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Can we ablate liver lesions close to large portal and hepatic veins with MR-guided HIFU? An experimental study in a porcine model

  • Ulrik CarlingEmail author
  • Leonid Barkhatov
  • Henrik M. Reims
  • Tryggve Storås
  • Frederic Courivaud
  • Airazat M. Kazaryan
  • Per Steinar Halvorsen
  • Eric Dorenberg
  • Bjørn Edwin
  • Per Kristian Hol
Interventional
  • 17 Downloads

Abstract

Objectives

Invasive treatment of tumors adjacent to large hepatic vessels is a continuous clinical challenge. The primary aim of this study was to examine the feasibility of ablating liver tissue adjacent to large hepatic and portal veins with magnetic resonance imaging–guided high-intensity focused ultrasound (MRgHIFU). The secondary aim was to compare sonication data for ablations performed adjacent to hepatic veins (HV) versus portal veins (PV).

Materials and methods

MRgHIFU ablations were performed in six male land swine under general anesthesia. Ablation cells of either 4 or 8 mm diameter were planned in clusters (two/animal) adjacent either to HV (n = 6) or to PV (n = 6), with diameter ≥ 5 mm. Ablations were made using 200 W and 1.2 MHz. Post-procedure evaluation was made on contrast-enhanced MRI (T1w CE-MRI), histopathology, and ablation data from the HIFU system.

Results

A total of 153 ablations in 81 cells and 12 clusters were performed. There were visible lesions with non-perfused volumes in all animals on T1w CE-MRI images. Histopathology showed hemorrhage and necrosis in all 12 clusters, with a median shortest distance to vessel wall of 0.4 mm (range 0–2.7 mm). Edema and endothelial swelling were observed without vessel wall rupture. In 8-mm ablations (n = 125), heat sink was detected more often for HV (43%) than for PV (19%; p = 0.04).

Conclusions

Ablations yielding coagulative necrosis of liver tissue can be performed adjacent to large hepatic vessels while keeping the vessel walls intact. This indicates that perivascular tumor ablation in the liver is feasible using MRgHIFU.

Key Points

High-intensity focused ultrasound ablation is a non-invasive treatment modality that can be used for treatment of liver tumors.

This study shows that ablations of liver tissue can be performed adjacent to large hepatic vessels in an experimental setting.

Liver tumors close to large vessels can potentially be treated using this modality.

Keywords

High-intensity focused ultrasound ablation Interventional magnetic resonance imaging Liver Portal veins Hepatic veins 

Abbreviations

BW

Bandwidth

CEUS

Contrast-enhanced ultrasound

DT

Dynamic scan time

EM

Equivalent minutes

FA

Flip angle

FFE

Fast field echo

GRE-EPI

Gradient echo sequence with echo-planar readout

HCC

Hepatocellular carcinoma

HIFU

High-intensity focused ultrasound

MRgHIFU

Magnetic resonance imaging–guided high-intensity focused ultrasound

NPV

Non-perfused volume

PFS

Proton frequency shift

PS

Pixel sum

SENSE

Sensitivity encoding

SpO2%

Oxygen saturation

T1w

T1 weighted

T2w

T2 weighted

TE

Echo time

TFE

Turbo field echo

TR

Repetition time

USgHIFU

Ultrasound-guided high-intensity focused ultrasound

VS

Voxel size

Notes

Funding

This study has received funding by The Norwegian Cancer Society (Kreftforeningen).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Per Kristian Hol Prof. M.D., The Intervention Center, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Manuela Zucknick, Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, Oslo University, kindly provided statistical advice for this manuscript.

Ethical approval

Approval from the Institutional Animal Care Committee was obtained.

Methodology

• experimental

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Ulrik Carling
    • 1
    • 2
    Email author
  • Leonid Barkhatov
    • 2
    • 3
    • 4
  • Henrik M. Reims
    • 5
  • Tryggve Storås
    • 4
  • Frederic Courivaud
    • 4
  • Airazat M. Kazaryan
    • 4
    • 6
    • 7
    • 8
  • Per Steinar Halvorsen
    • 4
  • Eric Dorenberg
    • 1
  • Bjørn Edwin
    • 2
    • 4
    • 9
  • Per Kristian Hol
    • 2
    • 4
  1. 1.Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
  2. 2.Institute of Clinical MedicineUniversity of OsloOsloNorway
  3. 3.Department of Gastrointestinal SurgeryHaukeland University HospitalBergenNorway
  4. 4.The Intervention CenterOslo University HospitalOsloNorway
  5. 5.Department of PathologyOslo University HospitalOsloNorway
  6. 6.Department of SurgeryFonna Hospital TrustStordNorway
  7. 7.Department of Surgery No. 1Yerevan State Medical University after M. HeratsiYerevanArmenia
  8. 8.Department of Faculty Surgery No. 2I.M. Sechenov First Moscow State Medical UniversityMoscowRussia
  9. 9.Department of Hepato-Pancreato-Biliary SurgeryOslo University HospitalOsloNorway

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