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Sartori S, Mauri G, Tombesi P, Di Vece F, Bianchi L, Pacella CM. Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk. Int J Hyperthermia 2018; 35:19-25. [PMID: 29749271 DOI: 10.1080/02656736.2018.1468038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The aim of this retrospective study was to assess the safety and effectiveness of laser ablation (LA) in patients with small renal cell carcinomas (RCC) and increased risk of bleeding. MATERIAL AND METHODS From 2013 to 2017, nine patients (six males, three females, aged 68.5 ± 12.2 years) at high risk of bleeding underwent ultrasonography-guided LA for an RCC. Patients were considered at increased risk of bleeding because of impairment of coagulation parameters, concomitant antiplatelet therapy, or at-risk location of the tumor (one, five, and three patients, respectively). RCC diameter ranged from 11 to 23 mm. According to tumor size, two or three laser fibers were introduced through 21-gauge needles and 1800 J per fiber were delivered in 6 min with a fixed power of 5 W. Major and minor complications, technical success, and primary and secondary technical effectiveness and tumor recurrence were recorded. RESULTS Just one Grade 1 complication was observed: a small asymptomatic hematoma that spontaneously resolved. Technical success was 100%, 1 month technical efficacy was 88.9% (8/9 patients). One patient with residual tumor was successfully retreated 1 month later, and secondary efficacy rate was 100%. No local tumor recurrence occurred during a median follow-up of 26 months (range 11-49 months). CONCLUSIONS LA is safe and effective in the treatment of small RCC and might represent a valid option in patients with increased risk of bleeding.
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Affiliation(s)
- Sergio Sartori
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Giovanni Mauri
- b Department of Interventional Radiology , European Institute of Oncology , Milan , Italy
| | - Paola Tombesi
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Francesca Di Vece
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Lara Bianchi
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Claudio Maurizio Pacella
- c Department of Diagnostic Imaging and Interventional Radiology , Regina Apostolorum Hospital , Albano Laziale, Rome , Italy
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Abstract
BACKGROUND Small renal masses are being commonly diagnosed incidentally in older patients. A partial nephrectomy is the first-line nephron sparing treatment option for these lesions. However, probe ablative therapy such as cryoablation is emerging as an alternative option for select patients requiring nephron sparing surgery. METHODS The current literature regarding the management of small renal lesions with cryoablation was retrospectively reviewed. We selected six of the largest published series of renal cryoablation with a total of 320 patients. The diagnosis, staging, treatment options, mechanism, efficacy and morbidity associated with renal cryoablation were evaluated. RESULTS Renal cryoablation for localized small renal masses is well tolerated and associated with a low complication rate. The range of mean tumor size in our literature review series (320 patients) was 2.3 to 2.6 cm. After a range of mean follow-up of 5.9 to 72 months, including a series with a minimum of 5 years of follow-up, the cancer specific survival was 97% to 100% and overall patient survival was 82% to 90.2%. CONCLUSIONS Renal cryoablation, based on available clinical reports, appears to be a curative option for patients with small localized renal cell carcinomas (RCCs) who are unwilling or unable to undergo a partial nephrectomy. With encouraging intermediate oncological follow-up available, longer-term follow-up is needed to validate the use of cryoablation as a primary treatment option.
