A comparison between 915 MHz and 2450 MHz microwave ablation systems for the treatment of small diameter lung metastases

Enhancing precision in lung tumor ablation through innovations in CT-guided technique and angle control

BACKGROUND

This retrospective study aimed to evaluate the precision and safety outcomes of image-guided lung percutaneous thermal ablation (LPTA) methods, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA). The study utilized an innovative angle reference guide to facilitate these techniques in the treatment of lung tumors.

METHODS

This study included individuals undergoing LPTA with the assistance of laser angle guide assembly (LAGA) at our hospital between April 2011 and March 2021. We analyzed patient demographics, tumor characteristics, procedure details, and complications. Logistic regressions were employed to assess risk factors associated with complications.

RESULTS

A total of 202 patients underwent ablation for 375 lung tumors across 275 sessions involving 495 ablations. Most procedures used RFA, especially in the right upper lobe, and the majority of ablations were performed in the prone position (49.7%). Target lesions were at a median depth of 39.3 mm from the pleura surface, and remarkably, 91.9% required only a single puncture. Complications occurred in 31.0% of ablations, with pneumothorax being the most prevalent (18.3%), followed by pain (12.5%), sweating (6.5%), fever (5.0%), cough (4.8%), hemothorax (1.6%), hemoptysis (1.2%), pleural effusion (2.0%), skin burn (0.6%), and air emboli (0.2%). The median procedure time was 21 min. Notably, smoking/chronic obstructive pulmonary disease emerged as a significant risk factor for complications.

CONCLUSION

The LAGA-assisted LPTA enhanced safety by improving accuracy and reducing risks. Overall, this investigation contributes to the ongoing efforts to refine and improve the clinical application of these thermal ablation techniques in the treatment of lung tumors.

Safety and local efficacy of computed tomography-guided microwave ablation for treating early-stage non-small cell lung cancer adjacent to bronchovascular bundles

OBJECTIVES

To retrospectively evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation in treating early-stage non-small cell lung cancer (NSCLC) adjacent to bronchovascular bundles.

METHODS

Two hundred and thirty-one patients with early-stage NSCLC who underwent CT-guided microwave ablation of the tumor were included for analysis. Among these, 66 lesions were located adjacent to the bronchovascular bundle. Achievement of the specific ablation range (defined as the ablation zone encompassing the tumor and the adjacent vessel) was assessed after ablation. Complications and tumor progression after treatment were examined and compared between the bronchovascular bundle and non-bronchovascular bundle groups.

RESULTS

A total of 231 patients were included. Overall, 1-, 2-, and 3-year local progression-free survival (LPFS) was 77.4%, 70.5%, and 63.8%, respectively. Bronchovascular bundle proximity, pure-solid tumor, tumor size, and ablation margin < 5 mm were independent risk factors for local progression in multivariate analysis. In the bronchovascular bundle group, the 1-, 2- and 3-year LPFS rates were 63.0%, 50.7%, and 43.4%, respectively; vessel proximity and specific ablation range failure were independent risk factors for local progression. Overall survival in the entire cohort was 93.0% at 1 year, 76.1% at 2 years, and 55.0% at 3 years. The incidence of postoperative complications did not significantly differ between the two groups (p > 0.05). The most common complication was pneumothorax. Severe hemoptysis did not occur.

CONCLUSION

Tumor location near the bronchovascular bundles was a significant risk factor for local progression after microwave ablation. Achieving a specific ablation range may increase LPFS for these lesions.

CLINICAL RELEVANCE STATEMENT

Achieving the specific ablation range may improve local efficacy for early-stage non-small cell lung cancer located adjacent to the bronchovascular bundle.

KEY POINTS

• Local efficacy of percutaneous microwave ablation in treating early-stage non-small cell lung cancer was affected by bronchovascular bundle proximity. • Achieving the specific ablation range may improve local efficacy for lesions located adjacent to the bronchovascular bundle.

