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Kübler J, Krumm P, Martirosian P, Winkelmann MT, Gohla G, Nikolaou K, Hoffmann R. Improved visualization of hepatic tumors in magnetic resonance-guided thermoablation using T1-inversion-recovery imaging with variable inversion time. Eur Radiol 2023; 33:7015-7024. [PMID: 37133519 PMCID: PMC10511564 DOI: 10.1007/s00330-023-09696-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES In magnetic resonance (MR)-guided interventions, visualization of hepatic lesions may be difficult using standard unenhanced T1-weighted gradient-echo volume-interpolated breath-hold (VIBE) sequence due to low contrast. Inversion recovery (IR) imaging may have the potential to improve visualization without the necessity to apply contrast agent. METHODS Forty-four patients (mean age 64 years, female 33%) scheduled for MR-guided thermoablation due to liver malignancies (hepatocellular carcinoma or metastases) were prospectively included in this study between March 2020 and April 2022. Fifty-one liver lesions were intra-procedurally characterized before treatment. Unenhanced T1-VIBE was acquired as part of the standard imaging protocol. Additionally, T1-modified look-locker images were acquired with eight different inversion times (TI) between 148 and 1743 ms. Lesion-to-liver contrast (LLC) was compared between T1-VIBE and IR images for each TI. T1 relaxation times for liver lesions and liver parenchyma were calculated. RESULTS Mean LLC in T1-VIBE sequence was 0.3 ± 0.1. In IR images, LLC was highest at TI 228 ms (1.04 ± 1.1) and significantly higher compared to T1-VIBE (p < 0.001). In subgroup analysis, lesions of colorectal carcinoma showed the highest LLC at 228 ms (1.14 ± 1.4), and hepatocellular carcinoma showed the highest LLC at 548 ms (1.06 ± 1.16). T1-relaxation times in liver lesions were higher compared to the adjacent liver parenchyma (1184 ± 456 vs. 654 ± 96 ms, p < 0.001). CONCLUSIONS IR imaging is promising to provide improved visualization during unenhanced MR-guided liver interventions compared to standard T1-VIBE sequence when using specific TI. Low TI between 150 and 230 ms yields the highest contrast between liver parenchyma and malignant liver lesions. CLINICAL RELEVANCE STATEMENT Improved visualization of hepatic lesions during MR-guided percutaneous interventions using inversion recovery imaging without the necessity to apply contrast agent. KEY POINTS • Inversion recovery imaging is promising to provide improved visualization of liver lesions in unenhanced MRI. • Planning and guidance during MR-guided interventions in the liver can be performed with greater confidence without necessity to apply contrast agent. • Low TI between 150 and 230 ms yields the highest contrast between liver parenchyma and malignant liver lesions.
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Affiliation(s)
- J Kübler
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany.
| | - P Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - P Martirosian
- Section On Experimental Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - M T Winkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - G Gohla
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - K Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - R Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
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Winkelmann MT, Kübler J, Hoffmann R. Magnetic Resonance-guided Procedures: Consensus on Rationale, Techniques, and Outcomes. Tech Vasc Interv Radiol 2023; 26:100914. [PMID: 38071023 DOI: 10.1016/j.tvir.2023.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Magnetic resonance (MR) image guidance has demonstrated significant potential in the field of interventional radiology in several applications. This article covers the main points of MR-guided hepatic tumor ablation as a representative of MR-guided procedures. Patient selection and appropriate equipment utilization are essential for successful MR-guided tumor ablation. Intra-procedural planning imaging enables the visualization of the tumor and surrounding anatomical structures in most cases without the application of a contrast agent, ensuring optimal planning of the applicator tract. MRI enables real-time, multiplanar imaging, thus simultaneous observation of the applicator and target tumor is possible during targeting with adaptable slice angulations in case of challenging tumor positions. Typical ablation zone appearance during therapy monitoring with MRI enables safe assessment of the therapy result, resulting in a high primary efficacy rate. Recent advancements in ablation probes have shortened treatment times, while technical strategies address applicator visibility issues. MR-imaging immediately after the procedure is used to rule out complications and to assess technical success. Especially in smaller neoplasms, MRI-guided liver ablation demonstrates positive outcomes in terms of technical success rates, as well as promising survival and recurrence rates. Additionally, percutaneous biopsy under MR guidance offers an alternative to classic guidance modalities, providing high soft tissue contrast and thereby increasing the reliability of lesion detection, particularly in cases involving smaller lesions. Despite these advantages, the use of MR guidance in clinical routine is still limited to few indications and centers, due to by high costs, extended duration, and the need for specialized expertise. In conclusion, MRI-guided interventions could benefit from ongoing advancements in hardware, software, and devices. Such progress has the potential to expand diagnostic and treatment options in the field of interventional radiology.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jens Kübler
