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Thomas A, Nolte T, Baragona M, Ritter A. Finding an effective MRI sequence to visualise the electroporated area in plant-based models by quantitative mapping. Bioelectrochemistry 2023; 153:108463. [PMID: 37235889 DOI: 10.1016/j.bioelechem.2023.108463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Plant-based models can reduce the number of animal studies for electroporation research in medical cancer treatment modalities like irreversible electroporation. Magnetic resonance imaging (MRI) provides volumetric visualisation of electroporated animal or plant tissues; however, contrast behaviour is complex, depending on tissue and sequence parameters. This study numerically analysed contrast between electroporated and non-electroporated tissue at 1.5 T in various MRI sequences (DWI, T1W, T2W, T2*W, PDW, FLAIR) performed 4 h after electroporation in apples (N = 4) and potatoes (N = 8). Sequence parameters (inversion time [TI], echo time [TE], b-value) for optimal contrast and electroporation-mediated changes in T1 and T2 relaxation times and apparent diffusion coefficient (ADC) were determined for potato (N = 4) using quantitative parameter mapping. FLAIR showed the electroporated zone in potatoes with best contrast, whereas no sequence yielded clear visibility in apples. After electroporation, T1 and T2 in potato decreased by 29% ([1245 ± 54 to 886 ± 119] ms) and 12% ([249 ± 17 to 217 ± 12] ms), respectively. ADC increased by 11% ([1303 ± 25 to 1449 ± 28] × 10-6 mm2/s). Optimal contrast was found for TI = 1000 ms, low TE and high b-value. T1 was most sensitive to EP-mediated tissue changes. Future research could use this methodology and findings to obtain high-contrast MR images of electroporated and non-electroporated biological tissues.
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Affiliation(s)
- Athul Thomas
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Teresa Nolte
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
| | | | - Andreas Ritter
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
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Kim HB, Baik KY, Sung CK. Histological Response to 5 kHz Irreversible Electroporation in a Porcine Liver Model. Technol Cancer Res Treat 2023; 22:15330338231171767. [PMID: 37125478 PMCID: PMC10134162 DOI: 10.1177/15330338231171767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Unlike necrosis by thermal ablation, irreversible electroporation (IRE) is known to induce apoptosis by disrupting plasma membrane integrity with electric pulses while preserving the structure of blood vessels and bile ducts in liver tissue without a heat sink effect. This study aimed to investigate thermal damage and histopathological effects in the porcine liver by high-frequency electric pulses (5 kHz) which is much higher than the widely used 1 Hz. The electric field and thermal distributions of 5 kHz electric pulses were compared with those of 1 Hz in numerical simulations. 5 kHz-IRE was applied on pigs under ultrasound imaging to guide the electrode placement. The animals underwent computed tomography (CT) examination immediately and 1 day after IRE. After CT, IRE-treated tissues were taken and analyzed histologically. CT revealed that hepatic veins were intact for 1-day post-IRE. Histopathologically, the structure of the portal vein was intact, but endothelial cells were partially removed. In addition, the hepatic artery structure from which endothelial cells were removed were not damaged, while the bile duct structure and cholangiocytes were intact. The thermal injury was observed only in the vicinity of the electrodes as simulated in silico. 5 kHz-IRE generated high heat due to its short pulse interval, but the thermal damage was limited to the tissue around the electrodes. The histopathological damage caused by 5 kHz-IRE was close to that caused by 1 Hz-IRE. If a short-time treatment is required for reasons such as anesthesia, high-frequency IRE treatment is worth considering. Our observations will contribute to a better understanding of the IRE phenomena and search for advanced therapeutic conditions.
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Affiliation(s)
- Hong Bae Kim
- Medical Engineering Research Center, The Standard Co. Ltd, Gunpo-si, Republic of Korea
| | - Ku Youn Baik
- Electrical and Biological Physics, Kwangwoon University, Seoul, Republic of Korea
| | - Chang Kyu Sung
- Department of Radiology, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea
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Early Single-Center Experience With Irreversible Electroporation for Stage 2, 3, and 4 Pancreatic Adenocarcinomas. Pancreas 2022; 51:976-984. [PMID: 36607943 DOI: 10.1097/mpa.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Irreversible electroporation (IRE) is an ablation technology that uses electrical energy delivered between electrodes. If the electrodes are placed atraumatically, there is little to no risk of collateral injury, making IRE appealing for the treatment of pancreatic tumors. METHODS We report on 20 patients with pancreatic adenocarcinoma (PAC) who underwent 21 IRE in our center. There were 6 IRE for stage 2 PAC, 11 for stage 3 PAC, 1 for stage 4 PAC, and 2 patients treated with IRE for recurrence after pancreaticoduodenectomy. One patient had local progression 18 months after IRE and received a second IRE treatment. Using propensity score matching (age, sex, stage, tumor size, and chemotherapy), cases were matched 2 to 1 with patients from the Surveillance, Epidemiology, and End Results database. RESULTS A total of 7 cases experienced 8 complications; 4 complications were mild, and 4 were severe. Significant survival benefit was seen for patients with stage 3 PAC (27.5 vs 14.6 months for the matched group, P = 0.003); for stage 2, median survival was 15 months, and the single stage 4 patient survived 9 months after IRE treatment. CONCLUSIONS Pancreatic cancers were safely and effectively treated with image-guided IRE in our medium-sized center.
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Eresen A, Sun C, Zhou K, Shangguan J, Wang B, Pan L, Hu S, Ma Q, Yang J, Zhang Z, Yaghmai V. Early Differentiation of Irreversible Electroporation Ablation Regions With Radiomics Features of Conventional MRI. Acad Radiol 2022; 29:1378-1386. [PMID: 34933803 PMCID: PMC10029937 DOI: 10.1016/j.acra.2021.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES Irreversible electroporation (IRE) is a promising non-thermal ablation technique for the treatment of patients with hepatocellular carcinoma. Early differentiation of the IRE zone from surrounding reversibly electroporated (RE) penumbra is vital for the evaluation of treatment response. In this study, an advanced statistical learning framework was developed by evaluating standard MRI data to differentiate IRE ablation zones, and to correlate with histological tumor biomarkers. MATERIALS AND METHODS Fourteen rabbits with VX2 liver tumors were scanned following IRE ablation and forty-six features were extracted from T1w and T2w MRI. Following identification of key imaging variables through two-step feature analysis, multivariable classification and regression models were generated for differentiation of IRE ablation zones, and correlation with histological markers reflecting viable tumor cells, microvessel density, and apoptosis rate. The performance of the multivariable models was assessed by measuring accuracy, receiver operating characteristics curve analysis, and Spearman correlation coefficients. RESULTS The classifiers integrating four radiomics features of T1w, T2w, and T1w+T2w MRI data distinguished IRE from RE zones with an accuracy of 97%, 80%, and 97%, respectively. Also, pixelwise classification models of T1w, T2w, and T1w+T2w MRI labeled each voxel with an accuracy of 82.8%, 66.5%, and 82.9%, respectively. Regression models obtained a strong correlation with behavior of viable tumor cells (0.62 ≤ r2 ≤ 0.85, p < 0.01), apoptosis (0.40 ≤ r2 ≤ 0.82, p < 0.01), and microvessel density (0.48 ≤ r2 ≤ 0.58, p < 0.01). CONCLUSION MRI radiomics features provide descriptive power for early differentiation of IRE and RE zones while observing strong correlations among multivariable MRI regression models and histological tumor biomarkers.
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Affiliation(s)
- Aydin Eresen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Radiological Sciences, University of California Irvine, Irvine, California
| | - Chong Sun
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kang Zhou
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bin Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, China
| | - Liang Pan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Su Hu
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Quanhong Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Radiological Sciences, University of California Irvine, Irvine, California
| | - Jia Yang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Radiological Sciences, University of California Irvine, Irvine, California; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California
| | - Vahid Yaghmai
- Department of Radiological Sciences, University of California Irvine, Irvine, California; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California.
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Belfiore MP, De Chiara M, Reginelli A, Clemente A, Urraro F, Grassi R, Belfiore G, Cappabianca S. An overview of the irreversible electroporation for the treatment of liver metastases: When to use it. Front Oncol 2022; 12:943176. [PMID: 36119531 PMCID: PMC9477084 DOI: 10.3389/fonc.2022.943176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Tumour ablation is an established therapy for local treatment of liver metastases and hepatocellular carcinoma. Most commonly two different kind of thermic ablation, radiofrequency ablation and microwave ablation, are used in clinical practice. The aim of both is to induce thermic damage to the malignant cells in order to obtain coagulative necrosis of the neoplastic lesions. Our main concerns about these procedures are the collateral thermic damage to adjacent structures and heat-sink effect. Irreversible electroporation (IRE) is a recently developed, non-thermal ablation procedure which works applying short pulses of direct current that generate an electric field in the lesion area. The electric field increase the transmembrane potential, changing its permeability to ions.Irreversible electroporation does not generate heat, giving the chance to avoid the heat-sink effect and opening the path to a better treatment of all the lesions located in close proximity to big vessels and bile ducts. Electric fields produced by the IRE may affect endothelial cells and cholangiocytes but they spare the collagen matrix, preserving re-epithelization process as well as the function of the damaged structures. Purpose of the authors is to identify the different scenarios where CT-guided percutaneous IRE of the liver should be preferred to other ablative techniques and why.
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Affiliation(s)
- Maria Paola Belfiore
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
- *Correspondence: Maria Paola Belfiore,
| | - Marco De Chiara
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Alfonso Reginelli
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Alfredo Clemente
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Fabrizio Urraro
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Roberto Grassi
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Giuseppe Belfiore
- Department of Diagnostic Imaging, Nursing home L.Cobellis, Vallo della Lucania Salerno, Italy
| | - Salvatore Cappabianca
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
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Bäumler W, Beyer LP, Lürken L, Wiggermann P, Stroszczynski C, Dollinger M, Schicho A. Detection of Incomplete Irreversible Electroporation (IRE) and Microwave Ablation (MWA) of Hepatocellular Carcinoma (HCC) Using Iodine Quantification in Dual Energy Computed Tomography (DECT). Diagnostics (Basel) 2022; 12:diagnostics12040986. [PMID: 35454034 PMCID: PMC9026630 DOI: 10.3390/diagnostics12040986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Early detection of local tumor progression (LTP) after irreversible electroporation (IRE) and microwave ablation (MWA) of hepatocellular carcinoma (HCC) remains challenging. The goal of this study was to identify cases with insufficient ablation and prevent HCC recurrencies by measuring iodine uptake using dual-energy computed tomography (DECT). In 54 HCC-patients, the volumetric iodine concentration (VIC) of the central and peripheral ablation area was evaluated by DECT within 24 h after IRE or MWA. Follow-up was performed with CT and/or MRI at 6 weeks, 3, 6, 9, and 12 months, respectively. In both groups, LTP was solely detected in the peripheral area (IRE: n = 4; MWA: n = 4) and LTP patients showed significantly higher VIC values in the peripheral zone than patients without LTP (IRE: * p = 0.0005; MWA: * p = 0.000). In IRE-LTP patients, no significant difference between the VIC values of non-ablated liver tissue and the peripheral zone was detected (p = 0.155). The peripheral zones of IRE patients without LTP (* p = 0.000) and MWA patients, irrespective of the presence of LTP (LTP: * p = 0.005; without LTP: * p = 0.000), showed significantly lower VIC values than non-ablated liver parenchyma. Higher BCLC tumor stages were indicative for LTP (* p = 0.008). The study suggests that elevated iodine uptake in the peripheral ablation zone could help identify LTP after IRE and MWA of HCC.
