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Stouthandel MEJ, Pullens P, Bogaert S, Schoepen M, Vangestel C, Achten E, Veldeman L, Van Hoof T. Application of frozen Thiel-embalmed specimens for radiotherapy delineation guideline development: a method to create accurate MRI-enhanced CT datasets. Strahlenther Onkol 2022; 198:582-592. [DOI: 10.1007/s00066-022-01928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
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2
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MR Imaging in Real Time Guiding of Therapies in Prostate Cancer. Life (Basel) 2022; 12:life12020302. [PMID: 35207589 PMCID: PMC8878909 DOI: 10.3390/life12020302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
Magnetic resonance imaging (MRI)-guided therapy for prostate cancer (PCa) aims to reduce the treatment-associated comorbidity of existing radical treatment, including radical prostatectomy and radiotherapy. Although active surveillance has been used as a conservative method to reduce overtreatment, there is a growing demand for less morbidity and personalized (focal) treatment. The development of multiparametric MRI was of real importance in improving the detection, localization and staging of PCa. Moreover, MRI has been useful for lesion targeting within the prostate, as it is used in the guidance of prostate biopsies, by means of cognitive registration, MRI-ultrasound fusion guidance or direct in-bore MRI-guidance. With regard to PCa therapies, MRI is used for precise probe placement into the lesion and to accurately monitor the treatment in real-time. Moreover, advances in MR-compatible thermal ablation allow for noninvasive real-time temperature mapping during treatment. In this review, we present an overview of the current status of MRI-guided therapies in PCa, focusing on cryoablation, focal laser ablation, high intensity focused ultrasound and transurethral ultrasound ablation. We explain the important role of MRI in the evaluation of the completeness of the ablation and during follow-up. Finally, we will discuss the challenges and future development inherent to these new technologies.
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Hankiewicz JH, Celinski Z, Camley RE. Measurement of sub-zero temperatures in MRI using T 1 temperature sensitive soft silicone materials: Applications for MRI-guided cryosurgery. Med Phys 2021; 48:6844-6858. [PMID: 34562287 DOI: 10.1002/mp.15252] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE One standard method, proton resonance frequency shift, for measuring temperature using magnetic resonance imaging (MRI), in MRI-guided surgeries, fails completely below the freezing point of water. Because of this, we have developed a new methodology for monitoring temperature with MRI below freezing. The purpose of this paper is to show that a strong temperature dependence of the nuclear relaxation time T1 in soft silicone polymers can lead to temperature-dependent changes of MRI intensity acquired with T1 weighting. We propose the use of silicone filaments inserted in tissue for measuring temperature during MRI-guided cryoablations. METHODS The temperature dependence of T1 in bio-compatible soft silicone polymers was measured using nuclear magnetic resonance spectroscopy and MRI. Phantoms, made of bulk silicone materials and put in an MRI-compatible thermal container with dry ice, allowed temperature measurements ranging from -60°C to + 20°C. T1 -weighted gradient echo images of the phantoms were acquired at spatially uniform temperatures and with a gradient in temperature to determine the efficacy of using these materials as temperature indicators in MRI. Ex vivo experiments on silicone rods, 4 mm in diameter, inserted in animal tissue were conducted to assess the practical feasibility of the method. RESULTS Measurements of nuclear relaxation times of protons in soft silicone polymers show a monotonic, nearly linear, change with temperature (R2 > 0.98) and have a significant correlation with temperature (Pearson's r > 0.99, p < 0.01). Similarly, the intensity of the MR images in these materials, taken with a gradient echo sequence, are also temperature dependent. There is again a monotonic change in MRI intensity that correlates well with the measured temperature (Pearson's r < -0.98 and p < 0.01). The MRI experiments show that a temperature change of 3°C can be resolved in a distance of about 2.5 mm. Based on MRI images and external sensor calibrations for a sample with a gradient in temperature, temperature maps with 3°C isotherms are created for a bulk phantom. Experiments demonstrate that these changes in MRI intensity with temperature can also be seen in 4 mm silicone rods embedded in ex vivo animal tissue. CONCLUSIONS We have developed a new method for measuring temperature in MRI that potentially could be used during MRI-guided cryoablation operations, reducing both procedure time and cost, and making these surgeries safer.
