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01-08-2010 | Interventional

MR-guided liver tumor ablation employing open high-field 1.0T MRI for image-guided brachytherapy

Authors: Jens Ricke, Markus Thormann, Matthias Ludewig, Kerstin Jungnickel, Oliver Grosser, Christian Wybranski, Nils Peters, Peter Hass, Jürgen Bunke, Frank Fischbach

Published in: European Radiology | Issue 8/2010

Abstract

Objective

To determine the feasibility and safety of image-guided brachytherapy employing a modified open high-field MR system.

Methods

This is a follow-up study of a development project enabling technologies for interventional use of 1.0T open MRI. Modifications included coils and in-bore visualization, fluoroscopic sequences and user interfaces. We recruited 104 patients with 224 liver malignancies to receive MR-guided brachytherapy. Interventions were performed >20 min after Gd-EOB-DTPA. We recorded interventional parameters including the intervention time (from acquisition of the first scout until the final sequence for brachytherapy treatment planning). Two reviewers assessed MR-fluoroscopic images in comparison to plain CT as used in CT intervention, applying a rating scale of 1–10. Statistical analysis included Friedman and Kendall’s W tests.

Results

We employed freehand puncture with interactive dynamic imaging for navigation. Technical success rate was 218 complete ablations in 224 tumours (97%). The median intervention time was 61 min. We recorded no adverse events related to the use of MRI. No major complications occurred. The rate of minor complications was 4%. Local control at 3 months was 96%. Superiority of MR-fluoroscopic, Gd-EOB-DTPA-enhanced images over plain CT was highly significant (P < 0.001).

Conclusion

MR-guided brachytherapy employing open high-field MRI is feasible and safe.

Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 16:765–778PubMed

Xiao YY, Tian JL, Li JK et al (2008) CT-guided percutaneous chemical ablation of adrenal neoplasms. AJR Am J Roentgenol 190:105–110CrossRefPubMed

Gillams AR, Lees WR (2008) Radiofrequency ablation of lung metastases: factors influencing success. Eur Radiol 18(4):672–677CrossRefPubMed

Curley SA (2008) Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol 15:11–13CrossRefPubMed

Zhang YJ, Liang HH, Chen MS et al (2007) Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: a prospective randomized trial. Radiology 244:599–607CrossRefPubMed

Vogl TJ, Straub R, Eichler K et al (2004) Colorectal carcinoma metastases in liver: laser-induced interstitial thermotherapy-local tumor control rate and survival data. Radiology 230:450–458CrossRefPubMed

Pech M, Mohnike K, Wieners G, Bialek E, Dudeck O, Seidensticker M, Peters N, Wust P, Gademann G, Ricke J (2008) Radiotherapy of liver metastases. Comparison of target volumes and dose-volume histograms employing CT- or MRI-based treatment planning. Strahlenther Onkol 184:256–261CrossRefPubMed

Mast TD, Pucke DP, Subramanian SE, Bowlus WJ, Rudich SM, Buell JF (2008) Ultrasound monitoring of in vitro radio frequency ablation by echo decorrelation imaging. J Ultrasound Med 27:1685–1697PubMed

Stroszczynski C, Gaffke G (2006) Use of imaging modalities for the guidance of minimally invasive tumor therapies (MITT). Recent Results Cancer Res 167:3–12CrossRefPubMed

10.

Nakai M, Sato M, Sahara S, Takasaka I, Kawai N, Minamiguchi H, Tanihata H, Kimura M, Takeuchi N (2009) Radiofrequency ablation assisted by real-time virtual sonography and CT for hepatocellular carcinoma undetectable by conventional sonography. Cardiovasc Intervent Radiol 32:62–69CrossRefPubMed

11.

Laganà D, Carrafiello G, Mangini M, Lumia D, Mocciardini L, Chini C, Pinotti G, Cuffari S, Fugazzola C (2008) Hepatic radiofrequency under CT-fluoroscopy guidance. Radiol Med 113:87–100CrossRefPubMed

12.