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Affiliation(s)
- Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
- Correspondence: ; Tel.: +49-941-944-7401; Fax: +49-941-944-7402
| | - Lukas Philipp Beyer
- Department of Diagnostic and Interventional Radiology, Ernst von Bergmann Hospital, Charlottenstraße 72, 14467 Potsdam, Germany;
| | - Lukas Lürken
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
| | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Salzdahlumer Straße 90, 38126 Braunschweig, Germany;
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
| | - Marco Dollinger
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
| | - Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
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Feasibility and effectiveness of endoscopic irreversible electroporation for the upper gastrointestinal tract: an experimental animal study. Sci Rep 2021; 11:15353. [PMID: 34321494 PMCID: PMC8319327 DOI: 10.1038/s41598-021-94583-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
Irreversible electroporation (IRE) is a local non-thermal ablative technique currently used to treat solid tumors. Here, we investigated the clinical potency and safety of IRE with an endoscope in the upper gastrointestinal tract. Pigs were electroporated with recently designed endoscopic IRE catheters in the esophagus, stomach, and duodenum. Two successive strategies were introduced to optimize the electrical energy for the digestive tract. First, each organ was electroporated and the energy upscaled to confirm the upper limit energy inducing improper tissue results, including bleeding and perforation. Excluding the unacceptable energy from the first step, consecutive electroporations were performed with stepwise reductions in energy to identify the energy that damaged each layer. Inceptive research into inappropriate electrical intensity contributed to extensive hemorrhage and bowel perforation for each tissue above a certain energy threshold. However, experiments performed below the precluded energy accompanying hematoxylin and eosin staining and terminal deoxynucleotidyl transferase dUTP nick-end labeling assays showed that damaged mucosal area and depth significantly decreased with decreased energy. Relevant histopathology showed infiltration of inflammatory cells with pyknotic nuclei at the electroporated lesion. This investigation demonstrated the possibility of endoscopic IRE in mucosal dysplasia or early malignant tumors of the hollow viscus.
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Comparison between high-frequency irreversible electroporation and irreversible electroporation ablation of small swine liver: follow-up of DCE-MRI and pathological observations. Chin Med J (Engl) 2021; 134:2081-2090. [PMID: 34172620 PMCID: PMC8439989 DOI: 10.1097/cm9.0000000000001663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: High-frequency irreversible electroporation (H-FIRE) is a novel, next-generation nanoknife technology with the advantage of relieving irreversible electroporation (IRE)-induced muscle contractions. However, the difference between IRE and H-FIRE with distinct ablation parameters was not clearly defined. This study aimed to compare the efficacy of the two treatments in vivo. Methods: Ten Bama miniature swine were divided into two group: five in the 1-day group and five in the 7-day group. The efficacy of IRE and H-FIRE ablation was compared by volume transfer constant (Krans), rate constant (Kep) and extravascular extracellular volume fraction (Ve) value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), size of the ablation zone, and histologic analysis. Each animal underwent the IRE and H-FIRE. Temperatures of the electrodes were measured during ablation. DCE-MRI images were obtained 1, 4, and 7 days after ablation in the 7-day group. All animals in the two groups were euthanized 1 day or 7 days after ablation, and subsequently, IRE and H-FIRE treated liver tissues were collected for histological examination. Student's t test or Mann-Whitney U test was applied for comparing any two groups. One-way analysis of variance (ANOVA) test and Welch's ANOVA test followed by Holm-Sidak's multiple comparisons test, one-way ANOVA with repeated measures followed by Bonferroni test, or Kruskal-Wallis H test followed by Dunn's multiple comparison test was used for multiple group comparisons and post hoc analyses. Pearson correlation coefficient test was conducted to analyze the relationship between two variables. Results: Higher Ve was seen in IRE zone than in H-FIRE zone (0.14 ± 0.02 vs. 0.08 ± 0.05, t = 2.408, P = 0.043) on day 4, but no significant difference was seen in Ktrans or Kep between IRE and H-FIRE zones at all time points (all P > 0.05). For IRE zone, the greatest Ktrans was seen on day 7, which was significantly higher than that on day 1 (P = 0.033). The ablation zone size of H-FIRE was significantly larger than IRE 1 day (4.74 ± 0.88 cm2vs. 3.20 ± 0.77 cm2, t = 3.241, P = 0.009) and 4 days (2.22 ± 0.83 cm2vs. 1.30 ± 0.50 cm2, t = 2.343, P = 0.041) after treatment. Apoptotic index (0.05 ± 0.02 vs. 0.73 ± 0.06 vs. 0.68 ± 0.07, F = 241.300, P < 0.001) and heat shock protein 70 (HSP70) (0.03 ± 0.01 vs. 0.46 ± 0.09 vs. and 0.42 ± 0.07, F = 64.490, P < 0.001) were significantly different between the untreated, IRE and H-FIRE zones, but no significant difference was seen in apoptotic index or HSP70 between IRE and H-FIRE zone (both P > 0.05). Electrode temperature variations were not significantly different between the two zones (18.00 ± 3.77°C vs. 16.20 ± 7.45°C, t = 0.682, P = 0.504). The Ktrans value (r = 0.940, P = 0.017) and the Kep value (r = 0.895, P = 0.040) of the H-FIRE zone were positively correlated with the number of hepatocytes in the ablation zone. Conclusions: H-FIRE showed a comparable ablation effect to IRE. DCE-MRI has the potential to monitor the changes of H-FIRE ablation zone.
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Granata V, Fusco R, Salati S, Petrillo A, Di Bernardo E, Grassi R, Palaia R, Danti G, La Porta M, Cadossi M, Gašljević G, Sersa G, Izzo F. A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115592. [PMID: 34073865 PMCID: PMC8197272 DOI: 10.3390/ijerph18115592] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Imaging methods and the most appropriate criteria to be used for detecting and evaluating response to oncological treatments depend on the pathology and anatomical site to be treated and on the treatment to be performed. This document provides a general overview of the main imaging and histopathological findings of electroporation-based treatments (Electrochemotherapy-ECT and Irreversible electroporation-IRE) compared to thermal approach, such as radiofrequency ablation (RFA), in deep-seated cancers with a particular attention to pancreatic and liver cancer. METHODS Numerous electronic datasets were examined: PubMed, Scopus, Web of Science and Google Scholar. The research covered the years from January 1990 to April 2021. All titles and abstracts were analyzed. The inclusion criteria were the following: studies that report imaging or histopathological findings after ablative thermal and not thermal loco-regional treatments (ECT, IRE, RFA) in deep-seated cancers including pancreatic and liver cancer and articles published in the English language. Exclusion criteria were unavailability of full text and congress abstracts or posters and different topic respect to inclusion criteria. RESULTS 558 potentially relevant references through electronic searches were identified. A total of 38 articles met the inclusion criteria: 20 studies report imaging findings after RFA or ECT or IRE in pancreatic and liver cancer; 17 studies report histopathological findings after RFA or ECT or IRE; 1 study reports both imaging and histopathological findings after RFA or ECT or IRE. CONCLUSIONS Imaging features are related to the type of therapy administrated, to the timing of re-assessment post therapy and to the imaging technique being used to observe the effects. Histological findings after both ECT and IRE show that the treated area becomes necrotic and encapsulated in fibrous tissue, suggesting that the size of the treated lesion cannot be measured as an endpoint to detect response. Moreover, histology frequently reported signs of apoptosis and reduced vital tissue, implying that imaging criteria, which take into account the viability and not the size of the lesion, are more appropriate to evaluate response to treatment.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (V.G.); (A.P.)
| | - Roberta Fusco
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
- Correspondence:
| | - Simona Salati
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (V.G.); (A.P.)
| | - Elio Di Bernardo
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Roberta Grassi
- Radiology Division, Università Degli Studi Della Campania Luigi Vanvitelli, I-80143 Naples, Italy;
- Italian Society of Medical and Interventional Radiology SIRM, SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (R.P.); (F.I.)
| | - Ginevra Danti
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, I-50139 Florence, Italy;
| | | | - Matteo Cadossi
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Gorana Gašljević
- Department of Pathology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia;
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia;
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (R.P.); (F.I.)
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Transcatheter Intraarterial Perfusion MRI Approaches to Differentiate Reversibly Electroporated Penumbra From Irreversibly Electroporated Zones in Rabbit Liver. Acad Radiol 2020; 27:1727-1733. [PMID: 32033861 PMCID: PMC9945946 DOI: 10.1016/j.acra.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate whether transcatheter intraarterial perfusion (TRIP) magnetic resonance imaging (MRI) can differentiate reversible electroporation (RE) zones from irreversible electroporation (IRE) zones immediately after IRE procedure in the rabbit liver. MATERIALS AND METHODS All studies were approved by the institutional animal care and use committee and performed in accordance with institutional guidelines. A total of 13 healthy New Zealand White rabbits were used. After selective catheterization of the hepatic artery under X-ray fluoroscopy, we acquired TRIP-MRI at 20 minutes post-IRE using 3 mL of 5% intraarterial gadopentetate dimeglumine. Semi-quantitative (peak enhancement, PE; time to peak, TTP; wash-in slope, WIS; areas under the time-intensity curve, AUT, over 30, 60, 90, 120, 150, and 180 seconds after the initiation of enhancement) and quantitative (Ktrans, ve, and vp) TRIP-MRI parameters were calculated. The relationships between TRIP-MRI parameters and histological measurements and the differential ability of TRIP-MRI parameters was assessed. RESULTS PE, AUT60, AUT90, AUT120, AUT150, AUT180, Ktrans, and ve were significantly higher in RE zones than in IRE zones (all P < 0.05), and AUC for these parameters ranged from 0.91(95% CI, 0.80, 1.00) to 0.99 (95% CI, 0.98, 1.00). There was no significant difference in AUC between any two parameters (Z, 0-1.47; P, 0.14-1.00). Hepatocyte apoptosis strongly correlated with PE, AUT60, AUT90, AUT120, AUT150, AUT180, Ktrans, and vp (the absolute value r, 0.6-0.7, all P < 0.0001). CONCLUSION AUT150 or AUT180 could be a potential imaging biomarker to differentiate RE from IRE zones, and TRIP-MRI permits to differentiate RE from IRE zones immediately after IRE procedure in the rabbit liver.
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Zhou L, Yin S, Chai W, Zhao Q, Tian G, Xu D, Jiang T. Irreversible electroporation in patients with liver tumours: treated-area patterns with contrast-enhanced ultrasound. World J Surg Oncol 2020; 18:305. [PMID: 33228665 PMCID: PMC7684738 DOI: 10.1186/s12957-020-02083-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/09/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Familiarity with post-IRE imaging interpretation is of considerable importance in determining ablation success and detecting recurrence. CEUS can be used to assess the tumour response and characteristics of the ablation zone. It is of clinical interest to describe the ultrasonographic findings of liver tumours after irreversible electroporation (IRE) percutaneous ablation. METHODS A prospective study of 24 cases of malignant liver tumours (22 cases of primary liver tumours and 2 cases of liver metastases) treated by IRE ablation was conducted. Two inspectors evaluated the ablation zone in a consensus reading performed immediately, 1 day, and 1 month after IRE ablation. The gold standard method, magnetic resonance imaging (MRI), was used to evaluate the effectiveness of the treatment at 1 month. RESULTS Immediately after IRE ablation and up to 1 month later, the ablation zones gradually changed from hypo-echogenicity to hyper-echogenicity on conventional ultrasound and showed non-enhancement on contrast-enhanced ultrasound (CEUS). One month after IRE ablation, CEUS and MRI results were highly consistent (κ = 0.78, p < 0.05). CONCLUSIONS We conclude that CEUS may be an effective tool for assessing post-IRE ablation changes after 1 month. CEUS enables the depiction of tumour vascularity in real time and serves as an easy, repeatable method.
