Laser interstitial thermal therapy (LITT) has recently emerged as a new treatment modality for cancer
pain management that targets the cingulum (pain center in the brain) and has shown promise over radio frequency
(RF)-based ablation, due to magnetic resonance image (MRI) guidance that allows for precise ablation.
Since laser ablation for pain management is currently exploratory and is only performed at a few centers worldwide,
its short- and long-term effects on the cingulum are currently unknown. Traditionally, treatment effects for
neurological conditions are evaluated by monitoring changes in intensities and/or volume of the ablation zone on
post-treatment Gadolinium-contrast T1-w (Gd-T1) MRI. However, LITT introduces subtle localized changes corresponding
to tissues response to treatment, which may not be appreciable on visual inspection of volumetric or
intensity changes. Additionally, different MRI protocols [Gd-T1, T2w, gradient echo sequence (GRE), fluidattenuated
inversion recovery (FLAIR)] are known to capture complementary diagnostic information regarding
the patient’s response to treatment; the utility of these MRI protocols has so far not been investigated to evaluate
early and localized response to LITT treatment in the context of neuropathic cancer pain. In this work, we present
the first attempt at (a) examining early treatment-related changes on a per-voxel basis via quantitative comparison
of computer-extracted texture descriptors across pre- and post-LITT multiparametric (MP-MRI) (Gd-T1,
T2w, GRE, FLAIR), subtle microarchitectural texture changes that may not be appreciable on original MR intensities
or volumetric differences, and (b) investigating the efficacy of different MRI protocols in accurately capturing
immediate post-treatment changes reflected (1) within and (2) outside the ablation zone. A retrospective
cohort of four patient studies comprising pre- and immediate (24 h) post-LITT 3 Tesla Gd-T1, T2w, GRE,
and FLAIR acquisitions was considered. Our quantitative approach first involved intensity standardization to
allow for grayscale MR intensities acquired pre- and post-LITT to have a fixed tissue-specific meaning within
the same imaging protocol, the same body region, and within the same patient. An affine registration was then
performed on individual post-LITT MRI protocols to a reference MRI protocol pre-LITT. A total of 78 computerized
texture features (co-occurrence matrix homogeneity, neighboring gray-level dependence matrix, Gabor)
are then extracted from pre- and post-LITT MP-MRI on a per-voxel basis. Quantitative, voxelwise comparison of
the changes in MRI texture features between pre- and post-LITT MRI indicate that (a) Gabor texture features at
specific orientations were highly sensitive as well as specific in predicting subtle microarchitectural changes
within and around the ablation zone pre- and post-LITT, (b) FLAIR was identified as the most sensitive MRI
protocol in identifying early treatment changes yielding a normalized percentage change of 360% within the
ablation zone relative to its pre-LITT value, and (c) GRE was identified as the most sensitive MRI protocol
in quantifying changes outside the ablation zone post-LITT. Our preliminary results thus indicate potential
for noninvasive computerized MP-MRI features over volumetric features in determining localized microarchitectural
early focal treatment changes post-LITT for neuropathic cancer pain treatment.
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