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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

  • Interventional
  • Published:
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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.

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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

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Funding

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

Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Post box 4950, N-0424, Oslo, Norway

    Ulrik Carling & Eric Dorenberg

  2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Ulrik Carling, Leonid Barkhatov, Bjørn Edwin & Per Kristian Hol

  3. Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway

    Leonid Barkhatov

  4. The Intervention Center, Oslo University Hospital, Oslo, Norway

    Leonid Barkhatov, Tryggve Storås, Frederic Courivaud, Airazat M. Kazaryan, Per Steinar Halvorsen, Bjørn Edwin & Per Kristian Hol

  5. Department of Pathology, Oslo University Hospital, Oslo, Norway

    Henrik M. Reims

  6. Department of Surgery, Fonna Hospital Trust, Stord, Norway

    Airazat M. Kazaryan

  7. Department of Surgery No. 1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia

    Airazat M. Kazaryan

  8. Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Airazat M. Kazaryan

  9. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway

    Bjørn Edwin

Authors
  1. Ulrik Carling
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  2. Leonid Barkhatov
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  7. Per Steinar Halvorsen
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  9. Bjørn Edwin
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  10. Per Kristian Hol
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Corresponding author

Correspondence to Ulrik Carling.

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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.

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Carling, U., Barkhatov, L., Reims, H.M. et al. Can we ablate liver lesions close to large portal and hepatic veins with MR-guided HIFU? An experimental study in a porcine model. Eur Radiol 29, 5013–5021 (2019). https://doi.org/10.1007/s00330-018-5996-8

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  • DOI: https://doi.org/10.1007/s00330-018-5996-8

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