Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size

Comparative efficacy of microwave ablation and radiofrequency ablation for treating metastatic liver cancer: a systematic review and meta-analysis

Objective

This study aims at evaluating and juxtaposing the efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for hepatic metastases treatment.

Methods

We undertook an extensive literature search across the Cochrane Library, Web of Science, Embase, PubMed, CNKI, and databases for studies published up to December 2023, assessing the outcomes of RFA versus MWA in hepatic metastases treatment. Studies were included or excluded based on established criteria. Continuous variables were analyzed with the aid of the weighted mean difference (WMD) and its 95% confidence interval (CI), while the odds ratio (OR) with its 95% CI was utilized for dichotomous variables. Data were processed by use of STATA 17.0 software. Key outcomes assessed included ablation time, post-operative local tumor progression (LTP), disease-free survival (DFS), and post-operative complications (POCs).

Results

Seven studies, comprising 357 patients undergoing MWA and 452 patients undergoing RFA, fulfilled the inclusion criteria. As unveiled by the meta-analysis, RFA and MWA did not significantly differ in ablation time, DFS, and POCs. Nonetheless, MWA resulted in a strikingly reduced rate of post-operative LTP versus RFA.

Conclusion

MWA offers superior control over post-operative LTP, suggesting better overall efficacy in hepatic metastases treatment compared with RFA.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023385201.

Strongly quenched activatable theranostic nanogel for precision imaging-guided photodynamic therapy and enhanced immunotherapy

Immune checkpoint inhibitors (ICIs) are innovative immunotherapeutic agents for cancer. However, their low therapeutic efficacy in patients with large or rapidly growing tumors, along with their high cost, represents a notable limitation in their clinical applications. Therefore, new and safe strategies must be developed to enhance the therapeutic efficacy of ICIs in clinical settings. In this study, we developed a near-infrared (NIR) fluorescent dye-loaded activatable theranostic nanogel (NATNgel) for precision imaging-guided photodynamic therapy (PDT) and combined immunotherapy for rapidly growing tumors. Although NIR fluorescence and phototoxicity of NATNgel are strongly quenched, these can be selectively activated inside target tumor cells. A high tumor-to-background ratio (7.31 ± 1.40) in NIR fluorescence imaging could be achieved in NATNgel-treated mice, enabling real-time image-guided PDT. The combination of PDT and anti-PD-1 antibody therapy resulted in complete tumor regression. Histopathological evaluation of major organs and blood chemistry analysis revealed no side effects of the combined treatment regimen. In addition, the combination treatment completely suppressed the growth of rechallenged tumors. Overall, NATNgel is a safe and promising theranostic material for precision imaging-guided PDT and enhanced immunotherapy.

Updates on the Surgical Approach to Fibroids: The Importance of Radiofrequency Ablation

Uterine fibroids are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which can range from heavy menstrual bleeding and bulk-related symptoms such as pelvic pressure with bladder and bowel dysfunction to reproductive dysfunction (e.g., infertility or obstetric complications) and pain. The choice of treatment is primarily guided by the type of symptoms in the individual patient and whether they prefer to retain fertility. While hysterectomy provides definitive resolution of fibroid symptoms and remains the most common treatment option, this procedure is invasive with a long recovery window. Radiofrequency ablation (RFA) is now emerging as a uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, growing evidence for safety and efficacy of RFA has been generated with low rates of complications. This review will discuss RFA for the management of symptomatic uterine fibroids with a special focus on technical approaches, short- and long-term outcomes including fertility outcomes.

Ablative Therapy in Non-HCC Liver Malignancy

Surgical extirpation of liver tumors remains a proven approach in the management of metastatic tumors to the liver, particularly those of colorectal origin. Ablative, non-resective therapies are an increasingly attractive primary therapy for liver tumors as they are generally better tolerated and result in far less morbidity and mortality. Ablative therapies preserve greater normal liver parenchyma allowing better post-treatment liver function and are particularly appropriate for treating subsequent liver-specific tumor recurrence. This article reviews the current status of ablative therapies for non-hepatocellular liver tumors with a discussion of many of the clinically available approaches.

Preliminary Exploration on the Value of Shear Wave Elastography in Evaluating the Effectiveness of Microwave Ablation on Hepatic Malignancies

ABSTRACT

Shear wave elastography (SWE) is a new type of ultrasonic elastography that can quantitatively assess the elasticity and stiffness of tissues. This study aimed to investigate the value of SWE in evaluating the effectiveness of microwave ablation in hepatic malignancies. A total of 24 patients (including 30 lesions) with liver malignancies receiving microwave ablation treatment at the Cancer Hospital of Guangzhou Medical University from April 2018 to January 2019 were enrolled. The elastography was performed within 1 week before and after ablation. The SWE values in the central zone, the marginal zone of the lesion, and peripheral liver parenchyma were collected and analyzed. Before ablation, the mean of SWE value was 65.80 ± 13.37 kPa for the central zone of the tumor and 39.93 ± 7.87 kPa for the marginal zone, both of which were significantly greater than that for the perinatal liver parenchyma (12.85 ± 2.67 kPa, both P < 0.05). In the central and marginal zone of the lesions, the SWE value was significantly elevated after ablation (both P < 0.001) but not in the peripheral liver parenchyma (P = 0.444). Receiver operating characteristic curve analysis showed that the cutoff value for ablation in the marginal zone was 53.87 kPa, suggesting that an SWE exceeding 53.87 kPa is an index guaranteeing the ablation effectiveness. These results suggested that SWE has the potential to be used in evaluating the effectiveness of microwave ablation in liver cancers.

Establishment of a Tissue-Mimicking Surrogate for Pulmonary Lesions to Improve the Development of RFA Instruments and Algorithms

(1) Development of radiofrequency ablation (RFA) systems for pulmonary lesions is restricted by availability of human tumor specimens and limited comparability of animal tissue. We aimed to develop a new surrogate tissue overcoming these drawbacks. (2) Reference values for electrical impedance in lung tumor tissue were collected during routine lung tumor RFA (n = 10). Subsequently, a tissue-mimicking surrogate with comparable electrical impedance and facilitating detection of the ablation margins was developed. (3) The mean electrical impedance for all patients was 103.5 ± 14.7 Ω. In the optimized surrogate tissue model consisting of 68% agar solution, 23% egg yolk, 9% thermochromic ink, and variable amounts of sodium chloride, the mean electrical impedance was adjustable from 74.3 ± 0.4 Ω to 183.2 ± 5.6 Ω and was a function (y = 368.4x + 175.2; R2 = 0.96; p < 0.001) of sodium chloride concentration (between 0 and 0.3%). The surrogate tissue achieved sufficient dimensional stability, and sample cuts revealed clear margins of color change for temperatures higher 60 °C. (4) The tissue-mimicking surrogate can be adapted to lung tumor with respect to its electrical properties. As the surrogate tissue allows for simple and cost-effective manufacturing, it is suitable for extensive laboratory testing of RFA systems for pulmonary ablation.

