An actively cooled water cushion provided skin cooling and enhanced acoustic coupling (Fig. 3a). This allowed the physician to observe the heating in and outside the target area (Fig. 3).