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Barrow B, Martin Ii RCG. Microwave ablation for hepatic malignancies: a systematic review of the technology and differences in devices. Surg Endosc 2023; 37:817-834. [PMID: 36076101 DOI: 10.1007/s00464-022-09567-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the tumor, the patients' comorbidities, and certain disease sites. The technical effectiveness, ablation success, local recurrence rates of hepatic malignancies treated with the various commercial microwave ablation devices has not been previously published in the peer reviewed literature. The aim of this systematic review is to summarize the clinical outcomes for the various MWA devices in the use of a hepatic malignancies to best educate hepatic surgeons as well as interventional radiologists. METHODS A comprehensive review of the literature and instructions for use of each device that was published from 1/2013 to 12/2020 was performed. The main outcomes extracted were technical success, ablation success, major complications, local and new recurrence rates, recurrence-free survival, ablation volumes, time, and the number of antennas required. A qualitative review of the literature was performed. RESULTS In total, 29 studies reporting data on 3250 patients and 4500 tumors were included in this review. Median patient age was 60.5 years (range 3-91). 76.3% (2420 M/753 F) of patients were male. Hepatocellular carcinoma (55%) was the most common tumor pathology followed by colorectal liver metastasis (10%) and cholangiocarcinoma (4%). A majority of studies reported technical success (range, 91.6-100%) and ablation success (range, 73.1-100%), as well as major complications (range, 0-9.1%). Local recurrence (range, 0-50%) was reported by 21 of the studies; however, new recurrence (range, 12.2-64%) was reported less frequently (6 studies) and were further specified in 12, six, and four studies as intrahepatic distant recurrence (11.3-54.2%), extrahepatic distant recurrence (3.6-20%), and metastasis (1.1-36%). A total of three, six, and five studies report disease, progression, and recurrence-free survival rates, respectively. CONCLUSION Microwave ablation is frequently used for the treatment of hepatic malignancies. A thorough understanding of the clinical outcomes associated with different pathologies and MWA devices can improve surgeon awareness and help prepare for operative planning and patient management. More consistent reporting of key outcomes in the literature is needed to achieve such an understanding.
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Affiliation(s)
- Brooke Barrow
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Robert C G Martin Ii
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA.
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Liu F, Hou B, Li Z, Zhang L, Zhou Y, Bian H, Huo Z. Microwave ablation of multifocal primary liver cancer guided by real-time 3.0T MRI. Int J Hyperthermia 2023; 40:2228519. [PMID: 37429585 DOI: 10.1080/02656736.2023.2228519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To investigate the feasibility and efficacy of real-time 3.0 T magnetic resonance imaging (MRI) guided percutaneous microwave ablation (MWA) in the treatment of multifocal liver cancer. METHODS A total of 76 lesions in 26 patients with multifocal liver cancer who underwent 3.0 T MRI-guided microwave ablation in our hospital from April 2020 to April 2022 were retrospectively analyzed. The technical success rate, average operation time, average ablation time, and complications were evaluated. The upper abdomen was reviewed by pre- and post-contrast enhanced MRI scan every 1 months after the operation. The short-term curative effect was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria (2020 version), and the local control rate was calculated. RESULTS All 76 lesions were successfully operated. The technical success rate was 100%, the average operation time was 103.58 ± 18.57 min, the average ablation time of a single lesion was 11.00 ± 4.05 min, and the average ablation power was 43.03 ± 4.45 W. There were no serious complications such as massive bleeding, liver failure, and infection after the operation, except in one case with a small amount of pleural effusion and one case with right upper abdominal pain. The average follow-up time was 13.88 ± 6.62 months. One patient died due to liver failure, and one lesion developed a local recurrence. The local control rate was 98.7%. CONCLUSIONS MWA of multifocal liver cancer guided by real-time 3.0 T MRI is a safe and feasible technique and has excellent short-term efficacy.