Histological and radiological evaluation of thermal denaturation depth using soft coagulation during partial nephrectomy in living pigs

OBJECTIVES

To evaluate thermal denaturation depth using soft coagulation in kidneys in vivo.

METHODS

In experiment 1, nine kidneys from five pigs were cauterized using five soft-coagulation settings at 80 W with effect 7 by VIO300D and one monopolar-coagulation setting. The surface of the kidney was cauterized over a period of 2, 5 and 10 s. The temperature change was measured at depths of 5 and 10 mm. In experiment 2, three kidneys from two pigs were excised in a semicircular shape with a diameter of 5, 10 and 20 mm without clamping the renal artery. Cauterization was carried out until hemostasis was confirmed by soft coagulation at 80 W with effect 7. After completion of the experiments, pathology examinations of the kidneys were carried out.

RESULTS

Experiment 1 showed that with proper saline dripping, denaturation spread with increased cauterization time, reaching a depth of 4 mm at 10 s with or without clamps. The depth remained at 2-3 mm at 10 s in the absence or excess of saline. The temperature increased by 15.6°C at a depth of 5 mm and 8.8°C at 10 mm. In experiment 2, the depth was 4.6 mm from the incision surface regardless of the cauterization time or excision size.

CONCLUSIONS

These findings suggest that soft coagulation can be useful for preserving renal function and reducing complications in partial nephrectomy.

Comparison of thermal ablative methods and myomectomy for the treatment of fibroids: a systematic review and meta-analysis

OBJECTIVE

To examine the effectiveness and safety of thermal ablative methods and myomectomy for the treatment of uterine fibroids.

MATERIALS AND METHODS

We searched EMBASE, PubMed, the Cochrane Central Register of Controlled Trials, Scopus, CINAHL, ClinicalTrials.gov and Web of Science databases through April 2021. Clinical trials comparing the thermal ablative methods and myomectomy for the treatment of uterine fibroids were included.

RESULTS

Thirteen studies including 4205 patients were eligible. The thermal ablative treatment group was associated with less major adverse events (only ultrasound guided high-intensity focused ultrasound) (RR, 0.111 [95% CI, 0.070-0.175], p=.0), shorter duration of hospital stays in observational studies (-0.1497 day, [95% CI, -1.593 to -0.321], p=.0) and in randomized controlled trials (RCTs) (-0.844 day, [95% CI, -0.1.142 to -0.546], p=.0), higher uterine fibroid symptom (UFS) score after operation (0.252 [95% CI, 0.165-0.339]; p=.0), transformed symptom severity (tSS) score after operation (0.515 [95% CI, 0.355-0.674]; p=.0) and quality of life (QoL) score after operation (0.188 [95% CI, 0.093-0.283]; p=.0) in comparison with myomectomy group. No statistically significant difference was found between the thermal ablative treatment group and myomectomy group with respect to reintervention rate and pregnancy rate.

CONCLUSION

The current data available demonstrate that thermal ablative methods were not inferior to myomectomy in the treatment of uterine fibroids. The findings in this study need to be further confirmed by large RCTs.

Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies

Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.

Evaluation of Microwave Ablation Efficacy by Strain Elastography and Shear Wave Elastography in ex Vivo Porcine Liver

The aim of this study was to evaluate the efficacy of microwave ablation by ultrasound (US), strain elastography (SE) and shear-wave elastography (SWE). An ex vivo model of porcine liver was adopted. According to ablation power and duration, 30 samples were divided into three groups: group 1 (45 W, 30 s), group 2 (45 W, 15 s) and group 3 (30 W, 30 s). US was used to measure the largest transverse diameter (D1), vertical diameter (D2) and anteroposterior diameter (D3) of the ablated area. SE was used to measure the largest transverse diameter (SEL1), vertical diameter (SEL2) and anteroposterior diameter (SEL3). The actual size of the ablated area was measured as the largest transverse diameter (L1), vertical diameter (L2) and anteroposterior diameter (L3). SWE values and temperatures were measured in the central lesion (region a), marginal area (region b) and unablated area (region c). At 1 h post-ablation, the values measured by US (D1, D2, D3) were all significantly smaller than the ablated area (L1, L2, L3) in all three groups. Except for SEL2 in group 1, there was no significant difference in the results between SEL and L among the three groups. All SWE results were significantly higher post-ablation than pre-ablation in the central lesion (region a) and marginal area (region b, all p values <0.05). In regions a, b and c, the temperatures measured immediately and 5 min post-ablation were all higher than that measured pre-ablation. These results suggest that SE and SWE can be used to evaluate the ablation efficacy of liver tissue.

Influence of the heat irrigating effect of radiofrequency ablation on regional liver tissue in Bama miniature pigs

BACKGROUND

The results of the heat irrigating effect of radiofrequency ablation (RFA) are uncertain, and the accurate impact of the heat irrigating effect on regional liver tissue is unknown due to a lack of control experiments.

AIM

The aim of this study was to determine the influence of the heat irrigating effect of RFA on regional liver tissue in Bama miniature pigs.

METHODS

Eight Bama miniature pigs were randomly divided into the observation group (group A) and the control group (group B), with 4 pigs/group. An RFA electrode needle was implanted near the hepatic segment vasculature (3-5 mm from the hepatic segment portal vein) under ultrasound guidance in group A. Similarly, an RFA electrode needle was implanted far from the hepatic segment vasculature (8-10 mm from the hepatic segment portal vein) in group B. The left internal lobe and right medial lobe were chosen as RFA sites in each pig. RFA was performed at the left internal lobe on day one in each pig, and at the right medial lobe 7 d later. Each RFA lasted 12 min. The general status of the pigs and serious complications were observed during the perioperative period. The pigs were sacrificed and the livers were removed immediately after RFA on the eighth day. The samples were roughly observed. Hematoxylin-eosin and Ki67 staining, as well as TUNEL detection, were performed on the tissue sections.

RESULTS

All 8 animals successfully underwent ultrasound-guided RFA. No serious complications, such as massive hemorrhage, biliary fistula, severe pleural effusion, pneumothorax, peripheral organ failure, or renal failure occurred in any of the animals during the perioperative period. The RFA coagulative necrosis lesion was spherical and the surrounding liver tissue showed an inflammatory response. The difference in the Suzuki score of the liver tissue surrounding the ablated portal vein, and its distal area between groups A and B, was statistically significant (P < 0.05). More apoptotic cells were seen in liver tissue surrounding the ablated portal vein and its distal area in group A, while fewer apoptotic cells in the same area were seen in group B. The difference in the apoptotic index of the above area between group A and group B was statistically significant (P < 0.05). Cells staining positive for Ki67 were observed in liver tissue at the left internal lobe around the ablated portal vein and its distal area in group A. No Ki67 staining positive cells were observed in other tissue sections. The difference in the Ki67 staining positive index in the above area was statistically significant (P < 0.05) between group A and group B.