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Affiliation(s)
- Janusz H Hankiewicz
- UCCS BioFrontiers Center, University of Colorado at Colorado Springs, USA.,MRX Analytics, PBC, Colorado Springs, Colorado, USA
| | - Zbigniew Celinski
- UCCS BioFrontiers Center, University of Colorado at Colorado Springs, USA.,MRX Analytics, PBC, Colorado Springs, Colorado, USA
| | - Robert E Camley
- UCCS BioFrontiers Center, University of Colorado at Colorado Springs, USA.,MRX Analytics, PBC, Colorado Springs, Colorado, USA
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Natesan H, Tian L, A Rogers J, Bischof J. A Microthermal Sensor for Cryoablation Balloons. J Biomech Eng 2020; 142:1083626. [PMID: 32391553 DOI: 10.1115/1.4047134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Indexed: 11/08/2022]
Abstract
Treatment of atrial fibrillation by cryoablation of the pulmonary vein (PV) suffers from an inability to assess probe contact, tissue thickness, and freeze completion through the wall. Unfortunately, clinical imaging cannot be used for this purpose as these techniques have resolutions similar in scale (∼1 to 2 mm) to PV thickness and therefore are unable to resolve changes within the PV during treatment. Here, a microthermal sensor based on the "3ω" technique which has been used for thin biological systems is proposed as a potential solution and tested for a cryoablation scenario. First, the sensor was modified from a linear format to a serpentine format for integration onto a flexible balloon. Next, using numerical analyses, the ability of the modified sensor on a flat substrate was studied to differentiate measurements in limiting cases of ice, water, and fat. These numerical results were then complemented by experimentation by micropatterning the serpentine sensor onto a flat substrate and onto a flexible balloon. In both formats (flat and balloon), the serpentine sensor was experimentally shown to: (1) identify tissue contact versus fluid, (2) distinguish tissue thickness in the 0.5 to 2 mm range, and (3) measure the initiation and completion of freezing as previously reported for a linear sensor. This study demonstrates proof of principle that a serpentine 3ω sensor on a balloon can monitor tissue contact, thickness, and phase change which is relevant to cryo and other focal thermal treatments of PV to treat atrial fibrillation.
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Affiliation(s)
- Harishankar Natesan
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455
| | - Limei Tian
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - John A Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208
| | - John Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455
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Hübner F, Schreiner R, Panahi B, Vogl TJ. Evaluation of the thermal sensitivity of porcine liver in CT-guided cryoablation: an initial study. Med Phys 2020; 47:4997-5005. [PMID: 32748398 DOI: 10.1002/mp.14432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate computed tomography (CT)-based thermometry in cryoablation, the thermal sensitivity of an ex-vivo porcine liver was determined in an initial study design. METHODS The CT-guided cryoablation was performed in three porcine liver samples over a period of 10 min. Fiber optic temperature probes were positioned parallel to the shaft of the cryoprobe in an axial slice orientation. During ablation, temperature measurements were performed simultaneously with CT imaging at 5 s intervals. On the CT images, the average CT number was calculated for a region of interest of 3 × 3 pixels just below the tip of each temperature probe. A linear regression analysis was performed using eleven data sets to determine the dependence of the CT number on the temperature. RESULTS With decreasing temperature, an increasing hypodense area around the tip of the cryoprobe was observed on the CT images and decreasing values of the CT number were determined. Starting at a temperature of - 40°C a linear relation between the CT number and the temperature was determined and a thermal sensitivity of 0.95 HU/°C (R2 = 0.73) was obtained. The thermal sensitivity was used to calculate color-coded temperature maps. The calculated temperature distribution corresponds quantitatively to the increasing hypodense area. CONCLUSIONS A noninvasive CT-based temperature determination during cryoablation in a normal ex vivo porcine liver is feasible. A thermal sensitivity of 0.95 HU/°C was determined by linear regression analysis. A color-coded map of the temperature distribution was presented.
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Affiliation(s)
- Frank Hübner
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
| | - Roland Schreiner
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
| | - Bita Panahi
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
| | - Thomas Josef Vogl
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
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Temperature-Sensitive Frozen-Tissue Imaging for Cryoablation Monitoring Using STIR-UTE MRI. Invest Radiol 2020; 55:310-317. [PMID: 31977600 DOI: 10.1097/rli.0000000000000642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to develop a method to delineate the lethally frozen-tissue region (temperature less than -40°C) arising from interventional cryoablation procedures using a short tau inversion-recovery ultrashort echo-time (STIR-UTE) magnetic resonance (MR) imaging sequence. This method could serve as an intraprocedural validation of the completion of tumor ablation, reducing the number of local recurrences after cryoablation procedures. MATERIALS AND METHODS The method relies on the short T1 and T2* relaxation times of frozen soft tissue. Pointwise Encoding Time with Radial Acquisition, a 3-dimensional UTE sequence with TE = 70 microseconds, was optimized with STIR to null tissues with a T1 of approximately 271 milliseconds, the threshold T1. Because the T1 relaxation time of frozen tissue in the temperature range of -40°C < temperature < -8°C is shorter than the threshold T1 at the 3-tesla magnetic field, tissues in this range should appear hyperintense. The sequence was evaluated in ex vivo frozen tissue, where image intensity and actual tissue temperatures, measured by thermocouples, were correlated. Thereafter, the sequence was evaluated clinically in 12 MR-guided prostate cancer cryoablations, where MR-compatible cryoprobes were used to destroy cancerous tissue and preserve surrounding normal tissue. RESULTS The ex vivo experiment using a bovine muscle demonstrated that STIR-UTE images showed regions approximately between -40°C and -8°C as hyperintense, with tissues at lower and higher temperatures appearing dark, making it possible to identify the region likely to be above the lethal temperature inside the frozen tissue. In the clinical cases, the STIR-UTE images showed a dark volume centered on the cryoprobe shaft, Vinner, where the temperature is likely below -40°C, surrounded by a doughnut-shaped hyperintense volume, where the temperature is likely between -40°C and -8°C. The hyperintense region was itself surrounded by a dark volume, where the temperature is likely above -8°C, permitting calculation of Vouter. The STIR-UTE frozen-tissue volumes, Vinner and Vouter, appeared significantly smaller than signal voids on turbo spin echo images (P < 1.0 × 10), which are currently used to quantify the frozen-tissue volume ("the iceball"). The ratios of the Vinner and Vouter volumes to the iceball were 0.92 ± 0.08 and 0.29 ± 0.07, respectively. In a single postablation follow-up case, a strong correlation was seen between Vinner and the necrotic volume. CONCLUSIONS Short tau inversion-recovery ultrashort echo-time MR imaging successfully delineated the area approximately between -40°C and -8°C isotherms in the frozen tissue, demonstrating its potential to monitor the lethal ablation volume during MR-guided cryoablation.