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Affiliation(s)
- Jason Hafron
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, OH 44195, USA
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Vallo S, Eichler K, Kelly K, Schulz B, Bartsch G, Haferkamp A, Vogl TJ, Zangos S. MR-guided laser-induced thermotherapy in ex vivo porcine kidney: comparison of four different imaging sequences. Lasers Surg Med 2014; 46:558-62. [PMID: 24902949 DOI: 10.1002/lsm.22262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate the clinical value of different magnetic resonance imaging (MRI) sequences for a real-time thermo-monitoring during laser-induced thermotherapy (LITT) in kidneys. METHODS Twenty-eight ex vivo pig kidneys were treated with laser ablation under MR guidance in a high-field MR scanner (Magnetom Espree or Avanto Fit, Siemens, Germany). For the thermal ablation of the kidney, a neodymium yttrium-aluminum-garnet (Nd:YAG) laser was used in combination with a special protective catheter (length 43 cm, 4 French) which is sealed at the distal end. First, ablation was performed for 7, 10, and 13 minutes using FLASH sequences for investigation of time-dependent growth of lesion size. In the second step, we evaluated the optimal imaging sequence during a 7 minutes ablation of the kidney and after cooling using four different MR sequences (Haste, FLASH, radial VIBE, and Caipirinha DIXON). RESULTS Macroscopic lesion volume increased from 3,784 ± 1,525 mm(3) to 7,683 ± 5,756 mm(3) after the ablation from 7 to 13 minutes and MR volume ranged from 2,107 ± 1,674 mm(3) to 2,934 ± 1,549 mm(3) after the ablation from 7 to 13 minutes. During ablation, FLASH (132 ± 34%) and radial VIBE (120 ± 43%) sequences displayed lesion volumes most efficiently with a trend to overestimation. The Caipirinha DIXON (323 ± 24%) sequence overestimated the volumes significantly during real-time monitoring. The volumes measured by MRI with FLASH (61 ± 30%), Haste (67 ± 28%), or radial VIBE (48 ± 14%) sequences after cooling of the kidney after ablation were always underestimated. The Caipirinha DIXON (142 ± 2%) sequence still overestimated the lesion volume after cooling of the kidney. CONCLUSION LITT is a feasible ablation modality in kidney tissue. Moreover, macroscopic and MR lesion volume increases time-dependently. For online monitoring, radial VIBE and FLASH sequences seem to be most efficient.
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Affiliation(s)
- Stefan Vallo
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Castro A, Jenkins LC, Salas N, Lorber G, Leveillee RJ. Ablative therapies for small renal tumours. Nat Rev Urol 2013; 10:284-91. [DOI: 10.1038/nrurol.2013.68] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Salagierski M, Salagierski M, Salagierska-Barwińska A, Sosnowski M. Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk. Int J Urol 2007; 13:1375-9. [PMID: 17083386 DOI: 10.1111/j.1442-2042.2006.01595.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to describe our experience with percutaneous ultrasound-guided radiofrequency ablation of kidney tumors. METHODS From July 2002 to August 2005, 45 radiofrequency ablations (RFA) in 42 selected patients with kidney tumor were performed. The patients had either contraindications to surgery procedures or had a solitary kidney. The average tumor size was 37.5 mm (range, 18-59 mm) with the mean age of 68 years (range, 28-83 years). RFA were performed based on radiographic findings. Needle biopsy was made only twice. Monopolar Cool-tip Tyco or bipolar Celon Olympus radiofrequency devices were used. The procedure was performed under conscious sedation with local anesthesia. Treatment efficacy was assessed by computed tomography and by Doppler ultrasound. The absence of contrast enhancement on computed tomography was considered to be a successful treatment. RESULTS The average follow up was 14 months (range, 3-36 months). In 42 tumors (93%), total absence of contrast enhancement was obtained after the initial RFA and in three tumors (7%) after the second ablation session. There were no complications following 41 procedures, including all ablations in small (<35 mm) renal masses. In four procedures, minor complications were observed. All patients are alive. There has been no need for chronic hemodialysis and, until now, we have not observed any local recurrences with the exception of one metastasis to an ipsilateral adrenal gland. CONCLUSIONS RFA of kidney tumors is a promising alternative treatment which could be considered for patients who are not suitable for surgery.
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Aron M, Gill IS. Minimally Invasive Nephron-Sparing Surgery (MINSS) for Renal Tumours. Eur Urol 2007; 51:348-57. [PMID: 17084513 DOI: 10.1016/j.eururo.2006.10.033] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Accepted: 10/17/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To review the evolution and current status of probe ablative methods of minimally invasive nephron-sparing surgery (MINSS) for renal tumours. METHODS The English language literature of the past 10 yr was reviewed by using the National Library of Medicine database and the following keywords: chemoablation, cryoablation, high-intensity focused ultrasound, kidney, laser interstitial thermotherapy, microwave thermotherapy, nephron-sparing surgery, radiofrequency ablation, radiosurgery, renal, and tumour. Over 300 papers were identified, 50 of which were selected for this review on the basis of their contribution in advancing the field with regards to (1) evolution of concepts, (2) development and refinement of techniques, and (3) intermediate- and long-term clinical outcomes. RESULTS Open partial nephrectomy is the reference standard for nephron-sparing surgery against which all MINSS techniques should be measured. Although the initial outcomes of cryoablation and radiofrequency ablation (RFA) are encouraging, long-term studies are necessary to confirm lasting efficacy. The optimal modality for tumour targeting, monitoring therapy, and follow-up remains to be determined. These ablative techniques should be reserved for carefully selected patients, the data should be prospectively accrued, and the long-term cancer cure rates should be compared with the reference standard. CONCLUSIONS Promising long-term data are available for cryoablation. RFA is still considered developmental, and instances of incomplete cell kill, despite nonenhancement, are concerning. Other modalities are still experimental.
