MR‐guided interstitial laser‐induced thermotherapy of hepatic metastasis combined with arterial blood flow reduction: Technique and first clinical results in an open MR system

The feasibility and safety of percutaneous laser‐induced thermotherapy (LITT) of liver metastases in an open low‐field magnetic resonance imaging (MRI) system combined with microsphere‐modulated blood flow reduction were tested. Nd:YAG laser therapy with an internally cooled laser applicator was performed under local anesthesia on 20 patients with 34 liver metastases. To increase the effectivenes of LITT, degradable starch microspheres were injected into the proper hepatic artery through an MR‐visible catheter initially inserted under fluoroscopy. Near real‐time imaging was used for positioning the laser applicator. A T1‐weighted gradient‐echo breath‐hold sequence was used for catheter localization and temperature monitoring. The volumes of the liver metastases and the thermonecroses were determined. MRI‐guided LITT could be performed in all patients with no clinically relevant complications. Intraprocedural imaging underestimated the extent of thermonecrosis. In conclusion, percutaneous LITT of liver metastases after injection of starch microspheres is both technically feasible and safe in an open MRI system. J. Magn. Reson. Imaging 2001;13:31–36. © 2001 Wiley‐Liss, Inc.

[1]  Takamichi Murakami,et al.  Percutaneous microwave coagulation therapy for patients with primary and metastatic hepatic tumors during interruption of hepatic blood flow , 2000, Cancer.

[2]  F K Wacker,et al.  Magnetic resonance‐guided vascular catheterization: Feasibility using a passive tracking technique at 0.2 telsa in a pig model , 1999, Journal of magnetic resonance imaging : JMRI.

[3]  M. Kornmann,et al.  Regional chemotherapy of non-resectable liver metastases from colorectal cancer – literature and institutional review , 1999, Langenbeck's Archives of Surgery.

[4]  A Roggan,et al.  Laser-induced thermotherapy combined with hepatic arterial embolization in the treatment of liver tumors in a rat tumor model. , 1999, Annals of surgery.

[5]  T. Murakami,et al.  Percutaneous microwave hepatic tumor coagulation with segmental hepatic blood flow occlusion in seven patients. , 1999, AJR. American journal of roentgenology.

[6]  K. Engelmann,et al.  [Therapeutic options in non-resectable liver metastases. Percutaneous radiological interventions]. , 1999, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[7]  J S Lewin,et al.  Temperature measurement using echo‐shifted FLASH at low field for interventional MRI , 1999, Journal of magnetic resonance imaging : JMRI.

[8]  E F Halpern,et al.  Radio-frequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter. , 1998, Radiology.

[9]  A Roggan,et al.  Internally cooled power laser for MR-guided interstitial laser-induced thermotherapy of liver lesions: initial clinical results. , 1998, Radiology.

[10]  U. Stenram,et al.  Interstitial laser thermotherapy in pig liver: effect of inflow occlusion on extent of necrosis and ultrasound image. , 1997, Hepato-gastroenterology.

[11]  Ulrich Mödder,et al.  MR-tomographische Temperaturquantifizierung bei 1,5 T in vitro : Vergleich von schnellen T1-Parameterbildern und einer phasensensitiven Sequenz , 1997 .

[12]  S Andersson-Engels,et al.  Hepatic inflow occlusion increases the efficacy of interstitial laser-induced thermotherapy in rat. , 1997, The Journal of surgical research.

[13]  Martin G Mack,et al.  Percutaneous MRI-guided laser-induced thermotherapy for hepatic metastases for colorectal cancer , 1997, The Lancet.

[14]  H. Keen,et al.  The impact of cardiovascular disease on people with diabetes: the potential for prevention , 1997, The Lancet.

[15]  L. Thorelius,et al.  Spherex (degradable starch microspheres) chemo-occlusion--enhancement of tumor drug concentration and therapeutic efficacy: an overview. , 1997, Seminars in oncology.

[16]  M A Viergever,et al.  Visualization of dedicated catheters using fast scanning techniques with potential for MR‐guided vascular interventions , 1996, Magnetic resonance in medicine.

[17]  M Deimling,et al.  Malignant liver tumors treated with MR imaging-guided laser-induced thermotherapy: technique and prospective results. , 1995, Radiology.

[18]  F Fobbe,et al.  Magnetic Resonance Imaging—Controlled Laser–Induced Interstitial Thermotherapy , 1994, Investigative radiology.

[19]  W N Hanafee,et al.  MR imaging—guided interstitial Nd:YAG laser phototherapy: Dosimetry study of acute tissue damage in an in vivo model , 1991, Journal of magnetic resonance imaging : JMRI.

[20]  D. Lewis,et al.  Temporary intestinal hypoxia induced by degradable microspheres , 1976, Nature.

[21]  C. Breedis,et al.  The blood supply of neoplasms in the liver. , 1954, The American journal of pathology.

[22]  A Roggan,et al.  Interstitial laser coagulation: Evaluation of the effect of normal liver blood perfusion and the application mode on lesion size , 1998, Lasers in surgery and medicine.

[23]  L Solbiati,et al.  Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? , 1998, Journal of vascular and interventional radiology : JVIR.