Learning Multiparametric Biomarkers for Assessing MR-Guided Focused Ultrasound Treatments Using Volume-Conserving Registration

Noninvasive MR-guided focused ultrasound (MRgFUS) treatments are promising alternatives to the surgical removal of malignant tumors. A significant challenge is assessing the treated tissue immediately after MRgFUS procedures. Although current clinical assessment uses the immediate nonperfused volume (NPV) biomarker derived from contrast enhanced imaging, the use of contrast agent prevents continuing MRgFUS treatment if margins are not adequate. In addition, the NPV has been shown to provide variable accuracy for the true treatment outcome as evaluated by follow-up biomarkers. This work presents a novel, noncontrast, learned multiparametric MR biomarker that is conducive for intratreatment assessment. MRgFUS ablations were performed in a rabbit VX2 tumor model. Multiparametric MRI was obtained both during and immediately after the MRgFUS ablation, as well as during follow-up imaging. Segmentation of the NPV obtained during follow-up imaging was used to train a neural network on noncontrast multiparametric MR images. The NPV follow-up segmentation was registered to treatment-day images using a novel volume-conserving registration algorithm, allowing a voxel-wise correlation between imaging sessions. Contrasted with state-of-the-art registration algorithms that change the average volume by 16.8%, the presented volume-conserving registration algorithm changes the average volume by only 0.28%. After registration, the learned multiparametric MR biomarker predicted the follow-up NPV with an average DICE coefficient of 0.71, outperforming the DICE coefficient of 0.53 from the current standard of NPV obtained immediately after the ablation treatment. Noncontrast multiparametric MR imaging can provide a more accurate prediction of treated tissue immediately after treatment. Noncontrast assessment of MRgFUS procedures will potentially lead to more efficacious MRgFUS ablation treatments.