Technical Principles and Clinical Workflow of Transcranial MR-Guided Focused Ultrasound

Transcranial MR-guided focused ultrasound (MRgFUS) is a rapidly developing technology in neuroscience for manipulating brain structure and function without open surgery. The effectiveness of transcranial MRgFUS for thermoablation is well established, and the technique is actively employed worldwide for movement disorders including essential tremor. A growing number of centers are also investigating the potential of microbubble-mediated focused ultrasound-induced opening of the blood-brain barrier (BBB) for targeted drug delivery to the brain. Here, we provide a technical overview of the principles, clinical workflow, and operator considerations of transcranial MRgFUS procedures for both thermoablation and BBB opening.

• Publication year

  2020

• Venue

  Stereotactic and Functional Neurosurgery

• Publication date

  2020-12-10

• Fields of study

  Medicine, Engineering

• Identifiers
  DOI 10.1159/000512111PMID 33302282
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Noninvasive hippocampal blood−brain barrier opening in Alzheimer’s disease with focused ultrasound

  2020cited by this paper
• Safety and feasibility of multiple blood-brain barrier disruptions for the treatment of glioblastoma in patients undergoing standard adjuvant chemotherapy.

  2020cited by this paper
• Kranion, an open-source environment for planning transcranial focused ultrasound surgery: technical note.

  2020cited by this paper
• Blood-brain barrier disruption in humans using an implantable ultrasound device: quantification with MR images and correlation with local acoustic pressure.

  2020cited by this paper
• The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound.

  2020cited by this paper
• Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures.

  2020cited by this paper
• Ultrafast three-dimensional microbubble imaging in vivo predicts tissue damage volume distributions during nonthermal brain ablation

  2020cited by this paper
• Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders.

  2020cited by this paper
• Physical triggering strategies for drug delivery.

  2020cited by this paper
• Focused ultrasound for opening blood-brain barrier and drug delivery monitored with positron emission tomography.

  2020cited by this paper
• Magnetic resonance-guided focused ultrasound capsulotomy for refractory obsessive compulsive disorder and major depressive disorder: clinical and imaging results from two phase I trials

  2020cited by this paper
• MRI follow-up after magnetic resonance-guided focused ultrasound for non-invasive thalamotomy: the neuroradiologist’s perspective

  2020cited by this paper
• Intraoperative imaging findings in transcranial MR imaging-guided focused ultrasound treatment at 1.5T may accurately detect typical lesional findings correlated with sonication parameters

  2020cited by this paper
• Anesthesia considerations of magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: a case series

  2020cited by this paper
• Echo‐Focusing in Transcranial Focused Ultrasound Thalamotomy for Essential Tremor: A Feasibility Study

  2020cited by this paper
• Resting state functional connectivity changes after MR-guided focused ultrasound mediated blood-brain barrier opening in patients with Alzheimer's disease

  2019cited by this paper
• Advances in acoustic monitoring and control of focused ultrasound-mediated increases in blood-brain barrier permeability.

  2019cited by this paper
• A Clinical System for Non-invasive Blood-Brain Barrier Opening Using a Neuronavigation-Guided Single-Element Focused Ultrasound Transducer.

  2019cited by this paper
• Transcranial Magnetic Resonance-Guided Focused Ultrasound Thalamotomy in Essential Tremor: A Comprehensive Lesion Characterization.

  2019cited by this paper
• First-in-human trial of blood–brain barrier opening in amyotrophic lateral sclerosis using MR-guided focused ultrasound

  2019cited by this paper
• Acoustic feedback enables safe and reliable carboplatin delivery across the blood-brain barrier with a clinical focused ultrasound system and improves survival in a rat glioma model

  2019cited by this paper
• Glymphatics Visualization after Focused Ultrasound‐Induced Blood–Brain Barrier Opening in Humans

  2019cited by this paper
• Elementwise approach for simulating transcranial MRI-guided focused ultrasound thermal ablation

  2019cited by this paper
• Safety and efficacy of focused ultrasound induced blood-brain barrier opening, an integrative review of animal and human studies.

  2019cited by this paper
• The neurovascular response is attenuated by focused ultrasound-mediated disruption of the blood-brain barrier

  2019cited by this paper
• Factors Related to Successful Energy Transmission of Focused Ultrasound through a Skull : A Study in Human Cadavers and Its Comparison with Clinical Experiences

  2019cited by this paper
• Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial.

