Yang Nannan, Gong Ju, Yao Linyan, Wang Chen, Chen Jun, Liu Jiangwen, Wang Zhongmin, Lu Jian
Department of Radiology, Ruijin Hospital/Luwan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Vascular and Interventional Radiology, The Third Affiliated Hospital, Shihezi University, Xinjiang, China.
J Cancer Res Ther. 2020 Sep;16(5):1151-1156. doi: 10.4103/jcrt.JCRT_1_20.
Percutaneous image-guided thermal ablation has emerged as a valuable therapeutic approach for hepatic malignancies. Magnetic resonance imaging (MRI) has shown potential for great soft-tissue resolution and multiplanar capabilities in arbitrary imaging planes, which are also critical for treatment planning, targeting, and evaluation.
The aim of this study was to investigate the feasibility, technical success, safety, and follow-up of hepatic malignancies treated with MRI-guided microwave ablation (MWA).
MRI-guided MWA was performed in a closed-bore 1.5 T MR system. T1-weighted imaging was used as a monitoring tool during surgery. T2-weighted imaging was performed to obtain an adequate tumor margin, to calculate the tumor size. Multi-b-value diffusion-weighted imaging (DWI) was performed postprocedurally. Enhanced MRI was performed at 4 weeks, to assess the technical success, and every 3-6 months as a follow-up.
Twenty-six patients (38 lesions) were enrolled in the study. A primary efficacy rate of 100% was achieved, and no major complications were observed. Two patient cohorts were identified based on lesion size. Six lesions with incomplete circles on reconstructed DWI appeared immediately postprocedure, and persistent hyperintense signals developed into new lesions over the subsequent 6-12 months.
MRI-guided ablation is feasible and effective for planning and evaluating MWA in hepatic malignancies. The available clinical data strongly support the advantages of the assessment of tumors through 3D imaging versus routine axial images.
经皮影像引导下热消融已成为治疗肝脏恶性肿瘤的一种重要方法。磁共振成像（MRI）在软组织分辨率和任意成像平面的多平面成像能力方面显示出潜力，这对于治疗规划、靶向和评估也至关重要。
本研究旨在探讨MRI引导下微波消融（MWA）治疗肝脏恶性肿瘤的可行性、技术成功率、安全性及随访情况。
在1.5T的封闭孔径MR系统中进行MRI引导下的MWA。手术过程中使用T1加权成像作为监测工具。进行T2加权成像以获得足够的肿瘤边界，计算肿瘤大小。术后进行多b值扩散加权成像（DWI）。在4周时进行增强MRI以评估技术成功率，并每3 - 6个月进行一次随访。
26例患者（38个病灶）纳入本研究。主要有效率达到100%，未观察到严重并发症。根据病灶大小确定了两个患者队列。重建DWI上呈不完整环形的6个病灶在术后即刻出现，后续6 - 12个月持续的高信号发展为新病灶。
MRI引导下消融对于肝脏恶性肿瘤的MWA规划和评估是可行且有效的。现有的临床数据有力地支持了通过三维成像评估肿瘤优于常规轴位图像的优势。