Thermal immuno-nanomedicine in cancer

Immunotherapy has revolutionized the treatment of patients with cancer. However, promoting antitumour immunity in patients with tumours that are resistant to these therapies remains a challenge. Thermal therapies provide a promising immune-adjuvant strategy for use with immunotherapy, mostly owing to the capacity to reprogramme the tumour microenvironment through induction of immunogenic cell death, which also promotes the recruitment of endogenous immune cells. Thus, thermal immunotherapeutic strategies for various cancers are an area of considerable research interest. In this Review, we describe the role of the various thermal therapies and provide an update on attempts to combine these with immunotherapies in clinical trials. We also provide an overview of the preclinical development of various thermal immuno-nanomedicines, which are capable of combining thermal therapies with various immunotherapy strategies in a single therapeutic platform. Finally, we discuss the challenges associated with the clinical translation of thermal immuno-nanomedicines and emphasize the importance of multidisciplinary and inter-professional collaboration to facilitate the optimal translation of this technology from bench to bedside.

Evaluation method of ex vivo porcine liver reduced scattering coefficient during microwave ablation based on temperature

The principle of microwave ablation (MWA) is to cause irreversible damage (protein coagulation, necrosis, etc.) to tumor cells at a certain temperature by heating, thereby destroying the tumor. We have long used functional near-infrared spectroscopy (fNIRs) to monitor clinical thermal ablation efficacy. After a lot of experimental verification, it can be found that there is a clear correlation between the reduced scattering coefficient and the degree of tissue damage. During the MWA process, the reduced scattering coefficient has a stable change. Therefore, both temperature (T) and reduced scattering coefficient ( μ s ′ ${\mu }_{s}^{\prime }$ ) are related to the thermal damage of the tissue. This paper mainly studies the changing law of T and μ s ′ ${\mu }_{s}^{\prime }$ during MWA and establishes a relationship model. The two-parameter simultaneous acquisition system was designed and used to obtain the T and μ s ′ ${\mu }_{s}^{\prime }$ of the ex vivo porcine liver during MWA. The correlation model between T and μ s ′ ${\mu }_{s}^{\prime }$ is established, enabling the quantitative estimation of μ s ′ ${\mu }_{s}^{\prime }$ of porcine liver based on T. The maximum and the minimum relative errors of μ s ′ ${\mu }_{s}^{\prime }$ are 79.01 and 0.39%, respectively. Through the electromagnetic simulation of the temperature field during MWA, 2D and 3D fields of reduced scattering coefficient can also be obtained using this correlation model. This study contributes to realize the preoperative simulation of the optical parameter field of microwave ablation and provide 2D/3D therapeutic effect for clinic.

Temperature control and intermittent time-set protocol optimization for minimizing tissue carbonization in microwave ablation

PURPOSE

The charring tissue formation in the ablated lesion during the microwave ablation (MWA) of tumors would induce various unwanted inflammatory responses. This paper aimed to deliver appropriate thermal dose for effective ablations while preventing tissue carbonization by optimizing the treatment protocol during MWA with the set combinations of temperature control and pulsed microwave energy delivery.

MATERIAL AND METHODS

The thermal phase transition of ex vivo porcine liver tissues were recorded by differential scanning calorimetry (DSC) to determine the temperature threshold during microwave output control. MWA was performed by an in-house built system with the ease of microwave output parameter adjustment and real-time temperature monitoring. The effects of continuous and pulsed microwave deliveries as well as various intermittent time-set of MWA were evaluated by measuring the dimensions of the coagulation zone and the carbonization zone.

RESULTS

The DSC scans demonstrated that the ex vivo porcine liver tissues have been in a state of endothermic heat during the heating process, where the maximum absorbed heat occurred at the temperature of 105 °C ± 5 °C. The temperature control during MWA resulted in effective coagulative necrosis while preventing tissue carbonization, after setting 100 °C as the upper threshold temperature and 60 °C as the lower threshold. Both the numerical simulation and ex vivo experiments have shown that, upon the optimization of the time-set parameters in the periodic intermittent pulsed microwave output, the tissue carbonization was significantly diminished.