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Woodrum DA, Kawashima A, Gorny KR, Mynderse LA. Magnetic Resonance-Guided Prostate Ablation. Semin Intervent Radiol 2019; 36:351-366. [PMID: 31798208 DOI: 10.1055/s-0039-1697001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade "localized" prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.
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de Marini P, Cazzato RL, Garnon J, Shaygi B, Koch G, Auloge P, Tricard T, Lang H, Gangi A. Percutaneous MR-guided prostate cancer cryoablation technical updates and literature review. BJR Open 2019; 1:20180043. [PMID: 33178928 PMCID: PMC7592492 DOI: 10.1259/bjro.20180043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/25/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignant tumor in males. The benefits in terms of overall reduction in specific mortality due to the widespread use of Prostate Specific Antigen (PSA) screening and the advancements in the curative treatments (radical prostatectomy or radiotherapy) appear to have reached a plateau. There remains, however, the questions of overdiagnosis and overtreatment of such patients. Currently, the main challenge in the treatment of patients with clinically organ-confined PCa is to offer an oncologically efficient treatment with as little morbidity as possible. Amongst the arising novel curative techniques for PCa, cryoablation (CA) is the most established one, which is also included in the NICE and AUA guidelines. CA is commonly performed under ultrasound guidance with the inherent limitations associated with this technique. The recent advancements in MRI have significantly improved the accuracy of detecting and characterizing a clinically significant PCa. This, alongside the development of wide bore interventional MR scanners, has opened the pathway for in bore PCa treatment. Under MRI guidance, PCa CA can be used either as a standard whole gland treatment or as a tumor targeted one. With MR-fluoroscopy, needle guidance capability, multiplanar and real-time visualization of the iceball, MRI eliminates the inherent limitations of ultrasound guidance and can potentially lead to a lower rate of local complications. The aim of this review article is to provide an overview about PCa CA with a more specific insight on MR guided PCa CA; the limitations, challenges and applications of this novel technique will be discussed.
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Affiliation(s)
- Pierre de Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Behnam Shaygi
- Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
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9
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Jones AK, Yevich S. Imaging Techniques to Aid IR Treatment of Musculoskeletal Malignancy. Semin Intervent Radiol 2019; 36:49-62. [PMID: 30936620 PMCID: PMC6440910 DOI: 10.1055/s-0039-1679952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A. Kyle Jones
- Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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10
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Cheng C, Zou C, Wan Q, Qiao Y, Pan M, Tie C, Liang D, Zheng H, Liu X. Dual-step iterative temperature estimation method for accurate and precise fat-referenced PRFS temperature imaging. Magn Reson Med 2018; 81:1322-1334. [PMID: 30230595 DOI: 10.1002/mrm.27396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/15/2018] [Accepted: 05/19/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to propose dual-step iterative temperature estimation (DITE) of a fat-referenced proton resonance frequency shift (PRFS) method to improve both the accuracy and precision of temperature estimations in fat-containing tissues. METHODS A fat-water signal model with multiple fat peaks was used to simultaneously estimate the temperature, fat/water intensity and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:msubsup><mml:mtext>T</mml:mtext> <mml:mrow><mml:mn>2</mml:mn></mml:mrow> <mml:mrow><mml:mrow/> <mml:mo>∗</mml:mo></mml:mrow> </mml:msubsup> </mml:math> , and field offset. In DITE, model fitting was implemented with alternating 2-step minimizations. The estimated temperature map was smoothed between the 2-step minimizations, which is considered to be the most important step for improving the temperature precision. The performance of DITE was evaluated with a Monte Carlo simulation, fat/water phantoms, and ex vivo brown adipose tissue experiments and then compared with the performance of previous fat-referenced proton resonance frequency shift methods. RESULTS In fat/water phantom experiment with a smooth temperature profile, the temperatures estimated by DITE are consistent with the thermometer results and present a better accuracy and precision than those of previous fat-referenced proton resonance frequency shift methods. In the brown adipose tissue heating experiment, the average mean error, SD, and RMS error were -0.08ºC, 0.46ºC, and 0.56ºC, respectively, over all of the measurements within the region of interest. CONCLUSION Our proposed DITE method improves both the accuracy and precision of temperature measurements in tissues with fat fractions between 20% and 80% under smooth distribution of the temperature profile and represents a simple fat-referenced thermometry method.