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Affiliation(s)
- Linyu Zhou
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China
| | - Shanyu Yin
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China
| | - Weilu Chai
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China
| | - Qiyu Zhao
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China
| | - Guo Tian
- Collaborative Innovation Center for Diagnosis and Treatment of Infection Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Danxia Xu
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China
| | - Tian'an Jiang
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China. .,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China.
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Shangguan AJ, Zhou K, Yang J, Eresen A, Wang B, Sun C, Pan L, Hu S, Khan AT, Mouli SK, Yaghmai V, Zhang Z. Intraprocedural Transcatheter Intraarterial Perfusion (TRIP)-MRI for Evaluation of Irreversible Electroporation Therapy Response in a Rabbit Liver Tumor Model. Clin Exp Gastroenterol 2020; 13:543-553. [PMID: 33192084 PMCID: PMC7654546 DOI: 10.2147/ceg.s269163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/24/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Irreversible electroporation (IRE) is a promising new ablation method for hepatocellular carcinoma (HCC) treatment with few side-effects; however, tissue perfusion and differentiation between treatment zones have not been sufficiently studied. In this project, we analyzed HCC tumor perfusion changes immediately after IRE treatment using transcatheter intraarterial perfusion (TRIP)-MRI to monitor treatment zone margins. Materials and Methods All protocols were approved by the institutional animal care and use committee. A total of 34 rabbits were used for this prospective study: tumor liver group (n=17), normal liver group (n=14), and 3 for growing VX2 tumors. All procedures and imaging were performed under anesthesia. VX2 tumors were grown by injection of VX2 cells into rabbit hindlimbs. Liver tumors were induced by percutaneous US-guided injection of VX2 tumor fragments into liver. For digital subtraction angiography (DSA), a 2F catheter was advanced through left hepatic artery via femoral artery access, followed by contrast injection. All rabbits underwent baseline anatomic MRI, then IRE procedure or IRE probe placement only, and lastly post-procedure anatomic and TRIP-MRI. Liver tissues were dissected immediately after imaging for histology. All statistical analyses were performed on GraphPad Prism, with P<0.05 considered significant. Results IRE generated central IRE zone and peripheral reversible electroporation (RE) zone on anatomic MRI for both normal liver and liver tumor tissues. The semiquantitative analysis showed that IRE zone had the lowest AUC, PE, WIS, Ktrans, ve , and vp as well as the highest TTP, followed by RE zone, then untreated tissues. Receiver operating characteristic analysis showed that WIS and AUC60 had the highest AUCROC. Histologic analysis showed a positive correlation in viable area fraction between MRI and histologic measurements. IRE zone had the highest %apoptosis and lowest CD31+ staining. Conclusion Our results demonstrated that intraprocedural TRIP-MRI can effectively differentiate IRE and RE zones after IRE ablation in normal liver and liver tumor tissues.
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Affiliation(s)
- Anna J Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kang Zhou
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, People's Republic of China
| | - Jia Yang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aydin Eresen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bin Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, People's Republic of China
| | - Chong Sun
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Liang Pan
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu, People's Republic of China
| | - Su Hu
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Ali T Khan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Samdeep K Mouli
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiological Sciences, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Tamura M, Pedersoli F, Schulze-Hagen M, Zimmerman M, Isfort P, Kuhl CK, Schmitz-Rode T, Bruners P. Predictors of Occlusion of Hepatic Blood Vessels after Irreversible Electroporation of Liver Tumors. J Vasc Interv Radiol 2020; 31:2033-2042.e1. [PMID: 33267950 DOI: 10.1016/j.jvir.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To examine predictors of midterm occlusion in portal and hepatic veins within or adjacent to the ablation zone after irreversible electroporation (IRE) of liver tumors. MATERIALS AND METHODS This retrospective cohort analysis included 39 patients who underwent CT-guided IRE of liver tumors. Vessels within or adjacent to the ablation zone were identified on CT images acquired immediately after the procedure, and the positional relationships with the ablation zone (within/adjacent), locations (proximal/distal), and diameters (< 4 mm or ≥ 4 mm) were evaluated. Using contrast-enhanced follow-up scans, each vessel was classified as patent, stenosed, or occluded. Associations between vessel occlusion and each variable were investigated. RESULTS Overall, 33 portal veins and 64 hepatic veins were analyzed. Follow-up scans showed occlusion in 12/33 (36.7%) portal veins and 17/64 (26.6%) hepatic veins. Vessels within the ablation zone were occluded significantly more frequently than vessels adjacent to the ablation zone (portal: 55.6% [10/18] vs 13.3% [2/15], P = .04; hepatic: 45.4% [15/33] vs 6.4% [2/31], P = .011). Vessels with a diameter < 4 mm were also occluded significantly more frequently than vessels with a diameter ≥ 4 mm (portal: 72.7% [8/11] vs 18.1% [4/22], P = .011; hepatic: 54.8% [17/31] vs 0% [0/33], P < .001). The respective positive and negative predictive values for occlusion of vessels categorized as both within and < 4 mm were 88% (7/8) and 82% (20/25) for portal veins and 79% (15/19) and 96% (43/45) for hepatic veins. CONCLUSIONS Midterm vessel occlusion after liver IRE could be predicted with relatively high accuracy by assessing ablation location and vessel diameter.
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Affiliation(s)
- Masashi Tamura
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany; Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Zimmerman
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
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The Evolution of Dendritic Cell Immunotherapy against HIV-1 Infection: Improvements and Outlook. J Immunol Res 2020; 2020:9470102. [PMID: 32537473 PMCID: PMC7267878 DOI: 10.1155/2020/9470102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022] Open
Abstract
Dendritic cells (DC) are key phagocytic cells that play crucial roles in both the innate and adaptive immune responses against the human immunodeficiency virus type 1 (HIV-1). By processing and presenting pathogen-derived antigens, dendritic cells initiate a directed response against infected cells. They activate the adaptive immune system upon recognition of pathogen-associated molecular patterns (PAMPs) on infected cells. During the course of HIV-1 infection, a successful adaptive (cytotoxic CD8+ T-cell) response is necessary for preventing the progression and spread of infection in a variety of cells. Dendritic cells have thus been recognized as a valuable tool in the development of immunotherapeutic approaches and vaccines effective against HIV-1. The advancements in dendritic cell vaccines in cancers have paved the way for applications of this form of immunotherapy to HIV-1 infection. Clinical trials with patients infected with HIV-1 who are well-suppressed by antiretroviral therapy (ART) were recently performed to assess the efficacy of DC vaccines, with the goal of mounting an HIV-1 antigen-specific T-cell response, ideally to clear infection and eliminate the need for long-term ART. This review summarizes and compares methods and efficacies of a number of DC vaccine trials utilizing autologous dendritic cells loaded with HIV-1 antigens. The potential for advancement and novel strategies of improving efficacy of this type of immunotherapy is also discussed.
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Hu S, Sun C, Wang B, Zhou K, Pan L, Shangguan J, Yang J, Yaghmai V, Figini M, Zhang Z. Diffusion-Weighted MR Imaging to Evaluate Immediate Response to Irreversible Electroporation in a Rabbit VX2 Liver Tumor Model. J Vasc Interv Radiol 2019; 30:1863-1869. [PMID: 31542271 DOI: 10.1016/j.jvir.2019.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 02/09/2023] Open
Abstract
PURPOSE To evaluate the feasibility of diffusion-weighted imaging (DWI) in magnetic resonance imaging for quantitative measurement of responses following irreversible electroporation (IRE) in a rabbit liver tumor model. MATERIALS AND METHODS Twelve rabbits underwent ultrasound-guided VX2 tumor implantation in the left medial and left lateral liver lobes. The tumors in the left medial lobe were treated with IRE, whereas those in the left lateral lobe served as internal controls. DWI was performed before and immediately after IRE. Tumors were then harvested for histopathologic staining. The apparent diffusion coefficient (ADC) and change in ADC (ΔADC) were calculated based on DWI. Tumor apoptosis index (AI) was assessed by terminal deoxynucleotidyl transferase dUTP nick-end labeling. These measurements from DWI and histopathology were compared between untreated and treated tumors. RESULTS The ADC values, ΔADC, and AI showed statistically significant differences between treated and untreated tumors (P < .05 for all). ADC values were higher in treated tumors than in untreated tumors (1.08 × 10-3 mm2/s ± 0.15 vs 0.88 × 10-3 mm2/s ± 0.19; P = .042). CONCLUSIONS DWI can be used to quantitatively evaluate treatment response in liver tumors immediately after IRE.
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Affiliation(s)
- Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Chong Sun
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, China
| | - Kang Zhou
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Pan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Jia Yang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Matteo Figini
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
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Shangguan AJ, Sun C, Wang B, Pan L, Ma Q, Hu S, Yang J, Eresen A, Velichko Y, Yaghmai V, Zhang Z. DWI and DCE-MRI approaches for differentiating reversibly electroporated penumbra from irreversibly electroporated ablation zones in a rabbit liver model. Am J Cancer Res 2019; 9:1982-1994. [PMID: 31598399 PMCID: PMC6780669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023] Open
Abstract
The purpose of our study was to investigate the hypothesis that DWI-MRI and DCE-MRI cab be used to distinguish between IRE and RE zones of IRE treatment in a rabbit liver model. 6 rabbits underwent baseline and post-procedure MR imaging with DWI and DCE-MRI as well as IRE (10 pulses, 2000 V, 10 µs/pulse, 10 ms between pulses). Rabbits were euthanized immediately after post-procedure MRI to acquire liver tissue for histology. Liver tissues were fixed and then stained with HE and TUNEL. T1w and T2w intensities in different treatment zones were calculated and normalized to paraspinal muscle signal. ADC maps were generated from DWI. AUC, PE, TTP, WIS, Ktrans, Kep, and VE were calculated from DCE-MRI. Apoptosis index was calculated from TUNEL stained tissues. P<0.05 was considered statistically significant. Entire IRE treated region was hyperintense compared with untreated tissues on T1w, with the RE zone having a higher signal intensity. On DWI, IRE treated tissue had decreased ΔADC. The IRE zone has a lower ΔADC than the RE zone within the treated region. On DCE-MRI, IRE zone demonstrated the highest TTP and the lowest PE, WIS, Ktrans, Kep, and VE, followed by the RE zone then the untreated tissue. TUNEL staining of liver tissues showed that the IRE zone had the highest apoptosis index, followed by the RE zone and then untreated tissue. In conclusion, DCE-MRI and DWI parameters allow differentiation between RE and IRE zones in a rabbit liver model.