CONCLUSION

Changes as a result of thermal damage occur in liver tissue around the ablated portal vein and its distal area due to the heat irrigating effect when the RFA electrode tip is close to (< 5 mm) the portal vein.

Intracellular Thermometry at the Micro-/Nanoscale and its Potential Application to Study Protein Aggregation Related to Neurodegenerative Diseases

Temperature is a fundamental physical parameter that influences biological processes in living cells. Hence, intracellular temperature mapping can be used to derive useful information reflective of thermodynamic properties and cellular behaviour. Herein, existing publications on different thermometry systems, focusing on those that employ fluorescence-based techniques, are reviewed. From developments based on fluorescent proteins and inorganic molecules to metal nanoclusters and fluorescent polymers, the general findings of intracellular measurements from different research groups are discussed. Furthermore, the contradiction of mitochondrial thermogenesis and nuclear-cytoplasmic temperature differences to current thermodynamic understanding are highlighted. Lastly, intracellular thermometry is proposed as a tool to quantify the energy flow and cost associated with amyloid-β42 (Aβ42) aggregation, a hallmark of Alzheimer's disease.

Alternatives to Surgery for Early-Stage Non-Small Cell Lung Cancer: Thermal Ablation

Thermal ablation involves the application of heat or cold energy to the lung under image guidance to eradicate tumors. It is indicated for treatment of early-stage non-small cell lung cancer in nonsurgical patients. Ablation technologies have advanced, such that nearly all small tumors can now be treated safely and effectively. Ablation does not cause a lasting decline in pulmonary function tests and may therefore be used to treat multiple synchronous and metachronous lung tumors, a chief advantage over other treatments. Large series with intermediate- and long-term data have been reported showing favorable overall survival, similar to radiation therapy.

Percutaneous microwave ablation of solitary presumptive pulmonary metastases in two dogs with appendicular osteosarcoma

OBJECTIVE

To describe percutaneous microwave ablation (MWA) of presumptive pulmonary metastases and the outcome of two dogs.

ANIMALS

Two dogs with pulmonary lesions after treatment of spontaneously occurring appendicular osteosarcoma.

STUDY DESIGN

Preliminary prospective clinical study.

METHODS

Two large-breed dogs were referred from tertiary veterinary hospitals 146 and 217 days after limb amputation to pursue MWA as an alternative therapy to metastasectomy. Both dogs had been receiving chemotherapy protocols at their respective referral centers.

RESULTS

A novel percutaneous approach for MWA with ultrasonographic or computed tomographic (CT) guidance was successfully performed. The only complications consisted of pneumothoraxes, requiring treatment in one dog. In the weeks after their procedures, both dogs were reported to do well at home. Dog 1 died and dog 2 was euthanized 82 and 19 days, respectively, after their MWA of confirmed (dog 1) or presumed (dog 2) metastatic disease.

CONCLUSION

Percutaneous MWA of pulmonary nodules was technically feasible in two dogs without major complications.

CLINICAL SIGNIFICANCE

Percutaneous MWA may provide a minimally invasive option for treatment of osteosarcoma pulmonary metastases. Additional studies are required to evaluate the benefits of MWA on survival and confirm histologic cell death within pulmonary neoplastic lesions.

Biomimetic Gold Nanoshell-Loaded Macrophage for Photothermal Biomedicine

The purpose of this study was to investigate the effect of photothermal treatment (PTT) with gold nanoshell (ANS) using a macrophage-mediated delivery system in a head and neck squamous cell carcinoma (HNSCC) cell line. To achieve this, ANS-loaded rat macrophages (ANS-MAs) were prepared via the coculture method with ANS. The human HNSCC (FaDu cell) and macrophage (rat macrophage; NR8383 cell) hybrid spheroid models were generated by the centrifugation method to determine the possibility of using ANS-MAs as a cancer therapy. These ANS-MAs were set into the tumor and macrophage hybrid spheroid model to measure PTT efficacy. Kinetic analysis of the spheroid growth pattern revealed that this PTT process caused a decreasing pattern in the volume of the hybrid model containing ANS-MAs (p < 0.001). Comparison with empty macrophages showed harmony between ANS and laser irradiation for the generation of PTT. An annexin V/dead cell marker assay indicated that the PTT-treated hybrid model induced increasing apoptosis and dead cells. Further studies on the toxicity of ANS-MAs are needed to reveal whether it can be considered biocompatible. In summary, the ANS was prepared with a macrophage as the delivery method and protective carrier. The ANS was successfully localized to the macrophages, and their photoabsorption property was stationary. This strategy showed significant growth inhibition of the tumor and macrophage spheroid model under NIR laser irradiation. In vivo toxicology results suggest that ANS-MA is a promising candidate for a biocompatible strategy to overcome the limitations of fabricated nanomaterials. This ANS-MA delivery and PTT strategy may potentially lead to improvements in the quality of life of patients with HNSCC by providing a biocompatible, minimally invasive modality for cancer treatment.

Hepatic Ablation Promotes Colon Cancer Metastases in an Immunocompetent Murine Model

OBJECTIVE

To determine the impact of radiofrequency (RF) and microwave (MW) energy compared to direct cautery on metatstatic colon cancer growth.

BACKGROUND

Hepatic ablation with MW and RF energy creates a temperature gradient around a target site with temperatures known to create tissue injury and cell death. In contrast, direct heat application (cautery) vaporizes tissue with a higher site temperature but reduced heat gradient on surrounding tissue. We hypothesize that different energy devices create variable zones of sublethal injury that may promote tumor recurrence. To test this hypothesis we applied MW, RF, and cautery to normal murine liver with a concomitant metastatic colon cancer challenge.

METHODS

C57/Bl6 mice received hepatic thermal injury with MW, RF, or cautery to create a superficial 3-mm lesion immediately after intrasplenic injection of 50K MC38 colon cancer cells. Thermal imaging recorded tissue temperature during ablation and for 10 seconds after energy cessation. Hepatic tumor location and volume was determined at day 7.

RESULTS

Cautery demonstrated the highest maximum tissue temperatures (129°C) with more rapid return to baseline compared to MW or RF energy. All mice had metastasis at the ablation site. Mean tumor volume was significantly greater in the MW (95.3 mm; P = 0.007) and RF (55.7 mm; P = 0.015) than cautery (7.13 mm). There was no difference in volume between MW and RF energy (P = 0.2).