CONCLUSION

This study developed a straight-forward anti-carbonization strategy in MWA by modulating the pulsing mode and intermittent time. The programmed protocols of intermittent pulsing MWA have demonstrated its potentials toward future expansion of MWA technology in clinical application.

Microwave ablation vs. cryoablation for treatment of primary and metastatic pulmonary malignant tumors

At present, minimally invasive surgery is one of the primary strategies for the treatment of malignant pulmonary tumors. Although, there are some comparative studies between microwave ablation and radiofrequency for the treatment of malignant pulmonary tumors, there are few studies that have investigated the comparison between microwave ablation and cryoablation. The aim of the study was to retrospectively compare the efficacy and complications of microwave ablation (MWA) and cryoablation in the treatment of malignant pulmonary tumors. A retrospective analysis was performed on 48 patients with malignant lung tumors treated with MWA or cryoablation in The Third Hospital of Mianyang and The Affiliated Hospital of North Sichuan Medical College between June 2014 and June 2018. Of these patients, 29 received MWA and 19 received cryoablation. Intraprocedural pain was evaluated by using the visual analog scale (VAS). The intraprocedural pain, response rates, overall survival (OS) and complications rates were compared between the MWA group and cryoablation group. The results showed that the patients in the MWA group experienced more pain than those in cryoablation group as the MWA group VAS scores were much higher than those in cryoablation group (P<0.001). The overall response rate of the MWA group [21/29 (72.41%)] was not significantly different from the cryoablation group [14/19 (73.68%)] (P=0.92). The 6-, 12-, 24- and 36-month OS rates in the MWA group and cryoablation group were 92.72, 81.28, 64.54 and 54.91%, and 94.07, 81.13, 57.33 and 43.04%, respectively. No significant differences were found in the OS rate between the two groups (P=0.79). The complication rates in the MWA and cryoablation groups were 34.48 and 36.84%, respectively; there was no significant difference between the two groups (P=0.59). No patients died during the perioperative period. Cryoablation had a similar therapeutic effect compared with MWA in the treatment of pulmonary malignant tumors, but was associated with less pain.

Local progression after computed tomography-guided microwave ablation in non-small cell lung cancer patients: prediction using a nomogram model

OBJECTIVES

To develop an effective nomogram model for predicting the local progression after computed tomography-guided microwave ablation (MWA) in non-small cell lung cancer (NSCLC) patients.

METHODS

NSCLC patients treated with MWA were randomly allocated to either the training cohort or the validation cohort (4:1). The predictors of local progression identified by univariable and multivariable analyses in the training cohort were used to develop a nomogram model. The C-statistic was used to evaluate the predictive accuracy in both the training and validation cohorts.

RESULTS

A total of 304 patients (training cohort: n = 250; validation cohort: n = 54) were included in this study. The predictors selected into the nomogram for local progression included the tumor subtypes (odds ratio [OR], 2.494; 95% confidence interval [CI], 1.415-4.396, p = 0.002), vessels ≥3 mm in direct contact with tumor (OR, 2.750; 95% CI, 1.263-5.988; p = 0.011), tumor diameter (OR, 2.252; 95% CI, 1.034-4.903; p = 0.041) and location (OR, 2.442; 95% CI, 1.201-4.965; p = 0.014). The C-statistic showed good predictive performance in both cohorts, with a C-statistic of 0.777 (95% CI, 0.707-0.848) internally and 0.712 (95% CI, 0.570-0.855) externally (training cohort and validation cohort, respectively). The optimal cutoff value for the risk of local progression was 0.39.

CONCLUSIONS

Tumor subtypes, vessels ≥3 mm in direct contact with the tumor, tumor diameter and location were predictors of local progression after MWA in NSCLC patients. The nomogram model could effectively predict the risk of local progression after MWA. Patients showing a high risk (>0.39) on the nomogram should be monitored for local progression.

