Current scenario and future prospects of MRgFUS in radiology

Dr SB Desai, Director, Department of Imaging and Interventional Radiology, Jaslok Hospital and Research Centre and Dr Ritu Kashikar, Consultant, Department of Radiology, Jaslok Hospital and Research Centre, explain how MrgFUS technology can be used for the treatment of various cancers

MRgFUSis one of the most highly innovative technologies introduced to the medical sector in recent years. It is a cutting-edge technology making incision-less surgery a standard of care for patients. Focussed ultrasound technology uses sound waves that pass safely through skin, muscle, bone, etc. The specific area where the sound waves converge is heated to temperatures that cause thermal ablation. With the help of MR imaging, a complete anatomical survey of the treatment area allows for patient-specific planning and real-time monitoring.

This path-breaking technology can be used for the treatment of various conditions like uterine fibroids, adenomyosis, backache due to facet arthropathy, bone metastasis, bone tumours like osteoid osteoma and prostate cancer.

Uterine fibroids also referred to as leiomyomas or myomas, are benign muscle tumours in various locations in the uterus. Many women who have uterine fibroids suffer from a range of symptoms, including pain and heavy menstrual bleeding. The technology provides a non-invasive option for treating symptomatic uterine fibroids with the help of MR-guided Focussed Ultrasound (MRgFUS).

During treatment, the ultrasound beams are focussed to a focal point and thereby they heat and ablate targeted tissue. MRI guide the treatment which provides high-resolution images of the target and adjacent structures, it also helps continuous temperature monitoring. The cumulative thermal impact on the tissue can be analysed by temperature data. If necessary, parameters can be adjusted to ensure an optimal response.
MR-guided-focussed ultrasound can also provide a non-invasive and non-radiation treatment option for the pain palliation of metastatic bone cancer. This treatment has been shown to provide significant pain relief, an improvement in the quality of life and a reduction in the need for pain medication in certain patients who have failed, who are not eligible for or who refuse radiation therapy. This treatment can also be used to treat painful benign lesions like osteoid osteoma.

Facet arthropathy is a common cause of low backache and stiffness. With MRgFUS we can ablate painful nerve endings around inflamed facets thereby alleviating pain caused by the disease.

Out of nine men, one will be diagnosed with prostate cancer during their lifetime. With PSA screening, many men are diagnosed with the locally-confined disease with low or intermediate risk for progression. The Exablate Prostate treatment is a minimally invasive (involves very less incisions in the body), focal treatment for locally-confined prostate cancer.

In the course of the treatment, the aim of ultrasound waves is focussed to heat and ablate the identified cancerous tissue. Real-time imaging for precise targeting and to avoid adjacent organs such as the neurovascular bundle (NVB), the urethra and the rectal wall is provided by MRI.

The benefits over other treatments include, incision-less treatment which has little risk of infection and no scarring from incisions, organ-preserving, minimal hospitalisation, a quick return to activities, low risk of complications and hence significant improvement in the quality of life. Women undergoing this procedure can have normal reproductive lives without adverse effect on fertility. Unlike standard surgeries for prostate cancer which involve a significant risk of impotence and incontinence, this procedure protects vital structures and hence completely negates chances of these complications. Treatment such as facet arthropathy can be treated on daycare basis without the need for hospitalisation.
With over 2000 patients treated, we at Jaslok Hospital are proud to announce that we have performed the third-highest number of MRgFUS procedures in the world. This consists of over 1600 fibroids, 200 adenomyosis, 125 facet joints, 25 bone metastasis, 10 cases of prostate cancer.

Another exciting application of MRgFUS is in the treatment of essential tremors. With MRgFUS, we can do sub-thalamic nucleosome without burr hole or craniotomy. The results are immediate and unbelievable. There will be extended applications in neurological disorders like treatment of epileptogenic focus, psychogenic disorders and debulking of inoperable tumours.

However, in a country with a population of over 1.3 billion, of which 0.6 billion are women, of which 0.2 billion suffer from fibroids, our numbers seem minuscule. India also has a high number of patients with prostatic cancer and bone metastasis and bearing these figures in mind one would ponder as to why the numbers of MrgFUS patients are nothing but a fraction.

Our vision is to make MRgFUS a standard of care for patients, to increase awareness both amongst patients and physicians.

However, the success of our vision remains obstructed by various obstacles. Poor awareness, poor acceptability and apathy for embracing a new technology amongst referrals is our foremost hindrance.

The future of medicine lies with minimally invasive procedures such as asMRgFUS.We at Jaslok Hospital aim to increase awareness, availability, the cost-effectiveness of this avant-garde technology in our country. With the active support of social media, NGOs, different medical forums, and hospitals, we aim to create more knowledge about this procedure amongst the larger populations.

As research continues and more patients seek non-surgical, non-radiation alternatives to their medical conditions, practitioners of MRgFUS see hope for more widespread adoption for this breathtaking and path-breaking treatment modality.