title: Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia.
abstract: OBJECTIVE
  The aims of this study were to evaluate in a canine model applicators designed for ablation of human benign prostatic hyperplasia (BPH) in vivo under magnetic resonance imaging (MRI) guidance, including magnetic resonance thermal imaging (MRTI), determine the ability of MRI techniques to visualize ablative changes in prostate, and evaluate the acute and longer term histologic appearances of prostate tissue ablated during these studies.
  
  
  METHODS
  An MRI-compatible transurethral device incorporating a tubular transducer array with dual 120° sectors was used to ablate canine prostate tissue in vivo, in zones similar to regions of human BPH (enlarged transition zones). Magnetic resonance thermal imaging was used for monitoring of ablation in a 3-T environment, and postablation MRIs were performed to determine the visibility of ablated regions. Three canine prostates were ablated in acute studies, and 2 animals were rescanned before killing at 31 days postablation. Acute and chronic appearances of ablated prostate tissue were evaluated histologically and were correlated with the MRTI and postablation MRI scans.
  
  
  RESULTS
  It was possible to ablate regions similar in size to enlarged transition zone in human BPH in 6 to 18 minutes. Regions of acute ablation showed a central "heat-fixed" region surrounded by a region of more obvious necrosis with complete disruption of tissue architecture. After 31 days, ablated regions demonstrated complete apparent resorption of ablated tissue with formation of cystic regions containing fluid. The inherent cooling of the urethra using the technique resulted in complete urethral preservation in all cases.
  
  
  CONCLUSIONS
  Prostatic ablation of zones of size and shape corresponding to human BPH is possible using appropriate transurethral applicators using MRTI, and ablated tissue may be depicted clearly in contrast-enhanced magnetic resonance images. The ability accurately to monitor prostate tissue heating, the apparent resorption of ablated regions over 1 month, and the inherent urethral preservation suggest that the magnetic resonance-guided techniques described are highly promising for the in vivo ablation of symptomatic human BPH.
authors: Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA. gsommer@stanford.edu
authors: Graham
authors: G
authors: Sommer
authors: Kim Butts
authors: KB
authors: Pauly
authors: Andrew
authors: A
authors: Holbrook
authors: Juan
authors: J
authors: Plata
authors: Bruce
authors: B
authors: Daniel
authors: Donna
authors: D
authors: Bouley
authors: Harcharan
authors: H
authors: Gill
authors: Punit
authors: P
authors: Prakash
authors: Vasant
authors: V
authors: Salgaonkar
authors: Peter
authors: P
authors: Jones
authors: Chris
authors: C
authors: Diederich
mesh_terms: D000818:Animals; D004285:Dogs; D004867:Equipment Design; D019544:Equipment Failure Analysis; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D011468:Prostatectomy / Q000295:instrumentation*; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology*; D011859:Radiography; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014159:Transducers; D016896:Treatment Outcome