  2019cited by this paper
• Repeat magnetic resonance imaging-guided focused ultrasound thalamotomy for recurrent essential tremor: case report and review of MRI findings.

  2019cited by this paper
• Blood-Brain Barrier Opening in Primary Brain Tumors with Non-invasive MR-Guided Focused Ultrasound: A Clinical Safety and Feasibility Study

  2019cited by this paper
• Blood–brain barrier opening in Alzheimer’s disease using MR-guided focused ultrasound

  2018cited by this paper
• Three-dimensional transcranial microbubble imaging for guiding volumetric ultrasound-mediated blood-brain barrier opening

  2018cited by this paper
• The reduction in treatment efficiency at high acoustic powers during MR‐guided transcranial focused ultrasound thalamotomy for Essential Tremor

  2018cited by this paper
• Cost‐Effectiveness of Magnetic Resonance‐Guided Focused Ultrasound for Essential Tremor

  2018cited by this paper
• Predicting lesion size by accumulated thermal dose in MR‐guided focused ultrasound for essential tremor

  2018cited by this paper
• Design and Implementation of a Transmit/Receive Ultrasound Phased Array for Brain Applications

  2018cited by this paper
• Safety and Efficacy of Focused Ultrasound Thalamotomy for Patients With Medication-Refractory, Tremor-Dominant Parkinson Disease: A Randomized Clinical Trial

  2017cited by this paper
• The Effects of Oxygen on Ultrasound-Induced Blood-Brain Barrier Disruption in Mice.

  2017cited by this paper
• Opening the Blood-Brain Barrier with MR Imaging-guided Focused Ultrasound: Preclinical Testing on a Trans-Human Skull Porcine Model.

  2017cited by this paper
• MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor.

  2017cited by this paper
• Nursing Management of the Patient Undergoing Focused Ultrasound: A New Treatment Option for Essential Tremor.

  2017cited by this paper
• Cost‐effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor

  2017cited by this paper
• Closed-loop control of targeted ultrasound drug delivery across the blood–brain/tumor barriers in a rat glioma model

  2017cited by this paper
• Clinical trial of blood-brain barrier disruption by pulsed ultrasound

  2016cited by this paper
• Transcranial focused ultrasound stimulation of human primary visual cortex

  2016cited by this paper
• Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull.

  2016cited by this paper
• A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor.

  2016cited by this paper
• Acoustic cavitation-based monitoring of the reversibility and permeability of ultrasound-induced blood-brain barrier opening

  2015cited by this paper
• Transcranial MRI-Guided Focused Ultrasound: A Review of the Technologic and Neurologic Applications.

  2015cited by this paper
• Three-Dimensional Transcranial Ultrasound Imaging of Microbubble Clouds Using a Sparse Hemispherical Array

  2014cited by this paper
• Pharmacokinetic Changes Induced by Focused Ultrasound in Glioma-Bearing Rats as Measured by Dynamic Contrast-Enhanced MRI

  2014cited by this paper
• Trans-cranial focused ultrasound without hair shaving: feasibility study in an ex vivo cadaver model

  2014cited by this paper
• Imaging Findings in MR Imaging–Guided Focused Ultrasound Treatment for Patients with Essential Tremor

  2014cited by this paper
• Numerical simulations of clinical focused ultrasound functional neurosurgery

  2014cited by this paper
• MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study.

  2013cited by this paper
• Transcranial passive acoustic mapping with hemispherical sparse arrays using CT-based skull-specific aberration corrections: a simulation study

  2013cited by this paper
• Drug delivery to the brain by focused ultrasound induced blood-brain barrier disruption: quantitative evaluation of enhanced permeability of cerebral vasculature using two-photon microscopy.

  2013cited by this paper
• A super-resolution ultrasound method for brain vascular mapping.

  2013cited by this paper
• Controlled Ultrasound-Induced Blood-Brain Barrier Disruption Using Passive Acoustic Emissions Monitoring

  2012cited by this paper
• Blood-brain barrier: real-time feedback-controlled focused ultrasound disruption by using an acoustic emissions-based controller.

  2012cited by this paper
• The kinetics of blood brain barrier permeability and targeted doxorubicin delivery into brain induced by focused ultrasound.

  2012cited by this paper
• Temporary disruption of the blood-brain barrier by use of ultrasound and microbubbles: safety and efficacy evaluation in rhesus macaques.

