PMC10289281_01
Representative T2-weighted treatment planning images in axial (A), sagittal (B) and coronal (C) views showing placements of MR-HIFU treatment cells (ellipsoids).
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A total of 34 treatment cells (4 x 4 x 10 mm3) were planned on the desmoid tumor ( Figure 1 ).
Representative example of a MR-HIFU ablation using a 4 mm treatment cell, 1.2 MHz, 60 W sonication power and 14.9 s sonication duration. The green arrows (A, B) depict the direction of incoming ultrasound energy. (A) A treatment cell (ellipsoid) positioned on the desmoid tumor. (B) Temperature map of a sonication. White contour and arrow mark the 240CEM43 thermal dose. (C) The corresponding temperature increase over time within the treatment cell during a sonication.
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Figure 2  shows a representative example of an ablation. For MR-HIFU therapy, ablations were performed using 1.2 MHz, 40 - 60 W, and 4.2 - 15.9 s sonication duration.
Contrast-enhanced T1-weighted MR images of desmoid tumor before and after MR-HIFU treatment. (A) Hyperintense desmoid tumor at dorsal humerus (arrow heads) before MR-HIFU. (B) Non-enhancing ablation zone immediately after treatment (arrows) with NPV ratio of 95%. (C, D) Tumor (arrow heads) at follow-up showing NPV (arrows) with hyperemic rim at 1.5 and 3 months after treatment. (E) Tumor at 10 months post MR-HIFU. (F) Complete resolution of desmoid tumor at 23 months post MR-HIFU. No tumor recurrence at 35 (G) and 48 months (H) after treatment.
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As illustrated in  Figures 3A ,  4A , before MR-HIFU ablation, an T1-weighted CE images showed a desmoid tumor with a volume of 9.7 cm3 was noted at the dorsal humerus. Immediately after treatment, a non-enhancing ablation zone was observed with a NPV ratio of 95% ( Figures 3B ). At 1.5 months post MR-HIFU, tumor regression was observed (4.8 cm3, 50.5% volume reduction,  Figures 3C ,  4A ). Also, NPV with a hyperemic rim was evident within the desmoid tumor as well as the adjacent bone marrow ( Figures 3C-F ). The tumor continued to shrink to 2.8 (71.1% volume reduction) and 0.15 cm3 (98.5% volume reduction) at 3- and 12-month follow-up time points, respectively ( Figures 3D, E ,  4A ). Interestingly, 24 months after MR-HIFU, no tumor was detected, achieving complete response ( Figure 3F ). No tumor recurrence was observed at 35 ( Figure 3G ) and 48 months ( Figure 3H ) after the treatment.  Figure 4A  shows the timeline of tumor response to surgery, which was the standard treatment, and after HIFU.
(A) Desmoid tumor response over 6 years. After the first diagnosis, the patient underwent 2 times R0 resections, which were standard of care (SoC) treatments, over a period of 2 years. As the tumor recurred after the second resection, the patient was subjected to MR-HIFU treatment and thereafter, was followed-up for 4 years. Time point 0 corresponds to the day of MR-HIFU treatment. (B) Pain relief assessed with visual analog scale (VAS) score at different time points after MR-HIFU treatments for 4 years.
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As illustrated in  Figures 3A ,  4A , before MR-HIFU ablation, an T1-weighted CE images showed a desmoid tumor with a volume of 9.7 cm3 was noted at the dorsal humerus. At 1.5 months post MR-HIFU, tumor regression was observed (4.8 cm3, 50.5% volume reduction,  Figures 3C ,  4A ). The tumor continued to shrink to 2.8 (71.1% volume reduction) and 0.15 cm3 (98.5% volume reduction) at 3- and 12-month follow-up time points, respectively ( Figures 3D, E ,  4A ). No tumor recurrence was observed at 35 ( Figure 3G ) and 48 months ( Figure 3H ) after the treatment.  Figure 4A  shows the timeline of tumor response to surgery, which was the standard treatment, and after HIFU. After MR-HIFU, tumor reduction was observed over time until complete remission was observed 24 months after treatment with no recurrence up to 48 months ( Figure 4A ). At 1.5 months after MR-HIFU, complete pain relief was observed ( Figure 4B ). The patient remained symptom-free (VAS score = 0) at 3-, 10-, 23-, 35-, and 48-month follow-up time points ( Figure 4B ).