Fahey BJ, Nelson RC, Hsu SJ, Bradway DP, Dumont DM, Trahey GE (2008) In vivo guidance and assessment of liver radio-frequency ablation with acoustic radiation force elastography. Ultrasound Med Biol 34:1590–1603CrossRefPubMed

13.

Ricke J, Wust P, Stohlmann A et al (2004) CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: phase I–II results of a novel technique. Int J Radiat Oncol Biol Phys 58:1496–1505CrossRefPubMed

14.

Vogl TJ, Müller PK, Hammerstingl R, Weinhold N, Mack MG, Philipp C, Deimling M, Beuthan J, Pegios W, Riess H (1995) Malignant liver tumors treated with MR imaging-guided laser-induced thermotherapy: technique and prospective results. Radiology 196:257–265PubMed

15.

Gaffke G, Gebauer B, Gnauck M, Knollmann FD, Helmberger T, Ricke J, Oettle H, Felix R, Stroszczynski C (2005) Potential advantages of the MRI for the radiofrequency ablation of liver tumors. Rofo 177:77–83PubMed

16.

Puls R, Stroszczynski C, Gaffke G, Hosten N, Felix R, Speck U (2003) Laser-induced thermotherapy (LITT) of liver metastases: MR-guided percutaneous insertion of an MRI-compatible irrigated microcatheter system using a closed high-field unit. J Magn Reson Imaging 17:663–670CrossRefPubMed

17.

Wacker FK, Reither K, Ritz JP, Roggan A, Germer CT, Wolf KJ (2001) MR-guided interstitial laser-induced thermotherapy of hepatic metastasis combined with arterial blood flow reduction: technique and first clinical results in an open MR system. J Magn Reson Imaging 13:31–36CrossRefPubMed

18.

Reither K, Wacker F, Ritz JP, Isbert C, Germer CT, Roggan A, Wendt M, Wolf KJ (2000) Laser-induced thermotherapy (LITT) for liver metastasis in an open 0.2T MRI. Rofo 172:175–178PubMed

19.

Huppert PE, Trübenbach J, Schick F, Pereira P, König C, Claussen CD (2000) MRI-guided percutaneous radiofrequency ablation of hepatic neoplasms—first technical and clinical experiences. Rofo 172:692–700PubMed

20.

Lewin JS, Duerk JL, Jain VR, Petersilge CA, Chao CP, Haaga JR (1996) Needle localization in MR-guided biopsy and aspiration: effects of field strength, sequence design, and magnetic field orientation. Am J Roentgenol 166:1337–1345

21.

Streitparth F, Gebauer B, Melcher I, Schaser K, Philipp C, Rump J, Hamm B, Teichgräber U (2009) MR-guided laser ablation of osteoid osteoma in an open high-field system (1.0 T). Cardiovasc Intervent Radiol 32:320–325CrossRefPubMed

22.

Gossmann A, Bangard C, Warm M, Schmutzler RK, Mallmann P, Lackner KJ (2008) Real-time MR-guided wire localization of breast lesions by using an open 1.0-T imager: initial experience. Radiology 247:535–542CrossRefPubMed

23.

Ricke J, Wust P, Wieners G et al (2004) Liver malignancies: CT-guided interstitial brachytherapy in patients with unfavorable lesions for thermal ablation. J Vasc Interv Radiol 15:1279–1286PubMed

24.

van Montfoort JE, Stieger B, Meijer DK, Weinmann HJ, Meier PJ, Fattinger KE (1999) Hepatic uptake of the magnetic resonance imaging contrast agent gadoxetate by the organic anion transporting polypeptide Oatp1. J Pharmacol Exp Ther 290:153–157PubMed

25.

Huppertz A, Balzer T, Blakeborough A et al (2004) Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology 230:266–275CrossRefPubMed

26.

Zimmermann H, Müller S, Gutmann B, Bardenheuer H, Melzer A, Umathum R, Nitz W, Semmler W, Bock M (2006) Targeted-HASTE imaging with automated device tracking for MR-guided needle interventions in closed-bore MR systems. Magn Reson Med 56:481–488CrossRefPubMed

27.

