van Oostenbrugge Tim J, Langenhuijsen Johan F, Overduin Christiaan G, Jenniskens Sjoerd F, Mulders Peter F A, Fütterer Jurgen J
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
J Vasc Interv Radiol. 2017 Aug;28(8):1098-1107.e1. doi: 10.1016/j.jvir.2017.05.009. Epub 2017 Jun 7.
To assess the feasibility of percutaneous magnetic resonance (MR) imaging-guided cryoablation of small renal masses (SRMs) in a 3-T environment and to evaluate intraprocedural imaging, procedural safety, and initial outcomes.
The analysis included 9 patients (4 men; median age, 72 y; range, 70-82 y) with 9 SRMs (diameter, 12-30 mm). Lesions underwent biopsy, and cryoneedles were inserted under ultrasound guidance. Verification of needle positions and ice-ball monitoring were performed by T1-weighted volumetric interpolated breath-hold examination and T2-weighted half-Fourier acquired single-shot turbo spin-echo sequences. On image analysis, needle positioning was considered appropriate if the target lesion border was visible, the needle tip was inside the target lesion, and the ice ball was expected to cover the target lesion with a 5-mm margin. If these criteria could not be assessed, imaging was considered inadequate. Technical success was defined as tumor coverage with a 5-mm margin and no residual disease on 1-mo follow-up MR imaging.
Median total procedure time was 170 min (range, 135-193 min). Intraoperative imaging allowed adequate needle visualization in 67% of acquired scans (4 of 7 T1-weighted and 6 of 8 T2-weighted). Appropriate positioning of two or three needles used for each procedure was confirmed in all cases on T1- or T2-weighted imaging. Ice-ball formation was adequately visualized in all patients. Technical success rate was 100%. No local recurrences were detected on follow-up imaging at a median of 12 mo (range, 3-22 mo).
Percutaneous MR-guided cryoablation of SRMs in a 3-T MR imaging environment is safe and feasible, showing adequate intraoperative imaging capabilities with promising short-term clinical outcomes.
评估在3T环境下经皮磁共振（MR）成像引导下对小肾肿块（SRM）进行冷冻消融的可行性，并评估术中成像、手术安全性和初步结果。
分析纳入9例患者（4例男性；中位年龄72岁；范围70 - 82岁），共9个SRM（直径12 - 30mm）。对病变进行活检，并在超声引导下插入冷冻针。通过T1加权容积内插屏气检查和T2加权半傅里叶采集单次激发快速自旋回波序列进行针位置验证和冰球监测。在图像分析中，如果目标病变边界可见、针尖位于目标病变内且预期冰球以5mm边缘覆盖目标病变，则认为针定位合适。如果无法评估这些标准，则认为成像不充分。技术成功定义为肿瘤以5mm边缘覆盖且1个月随访MR成像无残留病灶。
总手术时间中位数为170分钟（范围135 - 193分钟）。术中成像在67%的采集扫描中能充分显示针（7例T1加权中的4例和8例T2加权中的6例）。在所有病例中，通过T1或T2加权成像均确认了每次手术使用的两根或三根针的合适定位。所有患者均能充分观察到冰球形成。技术成功率为100%。在中位12个月（范围3 - 22个月）的随访成像中未检测到局部复发。
在3T MR成像环境下经皮MR引导下对SRM进行冷冻消融是安全可行的，显示出足够的术中成像能力及有前景的短期临床结果。
