Comparison of Imaging Changes and Pain Responses in Patients with Intra- or Extraosseous Bone Metastases Treated Palliatively with Magnetic Resonance-Guided High-Intensity-Focused Ultrasound.
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Date
2019-02-21Author
Giles, SL
Brown, MRD
Rivens, I
Deppe, M
Huisman, M
Kim, Y-S
Farquhar-Smith, P
Williams, JE
Ter Haar, GR
deSouza, NM
Type
Journal Article
Metadata
Show full item recordAbstract
PURPOSE: This study compared changes in imaging and in pain relief between patients with intraosseous, as opposed to extraosseous bone metastases. Both groups were treated palliatively with magnetic resonance-guided high-intensity-focused ultrasound (MRgHIFU). MATERIALS AND METHODS: A total of 21 patients were treated prospectively with MRgHIFU at 3 centers. Intraprocedural thermal changes measured using proton resonance frequency shift (PRFS) thermometry and gadolinium-enhanced T1-weighted (Gd-T1W) image appearances after treatment were compared for intra- and extraosseous metastases. Pain scores and use of analgesic therapy documented before and up to 90 days after treatment were used to classify responses and were compared between the intra- and extraosseous groups. Gd-T1W changes were compared between responders and nonresponders in each group. RESULTS: Thermal dose volumes were significantly larger in the extraosseous group (P = 0.039). Tumor diameter did not change after treatment in either group. At day 30, Gd-T1W images showed focal nonenhancement in 7 of 9 patients with intraosseous tumors; in patients with extraosseous tumors, changes were heterogeneous. Cohort reductions in worst-pain scores were seen for both groups, but differences from baseline at days 14, 30, 60, and 90 were only significant for the intraosseous group (P = 0.027, P = 0.013, P = 0.012, and P = 0.027, respectively). By day 30, 67% of patients (6 of 9) with intraosseous tumors were classified as responders, and the rate was 33% (4 of 12) for patients with extraosseous tumors. In neither group was pain response indicated by nonenhancement on Gd-T1W. CONCLUSIONS: Intraosseous tumors showed focal nonenhancement by day 30, and patients had better pain response to MRgHIFU than those with extraosseous tumors. In this small cohort, post-treatment imaging was not informative of treatment efficacy.
Collections
Subject
Humans
Bone Neoplasms
Analgesics
Pain Measurement
Treatment Outcome
Palliative Care
Prospective Studies
Predictive Value of Tests
Time Factors
Adult
Aged
Middle Aged
Europe
Female
Male
Magnetic Resonance Imaging, Interventional
Musculoskeletal Pain
Seoul
Extracorporeal Shockwave Therapy
Research team
Magnetic Resonance
Therapeutic Ultrasound
Language
eng
Date accepted
2019-02-21
License start date
2019-09
Citation
Journal of vascular and interventional radiology : JVIR, 2019, 30 (9), pp. 1351 - 1360.e1
Publisher
ELSEVIER SCIENCE INC