Stafford R Jason, Fuentes David, Elliott Andrew A, Weinberg Jeffrey S, Ahrar Kamran
Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Crit Rev Biomed Eng. 2010;38(1):79-100. doi: 10.1615/critrevbiomedeng.v38.i1.70.
Image-guided ablation of tumors is assuming an increasingly important role in many oncology services as a minimally invasive alternative to conventional surgical interventions for patients who are not good candidates for surgery. Laser-induced thermal therapy (LITT) is a percutaneous tumor-ablation technique that utilizes high-power lasers placed interstitially in the tumor to deliver therapy. Multiple laser fibers can be placed into the treatment volume and, unlike other interstitial heating techniques, can be fired simultaneously to rapidly treat large volumes of tissue. Modern systems utilize small, compact, high-power laser diode systems with actively cooled applicators to help keep tissue from charring during procedures. Additionally, because this approach to thermal therapy is easily made magnetic resonance (MR) compatible, the incorporation of magnetic resonance imaging (MRI) for treatment planning, targeting, monitoring, and verification has helped to expand the number of applications in which LITT can be applied safely and effectively. We provide an overview of the clinically used technology and algorithms that provide the foundations for current state-of-the-art MR-guided LITT (MRgLITT), including procedures in the brain, liver, bone, and prostate as examples. In addition to advances in imaging and delivery, such as the incorporation of nanotechnology, next-generation MRgLITT systems are anticipated to incorporate an increasing presence of in silico-based modeling of MRgLITT procedures to provide human-assisted computational tools for planning, MR model-assisted temperature monitoring, thermal-dose assessment, and optimal control.
在许多肿瘤治疗服务中，图像引导下的肿瘤消融作为一种微创替代方案，对于那些不适合传统手术干预的患者而言，正发挥着越来越重要的作用。激光诱导热疗（LITT）是一种经皮肿瘤消融技术，它利用高功率激光经间质放置于肿瘤内来进行治疗。多条激光光纤可放置于治疗区域，并且与其他间质加热技术不同，这些光纤可同时发射以快速治疗大面积组织。现代系统采用小型、紧凑的高功率激光二极管系统以及主动冷却的施照器，以防止组织在手术过程中烧焦。此外，由于这种热疗方法易于与磁共振（MR）兼容，将磁共振成像（MRI）用于治疗规划、靶向定位、监测和验证，有助于扩大LITT能够安全有效应用的领域数量。我们概述了为当前最先进的磁共振引导下的激光诱导热疗（MRgLITT）奠定基础的临床应用技术和算法，包括以脑部、肝脏、骨骼和前列腺的手术为例。除了成像和治疗方面的进展，如纳米技术的融入，预计下一代MRgLITT系统将越来越多地纳入基于计算机模拟的MRgLITT手术模型，并提供用于规划的人工辅助计算工具、MR模型辅助温度监测、热剂量评估以及优化控制功能。