CONCLUSIONS

Hepatic thermal ablation promotes colon cancer metastasis at the injury site. MV and RF energy result in greater metastatic volume than cautery. These data suggest that the method of energy delivery promotes local metastasis.

Thermal Ablation of Metastatic Colon Cancer to the Liver

Colorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.

Comparison of the Ablation and Hyperechoic Zones in Different Tissues Using Microwave and Radio Frequency Ablation

OBJECTIVES

The aim of this study was to compare the differences between the ablation region and hyperechoic zones in microwave and radio frequency ablation of different tissues.

METHODS

Microwave and radio frequency ablation were performed on fresh porcine muscle and liver with different power levels for 90 seconds. These 2 ablation methods were then performed on rabbit liver in vivo using 20 W for 60 seconds. The volumes of the ablation and hyperechoic zones were compared following different ablation methods.

RESULTS

The ablation zones were significantly greater than the hyperechoic zones (P < .05) with the same power and duration when using 2 ablation methods. The differences of the ablation and hyperechoic zones between muscle and liver tissues were significantly different (P < .05). The difference values of the ablation and hyperechoic zones were also significantly different (P < .05) using 2 ablation methods.

CONCLUSIONS

The hyperechoic zone may have underestimated the extent of ablation using a specified ablation time. In the same tissue, the hyperechoic zone could more accurately estimate the ablation zones using microwave ablation.

Penetration Depth in Nanoparticles Incorporated Radiofrequency Hyperthermia into the Tissue: Comprehensive Study with Histology and Pathology Observations

In present study, the effective penetration of radiofrequency (RF) induced gold decorated iron oxide nanoparticles (GS@IONPs) hyperthermia was investigated. The effective penetration depth of RF also the damage potency of hyperthermia was evaluated during histopathology observations which were done on the chicken breast tissue and hepatocellular carcinoma (HCC) models. The thermal damages are well- documented in our previous cellular study which was engaged with potency of RF hyperthermia in Epithelial adenocarcinoma (MCF-7) and fibroblast (L-929) cells deaths [1]. In recent work, PEGylated iron oxide nanoparticles (IONPs) were used as base platform for gold magnetic nanoparticles (GS@IONPs) formation. The 144.00015 MHz, 180W RF generator was applied for stimulating the nanoparticles. The chicken breast tissue and the hepatocellular tumor model was considered in the experimental section. In histology studies, the structural changes also the effective penetration depth of RF induced nanoparticles was observed through microscopic monitoring of the tissue slices in histology observations (Gazi medical school). The highest damage level was seen in 8.0 µm tissue slices where lower damages were seen in depth of 1.0 cm and more inside tissue. The histology observations clarified the effective penetration depth of RF waves and irreversible damages in the 2.0 cm inside the tissue.

Towards real-time multispectral endoscopic imaging for cardiac lesion quality assessment

Atrial fibrillation (Afib) can lead to life threatening conditions such as heart failure and stroke. During Afib treatment, clinicians aim to repress unusual electrical activity by electrically isolating the pulmonary veins (PV) from the left atrium (LA) using radiofrequency ablation. However, current clinical tools are limited in reliably assessing transmurality of the ablation lesions and detecting the presence of gaps within ablation lines, which can warrant repeat procedures. In this study, we developed an endoscopic multispectral reflectance imaging (eMSI) system for enhanced discrimination of tissue treatment at the PV junction. The system enables direct visualization of cardiac lesions through an endoscope at acquisition rates up to 25 Hz. Five narrowband, high-power LEDs were used to illuminate the sample (450, 530, 625, 810 and 940nm) and combinatory parameters were calculated based on their relative reflectance. A stitching algorithm was employed to generate large field-of-view, multispectral mosaics of the ablated PV junction from individual eMSI images. A total of 79 lesions from 15 swine hearts were imaged, ex vivo. Statistical analysis of the acquired five spectral data sets and ratiometric maps revealed significant differences between transmural lesions, non-transmural lesions around the venoatrial junctions, unablated posterior wall of left atrium tissue, and pulmonary vein (p < 0.0001). A pixel-based quadratic discriminant analysis classifier was applied to distinguish four tissue types: PV, untreated LA, non-transmural and transmural lesions. We demonstrate tissue type classification accuracies of 80.2% and 92.1% for non-transmural and transmural lesions, and 95.0% and 92.8% for PV and untreated LA sites, respectively. These findings showcase the potential of eMSI for lesion validation and may help to improve AFib treatment efficacy.

Management of small renal masses: An interventional radiologist's perspective

Renal cell carcinoma is relatively common malignancy. Its imaging features are often non-specific and can present a diagnostic dilemma for clinicians. Historically, all patients with a renal mass underwent radical nephrectomy. Advances in technology have allowed for an increase in partial nephrectomies and percutaneous ablations. This essay briefly describes some of the imaging findings of renal cell carcinoma and several of its mimics followed by an in-depth review of procedural management with a particular focus on recent advancements.

Bronchoscopic ablation of peripheral lung tumors

Lung cancer is the leading cause of cancer-related death worldwide and lobectomy remains the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). The combination of an aging population and the implementation of low-dose CT for lung cancer screening is leading to an increase in diagnosis of early stage NSCLC in medically "inoperable" patients. The recommended treatment for this latter group of patients is stereotactic body radiation therapy (SBRT). However, many patients cannot undergo SBRT because they have received prior radiation or because the tumor is located next to vital structures. Percutaneous ablative therapies have become an alternative to SBRT but, unfortunately, they all violate the pleura and are associated with high rate of pneumothorax. With a more favorable safety profile and the ability to provide also diagnosis and nodal staging, bronchoscopic ablation is hence emerging as a potential future therapeutic alternative for these patients. Herein we review the current state of the art including animal and human data that exists thus far. We also discuss technical and research challenges as well as future directions that this exciting new technology may take.

Renuvion/J-Plasma for Subdermal Skin Tightening Facial Contouring and Skin Rejuvenation of the Face and Neck

The Renuvion/J-Plasma helium based plasma device from Apyx Medical has technological features that result in a unique and effective method of action for the contraction of subdermal soft tissue. The device achieves soft tissue contraction by instantly heating tissue to temperatures greater than 85°C for between 0.040 and 0.080 seconds. The tissue surrounding the treatment site remains at much cooler temperatures resulting in rapid cooling of the tissue through conductive heat transfer. Compared to bulk tissue heating devices, this method of action results in effective soft tissue contraction with a lower risk of injury to surrounding tissue.

Photoacoustic temperature imaging based on multi-wavelength excitation

Building further upon the high spatial resolution offered by ultrasonic imaging and the high optical contrast yielded by laser excitation of photoacoustic imaging, and exploiting the temperature dependence of photoacoustic signal amplitudes, this paper addresses the question whether the rich information given by multispectral optoacoustic tomography (MSOT) allows to obtain 3D temperature images. Numerical simulations and experimental results are reported on agarose phantoms containing gold nanoparticles and the effects of shadowing, reconstruction flaws, etc. on the accuracy are determined.