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Affiliation(s)
- Chuanli Cheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Chao Zou
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Qian Wan
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Yangzi Qiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Min Pan
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Changjun Tie
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Chongqing Collaborative Innovation Center for Minimally Invasive and Noninvasive Medicine, Chongqing, China
| | - Xin Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Chongqing Collaborative Innovation Center for Minimally Invasive and Noninvasive Medicine, Chongqing, China
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Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive treatment of the whole gland, including radical prostatectomy, radiation therapy, and cryosurgery. Active surveillance is a growing alternative option for patients with documented low-volume and low-grade prostate cancer. However, many patients are wanting a less morbid focal treatment alternative. With recent advances in software and hardware of magnetic resonance imaging (MRI), multiparametric MRI of the prostate has been shown to improve the accuracy in detecting and characterizing clinically significant prostate cancer. Targeted biopsy is increasingly utilized to improve the yield of MR detected, clinically significant prostate cancer and to decrease in detection of indolent prostate cancer. MR-guided targeted biopsy techniques include cognitive MR fusion transrectal ultrasound (TRUS) biopsy, in-bore transrectal targeted biopsy using robotic transrectal device, and in-bore direct MR-guided transperineal biopsy with a software based transperineal grid template. In addition, advances in MR-compatible thermal ablation technology allow accurate focal or regional delivery of thermal ablative energy to the biopsy-proved, MRI-detected tumor. MR-guided ablative treatment options include cryoablation, laser ablation, and high-intensity focused ultrasound with real-time or near simultaneous monitoring of the ablation zone. We present a contemporary review of MR-guided techniques for prostatic interventions.
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12
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Woodrum D, Kawashima A, Gorny K, Mynderse L. Prostate cancer: state of the art imaging and focal treatment. Clin Radiol 2017; 72:665-679. [DOI: 10.1016/j.crad.2017.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/26/2017] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
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13
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van Oostenbrugge TJ, Langenhuijsen JF, Overduin CG, Jenniskens SF, Mulders PF, Fütterer JJ. Percutaneous MR Imaging–Guided Cryoablation of Small Renal Masses in a 3-T Closed-Bore MR Imaging Environment: Initial Experience. J Vasc Interv Radiol 2017; 28:1098-1107.e1. [DOI: 10.1016/j.jvir.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022] Open
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14
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Overduin CG, Fütterer JJ, Scheenen TW. 3D MR thermometry of frozen tissue: Feasibility and accuracy during cryoablation at 3T. J Magn Reson Imaging 2016; 44:1572-1579. [DOI: 10.1002/jmri.25301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christiaan G. Overduin
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
- MIRA Institute for Biomedical Engineering and Technical Medicine; University of Twente; Enschede the Netherlands
| | - Tom W.J. Scheenen
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
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15
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A Micro-Thermal Sensor for Focal Therapy Applications. Sci Rep 2016; 6:21395. [PMID: 26916460 PMCID: PMC4768245 DOI: 10.1038/srep21395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/20/2016] [Indexed: 11/08/2022] Open
Abstract
There is an urgent need for sensors deployed during focal therapies to inform treatment planning and in vivo monitoring in thin tissues. Specifically, the measurement of thermal properties, cooling surface contact, tissue thickness, blood flow and phase change with mm to sub mm accuracy are needed. As a proof of principle, we demonstrate that a micro-thermal sensor based on the supported "3ω" technique can achieve this in vitro under idealized conditions in 0.5 to 2 mm thick tissues relevant to cryoablation of the pulmonary vein (PV). To begin with "3ω" sensors were microfabricated onto flat glass as an idealization of a focal probe surface. The sensor was then used to make new measurements of 'k' (W/m.K) of porcine PV, esophagus, and phrenic nerve, all needed for PV cryoabalation treatment planning. Further, by modifying the sensor use from traditional to dynamic mode new measurements related to tissue vs. fluid (i.e. water) contact, fluid flow conditions, tissue thickness, and phase change were made. In summary, the in vitro idealized system data presented is promising and warrants future work to integrate and test supported "3ω" sensors on in vivo deployed focal therapy probe surfaces (i.e. balloons or catheters).
