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.