Elsevier

Journal of Hepatology

Volume 31, Issue 2, August 1999, Pages 347-353
Journal of Hepatology

MRI guidance of infra-red laser liver tumour ablations, utilising an open MRI configuration system: technique and early progress

https://doi.org/10.1016/S0168-8278(99)80234-7Get rights and content

Abstract

Background/Aims: Primary and secondary liver tumours are a common clinical problem, with a poor prognosis in most cases. Surgical resection offers the best outcome, but is only appropriate for the minority. Thermal ablation techniques have been described, but the lack of an optimal means of monitoring has limited their use. We undertook a pilot study to assess the feasibility and safety of an integrated MR-guided laser thermoablation technique under local anaesthesia using a real-time colourisation thermal monitoring technique in a newly developed open MR scanner.

Methods: Liver tumours were punctured after the administration of intravenous Mangafodipir trisodium (MnDPDP) using real-time MR image guidance under local or general anaesthesia, and treated using a water-cooled interstitial fibre and a Nd-YAG laser source. Twenty-seven procedures were performed in 12 patients. Therapy was monitored using a real-time MR colourisation sequence. Thermoablation was followed by a colour change in a region of interest.

Results: Thermal lesions of mean size 3 cm in diameter were produced with a maximum size of 5 cm. Eight out of 12 patients were discharged the next day with few significant complications. Repeat procedures have been performed in seven of 12 patients. Two patients with lesions of 3 cm diameter have had complete tumour ablation with only one procedure.

Conclusion: Percutaneous laser thermoablation for liver tumours performed as an integrated one-step technique in an open configuration MR scanner is described. It can be safely performed under local anaesthesia in the majority of patients, with few side effects. MR control shows the site and size of the evolving thermal lesions, allowing appropriate action to be taken in terms of further burns, time of application and power applied.

Section snippets

Materials and Methods

To date, 27 procedures have been performed on 12 patients aged 37–67 (M: F, 11:1). Eight patients had biopsy-proven HCC, two had biopsy-confirmed metastatic deposits from colorectal carcinoma, and there was one each with metastatic duodenal leiomyosarcoma and carcinoid tumour. Patients were included in the study if they had no more than 6 lesions, none of which exceeded 8 cm in maximum diameter at presentation; all patients were considered unsuitable for surgical resection or liver

Results

Twenty-seven MR-guided LITT procedures were performed in 12 patients. Three patients were unable to tolerate LITT under LA, due to pain within 2 min of the laser therapy commencing. All three patients subsequently had the procedure performed under GA. All the other patients received LITT under LA with additional intravenous midazolam sedation and intravenous opiate analgesia.

Table 1 shows the details of the laser treatment and the burn sizes produced as estimated by the colour changes on the

Discussion

Thermal energy can be applied to soft tissues using heat energy via laser, radiofrequency ablation (26), microwave fibres (27), or using cryogen cooling probes (28) to produce discrete regions of necrosis. All four of these techniques produce broadly similar-sized lesions within soft tissues with comparable percutaneous introduction systems. However, using MR guidance, targeted areas of pathological abnormality can be selectively destroyed, leaving adjacent tissues undamaged. Infra-red laser

Acknowledgements

We wish to thank the following for referring their patients for treatment: Professor C. Coombs, Dr C. Lowdell and Dr I. Murray-Lyon. We acknowledge the work of our radiographers during the study: Mrs L. Anderton, Miss K. Birnie, Miss C. Dowling and the departmental nursing staff: Mrs S. Hockley-Refson and Miss M. McGourty. We are indebted to Nycomed, Oslo, Norway for their generous donation of Mangafodipir trisodium: (Teslascan) used during the trial. An abstract of the study was presented at

References (29)

  • V Mazzaferro et al.

    Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis

    N Engl J Med

    (1996)
  • RF Holbrock et al.

    Resection of malignant primary liver tumours

    Am J Surg

    (1997)
  • SG Bown

    Phototherapy of tumours

    World J Surg

    (198)
  • AC Steger et al.

    Interstitial laser hyperthermia: a new approach to local destruction of tumours

    Br Med J

    (1989)

    • Cited by (39)

    • Preliminary clinical experiences of a motorized manipulator for magnetic resonance image-guided microwave coagulation therapy of liver tumors

      2009, American Journal of Surgery
      Citation Excerpt :

      Hepatic resection is considered as the primary treatment for hepatocellular carcinoma (HCC) or metastatic tumors, but many patients are not candidates for resection because of an inadequate functional hepatic reserve, the location or number of tumors, and/or extrahepatic metastatic lesions. As a strategy for these difficult diseases, minimally invasive thermal therapies, such as laser therapy,1,2 cryotherapy,3,4 radiofrequency ablation (RFA),5,6 and microwave coagulation,7,8 have been extensively applied. These therapies are effective for long-term survival,9 and in the case of small tumors, results comparative to those of hepatic resection have been reported.10,11

    • Non-surgical treatment of hepatocellular carcinoma

      2005, HPB
      Citation Excerpt :

      Other technologies are being developed to achieve similar ends to RFA and PEI and these include photodynamic therapy and laser thermal ablation. The latter has yielded encouraging results, and has the advantage that it can be carried out under magnetic resonance guidance, the whole procedure being monitored with near real‐time thermal imaging to assess the efficacy of tissue necrosis [35,36]. The application of external beam irradiation for the treatment of liver tumours has been severely limited by the radiosensitivity of normal hepatocytes.

    • Surgical Technology and its Impact on Practice

      2004, Asian Journal of Surgery

    • MR-guided laser thermal ablation of primary and secondary liver tumours

      2003, Clinical Radiology

    • Advances in the treatment of liver tumors

      2002, Current Problems in Surgery
      Citation Excerpt :

      The various MRI sequences that have been evaluated for monitoring of LITT include rapid acquisition and relaxation enhancement, spin echo MRI, diffusion-weighted imaging, and T1-weighted turbo fast low-angle shot sequence.140,141 MRI can be used to provide real-time thermal imaging maps because heating of the tissue results in a loss of the MR signal because of chemical and phase shift changes that are caused by protein denaturation and rapid changes in tissue water distribution.139 The irreversible changes in protein molecular structure and loss of tissue water in tumors that are heated to temperatures greater than 55°C results in a lengthening of the T1 relaxation times.

    • Laser interstitial thermotherapy (LITT) monitoring using high-resolution digital mammography: Theory and experimental studies

      2002, Physics in Medicine and Biology
    View all citing articles on Scopus
    View full text
    Copyright © 1999 Published by Elsevier Ireland Ltd.