TY - JOUR
T1 - Intrapleural fluid infusion for MR-guided high-intensity focused ultrasound ablation in the liver dome
AU - Wijlemans, Joost W.
AU - de Greef, Martijn
AU - Schubert, Gerald
AU - Moonen, Chrit T.W.
AU - van den Bosch, Maurice A.A.J.
AU - Ries, Mario
N1 - Publisher Copyright:
© 2014 AUR.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Rationale and Objectives: Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of tumors in the liver dome is challenging because of the presence of air in the costophrenic angle. In this study, we used a porcine liver model and a clinical MR-HIFU system to assess the feasibility and safety of using intrapleural fluid infusion (IPI) to create an acoustic window for MR-HIFU ablation in the liver dome. Materials and Methods: Healthy adult Dalland land pigs (n=6) under general anesthesia were used with animal committee approval. Degassed saline (200-800mL) was infused into the intrapleural space under ultrasound guidance. A clinical 1.5-T MR-HIFU system was used to perform sonications (4-mm treatment cells, 300-450W, 20-30seconds) in the liver dome under real-time MR thermometry. Anintercostal firing technique was used to prevent rib heating in one experiment. Technical success was defined as a temperature increase (>10°C) in the target area. After termination, the animal was examined for thermal damage to liver, diaphragm, pleura, lung, or intercostal muscle. Results: An acoustic window was established in all animals. A temperature increase in the target area was achieved in all animals (max. 47°C-67°C). MR thermometry showed no heating outside the target area. Intercostal firing effectively reduced rib heating (55°C vs. 42°C). Postmortem examination revealed no unwanted thermal damage. One complication occurred, in the first experiment, because of an ill-suited needle (displacement of the needle). Conclusions: The results indicate that IPI may be used safely to assist MR-HIFU ablation of tumors in the liver dome. For reliable tissue coagulation, IPI must be combined with an intercostal sonication technique. Considering the proportion of patients with tumors in the liver dome, IPI widens the applicability of MR-HIFU ablation for liver tumors considerably.
AB - Rationale and Objectives: Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of tumors in the liver dome is challenging because of the presence of air in the costophrenic angle. In this study, we used a porcine liver model and a clinical MR-HIFU system to assess the feasibility and safety of using intrapleural fluid infusion (IPI) to create an acoustic window for MR-HIFU ablation in the liver dome. Materials and Methods: Healthy adult Dalland land pigs (n=6) under general anesthesia were used with animal committee approval. Degassed saline (200-800mL) was infused into the intrapleural space under ultrasound guidance. A clinical 1.5-T MR-HIFU system was used to perform sonications (4-mm treatment cells, 300-450W, 20-30seconds) in the liver dome under real-time MR thermometry. Anintercostal firing technique was used to prevent rib heating in one experiment. Technical success was defined as a temperature increase (>10°C) in the target area. After termination, the animal was examined for thermal damage to liver, diaphragm, pleura, lung, or intercostal muscle. Results: An acoustic window was established in all animals. A temperature increase in the target area was achieved in all animals (max. 47°C-67°C). MR thermometry showed no heating outside the target area. Intercostal firing effectively reduced rib heating (55°C vs. 42°C). Postmortem examination revealed no unwanted thermal damage. One complication occurred, in the first experiment, because of an ill-suited needle (displacement of the needle). Conclusions: The results indicate that IPI may be used safely to assist MR-HIFU ablation of tumors in the liver dome. For reliable tissue coagulation, IPI must be combined with an intercostal sonication technique. Considering the proportion of patients with tumors in the liver dome, IPI widens the applicability of MR-HIFU ablation for liver tumors considerably.
KW - High-intensity focused ultrasound ablation
KW - Interventional
KW - Liver neoplasms
KW - Magnetic resonance imaging
UR - http://www.scopus.com/inward/record.url?scp=84908565520&partnerID=8YFLogxK
U2 - 10.1016/j.acra.2014.06.015
DO - 10.1016/j.acra.2014.06.015
M3 - Article
C2 - 25126972
AN - SCOPUS:84908565520
SN - 1076-6332
VL - 21
SP - 1597
EP - 1602
JO - Academic Radiology
JF - Academic Radiology
IS - 12
ER -