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16
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Overduin CG, Bomers JGR, Jenniskens SFM, Hoes MF, ten Haken B, de Lange F, Fütterer JJ, Scheenen TWJ. T1-weighted MR image contrast around a cryoablation iceball: A phantom study and initial comparison within vivofindings. Med Phys 2014; 41:112301. [DOI: 10.1118/1.4896824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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17
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Etheridge ML, Choi J, Ramadhyani S, Bischof JC. Methods for characterizing convective cryoprobe heat transfer in ultrasound gel phantoms. J Biomech Eng 2013; 135:021002. [PMID: 23445047 DOI: 10.1115/1.4023237] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While cryosurgery has proven capable in treating of a variety of conditions, it has met with some resistance among physicians, in part due to shortcomings in the ability to predict treatment outcomes. Here we attempt to address several key issues related to predictive modeling by demonstrating methods for accurately characterizing heat transfer from cryoprobes, report temperature dependent thermal properties for ultrasound gel (a convenient tissue phantom) down to cryogenic temperatures, and demonstrate the ability of convective exchange heat transfer boundary conditions to accurately describe freezing in the case of single and multiple interacting cryoprobe(s). Temperature dependent changes in the specific heat and thermal conductivity for ultrasound gel are reported down to -150 °C for the first time here and these data were used to accurately describe freezing in ultrasound gel in subsequent modeling. Freezing around a single and two interacting cryoprobe(s) was characterized in the ultrasound gel phantom by mapping the temperature in and around the "iceball" with carefully placed thermocouple arrays. These experimental data were fit with finite-element modeling in COMSOL Multiphysics, which was used to investigate the sensitivity and effectiveness of convective boundary conditions in describing heat transfer from the cryoprobes. Heat transfer at the probe tip was described in terms of a convective coefficient and the cryogen temperature. While model accuracy depended strongly on spatial (i.e., along the exchange surface) variation in the convective coefficient, it was much less sensitive to spatial and transient variations in the cryogen temperature parameter. The optimized fit, convective exchange conditions for the single-probe case also provided close agreement with the experimental data for the case of two interacting cryoprobes, suggesting that this basic characterization and modeling approach can be extended to accurately describe more complicated, multiprobe freezing geometries. Accurately characterizing cryoprobe behavior in phantoms requires detailed knowledge of the freezing medium's properties throughout the range of expected temperatures and an appropriate description of the heat transfer across the probe's exchange surfaces. Here we demonstrate that convective exchange boundary conditions provide an accurate and versatile description of heat transfer from cryoprobes, offering potential advantages over the traditional constant surface heat flux and constant surface temperature descriptions. In addition, although this study was conducted on Joule-Thomson type cryoprobes, the general methodologies should extend to any probe that is based on convective exchange with a cryogenic fluid.
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Affiliation(s)
- Michael L Etheridge
- Department of Mechanical Engineering, Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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Bomers JGR, Yakar D, Overduin CG, Sedelaar JPM, Vergunst H, Barentsz JO, de Lange F, Fütterer JJ. MR imaging-guided focal cryoablation in patients with recurrent prostate cancer. Radiology 2013; 268:451-60. [PMID: 23525206 DOI: 10.1148/radiol.13121291] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the feasibility of magnetic resonance (MR) imaging-guided focal cryoablation in patients with locally recurrent prostate cancer after radiation therapy. MATERIALS AND METHODS This was a prospective study, and informed consent was obtained from all patients. Ten consecutive patients with histopathologically proved recurrent prostate cancer after radiation therapy, without evidence of distant metastases, were treated while under general anesthesia in a 1.5-T MR unit. A urethral warmer was inserted. Cryoneedles were transperineally inserted under real-time MR imaging. Then, a rectal warmer was inserted. Ice ball growth was continuously monitored under MR imaging guidance. Two freeze-thaw cycles were performed. Follow-up consisted of a visit to the urologist, measurement of prostate-specific antigen level, and multiparametric MR imaging at 3, 6, and 12 months. Potential complications were recorded. RESULTS All patients were successfully treated. In one patient, the urethral warmer could not be inserted and the procedure was cancelled. Two months later, the procedure was successfully repeated. Another patient had urinary retention. Follow-up data were available for all patients. A local recurrence or remnant tumor was found in two patients after 6 months and in another patient after 12 months. These three patients underwent successful retreatment with MR imaging-guided focal cryoablation. CONCLUSION MR imaging-guided focal cryoablation of recurrent prostate cancer after radiation therapy is feasible and safe. Initial results are promising; however, longer follow-up is needed and more patients must be studied.
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Affiliation(s)
- Joyce G R Bomers
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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Ramsay E, Mougenot C, Köhler M, Bronskill M, Klotz L, Haider MA, Chopra R. MR thermometry in the human prostate gland at 3.0T for transurethral ultrasound therapy. J Magn Reson Imaging 2013; 38:1564-71. [PMID: 23440850 DOI: 10.1002/jmri.24063] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 01/10/2013] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To investigate the spatial, temporal, and temperature resolution of a segmented gradient echo echo-planar imaging (EPI) technique as applied to proton resonance frequency (PRF) shift thermometry at 3 T in the human prostate gland, and to determine appropriate sequence parameters for magnetic resonance imaging (MRI)-controlled transurethral ultrasound thermal therapy. MATERIALS AND METHODS Eleven healthy volunteers (age range 23-58) were scanned at 3 T with a 16-channel torso coil to study the behavior of a gradient echo EPI thermometry sequence. The temperature stability and geometric distortion were assessed for 11 different parameter sets. In a further five volunteers, the prostate T2* was measured. RESULTS For all scan parameters investigated, the temperature standard deviation within the prostate was less than 1°C, while the distortion was less than 1 mm. Temperature stability was best with higher TE values (up to 25 msec), larger voxel sizes and lower EPI factors, but this had to be balanced against requirements for good spatial and temporal resolution. Prostate T2* values ranged from 30-50 msec. CONCLUSION A good balance between temperature stability and temporal/spatial resolution is obtained with TE = 15 msec, voxel size = 1.14 mm, and EPI factor = 9, resulting in a dynamic scan time of 7.2 seconds for the nine slices.