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Affiliation(s)
- Anna J Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Medical Student Training Program, Northwestern UniversityChicago, IL, USA
| | - Chong Sun
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Orthopaedics, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Bin Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, China
| | - Liang Pan
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Radiology, The Third Affiliated Hospital of Suzhou UniversityChangzhou, Jiangsu, China
| | - Quanhong Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Su Hu
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Radiology, The First Affiliated Hospital of Soochow UniversitySuzhou, Jiangsu, China
| | - Jia Yang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Aydin Eresen
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Yuri Velichko
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
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López-Alonso B, Hernáez A, Sarnago H, Naval A, Güemes A, Junquera C, Burdío JM, Castiella T, Monleón E, Gracia-Llanes J, Burdio F, Mejía E, Lucía O. Histopathological and Ultrastructural Changes after Electroporation in Pig Liver Using Parallel-Plate Electrodes and High-Performance Generator. Sci Rep 2019; 9:2647. [PMID: 30804395 PMCID: PMC6389957 DOI: 10.1038/s41598-019-39433-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/25/2019] [Indexed: 12/18/2022] Open
Abstract
Irreversible electroporation (IRE) has gained attention as a new non-thermal therapy for ablation with important benefits in terms of homogeneous treatment and fast recovery. In this study, a new concept of high voltage generator is used, enabling irreversible electroporation treatment in large tissue volume using parallel plates. Unlike currently available generators, the proposed versatile structure enables delivering high-voltage high-current pulses. To obtain homogeneous results, 3-cm parallel-plates electrodes have also been designed and implemented. IRE ablation was performed on six female pigs at 2000 V/cm electric field, and the results were analysed after sacrifice three hours, three days and seven days after ablation. Histopathological and ultrastructural studies, including transmission and scanning electron microscopy, were carried out. The developed high-voltage generator has proved to be effective for homogeneous IRE treatment using parallel plates. The destruction of the membrane of the hepatocytes and the alterations of the membranes of the cellular organelles seem incompatible with cell death by apoptosis. Although endothelial cells also die with electroporation, the maintenance of vascular scaffold allows repairing processes to begin from the third day after IRE as long as the blood flow has not been interrupted. This study has opened new direction for IRE using high performance generators and highlighted the importance of taking into account ultrastructural changes after IRE by using electron microscopy analysis.
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Affiliation(s)
- B López-Alonso
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain
| | - A Hernáez
- Hospital Clínico Universitario, 50009, Zaragoza, Spain
| | - H Sarnago
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain
| | - A Naval
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain
| | - A Güemes
- Hospital Clínico Universitario, 50009, Zaragoza, Spain
| | - C Junquera
- Faculty of Medicine, Institute for Health Research Aragón, Zaragoza, Spain
| | - J M Burdío
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain
| | - T Castiella
- Faculty of Medicine, Institute for Health Research Aragón, Zaragoza, Spain
| | - E Monleón
- Faculty of Medicine, Institute for Health Research Aragón, Zaragoza, Spain
| | - J Gracia-Llanes
- Faculty of Medicine, Institute for Health Research Aragón, Zaragoza, Spain
| | - F Burdio
- Hospital del Mar, 08018, Barcelona, Spain
| | - E Mejía
- Faculty of Medicine, Institute for Health Research Aragón, Zaragoza, Spain
| | - O Lucía
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain.
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Figini M, Wang X, Lyu T, Su Z, Wang B, Sun C, Shangguan J, Pan L, Zhou K, Ma Q, Yaghmai V, Procissi D, Larson AC, Zhang Z. Diffusion MRI biomarkers predict the outcome of irreversible electroporation in a pancreatic tumor mouse model. Am J Cancer Res 2018; 8:1615-1623. [PMID: 30210929 PMCID: PMC6129492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/29/2017] [Indexed: 06/08/2023] Open
Abstract
The purpose of this work is to explore the potential contribution of diffusion MRI to predict the effects of irreversible electroporation (IRE) in a pancreatic ductal adenocarcinoma (PDAC) mouse model. Thirteen mice were injected with Panc-02 PDAC cells in both flanks. One tumor was treated with IRE when it reached a diameter of about 5 mm. T2- and diffusion-weighted MRI sequences were acquired before IRE treatment and 1, 3 and 7 days later. The mice were euthanized 1 day (n = 6) or 2 weeks (n = 7) after treatment. The tumors were excised and stained with H&E, caspase-3, CD-3, F4/80. The volume and the mean and standard deviation of the apparent diffusion coefficient (ADC) were compared between treated and untreated lesions and correlated with histology-derived measures. At 1-day post-treatment, a dramatic ADC increase (+50.81%, P < 0.05) was found in ablated lesions, strongly correlated with apoptosis (τ = 0.90). At later time points the ADC returned to pre-treatment values, though histopathology showed a quite different scenario compared to the untreated controls. The ADC standard deviation measured within the treated tumors 1 day after IRE treatment had a strong negative correlation with the number of tumor cells found 14 days later (τ = 0.80). There was also a strong correlation between 1-day ADC and 14-day apoptosis in untreated tumors (τ = 0.95). In conclusion, diffusion MRI is sensitive to the short-term effects of IRE in PDAC tumors, and can help predict the long-term treatment outcome.
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Affiliation(s)
- Matteo Figini
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Xifu Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong UniversityShanghai, People’s Republic of China
| | - Tianchu Lyu
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Zhanliang Su
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Radiology, Tianjin Xiqing HospitalTianjin, People’s Republic of China
| | - Bin Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong provincial Engineering Technology Research Center of Minimally Invasive SurgeryGuangzhou, People’s Republic of China
| | - Chong Sun
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Orthopedics, Qilu Hospital, Shandong UniversityJinan, Shandong, People’s Republic of China
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Liang Pan
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Kang Zhou
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Quanhong Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL, USA
| | - Daniele Procissi
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Andrew C Larson
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL, USA
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Wang X, Su Z, Lyu T, Figini M, Procissi D, Shangguan J, Sun C, Wang B, Shang N, Gu S, Ma Q, Gordon AC, Lin K, Wang J, Lewandowski RJ, Salem R, Yaghmai V, Larson AC, Zhang Z. 18F-FDG PET Biomarkers Help Detect Early Metabolic Response to Irreversible Electroporation and Predict Therapeutic Outcomes in a Rat Liver Tumor Model. Radiology 2017; 287:137-145. [PMID: 29232185 DOI: 10.1148/radiol.2017170920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To test the hypothesis that biomarkers of fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used for the early detection of therapeutic response to irreversible electroporation (IRE) of liver tumor in a rodent liver tumor model. Materials and Methods The institutional animal care and use committee approved this study. Rats were inoculated with McA-RH7777 liver tumor cells in the left median and left lateral lobes. Tumors were allowed to grow for 7 days to reach a size typically at least 5 mm in longest diameter, as verified with magnetic resonance (MR) imaging. IRE electrodes were inserted, and eight 100-μsec, 2000-V pulses were applied to ablate the tumor tissue in the left median lobe. Tumor in the left lateral lobe served as a control in each animal. PET/computed tomography (CT) and MR imaging measurements were performed at baseline and 3 days after IRE for each animal. Additional MR imaging measurements were obtained 14 days after IRE. After 14-day follow-up MR imaging, rats were euthanized and tumors harvested for hematoxylin-eosin, CD34, and caspase-3 staining. Change in the maximum standardized uptake value (ΔSUVmax) was calculated 3 days after IRE. The maximum lesion diameter change (ΔDmax) was measured 14 days after IRE by using axial T2-weighted imaging. ΔSUVmax and ΔDmax were compared. The apoptosis index was calculated by using caspase-3-stained slices of apoptotic tumor cells. Pearson correlation coefficients were calculated to assess the relationship between ΔSUVmax at 3 days and ΔDmax (or apoptosis index) at 14 days after IRE treatment. Results ΔSUVmax, ΔDmax, and apoptosis index significantly differed between treated and untreated tumors (P < .001 for all). In treated tumors, there was a strong correlation between ΔSUVmax 3 days after IRE and ΔDmax 14 days after IRE (R = 0.66, P = .01) and between ΔSUVmax 3 days after IRE and apoptosis index 14 days after IRE (R = 0.57, P = .04). Conclusion 18F-FDG PET imaging biomarkers can be used for the early detection of therapeutic response to IRE treatment of liver tumors in a rodent model. © RSNA, 2017.
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Affiliation(s)
- Xifu Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Zhanliang Su
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Tianchu Lyu
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Matteo Figini
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Daniel Procissi
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Junjie Shangguan
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Chong Sun
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Bin Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Na Shang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Shanzhi Gu
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Quanhong Ma
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Andrew C Gordon
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Kai Lin
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Jian Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Robert J Lewandowski
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Riad Salem
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Vahid Yaghmai
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Andrew C Larson
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Zhuoli Zhang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
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Vroomen LGPH, Scheffer HJ, Melenhorst MCAM, de Jong MC, van den Bergh JE, van Kuijk C, van Delft F, Kazemier G, Meijerink MR. MR and CT imaging characteristics and ablation zone volumetry of locally advanced pancreatic cancer treated with irreversible electroporation. Eur Radiol 2017; 27:2521-2531. [PMID: 27659702 PMCID: PMC5409808 DOI: 10.1007/s00330-016-4581-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess specific imaging characteristics after irreversible electroporation (IRE) for locally advanced pancreatic carcinoma (LAPC) with contrast-enhanced (ce)MRI and ceCT, and to explore the correlation of these characteristics with the development of recurrence. METHODS Qualitative and quantitative analyses of imaging data were performed on 25 patients treated with percutaneous IRE for LAPC. Imaging characteristics of the ablation zone on ceCT and ceMRI were assessed over a 6-month follow-up period. Contrast ratio scores between pre- and post-treatment were compared. To detect early imaging markers for treatment failure, attenuation characteristics at 6 weeks were linked to the area of recurrence within 6 months. RESULTS Post-IRE, diffusion-weighted imaging (DWI)-b800 signal intensities decreased in all cases (p < 0.05). Both ceMRI and ceCT revealed absent or decreased contrast enhancement, with a hyperintense rim on ceMRI. Ablation zone volume increase was noted on both modalities in the first 6 weeks, followed by a decrease (p < 0.05). In the patients developing tumour recurrence (5/25), a focal DWI-b800 hyperintense spot at 6 weeks predated unequivocal recurrence on CT. CONCLUSION The most remarkable signal alterations after pancreatic IRE were shown by DWI-b800 and ceMRI. These early imaging characteristics may be useful to establish technical success and predict treatment outcome. KEY POINTS • This study describes imaging characteristics after irreversible electroporation (IRE) for pancreatic adenocarcinoma. • Familiarity with typical post-IRE imaging characteristics helps to interpret ablation zones. • Post-IRE, no central and variable rim enhancement are visible on contrast-enhanced imaging. • DWI-b800 may prove useful to predict early tumour recurrence. • Post-IRE examinations reveal an initial volume increase followed by a decrease.
