Magnetic resonance imaging-guided laser ablation of bone tumors

Image-guided thermal ablation of bone tumors is gaining acceptance in the oncology community. Computed tomography-guided radiofrequency ablation and cryoablation are widely available and are used in clinical practice. However, a potentially devastating complication of these techniques is thermal injury to the spinal cord and nerve roots in patients with tumors involving the vertebra, paraspinal tissues, or pelvis. Magnetic resonance imaging-guided laser ablation with quantitative magnetic resonance temperature imaging is a novel technique that allows for accurate imaging of the tumor, real-time placement of laser fibers, and real-time monitoring of the ablation zone. With this technique, target temperature thresholds are placed on critical neural elements to provide real-time feedback that allows for automatic deactivation of the laser when the threshold temperature is reached. The ablation zone is generated quickly, with sharp and well-demarcated boundaries. As such, magnetic resonance imaging-guided laser ablation may be a safer technique for ablating bone tumors in the vicinity of the spinal cord, nerve roots, and peripheral nerves.