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Key Points Data from a 10-patient pilot clinical trial using focused ultrasound to treat cervical dystonia were recently published.  Cervical dystonia is a rare neurological disorder that causes uncontrollable neck muscle contractions.  Focused Ultrasound Pallidothalamic Tractotomy in Cervical Dystonia: A Pilot Study  Final data from a pilot clinical trial in Tokyo, Japan, were recently published in the journal Movement Disorders. Shiro Horisawa, MD, a neurosurgeon at Tokyo Women’s Medical University, led the 10-patient trial (Japan Registry of Clinical Trials Number 032210506). The study evaluated the safety and initial effectiveness of using Insightec’s Exablate Neuro focused ultrasound device to create a pallidothalamic tractotomy, or brain lesion, in patients with a rare condition of the neck called cervical dystonia.  People with cervical dystonia can experience uncontrollable neck muscle contractions, and the condition is also known as spasmodic torticollis. It is rare neurological disorder that is caused by faulty neurons in the brain. According to the National Organization for Rare Disorders, “In some cases, these abnormal contractions may be sustained or continuous; in others, they may be present as spasms that can resemble tremor. The severity of cervical dystonia can vary, but the disorder can cause significant pain and discomfort as well as difficulty due to the abnormal postures. It can affect quality of life and activities of daily living including employment.”  Six men and four women between the ages of 41 and 61 years were enrolled in the study. They were assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) at baseline and again six months after undergoing the focused ultrasound procedure. The TWSTRS score improved 43.4% from baseline to six months after treatment, and this improvement was significant (P < 0.001). Another significant improvement was measured in the Burke-Fahn-Marsden Dystonia Rating Scale, which improved by 38.2% (P < 0.001) from baseline. The Beck Depression Inventory, Beck Anxiety Inventory, and Apathy Evaluating Scale all improved as well. Some adverse effects were found, including reduced hand dexterity in three participants and weight gain in two of them.  The authors concluded that focused ultrasound pallidothalamic tractotomy may be an effective treatment option for patients with cervical dystonia. The publication also mentions that “Unilateral surgical treatment may be insufficient as a treatment for cervical dystonia,” noting that the treatment may need to be done bilaterally instead of only on one side, as is typically done with successful deep brain stimulation treatments.   “This is the first clinical trial of focused ultrasound surgery for cervical dystonia,” said Dr. Horisawa. “The participants showed significant improvements in their TWSTRS scores; however, we did find a wide range of individual responses. My next step is to investigate how focused ultrasound can address cases where the improvement from this treatment was insufficient. This includes exploring the potential for bilateral treatment and identifying the optimal parameters for selecting suitable patients. I am committed to continuing my research to solve these challenges and to improve the lives of dystonia patients worldwide.”  “The treatment of patients with Parkinson’s disease also produced some improvement in their dystonia, which prompted the expansion of this work to treat patients with other types of dystonia,” said Tim Meakem, MD, a managing director of the Foundation and co-director of the Research and Education Team. “We are thankful for Dr. Horisawa’s research and look forward to further refinements and expansions of this innovative technology.”  The Foundation funded this clinical trial, the first in the world use of focused ultrasound for treating cervical dystonia.  See Movement Disorders  Related Stories  Clinical Trial of Focused Ultrasound for Cervical Dystonia Begins June 2022

