Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany.
Int J Hyperthermia. 2020;37(1):349-355. doi: 10.1080/02656736.2020.1750713.
To investigate technical success, technique efficacy, safety and outcome of MR-guided microwave ablation (MWA) in hepatic malignancies. In this prospective IRB-approved study, patients scheduled for percutaneous treatment of hepatic malignancies underwent MR-guided MWA in a closed-bore 1.5 T MR system. Technical success was assessed on post-procedural MR control imaging. Technique efficacy was evaluated 4 weeks after the procedure on multi-parametric MRI. Assessment of safety followed the Society of Interventional Radiology grading system. Kaplan-Meier survival estimates were calculated to evaluate overall survival (OS), time to local tumor progression (TLTP), and time to non-target progression (TNTP). Between 2015 and 2019, 47 patients (60.5 ± 12.2 years; 39 male) underwent 50 procedures for 58 hepatic tumors (21 hepatocellular carcinomas; 37 metastases). Mean target tumor size was 16 ± 7mm (range: 6-39 mm). Technical success and technique efficacy were 100% and 98%, respectively. Lesions were treated using 2.6 applicator positions (range: 1-6). Mean energy, ablation duration per tumor, and procedure duration were 43.2 ± 23.5 kJ, 26.7 ± 13.1 min and 211.2 ± 68.7 min, respectively. 10 minor (20%) and 3 major (6%) complications were observed. Median post-interventional hospital admission was 1 day (range: 1-19 days). Median OS was 41.6 (IQR: 26.4-) months. Local recurrence occurred after 4 procedures (8%) with TLTP ranging between 3.1 and 41.9 months. Non-target recurrence was observed in 64% of patients after a median TNTP of 13.8 (IQR 2.3-) months. MR-guided MWA allows for safe and successful treatment of hepatic malignancies with a high technique efficacy however with relatively long procedure durations.
探讨磁共振引导下微波消融（MWA）治疗肝恶性肿瘤的技术成功率、技术疗效、安全性和结果。在这项前瞻性 IRB 批准的研究中，计划接受经皮肝恶性肿瘤治疗的患者在封闭孔 1.5T MR 系统中接受 MR 引导下 MWA。术后 MR 控制成像评估技术成功率。术后 4 周，多参数 MRI 评估技术疗效。安全性评估采用介入放射学学会分级系统。Kaplan-Meier 生存估计用于评估总生存期（OS）、局部肿瘤进展时间（TLTP）和非目标进展时间（TNTP）。2015 年至 2019 年，47 例患者（60.5±12.2 岁；39 例男性）共进行了 50 次 58 个肝肿瘤（21 个肝细胞癌；37 个转移瘤）的手术。平均靶肿瘤大小为 16±7mm（范围：6-39mm）。技术成功率和技术疗效分别为 100%和 98%。使用 2.6 个消融器位置（范围：1-6）治疗病变。平均能量、每个肿瘤的消融时间和手术时间分别为 43.2±23.5kJ、26.7±13.1min 和 211.2±68.7min。观察到 10 例轻微（20%）和 3 例严重（6%）并发症。术后中位住院时间为 1 天（范围：1-19 天）。中位 OS 为 41.6（IQR：26.4-）个月。4 例（8%）发生局部复发，TLTP 为 3.1-41.9 个月。非目标复发发生在 64%的患者中，中位 TNTP 为 13.8（IQR 2.3-）个月。MR 引导下 MWA 可安全、有效地治疗肝恶性肿瘤，技术疗效高，但手术时间相对较长。
