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Pain relief by Sonalleve MR-HIFU treatment

Case Study
Dr. Tröster, Fridolin Marienhospital Stuttgart • Germany

Patient history


The patient has mamma carcinoma with bone metastasis in the right os ischii. Initial pain score was 4 (scale 1-10) without medication.



Principle of MR-HIFU treatment


Bone metastases are a common cause of pain in cancer patients. The purpose of the bone palliative treatment is symptom relief and improvement of quality of life in the end-stage disease.


The periosteum is considered to be a major source of pain from bone metastases.

During MR-HIFU treatment the periosteal nerves are ablated using ultrasound energy in a non-invasive manner. This ablation of periosteal nerves may give immediate pain relief.



Patient preparation


Proper and sufficient pain management of the patient during the treatment is essential for good treatment outcome and cooperation with anesthesia department is needed. In this case the patient was under general anesthesia.





The treatment was done using Sonalleve Release 3.5 HE.

  • The patient was positioned supine, slightly off center to have the target in the middle of ultrasound window.
  • Cells were positioned to cover the whole metastasis: 23 sonications, mostly 8 mm cells.
  • As the cortex of the bone was intact, heating could be detected on the surface of the cortical bone using temperature sensitive MRI.



 T1W 3D tra shows the osteoblastic lesion in os ischii Position of the cells in coronal plane image
T1W 3D tra shows the osteoblastic lesion in os ischii
Position of the cells in coronal plane image
 Sonication heating on the bone surface Sonication heating along the bone surface
Sonication heating on the bone surface
Sonication heating along the bone surface



Outcome and follow-up


The bone palliative treatment outcome cannot be visualized by imaging. Pain relief is the only measurable treatment outcome.


Right after treatment the patient reported a pain score of 2 due to burning sensation. Patient received ibuprofen for 3 weeks. At 3 months follow-up, this burning sensation was gone and she reported a pain score of 0 without medication.




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Nov 3, 2015

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Case Study
Ingenia 1.5T, Sonalleve MR-HIFU
Release 5
dStream, HIFU, Oncology, Pelvis, Shoulder

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