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Affiliation(s)
- Monish Aron
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, United States
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Schmidt EJ, Reddy VK, Ruskin JN. Nonenhanced magnetic resonance imaging for characterization of acute and subacute radiofrequency ablation lesions. Heart Rhythm 2006; 4:215-7. [PMID: 17275760 DOI: 10.1016/j.hrthm.2006.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Indexed: 11/29/2022]
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Abstract
The treatment of RCC is rapidly changing. The introduction of minimally invasive thermal ablation techniques offers a safe and accurate alternative to open surgery in the treatment of renal tumors. Because of its technical benefits, percutaneous radiofrequency ablation took the lead among these minimally invasive techniques. Supported by convincing results from experimental studies, patient data prove this procedure to be safe and efficient. As a minimally invasive and nephron-sparing technique, it is well suited for patients with a single kidney, multiple tumors, or contraindications for open surgery.
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Affiliation(s)
- Andreas Mahnken
- Department of Diagnostic Radiology, University Hospital, RWTH Aachen University, Germany
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Abstract
PURPOSE OF REVIEW The success of partial nephrectomy for the treatment of small renal cancers has led to the development of energy ablative technologies, which are less invasive alternatives for performing nephron-sparing surgery. Currently, cryoablation and radiofrequency ablation are the two most reported technologies. Both technologies use very different means to cause cellular injury. Additionally, three newer technologies, high-frequency ultrasound ablation, laser interstitial therapy, and microwave therapy are emerging in the literature. RECENT FINDINGS Three- and 4-year data for cryoablation and radiofrequency ablation are now becoming available. On the basis of these studies, it is clear that ablative technologies can be effective treatments for select small renal tumors. It is also evident that both percutaneous and laparoscopic approaches offer minimal morbidity. SUMMARY As long-term (5 years and greater) outcome data for ablative technologies accumulate, we are likely to see an increase in clinical reports, including more patients who may be candidates for extirpative surgery. Technology will advance, leading to smaller probes with larger treatment zones, making it possible to treat larger tumors and potentially even tumors in the advanced disease state.
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Affiliation(s)
- C Charles Wen
- Division of Urology, Department of Surgery, University of Wisconsin-Madison Medical School, Madison, Wisconsin 53792, USA
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Abstract
The aim of this study is to describe all aspects of the process of using MR imaging to control thermal ablation procedures and the strengths and weaknesses of the individual thermal ablation modalities in relation to their use in the MR environment. Magnetic resonance thermal sequences, MR scanner configurations, and the different thermal ablation modalities are discussed in the context of how they are commonly used in MR scanners to provide optimal image guidance of therapy. The outcomes of completed research on some of the applications of thermal tissue ablation using MR guidance are described to indicate how these processes may impact patient treatment. At the end of this review, the reader should have an understanding of how MR guidance of thermal ablation may be carried out, in what areas it is currently most used, and were it may develop in the near future.
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Salomir R, Palussière J, Fossheim SL, Rogstad A, Wiggen UN, Grenier N, Moonen CTW. Local delivery of magnetic resonance (MR) contrast agent in kidney using thermosensitive liposomes and MR imaging-guided local hyperthermia: A feasibility study in vivo. J Magn Reson Imaging 2005; 22:534-40. [PMID: 16161081 DOI: 10.1002/jmri.20416] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To investigate the feasibility of local delivery of a magnetic resonance (MR) contrast agent in vivo using paramagnetic thermosensitive liposomes and infrared (IR) laser-induced local hyperthermia under real-time MR thermometry on rabbit kidney. MATERIALS AND METHODS Respiratory gated, radio frequency (RF)-spoiled gradient-echo sequences were used for precise MR temperature mapping (SD = 1 degrees C). In vivo heating experiments confirmed local release of MR contrast agent from liposomes. RESULTS T1 decreased from 800 msec to about 500 msec, as measured after tissue cooling, in those locations where the renal parenchyma was heated above the phase transition temperature of the liposome membrane. CONCLUSION The release of MR contrast agent has been demonstrated in rabbit kidney in vivo. This may be used as a reporter for simultaneous release of therapeutic agents.