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Affiliation(s)
- Laurien G P H Vroomen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Hester J Scheffer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marleen C A M Melenhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Janneke E van den Bergh
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Cornelis van Kuijk
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Foke van Delft
- Department of Gastroenterology and Hepatology, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Lyu T, Wang X, Su Z, Shangguan J, Sun C, Figini M, Wang J, Yaghmai V, Larson AC, Zhang Z. Irreversible electroporation in primary and metastatic hepatic malignancies: A review. Medicine (Baltimore) 2017; 96:e6386. [PMID: 28445252 PMCID: PMC5413217 DOI: 10.1097/md.0000000000006386] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Liver cancer makes up a huge percentage of cancer mortality worldwide. Irreversible electroporation (IRE) is a relatively new minimally invasive nonthermal ablation technique for tumors that applies short pulses of high frequency electrical energy to irreversibly destabilize cell membrane to induce tumor cell apoptosis. METHODS This review aims to investigate the studies regarding the use of IRE treatment in liver tumors and metastases to liver. We searched PubMed for all of IRE relevant English language articles published up to September 2016. They included clinical trials, experimental studies, observational studies, and reviews. This review manuscript is nothing with ethics issues and ethical approval is not provided. RESULTS In recent years, increasingly more studies in both preclinical and clinical settings have been conducted to examine the safety and efficacy of this new technique, shedding light on the crucial advantages and disadvantages that IRE possesses. Unlike the current leading thermal ablation techniques, such as radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation, IRE requires shorter ablation time without damaging adjacent important vital structures. CONCLUSION Although IRE has successfully claimed its valuable status in the field of hepatic cancer treatment both preclinical and clinical settings. In order to systemically test and establish its safety and efficacy for clinical applications, more studies still need to be conducted.
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Affiliation(s)
- Tianchu Lyu
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Xifu Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Zhanliang Su
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chong Sun
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Matteo Figini
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Andrew C. Larson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
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Figini M, Wang X, Lyu T, Su Z, Procissi D, Yaghmai V, Larson AC, Zhang Z. Preclinical and clinical evaluation of the liver tumor irreversible electroporation by magnetic resonance imaging. Am J Transl Res 2017; 9:580-590. [PMID: 28337285 PMCID: PMC5340692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
Irreversible electroporation (IRE) is a relatively new technique for tumor ablation. It has shown promising results in difficult cases where surgery is not recommended and delicate anatomic structures are present near or within the tumor. Currently, liver cancer is one of the most common targets for IRE treatment. Pre-operative and post-operative imaging has a key role in IRE procedures and research studies. Although ultrasound is usually the first choice, especially for intra-operative guidance, magnetic resonance imaging (MRI) plays an important role in the visualization and characterization of tumor before and after IRE in clinical and preclinical studies. However, the appearance of liver lesions after IRE with different MRI sequences has never been systematically investigated, and the most common practice is to limit the acquisition protocol to only contrast-enhanced T1-weighted images. In this work, the role of MRI in clinical and preclinical assessment of hepatic tumors treated with IRE is reviewed and discussed.
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Affiliation(s)
- Matteo Figini
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Xifu Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Tianchu Lyu
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Zhanliang Su
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Daniele Procissi
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL 60611, USA
| | - Andrew C Larson
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL 60611, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL 60611, USA
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Irreversible Electroporation: Defining the MRI Appearance of the Ablation Zone With Histopathologic Correlation in a Porcine Liver Model. AJR Am J Roentgenol 2017; 208:1141-1146. [PMID: 28177652 DOI: 10.2214/ajr.16.17207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the MRI appearance of the irreversible electroporation zone in porcine liver, with histopathologic correlation. MATERIALS AND METHODS Nine irreversible electroporation ablations were percutaneously created in two Yorkshire pigs. Irreversible electroporation was performed with a bipolar 16-gauge electrode with 3-cm exposure tip and fixed 8-mm interpolar distance. Gadoxetate disodium-enhanced 3-T MRI was performed 50 hours after irreversible electroporation. Livers were harvested immediately after MRI for histopathologic analysis. Ablation zone size was measured on each pulse sequence and correlated with pathologic ablation zone size. Qualitative MRI features of the ablation zone were assessed, and contrast-to-noise ratios (CNRs) were calculated. Statistical analysis included Pearson correlation and t tests. RESULTS Histopathologically, three distinct layers were present in the irreversible electroporation ablation zone: an inner layer of coagulative necrosis (hyperintense at T1- and T2-weighted imaging and nonenhancing), a middle layer of congestion and hemorrhage (hypointense at T1-weighted imaging, hyperintense at T2-weighted imaging and DWI, and progressively enhancing but hypointense at the hepatobiliary phase), and a peripheral layer of inflammation (hyperintense at the arterial phase but isointense at all other sequences). The hepatobiliary phase ablation zone size showed the highest correlation with the pathologic ablation zone size (r = 0.973). This correlation was significant (p < 0.001). T2-weighted imaging had the highest lesion-to-normal tissue CNR. CONCLUSION The irreversible electroporation ablation zone contains three distinct histopathologic zones, each with unique MRI features. T2-weighted imaging had the highest CNR, and the hepatobiliary phase had the strongest correlation with ablation zone size.
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Magnetic Resonance Imaging Findings After Percutaneous Irreversible Electroporation of Liver Metastases: A Systematic Longitudinal Study. Invest Radiol 2017; 52:23-29. [PMID: 27379698 PMCID: PMC5145252 DOI: 10.1097/rli.0000000000000301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective The aim of this study was to systematically investigate the course of magnetic resonance (MR) signal intensity (SI) changes that occur in noncirrhotic livers after irreversible electroporation (IRE) of liver metastases. Methods This study is an institutional review board–approved prospective longitudinal follow-up study on 27 patients with 37 liver metastases who underwent computed tomography–guided percutaneous IRE and a standardized follow-up protocol by serial hepatic MR imaging studies that consisted of a gadobutrol-enhanced dynamic series, axial T2-weighted (T2w) turbo spin echo, and diffusion-weighted imaging (b = 0/50/800), acquired before, within 2, and at 24 hours after IRE; at 1, 2, 4, 6, 8, and 12 weeks after IRE; and every 3 months thereafter for a follow-up of at least 12 months. Results The ablated target lesion remained visible within the ablation zone in 23 (62%) of 37 of cases for a mean time of 21 ± 20 weeks (median, 12 weeks). The ablation zone appeared homogeneously hyperintense on T2w turbo spin echo images on the day of IRE in 37 of 37 cases. By 24 hours after IRE, the ablation zone inverted its SI in 35 of 37 cases to intermediately hypointense, with a rim of T2w bright SI that exhibited arterial phase enhancement; this persisted for 7 ± 5 weeks (median, 4 weeks). The rim resolved in 35 (95%) of 37 cases within 3 months. The ablation zone increased slightly over the first 48 hours, then shrank progressively. Complete healing of the ablation zone was observed in 57% (21/37) after an average of 14 ± 15 (median, 8 weeks). Average apparent diffusion coefficient values of the ablation zone decreased from 0.74 ± 0.36 × 10−3 mm2/s pre-IRE to 0.63 ± 0.27 × 10−3 mm2/s within the first 24 hours (P < 0.05), followed by a progressive normalization to 0.91 ± 0.30 × 10−3 mm2/s at 2 months. Conclusions Knowledge of the broad spectrum of MR imaging findings after IRE is important to avoid diagnostic errors in the follow-up of patients after IRE.
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Sugimoto K, Moriyasu F, Saito K, Kobayashi Y, Itoi T. Multimodality imaging to assess immediate response following irreversible electroporation in patients with malignant hepatic tumors. J Med Ultrason (2001) 2016; 44:247-254. [DOI: 10.1007/s10396-016-0767-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/21/2016] [Indexed: 12/18/2022]
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Vogel JA, van Veldhuisen E, Agnass P, Crezee J, Dijk F, Verheij J, van Gulik TM, Meijerink MR, Vroomen LG, van Lienden KP, Besselink MG. Time-Dependent Impact of Irreversible Electroporation on Pancreas, Liver, Blood Vessels and Nerves: A Systematic Review of Experimental Studies. PLoS One 2016; 11:e0166987. [PMID: 27870918 PMCID: PMC5117758 DOI: 10.1371/journal.pone.0166987] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/07/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction Irreversible electroporation (IRE) is a novel ablation technique in the treatment of unresectable cancer. The non-thermal mechanism is thought to cause mostly apoptosis compared to necrosis in thermal techniques. Both in experimental and clinical studies, a waiting time between ablation and tissue or imaging analysis to allow for cell death through apoptosis, is often reported. However, the dynamics of the IRE effect over time remain unknown. Therefore, this study aims to summarize these effects in relation to the time between treatment and evaluation. Methods A systematic search was performed in Pubmed, Embase and the Cochrane Library for original articles using IRE on pancreas, liver or surrounding structures in animal or human studies. Data on pathology and time between IRE and evaluation were extracted. Results Of 2602 screened studies, 36 could be included, regarding IRE in liver (n = 24), pancreas (n = 4), blood vessels (n = 4) and nerves (n = 4) in over 440 animals (pig, rat, goat and rabbit). No eligible human studies were found. In liver and pancreas, the first signs of apoptosis and haemorrhage were observed 1–2 hours after treatment, and remained visible until 24 hours in liver and 7 days in pancreas after which the damaged tissue was replaced by fibrosis. In solitary blood vessels, the tunica media, intima and lumen remained unchanged for 24 hours. After 7 days, inflammation, fibrosis and loss of smooth muscle cells were demonstrated, which persisted until 35 days. In nerves, the median time until demonstrable histological changes was 7 days. Conclusions Tissue damage after IRE is a dynamic process with remarkable time differences between tissues in animals. Whereas pancreas and liver showed the first damages after 1–2 hours, this took 24 hours in blood vessels and 7 days in nerves.
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Affiliation(s)
- J. A. Vogel
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - E van Veldhuisen
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - P. Agnass
- Department of Radiation Therapy, Academic Medical Center, Amsterdam, the Netherlands
| | - J. Crezee
- Department of Radiation Therapy, Academic Medical Center, Amsterdam, the Netherlands
| | - F. Dijk
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - J. Verheij
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - T. M. van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
- Department of Experimental Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - M. R. Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - L. G. Vroomen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - K. P. van Lienden
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - M. G. Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
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Local Ablative Strategies for Ductal Pancreatic Cancer (Radiofrequency Ablation, Irreversible Electroporation): A Review. Gastroenterol Res Pract 2016; 2016:4508376. [PMID: 26981115 PMCID: PMC4770121 DOI: 10.1155/2016/4508376] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/28/2015] [Accepted: 01/13/2016] [Indexed: 02/07/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis. Locally advanced pancreatic cancer (LAPC) accounts for the 40% of the new diagnoses. Current treatment options are based on chemo- and radiotherapy regimens. Local ablative techniques seem to be the future therapeutic option for stage-III patients with PDAC. Radiofrequency Ablation (RFA) and Irreversible Electroporation (IRE) are actually the most emerging local ablative techniques used on LAPC. Initial clinical studies on the use of these techniques have already demonstrated encouraging results in terms of safety and feasibility. Unfortunately, few studies on their efficacy are currently available. Even though some reports on the overall survival are encouraging, randomized studies are still required to corroborate these findings. This study provides an up-to-date overview and a thematic summary of the current available evidence on the application of RFA and IRE on PDAC, together with a comparison of the two procedures.