  2012cited by this paper
• The Effect of Inhaled Gases on Ultrasound Contrast Agent Longevity In Vivo

  2011cited by this paper
• Two-Photon Fluorescence Microscopy Study of Cerebrovascular Dynamics in Ultrasound-Induced Blood—Brain Barrier Opening

  2011cited by this paper
• The effect of pre-activation vial temperature on the acoustic properties of definity

  2011cited by this paper
• Transcranial Ultrasonic Therapy Based on Time Reversal of Acoustically Induced Cavitation Bubble Signature

  2010cited by this paper
• Transcranial Magnetic Resonance Imaging– Guided Focused Ultrasound Surgery of Brain Tumors: Initial Findings in 3 Patients

  2010cited by this paper
• In vivo transcranial cavitation threshold detection during ultrasound-induced blood–brain barrier opening in mice

  2010cited by this paper
• Needle size and injection rate impact microbubble contrast agent population.

  2008cited by this paper
• Hyperintensity in the subarachnoid space on FLAIR MRI.

  2007cited by this paper
• Comparison of Accuracy and Precision between Frame-Based and Frameless Stereotactic Navigation for Deep Brain Stimulation Electrode Implantation

  2007cited by this paper
• Seizure‐Promoting Effect of Blood–Brain Barrier Disruption

  2007cited by this paper
• Attenuation and size distribution measurements of Definity and manipulated Definity populations.

  2007cited by this paper
• Attenuation and Size Distribution Measurements of Definity™ and Manipulated Definity™ Populations

  2007cited by this paper
• Targeted disruption of the blood–brain barrier with focused ultrasound: association with cavitation activity

  2006cited by this paper
• Noninvasive localized delivery of Herceptin to the mouse brain by MRI-guided focused ultrasound-induced blood-brain barrier disruption.

  2006cited by this paper
• A numerical study of transcranial focused ultrasound beam propagation at low frequency

  2005cited by this paper
• Transcranial ultrasound focus reconstruction with phase and amplitude correction

  2004cited by this paper
• Patterns of thermal deposition in the skull during transcranial focused ultrasound surgery

  2004cited by this paper
• Basic principles of thermal dosimetry and thermal thresholds for tissue damage from hyperthermia

  2003cited by this paper
• A non-invasive method for focusing ultrasound through the human skull.

  2002cited by this paper
• Noninvasive MR imaging-guided focal opening of the blood-brain barrier in rabbits.

  2001cited by this paper
• The response of human and rodent cells to hyperthermia.

  1991cited by this paper
• The effect of carbon dioxide on the diameter of brain capillaries.

  1990cited by this paper
• Thermal dose determination in cancer therapy.

  1984cited by this paper
• Acoustical properties of the human skull.

  1978cited by this paper
• Analysis of tissue and arterial blood temperatures in the resting human forearm.

  1948cited by this paper

• Chimeric antigen receptor macrophages therapy for glioblastoma: challenges and opportunities from preclinical evidence to clinical translation.

  2026cites this paper
• Data‐Driven Feedback Identifies Focused Ultrasound Exposure Regimens for Improved Nanotheranostic Targeting of the Brain

  2026cites this paper
• Data-driven feedback augments ultrasound nanotheranostics in brain tumors

  2025cites this paper
• A retraced spiral strategy with semi‐automatic deblurring for volumetric thermometry

  2025cites this paper
• Overcoming the blood-brain barrier: targeted delivery strategies for gliomas

  2025cites this paper
• 3D MR Thermometry Using Bi‐Directional Segmented EPI for Transcranial‐Focused Ultrasound

  2025cites this paper
• Comparison of Ray-Tracing and Diffraction Methods for Correcting Aberrations in Transcranial Focusing of Ultrasound Field

  2025cites this paper
• Enhanced blood–brain barrier opening induced by focused ultrasound combined with microbubble clusters trapped by an acoustic vortex tweezer

  2025cites this paper
• From Better Diagnostics to Earlier Treatment: The Rapidly Evolving Alzheimer’s Disease Landscape

  2025cites this paper
• A roadmap for focused ultrasound applications in psychiatry: Proceedings of the 2024 symposium on focused ultrasound in psychiatry (FUS-PULSE).

  2025cites this paper
• Focused ultrasound therapy for movement disorders.