Percutaneous lung and liver CT-guided ablation on swine model using microwave ablation to determine ablation size for clinical practice

PURPOSE

Microwave ablation (MWA) provides an effective treatment of lung and liver tumors but suffers from a lack of reproducibility of ablation size among currently available technologies. In-vitro evaluations are far removed from clinical practices because of uninfused tissue. This study is in-vivo preclinical testing of a new MWA system on swine lungs and liver.

MATERIALS AND METHODS

All ablations were performed under CT guidance and multiple algorithms were tested with a power of 50, 75, and 100 W for durations of 3, 5, 8, 10, and 15 min. A 3 D-evaluation of the ablation zone was carried out using enhanced-CT. The sphericity index, coefficients of variation, and energy efficiency (which corresponds to the volume yield according to the power supplied) were calculated.

RESULTS

Fifty liver and 48 lung ablations were performed in 17 swine. The sphericity index varies from 0.50 to 0.80 for liver ablations and from 0.40 to 0.69 for lung ablations. The coefficient of variation was below 15% for 4/5 and 4/8 protocols for lung and liver ablations, respectively. The energy efficiency seems to decrease with the duration of the ablation from 0.60 × 10^-3 cm³/J (75 W, 3 min) to 0.26 × 10^-3 cm³/J (100 W, 15 min) in the liver and from 0.57 × 10^-3 cm³/J (50 W, 10 min) to 0.42 × 10^-3 cm³/J (100 W, 12 min) in the lungs.

CONCLUSION

A shorter treatment time provides the best energy efficiency, and the best reproducibility is obtained for a 10 min treatment duration. The system tested provides an interesting reproducibility in both lung and liver measurements. Our results may help interventional radiologists in the optimal selection of treatment parameters.

Percutaneous microwave ablation of renal cell carcinoma: practice guidelines of the ultrasound committee of Chinese medical association, interventional oncology committee of Chinese research hospital association

Imaging-guided percutaneous microwave ablation (MWA) with high thermal efficiency comprises rapid, successful management of small renal cell carcinomas (RCCs) in selected patients. Ultrasound Committee of Chinese Medical Association, Interventional Oncology Committee of Chinese Research Hospital Association developed evidence-based guidelines for MWA of RCCs after systematically reviewing the 1969-2019 literature. Systematic reviews, meta-analyses, randomized controlled trials, cohort, and case-control studies reporting MWA of RCCs were included and levels of evidence assessed. Altogether, 146 articles were identified, of which 35 reported percutaneous MWA for T1a RCCs and 5 articles for T1b RCCs. Guidelines were established based on indications, techniques, safety, and effectiveness of MWA for RCCs, with the goal of standardizing imaging-guided percutaneous MWA treatment of RCCs. Key points Microwave ablation is recommended for managing small renal cell carcinoma in selected patients. Imaging protocols are tailored based on the procedural plan, guidance, and evaluation. Patient's selection evaluation, updated technique information, clinical efficacy, and complications are recommended to standardize management. A joint task force (multidisciplinary team) summarized the key elements of the standardized report.

Heating technology for malignant tumors: a review

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.

Risk prediction of pleural effusion in lung malignancy patients treated with CT-guided percutaneous microwave ablation: a nomogram and artificial neural network model

OBJECTIVES

To develop an effective nomogram and artificial neural network (ANN) model for predicting pleural effusion after percutaneous microwave ablation (MWA) in lung malignancy (LM) patients.

METHODS

LM patients treated with MWA were randomly allocated to either the training cohort or the validation cohort (7:3). The predictors of pleural effusion identified by univariable and multivariable analyses in the training cohort were used to develop a nomogram and ANN model. The C-statistic was used to evaluate the predictive accuracy in both the training and validation cohorts.