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Chung DJ, Sung K, Osuagwu FC, Wu HH, Lassman C, Lu DS. Contrast Enhancement Patterns after Irreversible Electroporation: Experimental Study of CT Perfusion Correlated to Histopathology in Normal Porcine Liver. J Vasc Interv Radiol 2016; 27:104-11. [DOI: 10.1016/j.jvir.2015.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022] Open
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Padia SA, Johnson GE, Yeung RS, Park JO, Hippe DS, Kogut MJ. Irreversible Electroporation in Patients with Hepatocellular Carcinoma: Immediate versus Delayed Findings at MR Imaging. Radiology 2015; 278:285-94. [PMID: 26523493 DOI: 10.1148/radiol.2015150031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the postprocedure findings of irreversible electroporation (IRE) in patients with hepatocellular carcinoma (HCC) at magnetic resonance (MR) imaging. MATERIALS AND METHODS This retrospective study was Institutional Review Board approved, and informed consent was waived. Twenty patients with HCC were treated with IRE over a 2.5-year period. The median patient age was 62 years, and 75% of patients had cirrhosis with a Child-Pugh score of A. The median tumor diameter was 2.0 cm (range, 1.0-3.3 cm). Contrast material-enhanced multiphase MR imaging was performed on postprocedure days 1 and 30 and every 90 days thereafter. Ablation zone sizes and signal intensities were compared between each time point for both T1- and T2-weighted images. Trends in signal intensity and tumor dimensions over time were quantified by using generalized linear models. RESULTS MR imaging appearances of treated tumors include a zone of peripheral enhancement with centripetal filling on delayed contrast-enhanced images. Compared with postprocedure day 1, every 90 days there is a decrease of 28.9% (mean, axis) in the size of the enhancing ablation zone. Over time, there is a trend toward decreasing signal intensity in the peripheral ablation zone on both T2-weighted (P = .01) and contrast-enhanced T1-weighted (P < .08) images. Conversely, the tumor itself typically has increased signal intensity on the same sequences. CONCLUSION IRE of HCC results in a large region of enhancement on immediate postprocedure MR images that, over time, involutes and is associated with decreasing signal intensity of the peripheral ablation zone. This phenomenon may represent resolution of the reversible penumbra.
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Affiliation(s)
- Siddharth A Padia
- From the Section of Interventional Radiology (S.A.P., G.E.J., M.J.K.), Department of Surgery (R.S.Y.), and Department of Radiology (D.S.H.), University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98119
| | - Guy E Johnson
- From the Section of Interventional Radiology (S.A.P., G.E.J., M.J.K.), Department of Surgery (R.S.Y.), and Department of Radiology (D.S.H.), University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98119
| | - Raymond S Yeung
- From the Section of Interventional Radiology (S.A.P., G.E.J., M.J.K.), Department of Surgery (R.S.Y.), and Department of Radiology (D.S.H.), University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98119
| | - James O Park
- From the Section of Interventional Radiology (S.A.P., G.E.J., M.J.K.), Department of Surgery (R.S.Y.), and Department of Radiology (D.S.H.), University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98119
| | - Daniel S Hippe
- From the Section of Interventional Radiology (S.A.P., G.E.J., M.J.K.), Department of Surgery (R.S.Y.), and Department of Radiology (D.S.H.), University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98119
| | - Matthew J Kogut
- From the Section of Interventional Radiology (S.A.P., G.E.J., M.J.K.), Department of Surgery (R.S.Y.), and Department of Radiology (D.S.H.), University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98119
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Jiang C, Davalos RV, Bischof JC. A review of basic to clinical studies of irreversible electroporation therapy. IEEE Trans Biomed Eng 2015; 62:4-20. [PMID: 25389236 DOI: 10.1109/tbme.2014.2367543] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The use of irreversible electroporation (IRE) for cancer treatment has increased sharply over the past decade. As a nonthermal therapy, IRE offers several potential benefits over other focal therapies, which include 1) short treatment delivery time, 2) reduced collateral thermal injury, and 3) the ability to treat tumors adjacent to major blood vessels. These advantages have stimulated widespread interest in basic through clinical studies of IRE. For instance, many in vitro and in vivo studies now identify treatment planning protocols (IRE threshold, pulse parameters, etc.), electrode delivery (electrode design, placement, intraoperative imaging methods, etc.), injury evaluation (methods and timing), and treatment efficacy in different cancer models. Therefore, this study reviews the in vitro, translational, and clinical studies of IRE cancer therapy based on major experimental studies particularly within the past decade. Further, this study provides organized data and facts to assist further research, optimization, and clinical applications of IRE.
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Percutaneous ablation therapy of hepatocellular carcinoma with irreversible electroporation: MRI findings. AJR Am J Roentgenol 2015; 204:1000-7. [PMID: 25905934 DOI: 10.2214/ajr.14.12509] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Irreversible electroporation is a new ablation modality. Our purpose was to describe the MRI findings after irreversible electroporation treatment of hepatocellular carcinoma (HCC). SUBJECTS AND METHODS In an 18-month period, we treated 24 HCC lesions in 20 patients who were not candidates for surgery. MRI was performed before and 1 month after irreversible electroporation. We used the liver-specific contrast medium gadoxetic acid. We evaluated the size, shape, signal intensity (T1-weighted, T2-weighted, and diffusion-weighted imaging), dynamic contrast enhancement pattern, and signal behavior during the liver-specific phase. Changes in the perilesional parenchyma, perfusion abnormalities, and complications were also recorded. RESULTS According to the modified Response Evaluation Criteria in Solid Tumors system, 22 of 24 lesions had a complete response, and two lesions showed a partial response and were retreated. The lesions showed a mean size increase of 10%, with a round or oval shape. On the T1-weighted images, we observed a hyperintense core and a hypointense rim. On the T2-weighted sequences, the signal was heterogeneously hypointense. On diffusion-weighted images, 83% of lesions showed restricted diffusion, with b values of 0-800 s/mm(2), whereas in 17% of the lesions, the signal was not clearly discernible for different b values. The apparent diffusion coefficient values did not show statistically significant differences between the baseline (800-1020 × 10(-3) mm(2)/s) and the reassessment after 1 month (900-1100 × 10(-3) mm(2)/s). The necrotic area did not show a signal increase after contrast material injection. Perfusion abnormalities, such as areas of transient hepatic intensity difference, were present in the tissue adjacent to six treated lesions. In two patients, a reduced or absent concentration of the contrast medium was observed during the liver-specific phase around the ablation zone. One patient had an arteriovenous shunt and another had biliary duct dilatation. CONCLUSION MRI detects characteristic morphologic and functional changes after irreversible electroporation treatment.
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Irreversible electroporation for nonthermal tumor ablation in patients with hepatocellular carcinoma: initial clinical experience in Japan. Jpn J Radiol 2015; 33:424-32. [PMID: 26032929 DOI: 10.1007/s11604-015-0442-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/20/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE This clinical study was conducted to evaluate the safety and short-term outcomes of irreversible electroporation (IRE) for the treatment of patients with hepatocellular carcinoma (HCC) in Japan. MATERIALS AND METHODS The study was designed in a prospective setting. Five patients (3 men and 2 women; mean age, 66.6 ± 5.8 years) with 6 HCCs were enrolled and treated using percutaneous ultrasound (US)-guided IRE. Safety was assessed based on adverse events and laboratory values. Local control was assessed using contrast-enhanced US with a perflubutane microbubble contrast agent, contrast-enhanced multiphase CT, and gadoxetic acid-enhanced MRI (EOB-MRI) at designated points. RESULTS The tumors ranged in diameter from 11 to 28 mm (mean diameter, 17.5 ± 6.3 mm). Five of the 6 tumors (83 %) were successfully treated, with no local recurrence to date (mean follow-up 244 ± 55 days). In 1 lesion located in liver segment 1, residual tumor was diagnosed at 7 days after intervention by follow-up EOB-MRI. No serious complications related to the IRE procedure were observed. CONCLUSION The results of this study suggest that image-guided percutaneous IRE can achieve satisfactory local disease control, particularly for small HCCs, and is well tolerated by patients.
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Bimonte S, Barbieri A, Palaia R, Leongito M, Albino V, Piccirillo M, Arra C, Izzo F. An overview of loco-regional treatments in patients and mouse models for hepatocellular carcinoma. Infect Agent Cancer 2015; 10:9. [PMID: 25755676 PMCID: PMC4353675 DOI: 10.1186/s13027-015-0004-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/20/2015] [Indexed: 12/20/2022] Open
Abstract
Hepatocellular carcinoma is a highly aggressive malignancy and is the third leading cause of cancer-related deaths worldwide. Although surgery is currently considered the most effective curative treatment for this type of cancer, it is note that most of patients have a poor prognosis due to chemioresistence and tumor recurrence. Loco-regional therapies, including radiofrequency ablation, surgical resection and transcatheter arterial chemoembolization play a major role in the clinical management of hepatocellular carcinoma. In order to improve the treatment outcome of patients diagnosed with this disease, several in vivo studies by using different techniques on cancer mouse models have been performed. This review will focus on the latest papers on the efficacy of loco-regional therapy and combined treatments in patients and mouse models of hepatocellular carcinoma.
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Affiliation(s)
- Sabrina Bimonte
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Antonio Barbieri
- INT Facility, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Maddalena Leongito
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Vittorio Albino
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Mauro Piccirillo
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Claudio Arra
- INT Facility, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
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Tam AL, Abdelsalam ME, Gagea M, Ensor JE, Moussa M, Ahmed M, Goldberg SN, Dixon K, McWatters A, Miller JJ, Srimathveeravalli G, Solomon SB, Avritscher R, Wallace MJ, Gupta S. Irreversible electroporation of the lumbar vertebrae in a porcine model: is there clinical-pathologic evidence of neural toxicity? Radiology 2014; 272:709-19. [PMID: 24766034 DOI: 10.1148/radiol.14132560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the effects of irreversible electroporation (IRE) in the porcine spine. MATERIALS AND METHODS This study was approved by the institutional animal care and use committee. Twenty computed tomographically guided IRE ablations in either a transpedicular location or directly over the posterior cortex were performed in the lumbar vertebrae of 10 pigs by a single operator. T1- and T2-weighted magnetic resonance (MR) imaging was performed with and without contrast material 2 or 7 days after ablation. Mathematical modeling was performed to estimate the extent of ablation. Clinical, radiologic, pathologic, and simulation findings were analyzed. The Miller low-bias back transformation was used to construct 95% confidence intervals for the mean absolute percentage difference between the maximum length and width of the ablation zone on MR images and pathologic measurements by using square-root-transformed data. RESULTS Bipolar IRE electrode placement and ablation were successful in all cases. The mean distances from the IRE electrode to the posterior wall of the vertebral body or the exiting nerve root were 2.93 mm ± 0.77 (standard deviation) and 7.87 mm ± 1.99, respectively. None of the animals had neurologic deficits. Well-delineated areas of necrosis of bone, bone marrow, and skeletal muscle adjacent to the vertebral body were present. Histopathologic changes showed outcomes that matched with simulation-estimated ablation zones. The percentage absolute differences in the ablation measurements between MR imaging and histopathologic examination showed the following average errors: 24.2% for length and 28.8% for width measurements on T2-weighted images, and 26.1% for length and 33.3% for width measurements on T1-weighted contrast material-enhanced images. CONCLUSION IRE ablation in the porcine spine is feasible and safe and produces localized necrosis with minimal neural toxicity. Signal intensity changes on images acquired with standard MR imaging sequences demonstrate the ablation zone to be larger than that at histopathologic examination.
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Affiliation(s)
- Alda L Tam
- From the Departments of Interventional Radiology (A.L.T., M.E.A., K.D., A.M., R.A., M.J.W., S.G.), Veterinary Medicine and Surgery (M.G., J.J.M.), and Biostatistics and Applied Mathematics (J.E.E.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.M., M.A., S.N.G.); Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); Radiochemistry and Imaging Science Service and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (G.S.); and Interventional Radiology Service and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (S.B.S.)