  2025cites this paper
• Focused ultrasound: focused on tremor

  2025cites this paper
• Optimizing Transcranial Focused Ultrasound Parameters: A Methodological Advancement in Non-invasive Brain Stimulation for Next-Gen Clinical Applications

  2025cites this paper
• Magnetic resonance-guided ultrasound thalamotomy for essential tremor: a review

  2025influential citation
• Magnetic resonance imaging-guided focused ultrasound and ExAblate Neuro™-emerging technologies in neurology

  2025cites this paper
• Transcranial Focused Ultrasound: A History of Our Future.

  2024cites this paper
• The Use of Focused Ultrasound to Enhance Liquid Biopsy.

  2024cites this paper
• Therapeutic ultrasound transducer technology and monitoring techniques: a review with clinical examples

  2024cites this paper
• Cyclic jetting enables microbubble-mediated drug delivery

  2024cites this paper
• Treatment envelope of transcranial histotripsy: challenges and strategies to maximize the treatment location profile

  2024cites this paper
• Workflow of a Preclinical Robotic Magnetic Resonance Imaging-guided Focused Ultrasound Body System

  2024influential citation
• MR-guided focused ultrasound in movement disorders and beyond: Lessons learned and new frontiers.

  2024cites this paper
• Design and Validation of a Patient-Specific Stereotactic Frame for Transcranial Ultrasound Therapy

  2024influential citation
• Feasibility of Ultrasonic Heating through Skull Phantom Using Single-element Transducer

  2023cites this paper
• Initiating a Magnetic Resonance-Guided Focused Ultrasound Program: Comprehensive Workflow and Lessons Learned from the Initial 116 Cases

  2023cites this paper
• Transcranial focused ultrasound-induced blood‒brain barrier opening in mice without shaving hairs

  2023cites this paper
• Successful magnetic resonance-guided focused ultrasound treatment of tremor in patients with a skull density ratio of 0.4 or less.

  2023cites this paper
• Evaluation of synthetically generated computed tomography for use in transcranial focused ultrasound procedures

  2023cites this paper
• Generating Patient-Specific Acoustic Simulations for Transcranial Focused Ultrasound Procedures Based on Optical Tracking Information

  2023cites this paper
• Low-Energy Transcranial Navigation-Guided Focused Ultrasound for Neuropathic Pain: An Exploratory Study

  2023cites this paper
• Combination of radiosurgery and immunotherapy in brain metastases: balance between efficacy and toxicities

  2023cites this paper
• Focused Ultrasound Central Lateral Thalamotomy for the Treatment of Refractory Neuropathic Pain: Phase I Trial

  2023cites this paper
• Breaking barriers: exploring mechanisms behind opening the blood–brain barrier

  2023cites this paper
• DBS, tcMRgFUS, and Gamma Knife radiosurgery for the treatment of essential tremor: a systematic review on techniques, indications, and current applications.

  2022cites this paper
• Transcranial MR-Guided Focused Ultrasound and Hyperostosis Calvariae Diffusa: Case Report and Systematic Review of the Literature

  2022cites this paper
• Evaluation of Synthetically Generated CT for use in Transcranial Focused Ultrasound Procedures

  2022cites this paper
• Iron based coupling media (IBCM) for MRI-guided ultrasound surgery.

  2022cites this paper
• Focus prediction of high-intensity focused ultrasound (HIFU) in biological tissues based on magnetic resonance images

  2022cites this paper
• Update in the clinical application of focused ultrasound

  2022cites this paper
• Comparison of sonication patterns and microbubble administration strategies for focused ultrasound-mediated large-volume drug delivery

  2022cites this paper
• Highly accelerated magnetic resonance acoustic radiation force imaging for in vivo transcranial ultrasound focus localization: A comparison of three reconstruction methods

  2021cites this paper
• Non-invasive transcranial ultrasound stimulation for neuromodulation.

  2021cites this paper
• Towards controlled drug delivery in brain tumors with microbubble-enhanced focused ultrasound.

  2021cites this paper
• Combining Low-Dose Radiation Therapy and Magnetic Resonance Guided Focused Ultrasound to Reduce Amyloid-β Deposition in Alzheimer’s Disease

  2021cites this paper
• Focused ultrasound: growth potential and future directions in neurosurgery

  2021cites this paper
• MRI Guided Focused Ultrasound-Mediated Delivery of Therapeutic Cells to the Brain: A Review of the State-of-the-Art Methodology and Future Applications

  2021cites this paper