Intrapleural fluid infusion for MR-guided high-intensity focused ultrasound ablation in the liver dome.

Autor:	Wijlemans JW; Department of Radiology, University Medical Center Utrecht, E01.132, P.O. Box 85500, Utrecht 3508 GA, The Netherlands. Electronic address: j.wijlemans@umcutrecht.nl., de Greef M; Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands., Schubert G; Philips Medical Systems MR, Vantaa, Finland., Moonen CT; Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands., van den Bosch MA; Department of Radiology, University Medical Center Utrecht, E01.132, P.O. Box 85500, Utrecht 3508 GA, The Netherlands., Ries M; Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Academic radiology [Acad Radiol] 2014 Dec; Vol. 21 (12), pp. 1597-602. Date of Electronic Publication: 2014 Aug 07.
DOI:	10.1016/j.acra.2014.06.015
Abstrakt:	Rationale and Objectives: Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of tumors in the liver dome is challenging because of the presence of air in the costophrenic angle. In this study, we used a porcine liver model and a clinical MR-HIFU system to assess the feasibility and safety of using intrapleural fluid infusion (IPI) to create an acoustic window for MR-HIFU ablation in the liver dome. Materials and Methods: Healthy adult Dalland land pigs (n = 6) under general anesthesia were used with animal committee approval. Degassed saline (200-800 mL) was infused into the intrapleural space under ultrasound guidance. A clinical 1.5-T MR-HIFU system was used to perform sonications (4-mm treatment cells, 300-450 W, 20-30 seconds) in the liver dome under real-time MR thermometry. An intercostal firing technique was used to prevent rib heating in one experiment. Technical success was defined as a temperature increase (>10°C) in the target area. After termination, the animal was examined for thermal damage to liver, diaphragm, pleura, lung, or intercostal muscle. Results: An acoustic window was established in all animals. A temperature increase in the target area was achieved in all animals (max. 47°C-67°C). MR thermometry showed no heating outside the target area. Intercostal firing effectively reduced rib heating (55°C vs. 42°C). Postmortem examination revealed no unwanted thermal damage. One complication occurred, in the first experiment, because of an ill-suited needle (displacement of the needle). Conclusions: The results indicate that IPI may be used safely to assist MR-HIFU ablation of tumors in the liver dome. For reliable tissue coagulation, IPI must be combined with an intercostal sonication technique. Considering the proportion of patients with tumors in the liver dome, IPI widens the applicability of MR-HIFU ablation for liver tumors considerably. (Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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