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Affiliation(s)
- Rares Salomir
- Molecular and Functional Imaging, Technological Research Unit, CNRS/University of Bordeaux 2, Bordeaux, France
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Sequeiros RB, Ojala R, Kariniemi J, Perälä J, Niinimäki J, Reinikainen H, Tervonen O. MR-guided interventional procedures: a review. Acta Radiol 2005; 46:576-86. [PMID: 16334839 DOI: 10.1080/02841850510021742] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Magnetic resonance imaging (MRI) has emerged as a potential guidance tool for a variety of procedures. Diagnostic and therapeutic procedures using either open surgical or percutaneous access are performed. They span from simple lesion targeting and biopsy to complex applications requiring multiple tasks performed simultaneously or in rapid succession. These tasks include instrument guidance and therapy monitoring as well as procedural follow-up. The interventional use of MRI (IMRI) is increasing steadily. This article reviews the prerequisites, systems, and clinical interventional procedures of IMRI.
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Abstract
PURPOSE OF REVIEW The management of small renal tumors is changing from radical nephrectomy to nephron-conserving surgery. The aim of this review is to discuss the currently prevailing methods used for nonextirpative renal tumor ablation. The studies published in English during 2004 to May 2005 have been reviewed in this article. RECENT FINDINGS Of the various ablation techniques, cryotherapy and radiofrequency ablation are being increasingly applied clinically. They can be performed either laparoscopically or percutaneously using a combination of fine probes and high-resolution imaging techniques for focusing and monitoring the therapy. Noninvasive tumor ablation by high-intensity focused ultrasound, and other techniques, is still at an experimental stage. SUMMARY Although the initial outcomes of cryoablation and radiofrequency ablation are encouraging, long-term studies are necessary to confirm their lasting efficacy. The optimal modality for tumor targeting, monitoring therapy, and follow-up remains to be determined. These ablative techniques should be reserved for carefully selected patients, the data should be prospectively accrued, and the results should be compared to that of the reference standard, open or laparoscopic partial nephrectomy.
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Affiliation(s)
- Monish Aron
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, The Cleveland Clinic Foundation, OH 44115, USA
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Affiliation(s)
- Murali K Ankem
- Division of Urology, Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin 53792-3236, USA
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Häcker A, Michel MS, Alken P. Minimally invasive treatments in renal cell carcinoma. Scand J Surg 2004; 93:137-44. [PMID: 15285566 DOI: 10.1177/145749690409300209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Häcker
- Department of Urology, University Hospital Mannheim, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
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Mabjeesh NJ, Avidor Y, Matzkin H. Emerging Nephron Sparing Treatments for Kidney Tumors: A Continuum of Modalities From Energy Ablation to Laparoscopic Partial Nephrectomy. J Urol 2004; 171:553-60. [PMID: 14713759 DOI: 10.1097/01.ju.0000093441.01453.68] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The current global medical trend toward minimally invasive treatment for various tumors has generated special interest in several minimally invasive options in the management of kidney tumors. We discuss the role of nephron sparing surgery by less invasive options than the time-honored partial nephrectomy, and the current multitude of energy based tumor ablative methods. MATERIALS AND METHODS We searched the English literature following the introduction of nephron sparing surgery, with special attention to various emerging minimally invasive surgical and ablative alternatives. RESULTS Laparoscopic partial nephrectomy can be performed safely following the surgical oncology principles established by open partial nephrectomy. Initial results from the various energy based modalities, most notably cryoablation, indicate that high local control rates can be achieved. However, caution is advised since viable tissue has been observed after minimally invasive ablative therapies. Available data, while promising, are still lacking for long-term followup. CONCLUSIONS Compared to open partial nephrectomy the laparoscopic approach offers similar cancer-free survival rates. However, the procedure requires highly skilled surgeons. Of the energy based ablative treatments cryoablation followed by radio frequency ablation offers the most meaningful results, with promising local control rates indicated in some series. These methods can be performed less invasively than partial nephrectomy and require less surgical expertise. We anticipate that these modalities will be formalized into urological practice and serve as a single continuum of care, customized according to disease and surgical expertise.
