Bathe Oliver F, Mahallati Houman, Sutherland Francis, Dixon Elijah, Pasieka Janice, Sutherland Garnette
Department of Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29th St N. W., Calgary, AB T2N 4N2, Canada.
Am J Surg. 2006 May;191(5):598-603. doi: 10.1016/j.amjsurg.2006.02.008.
Resection represents the best treatment for potentially curable liver tumors; radiofrequency ablation (RFA) is an alternative. The curative potential of RFA may be hampered because the extent of burn is difficult to estimate by ultrasound. We postulated that intraoperative MRI (iMRI) would enable a more accurate assessment of ablation completeness.
We performed open hepatic surgery in an operating room equipped with a unique, retractable 1.5-T magnet. Patients were selected because it was anticipated that RFA (with or instead of resection) was likelihood and that iMRI might be helpful in making intraoperative decisions. After baseline MRI, lesions were further assessed by ultrasound at the time of open surgery. Lesions were resected and/or ablated, and further imaging confirmed the margins of the procedure.
Nine patients underwent the procedure: 1 with metastatic carcinoid, 4 with hepatocellular carcinoma, and 4 with colorectal liver metastases. In 4 patients, iMRI had an effect on decision-making. In 5 individuals, there were nonlocal recurrences, and 1 patient who was never disease-free had a local recurrence.
Intraoperative MRI could potentially impact operative decision-making when ablating extensive disease. Its ability to prevent local recurrences must be determined. Moreover, the role of this technology in the overall treatment armamentarium must be defined.
手术切除是潜在可治愈性肝肿瘤的最佳治疗方法；射频消融（RFA）是一种替代方法。RFA的治愈潜力可能会受到阻碍，因为超声难以估计烧灼范围。我们推测术中磁共振成像（iMRI）能够更准确地评估消融的完整性。
我们在配备了独特的可伸缩1.5-T磁体的手术室中进行开放性肝脏手术。选择患者是因为预计RFA（联合或替代手术切除）可行，且iMRI可能有助于做出术中决策。在进行基线磁共振成像后，在开放手术时通过超声对病变进行进一步评估。对病变进行切除和/或消融，进一步成像确定手术切缘。
9例患者接受了该手术：1例为转移性类癌，4例为肝细胞癌，4例为结直肠癌肝转移。4例患者中，iMRI对决策有影响。5例患者出现非局部复发，1例从未无病的患者出现局部复发。
在消融广泛病变时，术中磁共振成像可能会影响手术决策。其预防局部复发的能力必须得到确定。此外，必须明确该技术在整个治疗手段中的作用。