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Affiliation(s)
- Elizabeth Ramsay
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Bydder GM. Review. The Agfa Mayneord lecture: MRI of short and ultrashort T₂ and T₂* components of tissues, fluids and materials using clinical systems. Br J Radiol 2011; 84:1067-82. [PMID: 22101579 PMCID: PMC3473831 DOI: 10.1259/bjr/74368403] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 04/29/2011] [Accepted: 06/30/2011] [Indexed: 11/05/2022] Open
Abstract
A variety of techniques are now available to directly or indirectly detect signal from tissues, fluids and materials that have short, ultrashort or supershort T₂ or T₂* components. There are also methods of developing image contrast between tissues and fluids in the short T₂ or T₂* range that can provide visualisation of anatomy, which has not been previously seen with MRI. Magnetisation transfer methods can now be applied to previously invisible tissues, providing indirect access to supershort T₂ components. Particular methods have been developed to target susceptibility effects and quantify them after correcting for anatomical distortion. Specific methods have also been developed to image the effects of magnetic iron oxide particles with positive contrast. Major advances have been made in techniques designed to correct for loss of signal and gross image distortion near metal. These methods are likely to substantially increase the range of application for MRI.
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Affiliation(s)
- G M Bydder
- Department of Radiology, University of California San Diego, San Diego, CA 92103-8226, USA.
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Correction of susceptibility-induced GRE phase shift for accurate PRFS thermometry proximal to cryoablation iceball. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2011; 25:23-31. [DOI: 10.1007/s10334-011-0277-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/23/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
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Lu A, Daniel BL, Kaye E, Butts Pauly K. MRI of frozen tissue demonstrates a phase shift. Magn Reson Med 2011; 66:1582-9. [PMID: 21630347 DOI: 10.1002/mrm.22953] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 03/04/2011] [Accepted: 03/14/2011] [Indexed: 11/11/2022]
Abstract
While temperature mapping is desired during cryosurgery for prostate cancer treatment, an effective approach for this purpose is still needed. We have demonstrated a phase shift with temperature in our in vivo canine experiments and ex vivo tissue sample experiments within the frozen tissue. The phase shift is much larger (~0.7 °/°C with an echo time of 0.1 ms at 0.5 T) in magnitude than that predicted by conventional proton resonant frequency shift (0.008 °/°C). It shows little dependence on the echo times used and thus is not due to a frequency change, although frequency-dependent phase shift has been observed near the frozen tissue. This phase shift varies monotonically with temperature within the frozen tissue and therefore may be potentially used as a novel temperature mapping approach in cryoablation applications.
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Affiliation(s)
- Aiming Lu
- Center for MR Research, University of Illinois Medical Center, Chicago, Illinois 60612, USA.
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Kaye EA, Josan S, Lu A, Rosenberg J, Daniel BL, Pauly KB. Consistency of signal intensity and T2* in frozen ex vivo heart muscle, kidney, and liver tissue. J Magn Reson Imaging 2010; 31:719-24. [PMID: 20187218 DOI: 10.1002/jmri.22029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate tissue dependence of the MRI-based thermometry in frozen tissue by quantification and comparison of signal intensity and T2* of ex vivo frozen tissue of three different types: heart muscle, kidney, and liver. MATERIALS AND METHODS Tissue samples were frozen and imaged on a 0.5 Tesla MRI scanner with ultrashort echo time (UTE) sequence. Signal intensity and T2* were determined as the temperature of the tissue samples was decreased from room temperature to approximately -40 degrees C. Statistical analysis was performed for (-20 degrees C, -5 degrees C) temperature interval. RESULTS The findings of this study demonstrate that signal intensity and T2* are consistent across three types of tissue for (-20 degrees C, -5 degrees C) temperature interval. CONCLUSION Both parameters can be used to calculate a single temperature calibration curve for all three types of tissue and potentially in the future serve as a foundation for tissue-independent MRI-based thermometry.
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Affiliation(s)
- Elena A Kaye
- Department of Electrical Engineering, Stanford University, Stanford, California, USA.