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Affiliation(s)
- Nicola J Mabjeesh
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
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Sequeiros RB, Hyvönen P, Sequeiros AB, Jyrkinen L, Ojala R, Klemola R, Vaara T, Tervonen O. MR imaging-guided laser ablation of osteoid osteomas with use of optical instrument guidance at 0.23 T. Eur Radiol 2003; 13:2309-14. [PMID: 12734670 DOI: 10.1007/s00330-003-1897-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2002] [Revised: 11/27/2002] [Accepted: 02/17/2003] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to determine the feasibility and features of low-field MR imaging in performing interstitial laser ablation of osteoid osteomas. Between September 2001 and April 2002, five consecutive patients with clinical and imaging findings suggesting osteoid osteoma and referred for removal of osteoid osteoma were treated with interstitial laser treatment. A low-field open-configuration MRI scanner (0.23 T, Outlook Proview, Philips Medical Systems, Finland) with optical instrument guidance hardware and software was used. Laser device used was of ND-Yag type (Fibertom medilas, Dornier Medizin Technik, Germany). A bare laser fiber (Dornier Medizin Technik, Germany) with a diameter of 400 microm was used. Completely balanced steady-state (CBASS; true fast imaging with steady precession) imaging was used for lesion localization, instrument guidance, and thermal monitoring. A 14-G (Cook Medical, USA) bone biopsy drill was used for initial approach. Laser treatment was conducted through the biopsy canal. All the lesions were successfully localized, targeted, and treated under MRI guidance. All the patients were symptom free 3 weeks and 3 months after the treatment. There was one recurrence reported during follow-up (6 months). The MRI-guided percutaneous interstitial laser ablation of osteoid osteomas seems to be a feasible treatment mode.
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Puls R, Stroszczynski C, Gaffke G, Hosten N, Felix R, Speck U. Laser-induced thermotherapy (LITT) of liver metastases: MR-guided percutaneous insertion of an MRI-compatible irrigated microcatheter system using a closed high-field unit. J Magn Reson Imaging 2003; 17:663-70. [PMID: 12766895 DOI: 10.1002/jmri.10298] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of a new MRI-compatible irrigated laser microcatheter system for thermal ablation of liver metastases. MATERIAL AND METHODS The new microcatheter system consists of a titanium needle with a diameter of 1.5 mm and a surrounding Teflon catheter with an outer diameter of 1.8 mm (5.5 F). In vitro laser-induced coagulation of bovine liver tissue was performed to determine the optimal perfusion rate of cooling saline flow, maximum laser energy, and ablation time. Laser-induced thermotherapy using the new microcatheter system, an Nd:YAG laser (Dornier), and a flexible laser light guide (Somatex GmbH, Berlin, Germany) was performed in 28 patients with liver metastases. Percutaneous insertion and positioning of multiple microcatheters in the lesion and monitoring of therapy was performed with a closed high-field MRI scanner using T1-weighted gradient-echo sequences during breath-hold. RESULTS A perfusion rate of 0.75 mL/minute, a laser energy of 15 W, and an ablation time of 20 minutes were found suitable to achieve safe and sufficient ablation of metastatic tissue. The mean volume of induced coagulation in vitro was 23.9 mL. Ablation of liver metastases in patients was technically and clinically successful. CONCLUSION The new microcatheter system allows for both catheter placement and monitoring of therapy using a single imaging modality. This shortens the procedure and enables more precise puncture and therapy of liver metastases. Due to the miniaturized design of the catheter and the real-time monitoring, the procedure is minimally invasive and very well tolerated by patients. This new technique seems to be a safe and feasible alternative in treating liver metastases.
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Affiliation(s)
- Ralf Puls
- Radiology Departments, Charité, Humboldt University of Berlin, Germany.