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Affiliation(s)
- Fenghai Liu
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
| | - Baozhou Hou
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
| | - Zhuofu Li
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
| | - Lei Zhang
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
| | - Yingwen Zhou
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
| | - Hao Bian
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
| | - Zhaoyang Huo
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
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Zhang Z, Wang J, Hu Y, Wang L. Microwaves, a potential treatment for bacteria: A review. Front Microbiol 2022; 13:888266. [PMID: 35958124 PMCID: PMC9358438 DOI: 10.3389/fmicb.2022.888266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023] Open
Abstract
Bacteria have brought great harm to the public, especially after the emergence of multidrug-resistant bacteria. This has rendered traditional antibiotic therapy ineffective. In recent years, hyperthermia has offered new treatments to remove bacteria. Microwaves (MW) are a component of the electromagnetic spectrum and can rapidly heat materials. Taking advantage of this characteristic of MW, related studies have shown that both thermal and non-thermal effects of MW can inactivate various bacteria. Even though the understanding of MW in the field of bacteria is not sufficient for widespread use at present, MW has performed well in dealing with microorganisms and controlling infection. This review will focus on the application of MW in bacteria and discuss the advantages, prospects and challenges of using MW in the bacterial field.
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Affiliation(s)
- Zhen Zhang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Jiahao Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Yihe Hu
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Long Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Long Wang,
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Hensen B, Drenkmann U, Frericks B, Rothgang E, Gutberlet M, Länger F, Gilson W, Valdeig S, Weiss CR, Wacker F. Detection of Ablation Boundaries Using Different MR Sequences in a Swine Liver Model. Cardiovasc Intervent Radiol 2022; 45:1010-1018. [PMID: 35449314 PMCID: PMC9226104 DOI: 10.1007/s00270-022-03143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the magnetic resonance (MR) sequences best suited for the assessment of ablation zones after radiofrequency ablation (RFA). METHODS Three percutaneous MR-guided RFA of the liver were performed on three swine. Four pre-contrast and two hepatobiliary post-contrast sequences were obtained after ablation. Tissue samples were extracted and stained for nicotinamide adenine dinucleotide diaphorase hydride (NADH) and with hematoxylin and eosin. Post-ablation MR images and NADH slides were segmented to determine the total ablation zone, their Dice similarity coefficient (DSC), and the contrast-to-noise ratio (CNR) of the visible ablation boundary to normal liver tissue. RESULTS Two distinct layers were combined to determine the ablation zone: an inner layer of coagulation necrosis and an outer layer defined as the peripheral transition zone. Corresponding zones could be found in the MR images as well. Compared to histology, the total area of the MR ablation zone was significantly smaller on the pre-contrast T1 images (p < 0.01) and significantly larger with T2 turbo spin-echo (p = 0.025). No significant difference in size of the ablation zone depiction could be found between histology, post-contrast T1 volumetric interpolated breath-hold examination (VIBE), and post-contrast T1 3D Turboflash (TFL) as well as T2 SPACE images. All sequences but the pre-contrast T1 VIBE sequence showed a DSC above 80% and a high CNR. CONCLUSIONS Post-contrast T1 3DTFL performs best when assessing ablation zones after RFA. Since the sequence requires a long acquisition time, T1 VIBE post-contrast offers the best compromise between acquisition time and estimation accuracy.
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Affiliation(s)
- Bennet Hensen
- Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany.
- STIMULATE-Solution Centre for Image Guided Local Therapies, Magdeburg, Germany.