Radiofrequency ablation of osteoid osteoma: Aiming for excellent outcomes in an Australasian context

INTRODUCTION

To report a series of patients with osteoid osteoma treated by radiofrequency ablation in whom no complications or recurrences occurred.

METHODS

Over a 13-year period, 32 consecutive patients with osteoid osteoma were treated by radiofrequency ablation in an Australasian teaching centre.

RESULTS

All patients had resolution of symptoms with no complication or recurrence.

CONCLUSIONS

This series is further evidence for the use of radiofrequency ablation as the primary treatment for osteoid osteoma.

Percutaneous laser ablation for benign and malignant thyroid diseases

Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.

Thermal effect of percutaneous radiofrequency ablation with a clustered electrode for vertebral tumors: In vitro and vivo experiments and clinical application

Purpose

To investigate effects and heat distribution of radiofrequency ablation (RFA) on vertebral tumors in vitro and in vivo swine experiments and its clinical application.

Materials and methods

RFA was performed on the swine spine in vitro and in vivo for 20 min at 90 °C at the electrode tip, and the temperature at the electrode tip and surrounding tissues were recorded. Clinical application of ablation combined with vertebroplasty was subsequently performed in 4 patients with spinal tumors.

Results

In the in vitro study, the mean temperature at the front and ventral wall of the spinal canal was 50.8 °C and 43.6 °C, respectively, at 20 mm significantly greater than 37.7 °C and 33.7 ± 1.7 °C, respectively, at 10 mm ablation depth. The coagulative necrosis area was significantly (P < 0.0001) greater at 20 mm depth than at 10 mm depth (mean 17.0 × 20.7 mm² vs. 14.2 × 16.6 mm²). In the in vivo experiment, the local temperature increased significantly (P < 0.05) from around 36 °C before ablation to over 41 °C at 20 min after ablation, with the temperature at the electrode tip (90.4 °C) and within the vertebral body (67.0 °C) significantly (P < 0.05) greater than at the posterior (41.9 °C) and lateral wall (41.8 °C). From 2 to 5 weeks, bone remodeling began. Clinically, all four patients had successful RFA and vertebroplasty, with no neurological deficits. The pain scores were significanlty (P < 0.05) improved before (4.5–10, mean 8.0) compared with at four weeks (0–1.8, mean 1.8).

Conclusion

The clustered electrode can be efficiently and safely applied in the treatment of spinal tumors without damaging the spinal cord and adjacent nerves by heat distribution.

Time and temperature dependence of radiofrequency ablation in the human placenta

OBJECTIVE

The objective of the study is to compare radiofrequency (RF) effects on fresh placentae with varying levels of sustained time (Ts) and degrees of target temperature (°t).

METHOD

A total of 108 pieces of fresh placentae were coagulated with a 2-cm RF needle at 60 W in an organ bath. The vertical and horizontal diameters (Vd, Hd) of tissue coagulation visualized by ultrasound were measured. The impacts of 12 different Ts-°t combinations on the ablation size ascertained on pathological examination (Vd_p , Hd_p ) were compared using 2-way ANOVA. The agreement between sonographic and pathological findings was assessed using Bland-Altman analysis.

RESULTS

Considerable changes in the Vd_p and Hd_p were associated with increasing the Ts and °t. The impact of RF on tissue coagulation was greatest when the °t was set at 100°C, with further destruction as the Ts progressed to 7 minutes of exposure. The ablation size estimated by ultrasound exhibited an overestimation by an average of 5.65% and 21.02% for Vd and Hd, respectively.

CONCLUSION

A prolonged Ts at a higher °t contributes to progressive placental tissue destruction by RF, with maximum destruction at 100°C for 7 minutes in an ex vivo nonperfused placenta. Tissue injury that is apparent on ultrasound may extend beyond pathological damage.

Anti-EGFR Indocyanine Green-Mitomycin C-Loaded Perfluorocarbon Double Nanoemulsion: A Novel Nanostructure for Targeted Photochemotherapy of Bladder Cancer Cells

The use of phototherapy as an adjuvant bladder cancer treatment has long been considered, but its application has been severely hampered due to a lack of tumor specificity, unpredicted cytotoxicity, and insufficient anticancer efficacy. In this study, we aim to manufacture anti-EGFR indocyanine green (ICG) mitomycin C (MMC) encapsulated perfluorocarbon double nanoemulsions (EIMPDNEs), and explore their photochemotherapeutic efficacy on EGFR-expressing bladder cancer cells in vitro. The EIMPDNEs were manufactured using a double emulsification technique followed by antibody conjugation on the particles’ surfaces. The EIMPDNE were 257 ± 19.4 nm in size, with a surface charge of −12.3 ± 2.33 mV. The EGFR targetability of the EIMPNDE was confirmed by its enhanced binding efficiency to T24 cells when compared with the performance of nanodroplets without EGFR conjugation (p < 0.05). In comparison with freely dissolved ICG, the EIMPDNEs with equal ICG content conferred an improved thermal stability to the encapsulated ICG, and were able to provide a comparable hyperthermia effect and significantly enhanced the production of singlet oxygen under 808 nm near infrared (NIR) exposure with an intensity of 6 W cm−2 for 5 min (p < 0.05). Based on viability analyses, our data showed that the EIMPDNEs were effective in bladder cancer cell eradication upon NIR exposure (808 nm; 6 W cm−2), and the resulting cell death rate was even higher than that caused by a five-fold higher amount of entrapped MMC alone. With the merits of improved ICG stability, EGFR binding specificity, and effective cancer cell eradication, the EIMPDNEs exhibit potential for use in EGFR-expressing bladder cancer therapy with lower chemotoxicity.

Chondromyxoid fibroma of the distal fibula treated by percutaneous radiofrequency ablation

BACKGROUND

Percutaneous radiofrequency ablation (RFA) has been shown to be an effective treatment for soft tissue lesions and also benign bone tumors, especially osteoid osteoma. There are limited data regarding this technique in other bone tumors, specifically larger and more aggressive ones.

PURPOSES

To describe the use of RFA as a definitive treatment and an alternative to traditional open surgery for the treatment of chondromyxoid fibroma (CMF), a benign but locally aggressive bone tumor.

CASE PRESENTATION

An 11.5-year-old girl was diagnosed with a 4-cm lytic bone lesion of the distal fibula. Evaluation, including biopsy, revealed CMF. It was managed by fluoroscopy-guided RFA only. Six-year follow-up demonstrated complete healing without damage to the adjacent distal fibular growth plate.