RESULTS

A total of 496 patients (training cohort: n = 357; validation cohort: n = 139) were enrolled in this study. The predictors selected into the nomogram for pleural effusion included the maximum power (hazard ratio [HR], 1.060; 95% confidence interval [CI], 1.022-1.100, p = 0.002), the number of pleural punctures (HR, 2.280; 95% CI, 1.103-4.722; p = 0.026) and the minimum distance from needle to pleura (HR, 0.840; 95% CI, 0.775-0.899; p < 0.001). The C-statistic showed good predictive performance in both cohorts, with a C-statistic of 0.866 (95% CI, 0.787-0.945) internally and 0.782 (95% CI, 0.644-0.920) externally (training cohort and validation cohort, respectively). The optimal cutoff value for the risk of pleural effusion was 0.16.

CONCLUSIONS

Maximum power, number of pleural punctures and minimum distance from needle to pleura were predictors of pleural effusion after MWA in LM patients. The nomogram and ANN model could effectively predict the risk of pleural effusion after MWA. Patients showing a high risk (>0.16) on the nomogram should be monitored for pleural effusion.

Image-guided percutaneous microwave ablation of early-stage non-small cell lung cancer

Although surgical lobectomy with systematic mediastinal lymph node evaluation is considered as the "gold standard" for management of early stage non-small cell lung cancer (NSCLC), image-guided percutaneous thermal ablation has been increasingly used for medically inoperable patients. Radiofrequency ablation (RFA) is a research-based technique that has the most studies for medically inoperable early-stage NSCLC. Other thermal ablation techniques used to treat pulmonary tumors include microwave ablation (MWA), cryoablation and laser ablation. MWA has several advantages over RFA including reduced procedural time, reduced heat-sink effect, large ablation zones, decreased susceptibility to tissue impedance, and simultaneous use of multiple antennae. This review article highlights the most relevant updates of MWA for the treatment of early-stage NSCLC, including mechanism of action, clinical outcomes, potential complications, the existing technique problems and future directions.

Study on the relationship between reduced scattering coefficient and Young's modulus of tumors in microwave ablation

BACKGROUND AND OBJECTIVE

In the clinical treatment of tumors using microwave ablation (MWA), although temperature can be used as an important reference index for evaluating the curative effect of ablation, it cannot fully reflect the biological activity status of tumor tissue during thermal ablation. Finding multi-parameter comprehensive evaluation factors to achieve real-time evaluation of therapeutic effects has become the key for precise ablation. More and more scholars use the reduced scattering coefficient (μs') and Young's modulus (E) to evaluate the treatment outcomes of MWA. However, the intrinsic relationship between these parameters is unclear. This paper aims to investigate the specific relationship between μs' and E during MWA.

MATERIAL AND METHODS

The MWA experiment was conducted on porcine liver in vitro, the two-parameter simultaneous acquisition system was designed to obtain the reduced scattering coefficient and Young's modulus of the liver tissue during MWA. The relationship between reduced scattering coefficient and Young's modulus was investigated.

RESULTS

It is found that the trend of change of μs' is very similar to E in the process of MWA, i.e. first increasing and then reaching a steady state, and in some experiments there are synchronous changes. Based on this, the quantitative relationship between E-μs'  is established, enabling the quantitative estimation of Young's modulus of liver tissue based on reduced scattering coefficient. The maximum absolute error is 29.37 kPa and the minimum absolute error is 0.88 kPa.

CONCLUSION

This study contributes to the further establishment of a multi-parameter MWA effectiveness evaluation model. It is also valuable for clinically evaluating the ablation outcomes of tumor in real time.

