Evaluation of Synthetically Generated CT for use in Transcranial Focused Ultrasound Procedures

Transcranial focused ultrasound (tFUS) is a therapeutic ultrasound method that focuses sound through the skull to a small region noninvasively and often under MRI guidance. CT imaging is used to estimate the acoustic properties that vary between individual skulls to enable effective focusing during tFUS procedures, exposing patients to potentially harmful radiation. A method to estimate acoustic parameters in the skull without the need for CT would be desirable. Here, we synthesized CT images from routinely acquired T1-weighted MRI by using a 3D patch-based conditional generative adversarial network (cGAN) and evaluated the performance of synthesized CT (sCT) images for treatment planning with tFUS. We compared the performance of sCT to real CT (rCT) images for tFUS planning using Kranion and simulations using the acoustic toolbox, k-Wave. Simulations were performed for 3 tFUS scenarios: 1) no aberration correction, 2) correction with phases calculated from Kranion, and 3) phase shifts calculated from time-reversal. From Kranion, skull density ratio, skull thickness, and number of active elements between rCT and sCT had Pearson's Correlation Coefficients of 0.94, 0.92, and 0.98, respectively. Among 20 targets, differences in simulated peak pressure between rCT and sCT were largest without phase correction (12.4$\pm$8.1%) and smallest with Kranion phases (7.3$\pm$6.0%). The distance between peak focal locations between rCT and sCT was less than 1.3 mm for all simulation cases. Real and synthetically generated skulls had comparable image similarity, skull measurements, and acoustic simulation metrics. Our work demonstrates the feasibility of replacing real CTs with the MR-synthesized CT for tFUS planning. Source code and a docker image with the trained model are available at https://github.com/han-liu/SynCT_TcMRgFUS

Synthetic CT Skull Generation for Transcranial MR Imaging-Guided Focused Ultrasound Interventions with Conditional Adversarial Networks

Transcranial MRI-guided focused ultrasound (TcMRgFUS) is a therapeutic ultrasound method that focuses sound through the skull to a small region noninvasively under MRI guidance. It is clinically approved to thermally ablate regions of the thalamus and is being explored for other therapies, such as blood brain barrier opening and neuromodulation. To accurately target ultrasound through the skull, the transmitted waves must constructively interfere at the target region. However, heterogeneity of the sound speed, density, and ultrasound attenuation in different individuals' skulls requires patient-specific estimates of these parameters for optimal treatment planning. CT imaging is currently the gold standard for estimating acoustic properties of an individual skull during clinical procedures, but CT imaging exposes patients to radiation and increases the overall number of imaging procedures required for therapy. A method to estimate acoustic parameters in the skull without the need for CT would be desirable. Here, we synthesized CT images from routinely acquired T1-weighted MRI by using a 3D patch-based conditional generative adversarial network and evaluated the performance of synthesized CT images for treatment planning with transcranial focused ultrasound. We compared the performance of synthetic CT to real CT images using Kranion and k-Wave acoustic simulation. Our work demonstrates the feasibility of replacing real CT with the MR-synthesized CT for TcMRgFUS planning.