Magnetic resonance imaging control of laser destruction of hepatic metastases: correlation with post-operative dynamic helical CT

SummaryInterstitial laser photocoagulation (ILP) is currently limited by deficient per-procedural monitoring. The purpose of this study was to evaluate MR control of ILP of hepatic metastases. Twenty-two laser activations were used to treat eight metastases in seven patients under local anaesthesia and sedation. Laser energy was delivered via optical fibres positioned in the tumour under ultrasound guidance. T1-weighted FLASH and spin-echo sequences were used to monitor the procedure. Enhanced CT was performed at 24 h to assess thermal necrosis. FLASH imaging showed an enlarging area of signal change during ILP. The final extent of this correlated closely with the extent of tissue necrosis on CT. Spin-echo imaging was disappointing because of poor contrast between the treated tissue and normal liver/untreated tumour. Per-procedural MR imaging accurately and reliably depicts ILP-induced necrosis. MR control may permit more widespread application of ILP to the treatment of hepatic tumours.

[1]  W R Lees,et al.  Hepatic metastases: interstitial laser photocoagulation with real-time US monitoring and dynamic CT evaluation of treatment. , 1993, Radiology.

[2]  A. Altendorf-Hofmann,et al.  Indicators of prognosis after hepatic resection for colorectal secondaries. , 1991, Surgery.

[3]  B. Wilson,et al.  Comparison of magnetic resonance images and the histopathological findings of lesions induced by interstitial laser photocoagulation in the brain , 1993, Lasers in surgery and medicine.

[4]  Boris Rubinsky,et al.  Ultrasound‐guided hepatic cryosurgery in the treatment of metastatic colon carcinoma. Preliminary results , 1991, Cancer.

[5]  D. Ilstrup,et al.  The Natural History of Hepatic Metastases from Colorectal Cancer: A Comparison with Resective Treatment , 1984, Annals of surgery.

[6]  F A Jolesz,et al.  Magnetic Resonance Imaging of the Acute Effects of Interstitial Neodymium:YAG Laser Irradiation on Tissues , 1992, Investigative radiology.

[7]  F. Jolesz,et al.  Tissue temperature monitoring for thermal interventional therapy: Comparison of T1‐weighted MR sequences , 1994, Journal of magnetic resonance imaging : JMRI.

[8]  W R Lees,et al.  Ultrasound features of low power interstitial laser hyperthermia. , 1992, Clinical Radiology.

[9]  F A Jolesz,et al.  Real‐time magnetic resonance imaging of laser heat deposition in tissue , 1991, Magnetic resonance in medicine.

[10]  Keyvan Farahani,et al.  Near "real" time magnetic resonance images as a monitoring system for interstitial laser therapy: experimental protocols , 1992, Photonics West - Lasers and Applications in Science and Engineering.

[11]  B. Coiffier,et al.  Possible toxicity with the association of G-CSF and bleomycin , 1994, The Lancet.

[12]  C. Kelly,et al.  Colorectal cancer: Principles of postoperative follow‐up , 1992, Cancer.

[13]  D. Ilstrup,et al.  Resection of hepatic metastases from colorectal cancer. , 1984, Archives of surgery.

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

[15]  J. Seitz,et al.  Ultrasound‐guided percutaneous alcohol injection of small liver metastases. Results in 40 patients , 1994, Cancer.

[16]  I. Wilkinson,et al.  Magnetic resonance imaging of interstitial laser photocoagulation of normal rat liver: imaging-histopathological correlation , 1997 .

[17]  W R Lees,et al.  Local treatment of colorectal liver metastases: a comparison of interstitial laser photocoagulation (ILP) and percutaneous alcohol injection (PAI). , 1993, Clinical radiology.

[18]  J. McGahan,et al.  Treatment of Liver Tumors by Percutaneous Radiofrequency Electrocautery , 1993 .

[19]  W. Edelstein,et al.  The intrinsic signal‐to‐noise ratio in NMR imaging , 1986, Magnetic resonance in medicine.

[20]  P. Schneider,et al.  Hepatic Resection of Coiorectal Metastases: Influence of Clinical Factors and Adjuvant Intraperitoneal 5‐Fluorouracil via Tenckhoff Catheter on Survival , 1985, Annals of surgery.

[21]  L H Blumgart,et al.  A retrospective study of the natural history of patients with liver metastases from colorectal cancer. , 1976, Clinical oncology.

[22]  T. Matalon,et al.  Percutaneous interstitial laser therapy of a patient with recurrent hepatoma in a transplanted liver. , 1992, Surgery.

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

[24]  P. Clingan,et al.  Treatment of hepatic metastases by cryotherapy and regional cytotoxic perfusion. , 1993, Gut.

[25]  J. Daly,et al.  Hepatic resection for metastases of the colon and rectum. , 1986, Surgery, gynecology & obstetrics.

[26]  Massimo Lopez.  Adjuvant therapy of colorectal cancer , 1994, Diseases of the colon and rectum.

[27]  D. Franco.  Malignancy of the liver , 1990 .

[28]  W. R. Lees,et al.  Dynamic magnetic resonance control of interstitial laser photocoagulation therapy of colorectal hepatic metastases , 1994, The Lancet.

[29]  F A Jolesz,et al.  Monitoring of laser and freezinginduced ablation in the liver with T1‐weighted MR imaging , 1992, Journal of magnetic resonance imaging : JMRI.

[30]  W. Lees,et al.  Multiple‐fibre low‐power interstitial laser hyperthermia: studies in the normal liver , 1992, The British journal of surgery.

[31]  J. P. O'sullivan,et al.  Biological effects of intrahepatic neodymium:yttrium-aluminum-garnet laser photocoagulation in rats. , 1987, Gastroenterology.

[32]  J. Sung,et al.  Low-power laserthermia for the treatment of small hepatocellular carcinoma. , 1991, European journal of cancer.

[33]  J. Jessup,et al.  Impact of combined modality therapy on the treatment of adenocarcinoma of the colon. , 1993, Seminars in surgical oncology.

[34]  J. Scheele.  Hepatectomy for liver metastases , 1993, The British journal of surgery.

[35]  N. Moriyama,et al.  Hepatic arterial embolization for hepatocellular carcinoma. Comparison of CT scans and resected specimens. , 1984, Radiology.

[36]  S. Torp-Pedersen,et al.  Interstitial hyperthermia of colorectal liver metastases with a US-guided Nd-YAG laser with a diffuser tip: a pilot clinical study. , 1993, Radiology.

[37]  A Oatridge,et al.  Further observations on the measurement of tissue T1 to monitor temperature in vivo by MRI , 1994, Magnetic resonance in medicine.

[38]  C. R. Hill,et al.  Minimally invasive cancer surgery using focused ultrasound: a pre-clinical, normal tissue study. , 1994, The British journal of radiology.

[39]  R. Marchesini,et al.  Potential and limitations of magnetic resonance imaging for real-time monitoring of interstitial laser phototherapy. , 1995, Academic radiology.

[40]  W Thurrell,et al.  Computed tomography-pathologic assessment of laser-induced necrosis in rat liver. , 1993, Investigative radiology.

[41]  Kullervo Hynynen,et al.  MR temperature mapping of focused ultrasound surgery , 1994, Magnetic resonance in medicine.

[42]  F A Jolesz,et al.  MR imaging of laser-tissue interactions. , 1988, Radiology.