title: Toward MR-guided high intensity focused ultrasound for presurgical localization: focused ultrasound lesions in cadaveric breast tissue.
abstract: OBJECTIVE
  To investigate magnetic resonance image-guided high intensity focused ultrasound (MR-HIFU) as a surgical guide for nonpalpable breast tumors by assessing the palpability of MR-HIFU-created lesions in ex vivo cadaveric breast tissue.
  
  
  METHODS
  MR-HIFU ablations spaced 5 mm apart were made in 18 locations using the ExAblate2000 system. Ablations formed a square perimeter in mixed adipose and fibroglandular tissue. Ablation was monitored using T1-weighted fast spin echo images. MR-acoustic radiation force impulse (MR-ARFI) was used to remotely palpate each ablation location, measuring tissue displacement before and after thermal sonications. Displacement profiles centered at each ablation spot were plotted for comparison. The cadaveric breast was manually palpated to assess stiffness of ablated lesions and dissected for gross examination. This study was repeated on three cadaveric breasts.
  
  
  RESULTS
  MR-ARFI showed a collective postablation reduction in peak displacement of 54.8% ([4.41 ± 1.48] μm pre, [1.99 ± 0.82] μm post), and shear wave velocity increase of 65.5% ([10.69 ± 1.60] mm pre, [16.33 ± 3.10] mm post), suggesting tissue became stiffer after the ablation. Manual palpation and dissection of the breast showed increased palpability, a darkening of ablation perimeter, and individual ablations were visible in mixed adipose/fibroglandular tissue.
  
  
  CONCLUSIONS
  The results of this preliminary study show MR-HIFU has the ability to create palpable lesions in ex vivo cadaveric breast tissue, and may potentially be used to preoperatively localize nonpalpable breast tumors.
authors.affiliation: School of Medicine, Department of Radiology, Stanford University, Stanford, California, USA. rbitton@stanford.edu
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Bitton
authors.forename: Elena
authors.initials: E
authors.lastname: Kaye
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Dirbas
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Daniel
authors.forename: Kim Butts
authors.initials: KB
authors.lastname: Pauly
mesh_terms: D001940:Breast / Q000601:surgery*; D002102:Cadaver; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D010173:Palpation; D014159:Transducers; D016217:Ultrasonography, Mammary