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Image-Based Monitoring of Magnetic Resonance-Guided Thermoablative Therapies for Liver Tumors

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Abstract

Minimally invasive treatment options for liver tumor therapy have been increasingly used during the last decade because their benefit has been proven for primary and inoperable secondary liver tumors. Among these, radiofrequency ablation has gained widespread consideration. Optimal image-guidance offers precise anatomical information, helps to position interventional devices, and allows for differentiation between already-treated and remaining tumor tissue. Patient safety and complete ablation of the entire tumor are the overriding objectives of tumor ablation. These may be achieved most elegantly with magnetic resonance (MR)-guided therapy, where monitoring can be performed based on precise soft-tissue imaging and additional components, such as diffusion-weighted imaging and temperature mapping. New MR scanner types and newly developed sequence techniques have enabled MR-guided intervention to move beyond the experimental phase. This article reviews the current role of MR imaging in guiding radiofrequency ablation. Signal characteristics of primary and secondary liver tumors are identified, and signal alteration during therapy is described. Diffusion-weighted imaging (DWI) and temperature mapping as special components of MR therapy monitoring are introduced. Practical information concerning coils, sequence selection, and parameters, as well as sequence gating, is given. In addition, sources of artifacts are identified and techniques to decrease them are introduced, and the characteristic signs of residual tumor in T1-, T2-, and DWI are described. We hope to enable the reader to choose MR sequences that allow optimal therapy monitoring depending on the initial signal characteristics of the tumor as well as its size and location in the liver.

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Acknowledgment

Many thanks to Eva Rothgang for her help.

Conflict of interest

Philippe Pereira is consultant for Siemens Healthcare, Erlangen, Germany, and receives grants from Olympus Celon, Teltow, Germany. The other authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, 72076, Tübingen, Germany

    Hansjörg Rempp & Stephan Clasen

  2. Clinic for Radiology, Nuclear Medicine, and Minimal Invasive Therapies, SLK-Kliniken, 74078, Heilbronn, Germany

    Philippe L. Pereira

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  1. Hansjörg Rempp
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  2. Stephan Clasen
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  3. Philippe L. Pereira
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Correspondence to Hansjörg Rempp.

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Rempp, H., Clasen, S. & Pereira, P.L. Image-Based Monitoring of Magnetic Resonance-Guided Thermoablative Therapies for Liver Tumors. Cardiovasc Intervent Radiol 35, 1281–1294 (2012). https://doi.org/10.1007/s00270-011-0227-6

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