| | - Urte Drenkmann
- STIMULATE-Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
| | - Bernd Frericks
- Diagnostic and Interventional Radiology, DRK Kliniken Westend, Berlin, Germany
| | - Eva Rothgang
- Industrial Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Weiden, Germany
| | - Marcel Gutberlet
- Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
| | - Florian Länger
- Department of Pathology, Hannover Medical School, Hanover, Germany
| | - Wesley Gilson
- Center for Applied Medical Imaging, Siemens Corporate Research, Baltimore, MD, USA
| | - Steffi Valdeig
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
- The Johns Hopkins Center for Bioengineering Innovation and Design (CBID), Johns Hopkins University, Baltimore, MD, USA
| | - Frank Wacker
- Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- STIMULATE-Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
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Pfannenstiel A, Iannuccilli J, Cornelis FH, Dupuy DE, Beard WL, Prakash P. Shaping the future of microwave tumor ablation: a new direction in precision and control of device performance. Int J Hyperthermia 2022; 39:664-674. [DOI: 10.1080/02656736.2021.1991012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Austin Pfannenstiel
- Precision Microwave Inc, Manhattan, KS, USA
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
| | - Jason Iannuccilli
- Department of Diagnostic Imaging, Division of Interventional Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Francois H. Cornelis
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Damian E. Dupuy
- Diagnostic Imaging, Brown University, Radiology, Cape Cod Hospital, MA, USA
| | - Warren L. Beard
- Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
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Thompson SM, Gorny KR, Koepsel EMK, Welch BT, Mynderse L, Lu A, Favazza CP, Felmlee JP, Woodrum DA. Body Interventional MRI for Diagnostic and Interventional Radiologists: Current Practice and Future Prospects. Radiographics 2021; 41:1785-1801. [PMID: 34597216 DOI: 10.1148/rg.2021210040] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical use of MRI for guidance during interventional procedures emerged shortly after the introduction of clinical diagnostic MRI in the late 1980s. However, early applications of interventional MRI (iMRI) were limited owing to the lack of dedicated iMRI magnets, pulse sequences, and equipment. During the 3 decades that followed, technologic advancements in iMRI magnets that balance bore access and field strength, combined with the development of rapid MRI pulse sequences, surface coils, and commercially available MR-conditional devices, led to the rapid expansion of clinical iMRI applications, particularly in the field of body iMRI. iMRI offers several advantages, including superior soft-tissue resolution, ease of multiplanar imaging, lack of ionizing radiation, and capability to re-image the same section. Disadvantages include longer examination times, lack of MR-conditional equipment, less operator familiarity, and increased cost. Nonetheless, MRI guidance is particularly advantageous when the disease is best visualized with MRI and/or when superior soft-tissue contrast is needed for treatment monitoring. Safety in the iMRI environment is paramount and requires close collaboration among interventional radiologists, MR physicists, and all other iMRI team members. The implementation of risk-limiting measures for personnel and equipment in MR zones III and IV is key. Various commercially available MR-conditional needles, wires, and biopsy and ablation devices are now available throughout the world, depending on the local regulatory status. As such, there has been tremendous growth in the clinical applications of body iMRI, including localization of difficult lesions, biopsy, sclerotherapy, and cryoablation and thermal ablation of malignant and nonmalignant soft-tissue neoplasms. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Scott M Thompson
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Krzysztof R Gorny
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Erica M Knavel Koepsel
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Brian T Welch
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lance Mynderse
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Aiming Lu
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Christopher P Favazza
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Joel P Felmlee
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David A Woodrum
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Gohla G, Archid R, Hoffmann R, Kübler J, Munzel M, Königsrainer A, Nadalin S, Nikolaou K, Winkelmann MT. MRI-guided percutaneous thermoablation as first-line treatment of recurrent hepatic malignancies following hepatic resection: single center long-term experience. Int J Hyperthermia 2021; 38:1401-1408. [PMID: 34542009 DOI: 10.1080/02656736.2021.1979257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Hepatic recurrence of liver malignancies is a leading problem in patients after liver resection with curative intention. Thermoablation is a promising treatment approach for patients after hepatic resection, especially in liver-limited conditions. This study aimed to investigate safety, survival, and local tumor control rates of MRI-guided percutaneous thermoablation of recurrent hepatic malignancies following hepatic resection. MATERIAL AND METHODS Data from patients with primary or secondary hepatic malignancies treated between 2004 and 2018 with MRI-guided percutaneous thermoablation of hepatic recurrence after prior hepatic resection were retrospectively analyzed. Disease-free survival and overall survival rates were calculated using the Kaplan-Meier method. RESULTS A total of 57 patients with hepatic recurrence (mean tumor size = 18.9 ± 9.1 mm) of colorectal cancer liver metastases (n = 27), hepatocellular carcinoma (n = 17), intrahepatic recurrence of cholangiocellular carcinoma (n = 9), or other primary malignant tumor entities (n = 4) were treated once or several times with MR-guided percutaneous radiofrequency (n = 52) or microwave ablation (n = 5) (range: 1-4 times). Disease progression occurred due to local recurrence at the ablation site in nine patients (15.8%), non-local hepatic recurrence in 33 patients (57.9%), and distant malignancy in 18 patients (31.6%). The median overall survival for the total cohort was 40 months and 49 months for the colorectal cancer group, with a 5-year overall survival rate of 40.7 and 42.5%, respectively. The median disease-free survival was 10 months for both the total cohort and the colorectal cancer group with a 5-year disease-free survival rate of 15.1 and 14.8%, respectively. The mean follow-up time was 39.6 ± 35.7 months. CONCLUSION MR-guided thermoablation is an effective and safe approach in the treatment of hepatic recurrences in liver-limited conditions and can achieve long-term survival.
