Department of Radiology and Nuclear Medicine, Oslo University Hospital, Post box 4950, N-0424, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur Radiol. 2019 Sep;29(9):5013-5021. doi: 10.1007/s00330-018-5996-8. Epub 2019 Feb 8.
Invasive treatment of tumors adjacent to large hepatic vessels is a continuous clinical challenge. The primary aim of this study was to examine the feasibility of ablating liver tissue adjacent to large hepatic and portal veins with magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU). The secondary aim was to compare sonication data for ablations performed adjacent to hepatic veins (HV) versus portal veins (PV).
MRgHIFU ablations were performed in six male land swine under general anesthesia. Ablation cells of either 4 or 8 mm diameter were planned in clusters (two/animal) adjacent either to HV (n = 6) or to PV (n = 6), with diameter ≥ 5 mm. Ablations were made using 200 W and 1.2 MHz. Post-procedure evaluation was made on contrast-enhanced MRI (T1w CE-MRI), histopathology, and ablation data from the HIFU system.
A total of 153 ablations in 81 cells and 12 clusters were performed. There were visible lesions with non-perfused volumes in all animals on T1w CE-MRI images. Histopathology showed hemorrhage and necrosis in all 12 clusters, with a median shortest distance to vessel wall of 0.4 mm (range 0-2.7 mm). Edema and endothelial swelling were observed without vessel wall rupture. In 8-mm ablations (n = 125), heat sink was detected more often for HV (43%) than for PV (19%; p = 0.04).
Ablations yielding coagulative necrosis of liver tissue can be performed adjacent to large hepatic vessels while keeping the vessel walls intact. This indicates that perivascular tumor ablation in the liver is feasible using MRgHIFU.
• High-intensity focused ultrasound ablation is a non-invasive treatment modality that can be used for treatment of liver tumors. • This study shows that ablations of liver tissue can be performed adjacent to large hepatic vessels in an experimental setting. • Liver tumors close to large vessels can potentially be treated using this modality.
毗邻大肝血管的肿瘤侵袭性治疗是一项持续的临床挑战。本研究的主要目的是检验磁共振引导高强度聚焦超声（MRgHIFU）消融毗邻大肝静脉和门静脉肝组织的可行性。次要目的是比较毗邻肝静脉（HV）和门静脉（PV）行超声消融的数据。
在全身麻醉下，对 6 头雄性 Land 猪进行 MRgHIFU 消融。在毗邻 HV（n=6）或毗邻 PV（n=6）的情况下，以 2/动物的方式规划 4 或 8mm 直径的消融单元（簇），其直径≥5mm。采用 200W 和 1.2MHz 进行消融。通过对比增强磁共振成像（T1w CE-MRI）、组织病理学和 HIFU 系统的消融数据对术后情况进行评估。
共进行了 153 次消融，涉及 81 个细胞和 12 个单元。在所有动物的 T1w CE-MRI 图像上均可见到无灌注的可见病变。组织病理学显示 12 个单元均有出血和坏死，血管壁最短距离中位数为 0.4mm（范围 0-2.7mm）。观察到水肿和内皮肿胀，而无血管壁破裂。在 8mm 消融（n=125）中，HV（43%）比 PV（19%）更常出现热沉（p=0.04）。
毗邻大肝血管的肝组织消融可产生凝固性坏死，同时保持血管壁完整。这表明使用 MRgHIFU 可行肝血管周围肿瘤消融。
•高强度聚焦超声消融是一种非侵入性治疗方法，可用于治疗肝脏肿瘤。•本研究表明，在实验环境中可以在毗邻大肝血管的部位进行肝组织消融。•靠近大血管的肝脏肿瘤可能可以使用这种方式进行治疗。