Duerk JL, Wong EY, Lewin JS (2002) A brief review of hardware for catheter tracking in magnetic resonance imaging. MAGMA 13:199–208CrossRefPubMed

28.

Weiss CR, Nour SG, Lewin JS (2008) MR-guided biopsy: a review of current techniques and applications. J Magn Reson Imaging 27:311–325CrossRefPubMed

29.

Immel E, Melzer A (2006) Improvement of the MR imaging behavior of vascular implants. Minim Invasive Ther Allied Technol 15:85–92CrossRefPubMed

30.

Bock M, Wacker FK (2008) MR-guided intravascular interventions: techniques and applications. J Magn Reson Imaging 27:326–338CrossRefPubMed

31.

Weiss S, Vernickel P, Schaeffter T, Schulz V, Gleich B (2005) Transmission line for improved RF safety of interventional devices. Magn Reson Med 54:182–189CrossRefPubMed

32.

Busse H, Trampel R, Gründer W, Moche M, Kahn T (2007) Method for automatic localization of MR-visible markers using morphological image processing and conventional pulse sequences: feasibility for image-guided procedures. J Magn Reson Imaging 2:1087–1096CrossRef

33.

Will K, Schimpf F, Fischbach F, Ricke J, Schmidt B, Rose G (2010) Pre-tuned resonant marker for iMRI using aerosol deposition on polymer catheters. Proceedings of the SPIE medical imaging conference, 13–18 February 2010, San Diego

34.

Mohnike K, Pech M, Seidensticker M, Rühl R, Wieners G, Gaffke G, Kropf S, Felix R, Wust P, Ricke J (2010) Computed-tomography-guided high-dose-rate brachytherapy in hepatocellular carcinoma: safety, efficacy and effect on survival. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2009.07.1700

35.

Ricke J, Mohnike K, Pech M, Seidensticker M, Rühl R, Wieners G, Gaffke G, Kropf S, Felix R, Wust P (2010) Local response and impact on survival after local ablation of liver metastases from colorectal carcinoma by CT-guided HDR-brachytherapy. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2009.09.026

36.

Buecker A, Spuentrup E, Schmitz-Rode T, Kinzel S, Pfeffer J, Hohl C, van Vaals JJ, Günther RW (2004) Use of a nonmetallic guide wire for magnetic resonance-guided coronary artery catheterization. Invest Radiol 39:656–660CrossRefPubMed

37.

Kos S, Huegli R, Hofmann E, Quick HH, Kuehl H, Aker S, Kaiser GM, Borm PJ, Jacob AL, Bilecen D (2009) Feasibility of real-time magnetic resonance-guided angioplasty and stenting of renal arteries in vitro and in swine, using a new polyetheretherketone-based magnetic resonance-compatible guidewire. Invest Radiol 44:234–241CrossRefPubMed

38.

Jungnickel K, Gaffke G, Lohfink K, Fischbach F, Bunke J, Will K, Ludewig M, Großer O, Omar A, Ricke J (2009) Evaluation of online thermometry during MR-guided intervention in a high field open system at 1.0 T. Int J CARS 4:S60–S61

39.

Seror O, Lepetit-Coiffé M, Le Bail B, de Senneville BD, Trillaud H, Moonen C, Quesson B (2008) Real time monitoring of radiofrequency ablation based on MR thermometry and thermal dose in the pig liver in vivo. Eur Radiol 18:408–416CrossRefPubMed

Title: MR-guided liver tumor ablation employing open high-field 1.0T MRI for image-guided brachytherapy
Authors: Jens Ricke
Markus Thormann
Matthias Ludewig
Kerstin Jungnickel
Oliver Grosser
Christian Wybranski
Nils Peters
Peter Hass
Jürgen Bunke
Frank Fischbach
Publication date: 01-08-2010
Publisher: Springer-Verlag
Published in: European Radiology / Issue 8/2010
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-010-1751-5

At a glance: The STEP trials

Springer Medicine

MR-guided liver tumor ablation employing open high-field 1.0T MRI for image-guided brachytherapy

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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