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Josan S, Bouley DM, van den Bosch M, Daniel BL, Butts Pauly K. MRI-guided cryoablation: In vivo assessment of focal canine prostate cryolesions. J Magn Reson Imaging 2009; 30:169-76. [PMID: 19557805 DOI: 10.1002/jmri.21827] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To analyze the appearance of acute and chronic canine prostate cryolesions on T1-weighted (T1w) and T2-weighted (T2w) magnetic resonance imaging (MRI) and compare them with contrast-enhanced (CE) MRI and histology for a variety of freezing protocols. MATERIALS AND METHODS Three different freezing protocols were used in canine prostate cryoablation experiments. Six acute and seven chronic (survival times ranging between 4-53 days) experiments were performed. The change in T2w signal intensity was correlated with freezing protocol parameters. The lesion area on T2w MRI was compared to CE-MRI. Histopathologic evaluation of the cryolesions was performed and visually compared to the appearance on MRI. RESULTS The T2w signal increased from pre- to postfreeze at the site of the cryolesion, and the enhancement was higher for smaller freeze area and duration. The T2w lesion area was between the CE nonperfused area and the hyperenhancing CE rim. The appearance of the lesion on T1w and T2w imaging over time correlated with outcome on pathology. CONCLUSION T1w and T2w MRI can potentially be used to assess cryolesions and to monitor tissue response over time following cryoablation.
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Affiliation(s)
- Sonal Josan
- Department of Electrical Engineering, Stanford University, Stanford, California, USA.
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MR imaging-guided percutaneous cryoablation of the prostate in an animal model: in vivo imaging of cryoablation-induced tissue necrosis with immediate histopathologic correlation. J Vasc Interv Radiol 2008; 20:252-8. [PMID: 19091600 DOI: 10.1016/j.jvir.2008.10.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 10/23/2008] [Accepted: 10/23/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the feasibility of magnetic resonance (MR) imaging-guided percutaneous cryoablation of normal canine prostates and to identify MR imaging features that accurately predict the area of tissue damage at a microscopic level. MATERIALS AND METHODS Six adult male mixed-breed dogs were anesthetized, intubated, and placed in a 0.5-T open MR imaging system. A receive-only endorectal coil was placed, and prostate location and depth were determined on T1-weighted fast spin-echo (FSE) MR imaging. After placement of cryoprobes and temperature sensors, three freezing protocols were used to ablate prostate tissue. Ice ball formation was monitored with T1-weighted FSE imaging. Tissue necrosis area was assessed with contrast-enhanced weighted MR imaging and compared with histopathologic findings. RESULTS A total of 12 cryolesions (mean size, 1.2 cm) were bilaterally created in six prostates. Ice ball formation was oval and signal-free on T1-weighted FSE sequences in all cases. Postprocedural contrast-enhanced MR imaging typically showed a nonenhancing area of low signal intensity centrally located within the frozen area, surrounded by a bright enhancing rim in all cases. On histopathologic examination, two distinct zones were identified within cryolesions. Centrally, a necrotic zone with complete cellular destruction and hemorrhage was found. Between this necrotic zone and normal glandular tissue, a zone of fragmented and intact glands, interstitial edema, and rare acute inflammatory cells was seen. Correlation between nonenhancement on contrast-enhanced weighted MR images and tissue necrosis on pathologic examination was consistent within all six dogs. CONCLUSIONS MR imaging-guided cryoablation of the prostate is technically feasible. The nonenhancing area on postablation contrast-enhanced weighted MR imaging accurately predicts the area of cryoablation-induced tissue necrosis on pathologic analysis.
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Lu A, Daniel BL, Pauly JM, Pauly KB. Improved slice selection for R2* mapping during cryoablation with eddy current compensation. J Magn Reson Imaging 2008; 28:190-8. [PMID: 18581340 DOI: 10.1002/jmri.21396] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To improve the slice profile and image quality of R2* mapping in the iceball during cryoablation with ultrashort echo time (UTE) imaging by compensating for eddy currents induced by the selective gradient when half-pulse radiofrequency (RF) excitation is employed to achieve UTEs. MATERIALS AND METHODS A method to measure both B0 and linear eddy currents simultaneously is first presented. This is done with a least-square fitting process on calibration data collected on a phantom. Eddy currents during excitation are compensated by redesigning the RF pulse and the selective gradient accordingly, while that resultant from the readout gradient are compensated for during image reconstruction. In vivo data were obtained continuously during the cryoablation experiments to calculate the R2* values in the iceball and to correlate them with the freezing process. RESULTS Image quality degradation due to eddy currents is significantly reduced with the proposed approaches. R2* maps of iceball throughout the cryoablation experiments were achieved with improved quality. CONCLUSION The proposed approaches are effective for compensating eddy currents during half-pulse RF excitation as well as readout. TEs as short as 100 microsec were obtained, allowing R2* maps to be obtained from frozen tissues with improved quality.
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Affiliation(s)
- Aiming Lu
- Department of Radiology, Stanford University, Stanford, CA, USA.