DISCUSSION AND CONCLUSIONS

RFA induces local heat in the ablation field and causes tissue necrosis. The depth of heat penetration and the size of heated sphere are accurately controlled by modern types of ablation probes and accurate positioning. The current report demonstrates the ability to use this percutaneous technique for larger and more aggressive bone tumors than has been indicated previously.

Laser-Induced Thermal Therapy in Neuro-Oncology: A Review

OBJECTIVES

Laser therapy has become an appealing treatment modality in neurosurgery. In this review, we report on the history, physics, surgical steps, indications and uses, and complications that have been reported to date.

METHODS

An extensive literature search was performed for laser interstitial thermal therapy (LITT) and laser therapy in the context of glial tumors, metastatic lesions, pediatric brain tumors, and radiation necrosis. Reported complications in each series also were reviewed.

RESULTS

In the past decade, multiple studies have demonstrated the use, outcomes, and complications associated with LITT in neurosurgery. These same studies have consistently reported an overall benefit of LITT in cases in which traditional surgical approaches may be limited by the patient's clinical status, tumor location, or overall prognosis. However, there have been complications reported from local effects of thermal damage, technical error, and edema development. Increased experience has reduced complications and brought more promising results.

CONCLUSIONS

With the advent of real-time monitoring and damage estimation, LITT has gained ground in the management of intracranial tumors. Larger scale trials must be performed to develop standard protocols to define specific indications for use. Further large clinical studies for LITT in non-oncologic cases are also of interest.

Optimization of Electrode Configuration and Pulse Strength in Irreversible Electroporation for Large Ablation Volumes Without Thermal Damage

The aim of this study was to analyze five factors that are responsible for the ablation volume and maximum temperature during the procedure of irreversible electroporation (IRE). The five factors used in this study were the pulse strength (U), the electrode diameter (B), the distance between the electrode and the center (D), the electrode length (L), and the number of electrodes (N). A validated finite element model (FEM) of IRE was built to collect the data of the ablation volume and maximum temperature generated in a liver tissue. Twenty-five experiments were performed, in which the ablation volume and maximum temperature were taken as response variables. The five factors with ranges were analyzed to investigate their impacts on the ablation volume and maximum temperature, respectively, using analysis of variance. Response surface method (RSM) was used to optimize the five factors for the maximum ablation volume without thermal damage (the maximum temperature ≤ 50 °C for 90 s). U and L were found with significant impacts on the ablation volume (P < 0.001, and P = 0.009, respectively) while the same conclusion was not found for B, D and N (P = 0.886, P = 0.075 and P = 0.279, respectively). Furthermore, U, D, and N had the significant impacts on the maximum temperature with P < 0.001, P < 0.001, and P = 0.003, respectively, while same conclusion was not found for B and L (P = 0.720 and P = 0.051, respectively). The maximum ablation volume of 2952.9960 mm3 without thermal damage can be obtained by using the following set of factors: U = 2362.2384 V, B = 1.4889 mm, D = 7 mm, L = 4.5659 mm, and N = 3. The study concludes that both B and N have insignificant impacts (P = 0.886, and P = 0.279, respectively) on the ablation volume; U has the most significant impact (P < 0.001) on the ablation volume; electrode configuration and pulse strength in IRE can be optimized for the maximum ablation volume without thermal damage using RSM.

New experimental model for single liver lobe hyperthermia in small animals using non-directional microwaves

PURPOSE

Our aim was to develop a new experimental model for in vivo hyperthermia using non-directional microwaves, applicable to small experimental animals. We present an affordable approach for targeted microwave heat delivery to an isolated liver lobe in rat, which allows rapid, precise and stable tissue temperature control.

MATERIALS AND METHODS

A new experimental model is proposed. We used a commercial available magnetron generating 2450 MHz, with 4.4V and 14A in the filament and 4500V anodic voltage. Modifications were required in order to adjust tissue heating such as to prevent overheating and to allow for fine adjustments according to real-time target temperature. The heating is controlled using a virtual instrument application implemented in LabView® and responds to 0.1° C variations in the target. Ten healthy adult male Wistar rats, weighing 250-270 g were used in this study. The middle liver lobe was the target for controlled heating, while the rest of the living animal was protected.

RESULTS

In vivo microwave delivery using our experimental setting is safe for the animals. Target tissue temperature rises from 30°C to 40°C with 3.375°C / second (R2 = 0.9551), while the increment is lower it the next two intervals (40-42°C and 42-44°C) with 0.291°C/ s (R2 = 0.9337) and 0.136°C/ s (R2 = 0.7894) respectively, when testing in sequences. After reaching the desired temperature, controlled microwave delivery insures a very stable temperature during the experiments.

CONCLUSIONS

We have developed an inexpensive and easy to manufacture system for targeted hyperthermia using non-directional microwave radiation. This system allows for fine and stable temperature adjustments within the target tissue and is ideal for experimental models testing below or above threshold hyperthermia.

[Image-guided tumor ablation]

INTRODUCTION

Ablatives techniques for destroying in situ a tumoral process aim tissular necrosis by the application of several physical principles.

MATERIAL AND METHODS

We searched MEDLINE^®, Embase^®, using (MeSH) words; from January 2005 through May 2017, and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance.

RESULTS

Forty-seven articles were analyzed. We described ablative techniques and sorted them in thermal and non-thermal therapies according to the used physical principle and their frequency of use in the urological pathology.

CONCLUSION

Percutaneous ablative therapies are mini-invasive techniques, which have an important role in tumors focal treatment. This article is a review of the ablative therapies and describes their physical principles, their equipment and their recent technological modifications, which have been developed to improve the clinical success of these techniques.

Synthesis, characterization, and biological verification of anti-HER2 indocyanine green-doxorubicin-loaded polyethyleneimine-coated perfluorocarbon double nanoemulsions for targeted photochemotherapy of breast cancer cells

Background

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females worldwide. Among various types of breast cancer, the human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer is known to be more aggressive and often resistant to medicinal treatment, leading to an insufficient prognosis and poor susceptibility to chemotherapy and/or hormonal therapy in the current clinic. These circumstances implicate that developing an improved therapeutic strategy rather than persistently changing the anticancer drugs for trying is truly needed to successfully cure this type of breast cancer. In this study, we aimed to fabricate anti-HER2 indocyanine green (ICG)–doxorubicin (DOX)-loaded polyethyleneimine-coated perfluorocarbon double nanoemulsions (HIDPPDNEs) to explore the co-administration of phototherapy and chemotherapy for HER2-overexpressing breast cancer in vitro.