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Affiliation(s)
- G Gohla
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - R Archid
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - R Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - J Kübler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - M Munzel
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - S Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - K Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - M T Winkelmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
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Kok HP, Cressman ENK, Ceelen W, Brace CL, Ivkov R, Grüll H, Ter Haar G, Wust P, Crezee J. Heating technology for malignant tumors: a review. Int J Hyperthermia 2021; 37:711-741. [PMID: 32579419 DOI: 10.1080/02656736.2020.1779357] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 °C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 °C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik N K Cressman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Christopher L Brace
- Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Holger Grüll
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Gail Ter Haar
- Department of Physics, The Institute of Cancer Research, London, UK
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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11
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Zhou Y, Yang Y, Zhou B, Wang Z, Zhu R, Chen X, Ouyang J, Li Q, Zhou J. Challenges Facing Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Extension of Ablation Criteria. J Hepatocell Carcinoma 2021; 8:625-644. [PMID: 34189133 PMCID: PMC8232857 DOI: 10.2147/jhc.s298709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
As an emerging minimally invasive treatment method, percutaneous ablation is more and more widely used in the treatment of liver tumors. It has been recommended by guidelines for diagnosis and treatment of hepatocellular carcinoma (HCC) as a curative treatment alongside surgical resection and liver transplantation. In recent years, with the continuous advancement and innovation of percutaneous ablation technologies, their clinical efficacy and safety have been significantly improved, which has led to the expanded application of percutaneous ablation in the treatment of HCC—more and more patients who were previously considered unsuitable for ablation therapies are now being treated with percutaneous ablation. Obviously, percutaneous ablation can reduce the risk of treatment changes from curative strategies to palliative strategies. Based on clinical practice experience, this review enumerates the advantages and disadvantages of different ablative modalities and summarizes the existing combinations of ablation techniques, thus will help clinicians choose the most appropriate ablative modality for each patient and will provide scientific guidance for improving prognosis and making evidence-based treatment decisions. In addition, we point out the challenges and future prospects of the ablation therapies, thereby providing direction for future research.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Yi Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Bingyan Zhou
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People's Republic of China
| | - Zhengzheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Ruili Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Xun Chen
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Qingjun Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
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12
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MR-Guided Microwave Ablation in T1 Renal Cell Carcinoma: Initial Results in Clinical Routine. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5537192. [PMID: 34055980 PMCID: PMC8147533 DOI: 10.1155/2021/5537192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/03/2021] [Indexed: 11/23/2022]
Abstract
Objective Percutaneous tumor ablation is usually performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor could be challenging. Magnetic resonance- (MR-) guided ablation provides more reliable visualization of the target tumors and allows multiplanar imaging of the treatment process, making it the modality of choice, in particular if lesions are small. Methods From March 2016 to January 2018, 32 patients scheduled for percutaneous treatment of T1 RCC underwent MR-guided MWA. Complications were classified according to the Clavien grade. Kaplan–Meier survival estimates were calculated to evaluate progression-free survival (PFS). Results Technical success was achieved in all lesions. The mean energy and procedure duration were 61.6 ± 8.7 kJ and 118.2 ± 26.7 min, respectively. The glomerular filtration rate (GFR) dropped rapidly after 1 month of treatment and slowly recovered within three months (P < 0.05). Postoperative pain and fever were the most common adverse events after treatment. Perirenal hematoma, thermal injury of the psoas muscle, and abdominal distension were common complications after MWA, and the incidence rates were 9.4% (3/32), 6.3% (2/32), and 6.3% (2/32), respectively. According to the Clavien grade classification, serious complications include hydrothorax, bowel injury, and renal failure, all of which have a probability of 3.1%. Of note, the three serious complications occurred in one patient. The 1-, 2-, and 3-year PFS rates were 96.9%, 93.8%, and 83.9%, respectively. The mean PFS rates were 33.972 months (95% CI: 33.045, 35.900). Conclusion Microwave ablation is feasible under MR guidance and provides effective treatment of RCC in one session.