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Kranjc M, Markelc B, Bajd F, Čemažar M, Serša I, Blagus T, Miklavčič D. In situ monitoring of electric field distribution in mouse tumor during electroporation. Radiology 2014; 274:115-23. [PMID: 25144647 DOI: 10.1148/radiol.14140311] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To investigate the feasibility of magnetic resonance (MR) electric impedance tomography ( EIT electric impedance tomography ) technique for in situ monitoring of electric field distribution during in vivo electroporation of mouse tumors to predict reversibly electroporated tumor areas. MATERIALS AND METHODS All experiments received institutional animal care and use committee approval. Group 1 consisted of eight tumors that were used for determination of predicted area of reversibly electroporated tumor cells with MR EIT electric impedance tomography by using a 2.35-T MR imager. In addition, T1-weighted images of tumors were acquired to determine entrapment of contrast agent within the reversibly electroporated area. A correlation between predicted reversible electroporated tumor areas as determined with MR EIT electric impedance tomography and areas of entrapped MR contrast agent was evaluated to verify the accuracy of the prediction. Group 2 consisted of seven tumors that were used for validation of radiologic imaging with histopathologic staining. Histologic analysis results were then compared with predicted reversible electroporated tumor areas from group 1. Results were analyzed with Pearson correlation analysis and one-way analysis of variance. RESULTS Mean coverage ± standard deviation of tumors with electric field that leads to reversible electroporation of tumor cells obtained with MR EIT electric impedance tomography (38% ± 9) and mean fraction of tumors with entrapped MR contrast agent (41% ± 13) were correlated (Pearson analysis, r = 0.956, P = .005) and were not statistically different (analysis of variance, P = .11) from mean fraction of tumors from group 2 with entrapped fluorescent dye (39% ± 12). CONCLUSION MR EIT electric impedance tomography can be used for determining electric field distribution in situ during electroporation of tissue. Implementation of MR EIT electric impedance tomography in electroporation-based applications, such as electrochemotherapy and irreversible electroporation tissue ablation, would enable corrective interventions before the end of the procedure and would additionally improve the treatment outcome.
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Affiliation(s)
- Matej Kranjc
- From the Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, SI-1000 Ljubljana, Slovenia (M.K., D.M.); Ljubljana Institute of Oncology, Ljubljana, Slovenia (B.M., M. Č., T.B.); Department of Condensed Matter Physics, Jozef Stefan Institute, Ljubljana, Slovenia (F.B., I.S.); Department of Biomedical Engineering, Kyung Hee University, Republic of Korea (I.S.); and Faculty of Health Sciences, University of Primorska, Izola, Slovenia (M.Č.)
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Silk M, Tahour D, Srimathveeravalli G, Solomon SB, Thornton RH. The state of irreversible electroporation in interventional oncology. Semin Intervent Radiol 2014; 31:111-7. [PMID: 25053862 DOI: 10.1055/s-0034-1373785] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A new ablation modality, irreversible electroporation (IRE), has been of increasing interest in interventional radiology. Its nonthermal mechanism of action of killing tumor cells allows physicians the ability to ablate tumors in areas previously contraindicated for thermal ablation. This article reviews the current published clinical outcomes, imaging follow-up, and the current knowledge gaps in the procedure for patients treated with IRE.
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Affiliation(s)
- Mikhail Silk
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Tahour
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Govindarajan Srimathveeravalli
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond H Thornton
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Jourabchi N, Beroukhim K, Tafti BA, Kee ST, Lee EW. Irreversible electroporation (NanoKnife) in cancer treatment. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Zhang Y, White SB, Nicolai JR, Zhang Z, West DL, Kim DH, Goodwin AL, Miller FH, Omary RA, Larson AC. Multimodality imaging to assess immediate response to irreversible electroporation in a rat liver tumor model. Radiology 2014; 271:721-9. [PMID: 24555632 DOI: 10.1148/radiol.14130989] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare changes on ultrasonographic (US), computed tomographic (CT), and magnetic resonance (MR) images after irreversible electroporation (IRE) ablation of liver and tumor tissues in a rodent hepatoma model. MATERIALS AND METHODS Studies received approval from the institutional animal care and use committee. Forty-eight rats were used, and N1-S1 tumors were implanted in 24. Rats were divided into groups and allocated for studies with each modality. Imaging was performed in normal liver tissues and tumors before and after IRE. MR imaging was performed in one group before and after IRE after hepatic vessel ligation. US images were graded to determine echogenicity changes, CT attenuation was measured (in Hounsfield units), and MR imaging signal-to-noise ratio (SNR) was measured before and after IRE. Student t test was used to compare attenuation and SNR measurements before and after IRE (P < .05 indicated a significant difference). RESULTS IRE ablation produced greater alterations to echogenicity in normal tissues than in tumors. Attenuation in ablated liver tissues was reduced compared with that in control tissues (P < .001), while small attenuation differences between ablated (42.11 HU ± 2.11) and control (45.14 HU ± 2.64) tumors trended toward significance (P = .052). SNR in ablated normal tissues was significantly altered after IRE (T1-weighted images: pre-IRE, 145.95 ± 24.32; post-IRE, 97.80 ± 18.03; P = .004; T2-weighted images, pre-IRE, 47.37 ± 18.31; post-IRE, 90.88 ± 37.15; P = .023). In tumors, SNR differences before and after IRE were not significant. No post-IRE signal changes were observed after hepatic vessel ligation. CONCLUSION IRE induces rapid changes on gray-scale US, unenhanced CT, and MR images. These changes are readily visible and may assist a performing physician to delineate ablation zones from the unablated surrounding parenchyma.
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Affiliation(s)
- Yue Zhang
- From the Department of Bioengineering, University of Illinois at Chicago, Chicago, Ill (Y.Z., A.C.L.); Department of Radiology (Y.Z., S.B.W., J.R.N., Z.Z., D.L.W., D.H.K., A.L.G., F.H.M., R.A.O., A.C.L.) and Robert H. Lurie Comprehensive Cancer Center (A.C.L.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (A.C.L.)
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Nanoknife and Hepatic Embolization for Colorectal Cancer Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-013-0202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The effect of blood flow on magnetic resonance imaging of non thermal irreversible electroporation. Sci Rep 2013; 3:3088. [PMID: 24169528 PMCID: PMC3812656 DOI: 10.1038/srep03088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/15/2013] [Indexed: 12/18/2022] Open
Abstract
To generate an understanding of the physiological significance of MR images of Non-Thermal Irreversible Electroporation (NTIRE) we compared the following MR imaging sequences: T1W, T2W, PD, GE, and T2 SPAIR acquired after NTIRE treatment in a rodent liver model. The parameters that were studied included the presence or absence of a Gd-based contrast agent, and in vivo and ex-vivo NTIRE treatments in the same liver. NTIRE is a new minimally invasive tissue ablation modality in which pulsed electric fields cause molecularly selective cell death while, the extracellular matrix and large blood vessels remain patent. This attribute of NTIRE is of major clinical importance as it allows treatment of undesirable tissues near critical blood vessels. The presented study results suggest that MR images acquired following NTIRE treatment are all directly related to the unique pattern of blood flow after NTIRE treatment and are not produced in the absence of blood flow.
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Zhang Z, Li W, Procissi D, Tyler P, Omary RA, Larson AC. Rapid dramatic alterations to the tumor microstructure in pancreatic cancer following irreversible electroporation ablation. Nanomedicine (Lond) 2013; 9:1181-92. [PMID: 24024571 DOI: 10.2217/nnm.13.72] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM NanoKnife(®) (Angiodynamics, Inc., NY, USA) or irreversible electroporation (IRE) is a newly available ablation technique to induce the formation of nanoscale pores within the cell membrane in targeted tissues. The purpose of this study was to elucidate morphological alterations following 30 min of IRE ablation in a mouse model of pancreatic cancer. MATERIALS & METHODS Immunohistochemistry markers were compared with diffusion-weighted MRI apparent diffusion coefficient measurements before and after IRE ablation. RESULTS Immunohistochemistry apoptosis index measurements were significantly higher in IRE-treated tumors than in controls. Rapid tissue alterations after 30 min of IRE ablation procedures (structural and morphological alterations along with significantly elevated apoptosis markers) were consistently observed and well correlated to apparent diffusion coefficient measurements. DISCUSSION This imaging assay offers the potential to serve as an in vivo biomarker for noninvasive detection of tumor response following IRE ablation.
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Affiliation(s)
- Zhuoli Zhang
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, 16th Floor, Chicago, IL 60611, USA
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Guo Y, Zhang Z, Kim DH, Li W, Nicolai J, Procissi D, Huan Y, Han G, Omary RA, Larson AC. Photothermal ablation of pancreatic cancer cells with hybrid iron-oxide core gold-shell nanoparticles. Int J Nanomedicine 2013; 8:3437-46. [PMID: 24039426 PMCID: PMC3771851 DOI: 10.2147/ijn.s47585] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose Photothermal ablation is a minimally invasive approach, which typically involves delivery of photothermal sensitizers to targeted tissues. The purpose of our study was to demonstrate that gold nanoparticles are phagocytosed by pancreatic cancer cells, thus permitting magnetic resonance imaging (MRI) of sensitizer delivery and photothermal ablation. Patients and methods Iron-oxide core/gold-shell nanoparticles (GoldMag®, 30 nm diameter; Xi’an GoldMag Biotechnology Co, Xi’an, People’s Republic of China) were used. In a 96-well plate, 3 × 104 PANC-1 (human pancreatic cancer cell line) cells were placed. GoldMag (0, 25, or 50 μg/mL) was added to each well and 24 hours allowed for cellular uptake. Samples were then divided into two groups: one treated with photothermal ablation (7.9 W/cm2) for 5 minutes, the other not treated. Photothermal ablation was performed using laser system (BWF5; B&W Tek, Inc, Newark, DE, USA). Intraprocedural temperature changes were measured using a fiber optic temperature probe (FTP-LN2; Photon Control Inc, Burnaby, BC, Canada). After 24 hours, the remaining number of viable cells was counted using trypan blue staining; cell proliferation percentage was calculated based on the total number of viable cells after treatment compared with control. MRI of GoldMag uptake was performed using a 7.0T ClinScan system (Bruker BioSpin, Ettlingen, Germany). Results Temperature curves demonstrated that with increased GoldMag uptake, laser irradiation produced higher temperature elevations in the corresponding samples; temperature elevations of 12.89°C, 35.16°C, and 79.51°C were achieved for 0, 25, and 50 μg/mL GoldMag. Without photothermal ablation, the cell proliferation percentage changed from 100% to 71.3% and 47.0% for cells treated with 25 and 50 μg/mL GoldMag. Photothermal ablation of PANC-1 cells demonstrated an effective treatment response, specifically a reduction to only 61%, 21.9%, and 2.3% cell proliferation for cells treated with 0, 25, and 50 μg/mL GoldMag. MRI was able to visualize GoldMag uptake within PANC-1 cells. Conclusion Our findings suggest that photothermal ablation may be effective in the treatment of pancreatic cancer. GoldMag nanoparticles could serve as photothermal sensitizers, and MRI is feasible to quantify delivery.