Results

The HIDPPDNE was first characterized as a sphere-like nanoparticle with surface charge of −57.1 ± 5.6 mV and size of 340.6 ± 4.5 nm, whereas the DOX release rates for the nanodroplets within 48 h in 4 and 37 °C were obtained by 8.13 ± 2.46% and 19.88 ± 2.75%, respectively. We then examined the target-ability of the nanostructure and found that the adhesion efficiency of the HIDPPDNEs onto HER2+ MDA-MB-453 cells was threefold higher than the nanodroplets without anti-HER2 antibody, indicating that the HIDPPDNEs are the product with HER2 binding specificity. In comparison to freely dissolved ICG, the HIDPPDNEs conferred an enhanced thermal stability to the entrapped ICG, and were able to provide a comparable hyperthermia effect and markedly increased production of singlet oxygen under near infrared irradiation (808 nm; 6 W/cm²). Based on the viability analyses, the results showed that the HIDPPDNEs were effective on cell eradication upon near infrared irradiation (808 nm; 6 W/cm²), and the resulting cell mortality was even higher than that caused by using twice amount of encapsulated DOX or ICG alone.

Conclusions

This work demonstrates that the HIDPPDNEs are able to provide improved ICG stability, binding specificity, and enhanced anticancer efficacy as compared to equal dosage of free ICG and/or DOX, showing a high potential for use in HER2 breast cancer therapy with reduced chemotoxicity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12951-017-0274-5) contains supplementary material, which is available to authorized users.

Indocyanine green-loaded hollow mesoporous silica nanoparticles as an activatable theranostic agent

Here we report indocyanine green (ICG)-loaded hollow mesoporous silica nanoparticles (ICG@HMSNP) as an activatable theranostic platform. Near-infrared fluorescence and singlet oxygen generation of ICG@HMSNP was effectively quenched (i.e. turned off) in its native state because of the fluorescence resonance energy transfer between ICG molecules. Therefore, ICG@HMSNP was nonfluorescent and nonphototoxic in the extracellular region. After the nanoparticles entered the cancer cells via endocytosis, they became highly fluorescent and phototoxic. In addition, intracellular uptake of ICG@HMSNP was 2.75 times higher than that of free ICG, resulting in an enhanced phototherapy of cancer.

Fabrication, characterization, and biological evaluation of anti-HER2 indocyanine green-doxorubicin-encapsulated PEG-b-PLGA copolymeric nanoparticles for targeted photochemotherapy of breast cancer cells

In this study, we aimed to develop anti-human epidermal growth factor receptor 2 (HER2) indocyanine green (ICG)-doxorubicin (DOX)-encapsulated polyethylene glycol-poly(lactic-co-glycolic acid) diblock copolymeric nanoparticles (HIDPPNPs) to explore the co-administration of phototherapy and chemotherapy for HER2-overexpressing breast cancer, a highly aggressive and medicine-resistant breast carcinoma. The HIDPPNPs were fabricated using a solvent evaporation technique followed by carbodiimide-mediated antibody conjugation on the nanoparticle surface. Compared with freely dissolved ICG, the HIDPPNPs conferred enhanced thermal stability to the entrapped ICG, were able to generate a hyperthermia effect at concentrations ≥1 μM ICG equivalent and provided increased production of singlet oxygen under 808-nm laser irradiation with an intensity of 6 W/cm2. Furthermore, the uptake efficiency of the HIDPPNPs in MDA-MB-453/HER2(+) cells was approximately 2-fold higher than that in MCF7/HER2(-) cells, demonstrating that the HIDPPNPs specifically target HER2-expressing cells. Based on the viability analysis, the HIDPPNPs exhibited effective cytotoxicity upon light exposure (808 nm; 6 W/cm2), and the resulting cell death rate was even higher than that caused by using twice amount of encapsulated DOX or ICG alone. These results indicate that the developed HIDPPNPs may serve as a feasible tool for use in anti-HER2 breast cancer therapy with reduced chemotoxicity.

Effects of Anesthetic Fluid Injectates on Lesion Sizes in Cooled Radiofrequency Ablation

STUDY DESIGN

Nonrandomized trial.

OBJECTIVE

This is an ex vivo study using pork chops to simulate human vertebra to determine the effects of various anesthetic fluids injectates and concentrations on lesion size and shape created when using cooled radiofrequency ablation. Secondary objective is to determine the effects of various time durations of applied lesion on lesion size created. Our final objective is to determine the effects of fluid injectates on tissue temperature and impedance.

SUMMARY OF BACKGROUND DATA

Radiofrequency neurotomy is a therapeutic procedure involving ablation of sensory afferent nerves to the vertebral zygapophyseal joints. Larger lesions increase the likelihood the target nerve is ablated.

METHODS

Before cooled radiofrequency ablation, tissue was injected with either 0.9% normal saline, 1% lidocaine, 2% lidocaine, 0.25% bupivacaine, 0.5% bupivacaine, 0.75% bupivacaine, 0.2% ropivacaine, 0.5% ropivacaine, or 1% ropivacaine. Duration of cooled radiofrequency was either 45, 90, or 150 seconds.

RESULTS

There was no significant difference in the size of the lesion created when using different injectates and concentrations. There was no significant difference in the size of the lesion created when applying a 90 seconds duration lesion compared with a 150 seconds duration lesion.

CONCLUSION

Applying a 90 seconds duration lesion can be considered in clinical use for cooled radiofrequency ablation. The use of an injectate did not significantly alter the size or desired spherical shape of the lesion created, did not significantly alter the time required to create the lesion, and did not significantly lower the temperature threshold. The study is limited by the use of ex vivo tissue which does not account for the effects of tissue perfusion. The use of an injectate before cooled radiofrequency ablation can be made at the interventionalist's discretion.

LEVEL OF EVIDENCE

N/A.

Photosensitizer loaded PEG-MoS2–Au hybrids for CT/NIRF imaging-guided stepwise photothermal and photodynamic therapy

We develop X-ray computed tomography/near-infrared fluorescence imaging for visually guiding the photothermal/photodynamic therapy of antitumor nanocomposites (PEG-MoS₂–Au–Ce6), by adsorbing chlorin e6 to the gold nanoparticle-decorated molybdenum disulfide nanosheets.