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Li Z, Jiao D, Wang C, Li J, Liu Z, Zhang W, Han X. Microwave Ablation of Small Hepatic Metastases Using MR Guidance and Monitoring: Clinical Safety and Efficacy. Cancer Manag Res 2021; 13:3357-3366. [PMID: 33889024 PMCID: PMC8057791 DOI: 10.2147/cmar.s301856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the technical success and clinical safety of magnetic resonance (MR)-guided microwave ablation (MWA) of small hepatic metastases. Materials and Methods Institutional review board approval and informed patient consent were obtained. A retrospective analysis of the patient data revealed 50 patients with small hepatic metastases (34 men, 16 women) who underwent MWA under MR guidance and monitoring. After the procedure, the intervention-related complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) and Society of Interventional Radiology (SIR) classification system. Furthermore, the overall survival (OS) and local tumor-free survival (LTP) of the patients were analyzed. Results The patients who underwent MR-guided MWA achieved technical success. The mean energy, ablation duration per tumor, and procedure duration were 55.3 ± 9.4 kJ, 11.7 ± 5.6 min and 89.5 ± 30.9 min, respectively. Most adverse events and complications were CTCAE grade 1 or 2 or SIR classification grade A or B. The 1-, 2-, and 3-year local tumor progression (LTP) rates were 65.9%, 31.5% and 18.5%, respectively, with a mean LTP of 19.216 months (95% CI: 16.208, 22.224); and the 1-, 2- and 3-year overall survival (OS) rates were 81.8%, 60.8% and 44.7%, respectively, with a mean OS of 26.378 months (95% CI: 23.485, 29.270). Multivariate Cox’s regression analysis further illustrated that tumor location (challenging locations vs ordinary locations) and the anesthesia (general anesthesia VS local anesthesia) were important factors affecting LTP and OS. Conclusion MR-guided MWA can successfully treat small hepatic metastases with potentially favorable safety and technical efficacy.
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Affiliation(s)
- Zhaonan Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Dechao Jiao
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Chaoyan Wang
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Jing Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Zaoqu Liu
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Wenguang Zhang
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
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14
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Li Z, Wang C, Si G, Zhou X, Li Y, Li J, Jiao D, Han X. Image-guided microwave ablation of hepatocellular carcinoma (≤5.0 cm): is MR guidance more effective than CT guidance? BMC Cancer 2021; 21:366. [PMID: 33827464 PMCID: PMC8028080 DOI: 10.1186/s12885-021-08099-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Given their widespread availability and relatively low cost, percutaneous thermal ablation is commonly performed under the guidance of computed tomography (CT) or ultrasound (US). However, such imaging modalities may be restricted due to insufficient image contrast and limited tumor visibility, which results in imperfect intraoperative treatment or an increased risk of damage to critical anatomical structures. Currently, magnetic resonance (MR) guidance has been proven to be a possible solution to overcome the above shortcomings, as it provides more reliable visualization of the target tumor and allows for multiplanar capabilities, making it the modality of choice. Unfortunately, MR-guided ablation is limited to specialized centers, and the cost is relatively high. Is ablation therapy under MR guidance better than that under CT guidance? This study retrospectively compared the efficacy of CT-guided and MR-guided microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC ≤ 5.0 cm). METHODS In this retrospective study, 47 patients and 54 patients received MWA under the guidance of CT and MR, respectively. The inclusion criteria were a single HCC ≤ 5.0 cm or a maximum of three. The local tumor progression (LTP), overall survival (OS), prognostic factors for local progression, and safety of this technique were assessed. RESULTS All procedures were technically successful. The complication rates of the two groups were remarkably different with respect to incidences of liver abscess and pleural effusion (P < 0.05). The mean LTP was 44.264 months in the CT-guided group versus 47.745 months in the MR-guided group of HCC (P = 0.629, log-rank test). The mean OS was 56.772 months in the patients who underwent the CT-guided procedure versus 58.123 months in those who underwent the MR-guided procedure (P = 0.630, log-rank test). Multivariate Cox regression analysis further illustrated that tumor diameter (< 3 cm) and the number of lesions (single) were important factors affecting LTP and OS. CONCLUSIONS Both CT-guided and MR-guided MWA are comparable therapies for the treatment of HCC (< 5 cm), and there was no difference in survival between the two groups. However, MR-guided MWA could reduce the incidence of complications.
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Affiliation(s)
- Zhaonan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Chaoyan Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Guangyan Si
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, 646000, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Jing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
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