Effect of changes in lung physical properties on microwave ablation zone during respiration

Microwave ablation is a promising minimally invasive treatment for cancer. However, due to the respiratory movement of the lungs, it is very difficult to accurately predict and control the microwave ablation zone. Therefore, the influence of the changes of the physical parameters of the respiratory process on the microwave ablation zone is studied. Firstly, based on the 4D-CT describing the respiratory process of the lungs, all the image data are from 100 non-small cell lung cancer radiotherapy patients (50 males and 50 females, average 58 years, range 55-61 years). According to the theory of porous media, the change of the effective thermal conductivity of the lung tissue during the breathing process is obtained. The effective thermal conductivity of the lung parenchyma during respiration varies from 0.16 to 0.20 W/m °C, with the lowest vale at the end of inspiration and the highest at the end of expiration. The transient problems during microwave ablation of pulmonary tissue are analyzed by finite element method. The changes of relative permittivity, conductivity and density changes during the breathing process are also considered. The results show that the microwave ablation zone is significantly larger under dynamic physical parameters. At the end of expiration, when the tissue parameter is set to constant, the ablation lesion area is more concentrated around the tip and slot of the antenna, and the backward heating effect is smaller, Ablation volume was superior in nonventilated lungs. Therefore, single-lung ventilation can be considered during pulmonary ablation to reduce the impact of breathing on the ablation area. These findings can be useful to further our understanding the MWA and hold promise towards achieving successful treatment objective as well as enhanced therapeutic output via improved treatment planning and strategy. This study provides the basis for clinical pulmonary ablation and can also be used as a preoperative plan to provide guidance to physicians.

Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Purpose

Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), have become important minimally invasive treatment options for liver cancer. This systematic review compared MWA with RFA for treatment of liver cancer.

Methods

The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for randomized and observational studies published from 2006 onwards. A random-effects model was used for meta-analyses and local tumor progression (LTP), technique efficacy, overall survival (OS), disease-free survival (DFS), intrahepatic de novo lesions (IDL), extrahepatic metastases (EHM), length of stay (LOS), and complications were analyzed. Subgroup and sensitivity analyses were also conducted.

Results

Of 1379 studies identified, 28 randomized and observational studies met inclusion criteria. The main analysis demonstrated that LTP was significantly reduced by 30% with MWA versus RFA (RR=0.70; P=0.02) (all studies) and by 45% with MWA versus RFA (RR=0.55; P=0.007) (randomized studies only). There were no significant differences between MWA and RFA for other efficacy and safety outcomes. Higher frequency (2450 MHz) and larger tumor size (≥2.5 cm) are amongst variables that may be associated with improved outcomes for MWA. Sensitivity analyses were generally congruent with the main results.

Conclusion

MWA is at least as safe and effective as RFA for treating liver cancer and demonstrated significantly reduced LTP rates. Future studies should assess time and costs associated with these two treatment modalities.

Ex vivo validation of microwave thermal ablation simulation using different flow coefficients in the porcine liver

The purpose of the study was to validate the simulation model for a microwave thermal ablation in ex vivo liver tissue. The study aims to show that heat transfer due to the flow of tissue water during ablation in ex vivo tissue is not negligible. Ablation experiments were performed in ex vivo porcine liver with microwave powers of 60 W to 100 W. During the procedure, the temperature was recorded in the liver sample at different distances to the applicator using a fiber-optic thermometer. The position of the probes was identified by CT imaging and transferred to the simulation. The simulation of the heat distribution in the liver tissue was carried out with the software CST Studio Suite. The results of the simulation with different flow coefficients were compared with the results of the ablation experiments using the Bland-Altman analysis. The analysis showed that the flow coefficient of 90,000 W/(K*m³) can be considered as the most suitable value for clinically used powers. The presented simulation model can be used to calculate the temperature distribution for microwave ablation in ex vivo liver tissue.

Understanding the nuances of microwave ablation for more accurate post-treatment assessment

Microwave ablation (MWA) is a relatively new thermal modality for minimally invasive procedures compared with radiofrequency ablation. Although MWA and radiofrequency ablation are thermal modalities, their underlying physics and principles greatly differ. Consequently, it is imperative that clinicians be aware of how these differences impact realized ablation volumes to consistently ensure technical success and better patient outcomes. This paper will review the nuances specific to MWA technology (i.e., tissue properties, perfusion/heat sink effect, ablation assessment, imaging accuracy and tissue contraction) that are often overlooked based on familiarity with conventional thermal modalities to guide more accurate assessment of post-treatment MWA volumes.