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Affiliation(s)
- Yang Guo
- Department of Radiology, Northwestern University, Chicago, IL, USA
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Chen J, Woodrum DA, Glaser KJ, Murphy MC, Gorny K, Ehman R. Assessment of in vivo laser ablation using MR elastography with an inertial driver. Magn Reson Med 2013; 72:59-67. [PMID: 23904298 DOI: 10.1002/mrm.24891] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the feasibility of using MR Elastography (MRE) to monitor tissue coagulation extent during in vivo percutaneous laser ablation of the liver. METHODS A novel inertial acoustic driver was developed to apply mechanical waves via the ablation instrument. Ablation testing was performed in live juvenile female pigs under anesthesia in a 1.5-T whole-body MRI scanner. RESULTS The inertial driver produced suitable mechanical wave fields in the liver before, during, and after the laser ablation. During 2-min ablations using 4.5-, 7.5- and 15-W laser power, the stiffness of the lesions changed substantially in response to laser heating, indicative of protein denaturation. After a lethal thermal dose (2-min, 15-W) ablation, lesion stiffness was significantly greater than the baseline values (P < 0.007) and became stiffer over time; the mean stiffness increments from baseline were significantly greater than those after lower dose (2-min, 7.5-W) ablations (64.4% vs. 22.5%, P = 0.009). CONCLUSION MRE was shown capable of measuring tissue stiffness changes due to in vivo laser ablation. If confirmed through additional studies, this technology may be useful in clinical tumor ablation to monitor the spatial extent of tissue coagulation.
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Affiliation(s)
- Jun Chen
- Radiology Department, Mayo Clinic, Rochester, Minnesota, USA
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Kim HB, Sung CK, Baik KY, Moon KW, Kim HS, Yi JH, Jung JH, Moon MH, Choi OK. Changes of apoptosis in tumor tissues with time after irreversible electroporation. Biochem Biophys Res Commun 2013; 435:651-6. [PMID: 23688425 DOI: 10.1016/j.bbrc.2013.05.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 12/18/2022]
Abstract
Irreversible electroporation is a novel method of ablating living tissues through its non-thermal effects, unlike radiofrequency ablation which has a severe problem of heat sink. It is due to high-energy direct current which leads to permanent disruption of lipid bilayer integrity in terms of exchanges between intra- and extracellular components via nano-sized pores. That finally causes irreversible damage to cellular homeostasis. Irreversibly damaged cells may undergo apoptosis followed by necrosis with time after electroporation. This damage can make it possible to monitor the ablated area with time post-IRE through MR imaging and an ultrasound system. Most previous studies have investigated the immediate response of undesired tissue to IRE. In our study, we showed changes of tumor tissues with time post-IRE by histological analysis and MR imaging. Tissues under IRE ablation showed a peak apoptotic rate at 24 h after IRE ablation with viable tissues at the peripheral rim of treated tissues in histological analysis. This phenomenon was also observed with no enhancement on contrast-enhanced MR images due to devascularization of IRE ablated zones.
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Affiliation(s)
- Hong-Bae Kim
- Department of Radiology and Seoul National University Cancer Research Institute, Seoul National University College of Medicine, SNU-SMG Boramae Medical Center, 39 Boramae-Gil, Dongjak-Gu, Seoul 156-707, Republic of Korea
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Irreversible electroporation in porcine liver: acute computed tomography appearance of ablation zone with histopathologic correlation. J Comput Assist Tomogr 2013; 37:154-8. [PMID: 23493202 DOI: 10.1097/rct.0b013e31827dbf9b] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to define acute computed tomography (CT) characteristics of ablation zone created by irreversible electroporation (IRE) in porcine liver, with histopathologic correlation. METHODS Twenty-three IRE ablation zones were created in 4 Yorkshire pig livers percutaneously under image guidance. A prototype generator was used (Ethicon Endo-surgery, Cincinnati, Ohio). Variable spacing of paired electrodes between 1 and 2.0 cm was used. Contrast-enhanced multiphasic CT scans were obtained. Pigs were killed after 5 to 6 hours for gross pathology sectioning with routine and vital histological stains. Computed tomography images were analyzed using 3-dimensional software, and ablation zone size measured on CT was correlated with pathologically determined size. RESULTS Nineteen of 19 ablation zones created with up to 1.5-cm spacing showed fusion between individual ablation zones generated by each electrode. Ablation zones were isodense precontrast and hypodense to liver postcontrast, with best delineation in the portal phase. Nine of these had nondistorted circumferential margins on both CT and gross pathology suitable for correlation, and among these, size measurements on CT were closely correlated with pathologically determined ablation zone size. Most importantly, on the delayed venous phase, there is internal enhancement within the ablation zone itself, except for small perielectrode zones that remained hypodense. On histopathology, IRE ablation zones showed preserved microvasculature with congestion of sinusoids, except for small perielectrode zones where coagulative changes were suggested. CONCLUSION Portal phase contrast-enhanced CT scans correlate well with liver IRE ablation size and shape on histopathology.
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Golberg A, Yarmush ML. Nonthermal irreversible electroporation: fundamentals, applications, and challenges. IEEE Trans Biomed Eng 2013; 60:707-14. [PMID: 23314769 DOI: 10.1109/tbme.2013.2238672] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tissue ablation is an essential procedure for the treatment of many diseases. In the last decade, a nonthermal tissue ablation using intensive pulsed electric fields, called nonthermal irreversible electroporation (NTIRE), has rapidly emerged. The exact mechanisms responsible for cell death by NTIRE, however, are currently unknown. Nevertheless, the technique's remarkable ability to ablate tissue in the proximity of larger blood vessels, to preserve tissue architecture, short procedure duration, and shortened postoperative recovery period rapidly moved NTIRE from bench to bed side. This work provides an overview on the development of NTIRE, its current state-of-the-art, challenges, and future needs.
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Affiliation(s)
- Alexander Golberg
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Mannelli L, Padia SA, Yeung RS, Green DE. Irreversible electroporation of a liver metastasis. Liver Int 2013; 33:104. [PMID: 22925039 DOI: 10.1111/liv.12000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 07/28/2012] [Indexed: 02/13/2023]
Affiliation(s)
- Lorenzo Mannelli
- Department of Radiology, University of Washington, Seattle, WA, USA
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Short- and mid-term effects of irreversible electroporation on normal renal tissue: an animal model. Cardiovasc Intervent Radiol 2012; 36:512-20. [PMID: 22893419 DOI: 10.1007/s00270-012-0452-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/12/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE Irreversible electroporation (IRE) is a novel nonthermal tissue ablation technique by high current application leading to apoptosis without affecting extracellular matrix. Previous results of renal IRE shall be supplemented by functional MRI and differentiated histological analysis of renal parenchyma in a chronic treatment setting. METHODS Three swine were treated with two to three multifocal percutaneous IRE of the right kidney. MRI was performed before, 30 min (immediate-term), 7 days (short-term), and 28 days (mid-term) after IRE. A statistical analysis of the lesion surrounded renal parenchyma intensities was made to analyze functional differences depending on renal part, side and posttreatment time. Histological follow-up of cortex and medulla was performed after 28 days. RESULTS A total of eight ablations were created. MRI showed no collateral damage of surrounded tissue. The highest visual contrast between lesions and normal parenchyma was obtained by T2-HR-SPIR-TSE-w sequence of DCE-MRI. Ablation zones showed inhomogeneous necroses with small perifocal edema in the short-term and sharp delimitable scars in the mid-term. MRI showed no significant differences between adjoined renal parenchyma around ablations and parenchyma of untreated kidney. Histological analysis demonstrated complete destruction of cortical glomeruli and tubules, while collecting ducts, renal calyxes, and pelvis of medulla were preserved. Adjoined kidney parenchyma around IRE lesions showed no qualitative differences to normal parenchyma of untreated kidney. CONCLUSIONS This porcine IRE study reveals a multifocal renal ablation, while protecting surrounded renal parenchyma and collecting system over a mid-term period. That offers prevention of renal function ablating centrally located or multifocal renal masses.
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Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg 2012; 215:379-87. [PMID: 22704820 DOI: 10.1016/j.jamcollsurg.2012.04.029] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 04/10/2012] [Accepted: 04/11/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ablation is increasingly used to treat primary and secondary liver cancer. Ablation near portal pedicles and hepatic veins is challenging. Irreversible electroporation (IRE) is a new ablation technique that does not rely on heat and, in animals, appears to be safe and effective when applied near hepatic veins and portal pedicles. This study evaluated the safety and short-term outcomes of IRE to ablate perivascular malignant liver tumors. STUDY DESIGN A retrospective review of patients treated with IRE between January 1, 2011 and November 2, 2011 was performed. Patients were selected for IRE when resection or thermal ablation was not indicated due to tumor location. Treatment outcomes were classified by local, regional, and systemic recurrence and complications. Local failure was defined as abnormal enhancement at the periphery of an ablation defect on post-procedure contrast imaging. RESULTS Twenty-eight patients had 65 tumors treated. Twenty-two patients (79%) were treated via an open approach and 6 (21%) were treated percutaneously. Median tumor size was 1 cm (range 0.5 to 5 cm). Twenty-five tumors were <1 cm from a major hepatic vein; 16 were <1 cm from a major portal pedicle. Complications included 1 intraoperative arrhythmia and 1 postoperative portal vein thrombosis. Overall morbidity was 3%. There were no treatment-associated mortalities. At median follow-up of 6 months, there was 1 tumor with persistent disease (1.9%) and 3 tumors recurred locally (5.7%). CONCLUSIONS This early analysis of IRE treatment of perivascular malignant hepatic tumors demonstrates safety for treating liver malignancies. Larger studies and longer follow-up are necessary to determine long-term efficacy.
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Electroporation-mediated transcatheter arterial chemoembolization in the rabbit VX2 liver tumor model. Invest Radiol 2012; 47:116-20. [PMID: 21934518 DOI: 10.1097/rli.0b013e31822e57cc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
RATIONALE AND OBJECTIVES Electropermeabilization involves the application of electrical pulses to increase cell membrane permeability. The purpose of our study was to demonstrate the potential to use electroporation-mediated transcatheter arterial chemoembolization (E-TACE) approaches to increase liver tumor drug uptake while using magnetic resonance imaging (MRI) for intraprocedural optimization of these procedures. METHODS Fourteen VX2 tumors were grown in the left hepatic lobes of 8 rabbits. Two tumors were grown in each of 6 rabbits (1 tumor serving as E-TACE-treated tumor and the other as nonelectroporated control), and solitary larger tumors were grown in 2 rabbits (half of the tumor treated with E-TACE, remaining half serving as control). Each rabbit was selectively catheterized under digital subtraction angiography guidance. Baseline MRI was performed to generate tumor contrast enhancement curves following catheter-directed infusion of gadopentetate dimeglumine to estimate the proper time delay between subsequent bolus infusion of cisplatin and application of electrical pulses (electrodes were used to deliver 8, 100-μs, 1300-V pulses at the selected delay interval postinfusion). Three hours after E-TACE, rabbits were euthanized, and tumors were sectioned for inductively coupled plasma mass spectroscopy measurements of platinum concentration (serving as reference standard of cisplatin uptake levels). RESULTS Inductively coupled plasma mass spectroscopy results demonstrated significantly increased cisplatin uptake in E-TACE-treated tumor tissues, increases of 6.0 ± 3.3-fold compared with transcatheter infusion alone (P = 0.017). CONCLUSIONS Our findings suggest that our E-TACE approach may significantly increase liver tumor drug uptake after targeted transcatheter infusion. MRI measurements permitted intraprocedural guidance during these catheter-directed E-TACE procedures.
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