Key Points Distinguished editors from the Institute of Cancer Research and the University of Oxford recently published a comprehensive new focused ultrasound textbook.  The book describes the various mechanisms of focused ultrasound, along with the bioeffects and clinical applications of each mechanism.  Image-Guided Focused Ultrasound Therapy: Physics and Clinical Applications, 1st Edition Edited By Feng Wu, MD, PhD, Gail ter Haar, DSc, and Ian Rivens, PhD  A comprehensive new focused ultrasound textbook was published this year. The editors – focused ultrasound experts from the Institute for Cancer Research (ICR) and the University of Oxford – invited world experts to write each chapter with the goal of presenting the latest clinical outcomes of using focused ultrasound for the treatment of benign and malignant diseases.  “This book is a great primer for anyone entering the field of focused ultrasound,” said Emily White, MD, the Foundation’s managing director for operations and FUS Partners. “It would be appropriate for grad students, post-docs, and for new hires at focused ultrasound manufacturers, sales teams, and distributors. It is a good reference to have on anyone’s bookcase!”  The book describes the fundamental physics behind the various mechanisms of focused ultrasound, along with the bioeffects and clinical applications of each mechanism. Ablation, hyperthermia, drug delivery, sonoporation, histotripsy, cancer immunotherapy, and the interaction between microbubbles and ultrasound are all included.  The specific use of focused ultrasound therapy for more than ten indications is also described. These chapters cover the current clinical guidelines for indications, contraindications, patient selection, the treatment procedure, follow-up, and the expected imaging changes after treatment.  Chapters/Table of Contents  Image-Guided Focused Ultrasound Therapy: Past, Current and Future.  Physical Principles of Focused Ultrasound Therapy.  Mechanisms for Induction of Bio-Effects of Focused Ultrasound in Tissue.  Image-Guided Focused Ultrasound Therapy: Physics and Clinical Applications.  Calibration and quality assurance for high intensity focused ultrasound fields.  Numerical Modelling for Simulation and Planning of Focused Ultrasound Treatments.  Ultrasound Monitoring Techniques for Focused Ultrasound Therapy.  Extracorporeal Ultrasound-guided HIFU Devices — Clinical Application, Treatment Planning and B-mode Ultrasound for Real-time Monitoring and Controlling of Treatment.  Imaging Assessments of Tumour Response and Treatment Outcome after High-intensity Focused Ultrasound Ablation.  Focused Ultrasound Treatment of the Prostate: Devices and Clinical Results.  Ultrasound-Guided Focused Ultrasound Ablation for Uterine Fibroids.  Clinical Application of Ultrasound-Guided Focused Ultrasound Ablation for Liver Tumours.  Clinical Application of Ultrasound-Guided Focused Ultrasound Ablation for Kidney Tumours.  Clinical Application of Ultrasound-Guided Focused Ultrasound Ablation for Pancreatic Cancer.  Clinical Application of Ultrasound-Guided Focused Ultrasound Ablation for Breast Tumours.  Clinical Application of Ultrasound-guided High Intensity Focused Ultrasound Treatment for Primary Bone Malignancies and Soft Tissue Sarcomas.  Clinical Extracorporeal MR-Guided Focused Ultrasound Systems: Treatment Planning, Therapy Delivery, and Online Monitoring via Thermometry and Thermal Dose Mapping.  Clinical Application of MR-Guided Focused Ultrasound Ablation for Uterine Fibroids.  Clinical Application of MR-Guided Focused Ultrasound Ablation for Tumours in the Breast.  Clinical Application of MR-Guided Focused Ultrasound Ablation for Bone Metastasis.  Clinical Application of MR-Guided Focused Ultrasound Therapy in the Brain.  Sonoporation: Concept, Mechanisms and Application to Cancer Treatment.  Nano/Microbubble-assisted Ultrasound for Drug Delivery in Cancer.  Anaesthesia, Ventilation and immobilisation Strategies for Focused Ultrasound Therapy (with special reference to high frequency ventilation).  Triggered Temperature-Sensitive Liposome Release by Focused Ultrasound for Localised Drug Delivery.  Transcranial Ultrasound-Mediated Blood-Brain Barrier Disruption for Targeted Drug Delivery.  Histotripsy: Focused Ultrasound Therapy by Mechanical Tissue Fractionation.  Focused Ultrasound Ablation Enhancement of Specific Anti-Tumour Immunity.  Focused Ultrasound Therapy for Treatment of Pain.  Image-Guided Focused Ultrasound Therapy: Physics and Clinical Applications is part of a series on Medical Physics and Biomedical Engineering.  Order the Book from Routledge Publishing 

Join us Wednesday, October 30, for a free virtual webinar on the potential impact of cancer immunotherapies for the treatment of breast cancer.

The American Society of Neuroradiology (ASNR) hosted its 2024 Annual Meeting from May 18–22 in Las Vegas, NV, bringing together neuroradiologists, neurosurgeons, researchers, and industry leaders in neuroradiology.