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Beemster PW, Lagerveld BW, Witte LPW, de la Rosette JJMCH, Pes MPL, Wijkstra H. The Performance of 17-gauge Cryoprobes In Vitro. Technol Cancer Res Treat 2008; 7:321-7. [DOI: 10.1177/153303460800700406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In cryosurgery it is crucial that the performance of cryoprobes is predictable and constant. In this study we tested the intra- and interneedle variation between 17-gauge cryoprobes in two homogeneous mediums. Also, a multiprobe setup was tested. Cryoprobe performance was defined as the time it takes one cryoprobe to lower the temperature from 0 to −20 °C as measured by four thermosensors each at 3 mm distance from the cryoprobe. In agar eight cryoprobes were tested during six freeze cycles, and in gel four cryoprobes during four freeze cycles; each freeze cycle in a different cup of agar or gel. Using more accurate ‘bare’ thermosensors three cryoprobes were tested in gel during two freeze cycles. A multiprobe configuration with four cryoprobes was tested during two freeze cycles in both agar and gel. Statistical analyses were done using ANOVA for repeated measures. There was no significant intraneedle variation, whereas both in agar and gel there was a significant interneedle variation (p<0.05). Mean performance in gel was better than in agar (p<0.001). Also, there was a significant variation between the four thermosensors (p< 0.001). Using bare thermosensors mean performance was 2.7 times faster compared to measurements by regular thermosensors (p<0.001). In a multiprobe configuration, overall performance seems less variable and more reproducible compared to a single cryoprobe. In conclusion, the performance of cryoprobes differs depending on the medium and measuring device used. Cryoprobes deliver reproducible freeze cycles, although there is variation between different cryoprobes. In a multiprobe configuration performance seems less variable.
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Affiliation(s)
- Patricia W.T. Beemster
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - Brunolf W. Lagerveld
- Department of Urology St. Lucas Andreas Hospital Jan Tooropstraat 164 1061 AE Amsterdam The Netherlands and Onze Lieve Vrouwen Gasthuis Oosterpark 9 1091 AC Amsterdam The Netherlands
| | - Lambertus P. W. Witte
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - Jean J. M. C. H. de la Rosette
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - M. Pilar Laguna Pes
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - Hessel Wijkstra
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
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Morrison PR, Silverman SG, Tuncali K, Tatli S. MRI-guided cryotherapy. J Magn Reson Imaging 2008; 27:410-20. [DOI: 10.1002/jmri.21260] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Evans J. Ablative and catheter-delivered therapies for colorectal liver metastases (CRLM). Eur J Surg Oncol 2007; 33 Suppl 2:S64-75. [DOI: 10.1016/j.ejso.2007.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 09/26/2007] [Indexed: 01/26/2023] Open
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Gage AA, Baust JG. Cryosurgery for tumors. J Am Coll Surg 2007; 205:342-56. [PMID: 17660083 DOI: 10.1016/j.jamcollsurg.2007.03.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 03/07/2007] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew A Gage
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
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Bouley DM, Daniel B, Pauly KB, Liu E, Kinsey A, Nau W, Diederich CJ, Sommer G. Correlation of contrast-enhanced MR images with the histopathology of minimally invasive thermal and cryoablation cancer treatments in normal dog prostates. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2007; 6440:644006. [PMID: 25076818 DOI: 10.1117/12.701049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Magnetic Resonance Imaging (MRI) is a promising tool for visualizing the delivery of minimally invasive cancer treatments such as high intensity ultrasound (HUS) and cryoablation. We use an acute dog prostate model to correlate lesion histopathology with contrast-enhanced (CE) T1 weighted MR images, to aid the radiologists in real time interpretation of in vivo lesion boundaries and pre-existing lesions. Following thermal or cryo treatments, prostate glands are removed, sliced, stained with the vital dye triphenyl tetrazolium chloride, photographed, fixed and processed in oversized blocks for routine microscopy. Slides are scanned by Trestle Corporation at .32 microns/pixel resolution, the various lesions traced using annotation software, and digital images compared to CE MR images. Histologically, HUS results in discrete lesions characterized by a "heat-fixed" zone, in which glands subjected to the highest temperatures are minimally altered, surrounded by a rim or "transition zone" composed of severely fragmented, necrotic glands, interstitial edema and vascular congestion. The "heat-fixed" zone is non-enhancing on CE MRI while the "transition zone" appears as a bright, enhancing rim. Likewise, the CE MR images for cryo lesions appear similar to thermally induced lesions, yet the histopathology is significantly different. Glands subjected to prolonged freezing appear totally disrupted, coagulated and hemorrhagic, while less intensely frozen glands along the lesion edge are partially fragmented and contain apoptotic cells. In conclusion, thermal and cryo-induced lesions, as well as certain pre-existing lesions (cystic hyperplasia - non-enhancing, chronic prostatitis - enhancing) have particular MRI profiles, useful for treatment and diagnostic purposes.
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Affiliation(s)
- D M Bouley
- Comparative Medicine, Stanford University, Stanford, CA
| | - B Daniel
- Radiology, Stanford University, Stanford, CA
| | | | - E Liu
- Radiology, Stanford University, Stanford, CA
| | - A Kinsey
- Radiation Oncology, UCSF, San Francisco, CA
| | - W Nau
- Radiation Oncology, UCSF, San Francisco, CA
| | | | - G Sommer
- Radiology, Stanford University, Stanford, CA
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Carrino JA, Jolesz FA. MRI-Guided interventions. Acad Radiol 2005; 12:1063-4. [PMID: 16099692 DOI: 10.1016/j.acra.2005.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 06/09/2005] [Accepted: 06/09/2005] [Indexed: 11/18/2022]
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