Synthesis, Characterization, and Biological Evaluation of Anti-HER2 Indocyanine Green-Encapsulated PEG-Coated PLGA Nanoparticles for Targeted Phototherapy of Breast Cancer Cells

Human epidermal growth factor receptor 2 (HER2)-overexpressed breast cancer is known to be more aggressive and resistant to medicinal treatment and therefore to whom an alternative therapeutics is needed. Indocyanine green (ICG) has been widely exploited in breast cancer phototherapy. However, drawbacks of accelerated degradation and short half-life (2-4 min) in blood seriously hamper its use in the clinic. To overcome these challenges, an anti-HER2 ICG-encapsulated polyethylene glycol-coated poly(lactic-co-glycolic acid) nanoparticles (HIPPNPs) were developed in this study. Through the analyses of degradation rate coefficients of ICG with and without polymeric encapsulation, the photostability of HIPPNP-entrapped ICG significantly enhanced 4 folds (P < 0.05) while its thermal stabilities at 4 and 37°C significantly enhanced 5 and 3 (P < 0.05 for each) folds, respectively, under equal lighting and/or heating treatment for 48 h. The target specificity of HIPPNPs to HER2-positive cells was demonstrated based on a 6-fold (P < 0.05) enhancement of uptake efficiency of HIPPNPs in MDA-MB-453/HER2(+) cells within 4 h as compared with that in MCF7/HER2(-) cells. Moreover, the HIPPNPs with ≤ 25 μM ICG equivalent were nontoxic to cells in the absence of light illumination, and enabled to generate similar amount of singlet oxygen and hyperthermia effect as compared with that used by free ICG upon NIR irradiation. After 808 nm-laser irradiation with intensity of 6 W/cm2 for 5 min, the viability of MDA-MB-453 cells pre-treated by HIPPNPs with ≥ 5 μM ICG equivalent for 4 h significantly reduced as compared with that treated by equal concentration of free ICG (P < 0.05) and > 90% of the cells were eradicated while the dose of HIPPNPs was increased to 25 μM ICG equivalent. In summary, the developed HIPPNPs are anticipated as a feasible tool for use in phototherapy of breast cancer cells with HER2 expression.

Radiofrequency Ablation of Uterine Fibroids: a Review

Laparoscopic, ultrasound-guided radiofrequency ablation (RFA) is a new, FDA-cleared uterine sparing, outpatient procedure for uterine fibroids. The procedure utilizes recent technological advancements in instrumentation and imaging, allowing surgeons to treat numerous fibroids of varying size and location in a minimally invasive fashion. Early and mid-term data from multi-center clinical trials have demonstrated safety and efficacy, with resolution or improvement of symptoms and significant volume reduction. Re-intervention rates for fibroid symptoms have been low. The procedure is well tolerated with a typically uneventful and rapid recovery requiring NSAIDs only for postoperative pain. While post RFA pregnancy data are limited, the results are promising.

ANALYTICAL SOLUTIONS IN THE MODELING OF THE LOCAL RF ABLATION

Coupled mathematical models for the radiofrequency (RF) ablation performed in biomedical sciences have been developed based on the bioheat transfer theory. The heat exchange problem is important to be analytically studied in order to control the size of the necrosis zone caused by RF ablation. This lesion size in the tissue may be predicted by the knowledge of the internal tissue temperature. We propose an analytical solution for the Pennes heat transfer equation in bi- and tri-region domains, applicable to the RF ablation of cancerigeneous tissue — a clinical relevant problem. The model consists of two partial differential equations describing the spatio-temporal interactions between the electric and thermic effects. The aim is to find simple algebraic expressions of analytical solutions that may allow to generate quantitative results which in turn may be interpreted (including uncertainties). The dependence of the temperature as function of the electrothermal parameters in both diseased and surrounding healthy tissues is pointed out. Two cases, namely the tumor–tissue and tumor–tissue–skin systems, are graphically computed, and important findings include the fact that the presence of tissue with smaller value parameters protects somehow healthy cells. Moreover, the graphical representations are conducted to highlight the link of the profile of current density distribution in the physiological problem with the (neither oval nor circular) shape of the temperature isoclinic lines.

Radiofrequency Ablation, MR Thermometry, and High-Spatial-Resolution MR Parametric Imaging with a Single, Minimally Invasive Device

Purpose To develop and demonstrate in vitro and in vivo a single interventional magnetic resonance (MR)-active device that integrates the functions of precise identification of a tissue site with the delivery of radiofrequency (RF) energy for ablation, high-spatial-resolution thermal mapping to monitor thermal dose, and quantitative MR imaging relaxometry to document ablation-induced tissue changes for characterizing ablated tissue. Materials and Methods All animal studies were approved by the institutional animal care and use committee. A loopless MR imaging antenna composed of a tuned microcable either 0.8 or 2.2 mm in diameter with an extended central conductor was switched between a 3-T MR imaging unit and an RF power source to monitor and perform RF ablation in bovine muscle and human artery samples in vitro and in rabbits in vivo. High-spatial-resolution (250-300-μm) proton resonance frequency shift MR thermometry was interleaved with ablations. Quantitative spin-lattice (T1) and spin-spin (T2) relaxation time MR imaging mapping was performed before and after ablation. These maps were compared with findings from gross tissue examination of the region of ablated tissue after MR imaging. Results High-spatial-resolution MR imaging afforded temperature mapping in less than 8 seconds for monitoring ablation temperatures in excess of 85°C delivered by the same device. This produced irreversible thermal injury and necrosis. Quantitative MR imaging relaxation time maps demonstrated up to a twofold variation in mean regional T1 and T2 after ablation versus before ablation. Conclusion A simple, integrated, minimally invasive interventional probe that provides image-guided therapy delivery, thermal mapping of dose, and detection of ablation-associated MR imaging parametric changes was developed and demonstrated. With this single-device approach, coupling-related safety concerns associated with multiple conductor approaches were avoided. ^© RSNA, 2016 Online supplemental material is available for this article.

Thermochromic tissue-mimicking phantom for optimisation of thermal tumour ablation

Purpose The purpose of this study was to (1) develop a novel tissue-mimicking thermochromic (TMTC) phantom that permanently changes colour from white to magenta upon heating above ablative temperatures, and (2) assess its utility for specific applications in evaluating thermal therapy devices. Materials and methods Polyacrylamide gel mixed with thermochromic ink was custom made to produce a TMTC phantom that changes its colour upon heating above biological ablative temperatures (> 60 °C). The thermal properties of the phantom were characterised, and compared to those of human tissue. In addition, utility of this phantom as a tool for the assessment of laser and microwave thermal ablation was examined. Results The mass density, thermal conductivity, and thermal diffusivity of the TMTC phantom were measured as 1033 ± 1.0 kg/m(3), 0.590 ± 0.015 W/m.K, and 0.145 ± 0.002 mm(2)/s, respectively, and found to be in agreement with reported values for human soft tissues. Heating the phantom with laser and microwave ablation devices produced clearly demarcated regions of permanent colour change geographically corresponding to regions with temperature elevations above 60 °C. Conclusion The TMTC phantom provides direct visualisation of ablation dynamics, including ablation volume and geometry as well as peak absolute temperatures within the treated region post-ablation. This phantom can be specifically tailored for different thermal therapy modalities, such as radiofrequency, laser, microwave, or therapeutic ultrasound ablation. Such modality-specific phantoms may enable better quality assurance, device characterisation, and ablation parameter optimisation, or optimise the study of dynamic heating parameters integral to drug device combination therapies relying upon heat.