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Dick EA, Joarder R, De Jode MG, Wragg P, Vale JA, Gedroyc WMW. Magnetic resonance imaging-guided laser thermal ablation of renal tumours. BJU Int 2002; 90:814-22. [PMID: 12460338 DOI: 10.1046/j.1464-410x.2002.03026.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To test the hypothesis that magnetic resonance imaging (MRI)-guided laser thermal ablation (LTA) of inoperable renal tumours is a safe, tolerable and potentially effective treatment. PATIENTS AND METHODS Nine patients (aged 56-81 years) with malignant renal tumours underwent percutaneous LTA under MRI guidance in a 0.5 T open magnet. Real-time colour thermal mapping was used to monitor tumour ablation, and the follow-up was with gadolinium-enhanced MRI at 6 weeks and (where appropriate) 3-4 months after the procedure. Tumour volume and percentage tumour enhancement before and after ablation were compared. The percentage of tumour ablated on real-time T1-weighted thermal maps was compared with that on gadolinium-enhanced follow-up MRI. RESULTS The mean (range) follow-up was 16.9 (3-32) months after the first ablation. The mean tumour size did not change significantly, but the mean percentage of viable tumour decreased significantly from 73.7% before to 29.5% after ablation (P = 0.012, Wilcoxon signed-ranks test). Thermal maps correlated moderately well with follow-up MRI in predicting the extent of tumour ablation (Pearson correlation coefficient 0.55). There were two minor and one major complication. CONCLUSION In this pilot study of patients unsuitable for surgery, MRI-guided LTA of renal tumours was safe, feasible (being well tolerated by the patient) and significantly reduced enhancing tumour volume by a mean of 45%.
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Affiliation(s)
- E A Dick
- Department of International MR and Urology, St Mary's Hospital, London, UK
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Hirose M, Kacher DF, Smith DN, Kaelin CM, Jolesz FA. Feasibility of MR imaging-guided breast lumpectomy for malignant tumors in a 0.5-T open-configuration MR imaging system. Acad Radiol 2002; 9:933-41. [PMID: 12186443 DOI: 10.1016/s1076-6332(03)80464-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVES The authors performed this study to develop the technology for and evaluate the utility of a 0.5-T vertical open-configuration magnetic resonance (MR) imaging system for imaging-guided breast lumpectomy of malignant tumors. MATERIALS AND METHODS Twenty women with breast cancer underwent MR imaging-guided lumpectomy in a 0.5-T vertical open-configuration MR system. During lumpectomy, pre- and postresection images were acquired with and without contrast material. Images were used both for tumor localization and to monitor resection. If residual enhancement was observed, additional resection was performed in an effort to secure negative pathologic margins. RESULTS The procedure evolved over time with technology innovations and improvements. Specifically, instruments were acquired that were compatible with MR imaging breast procedures, the echo time with the Dixon technique was modified to optimize image quality, contrast material injection was timed for maximum lesion enhancement, breath-hold image acquisition was instituted, and the biopsy cavity was filled with saline and the incision closed before image acquisition. CONCLUSION All breast lesions were identified despite limited spatial resolution and fat-suppression techniques. The evolved techniques facilitated intraoperative margin evaluation and prompted additional surgical margin resection in five patients, sparing four from an additional surgical procedure. Intraoperative MR imaging has the potential to improve the complete pathologic excision of invasive breast cancer.
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Affiliation(s)
- Masanori Hirose
- Departments of Radiology, Brigham and Women's Hospital, Boston, MA 02215, USA
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Abstract
Intraoperative magnetic resonance imaging (iMRI) is a new development in medicine that bridges the specialties of surgery and radiology. Deficiencies in the visualization of anatomical architecture and the perception of tumour boundaries in conventional open surgery have led to the integration of imaging within surgery. The superior soft tissue and multiplanar imaging features of magnetic resonance (MR) make this imaging modality superior to that of alternatives. The unique properties of MR to detect heat change and perfusion, and diffusion characteristics of tissue enhance the usefulness of this medium. Concurrent developments in computer aided image guidance and thermoablative technology, herald the era of minimally invasive tumour ablation. Applications have been developed for areas such as neurosurgery, general surgery, gynaecology and urology.
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Affiliation(s)
- Laurence Gluch
- Magnetic Resonance Therapy Unit, Brigham and Womens' Hospital, Boston, Massachusetts, USA.
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Bremer C, Kreft G, Roggan A, Filler T, Reimer P. Ex vivo evaluation of novel miniaturized laser-induced interstitial thermotherapy applicators for effective small-volume tissue ablation. Invest Radiol 2001; 36:327-34. [PMID: 11410753 DOI: 10.1097/00004424-200106000-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES For effective small-volume tissue ablation in clinical and experimental settings, smaller laser-induced interstitial thermotherapy (LITT) applicator designs are required. The aim of this study was to compare the ablation properties of recently developed ultrasmall and small to standard LITT applicators. METHODS Laser-induced interstitial thermotherapy was performed on liver samples using ultrasmall, small, and standard LITT applicators. Thermotherapy was monitored by magnetic resonance imaging, and lesion sizes were measured for each image. True lesion sizes were then determined macroscopically and by histology. RESULTS For continuous laser application over 5 minutes, maximum power settings were 5 W for the ultrasmall and small applicators and 10 W for the standard applicator. Given identical LITT settings, lesion volume measured by magnetic resonance imaging was significantly larger and histological tissue damage was more severe with the ultrasmall and small applicators than with the standard applicator. CONCLUSIONS Small and ultrasmall LITT applicators can be used for effective tissue ablation of small target volumes in experimental and clinical applications.
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Affiliation(s)
- C Bremer
- Institute for Clinical Radiology, University of Muenster, Germany.
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Hilger I, Andrä W, Hergt R, Hiergeist R, Schubert H, Kaiser WA. Electromagnetic heating of breast tumors in interventional radiology: in vitro and in vivo studies in human cadavers and mice. Radiology 2001; 218:570-5. [PMID: 11161180 DOI: 10.1148/radiology.218.2.r01fe19570] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess relevant parameters for the minimally invasive elimination of breast tumors by using a selective application of magnetite and exposure of the breast to an alternating magnetic field. MATERIALS AND METHODS The specific absorption rate (SAR) of different magnetite samples was determined calorimetrically. Temperature elevations based on magnetite mass (7-112 mg) and magnetic field amplitude (1.2-6.5 kA/m frequency, 400 kHz) were investigated by using human breast tissue. Parameter combinations (21 mg +/- 9 [SD], 242-second magnetic field exposure, 6.5-kA/m amplitude) were tested in 10 immunodeficient mice bearing human adenocarcinomas (MX-1 cells). Histologic sections of heated tumor tissue were analyzed. RESULTS SAR data of different magnetite particle types ranged from 3 to 211 W/g. Temperature elevation (DeltaT) as a function of the magnetite mass increased linearly up to 28 mg; at higher masses, a saturation of DeltaT was observed at nearly 88 degrees C. The dependence of DeltaT on magnetic field amplitude (H) revealed a third-order power law: DeltaT = 0.26 degrees C/(kA/m)(3). H(3), with r(2) = 0.95. A mean temperature of 71 degrees C +/- 8 was recorded in the tumor region at the end of magnetic field exposure of the mice. Typical macroscopic findings included tumor shrinkage after heating. Histologically nuclear degenerations were observed in heated malignant cells. CONCLUSION Magnetic heating of breast tumors is a promising technique for future interventional radiologic treatments.
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Affiliation(s)
- I Hilger
- Institutes of Diagnostic and Interventional Radiology, Clinics of Friederich Schiller University Jena, Bachstrasse 18, D-07740 Jena, Germany
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Abstract
Magnetic resonance imaging (MRI)-based monitoring has been shown in recent years to enhance the effectiveness of minimally or noninvasive thermal therapy techniques, such as laser, radiofrequency, microwave, ultrasound, and cryosurgery. MRI's unique soft-tissue contrast and ability to image in three dimensions and in any orientation make it extremely useful for treatment planning and probe localization. The temperature sensitivity of several intrinsic parameters enables MRI to visualize and quantify the progress of ongoing thermal treatment. MRI is sensitive to thermally induced tissue changes resulting from the therapies, giving the physician a method to determine the success or failure of the treatment. These methods of using MRI for planning, guiding, and monitoring thermal therapies are reviewed.
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Affiliation(s)
- N J McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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