Abstract
PurposeTo evaluate the appearance and size of ablation zones in gadoxetic-acid-enhanced magnetic resonance imaging (MRI) during the first year after irreversible electroporation (IRE) of primary or secondary hepatic malignancies and to investigate potential correlations to clinical features.Material and methodsThe MRI-appearance of the ablation area was assessed 1–3 days, 6 weeks, 3 months, 6 months, 9 months and 1 year after IRE. The size of the ablation zone and signal intensities of each follow-up control were compared. Moreover, relationships between clinical features and the MRI-appearance of the ablation area 1–3 days after IRE were analyzed.ResultsThe ablation zone size decreased from 5.6 ± 1.4 cm (1–3 days) to 3.7±1.2 cm (1 year). A significant decrease of central hypointensities was observed in T2-blade- (3 months), T2 haste- (6 weeks; 3 months; 6 months; 1 year), T1 arterial phase- (3 months; 1 year), and diffusion-sequences (6 weeks; 3 months; 6 months; 9 months; 1 year). The unenhanced T1-sequences showed significantly increasing central hypointensities (6 weeks; 3 months; 6 months; 9 months; 1 year). Significantly increasing peripheral hypointensities were detected in T1 arterial phase- (3 months; 6 months; 9 months; 1 year) and in T1 portal venous phase-sequences (6 weeks; 3 months; 6 months; 9 months; 1 year). Peripheral hypointensities of unenhanced T1-sequences decreased significantly 1 year after IRE. 1–3 days after IRE central T1 portal venous hypo- or isointensities were detected significantly more often than hyperintensities, if more than 3 IRE electrodes were used.ConclusionHepatic IRE results in continuous reduction of ablation zone size during the first postinterventional year. In addition to centrally decreasing T1-signal and almost steadily increasing signal in the enhanced T2 haste-, diffusion- and T1 arterial phase-sequences, there is a trend toward long-term decreasing T1 arterial- and portal venous MRI-signal intensity of the peripheral ablation area, probably representing a region of reversible electroporation.
Highlights
Surgical resection is considered as the most effective treatment method for primary and secondary hepatic malignancies, many patients are not candidates for surgery if the tumor is too advanced or if there are several comorbidities [1]
As magnetic resonance imaging (MRI) is considered the reference standard for the detection of hepatic tumors [6, 7], it is very important that radiologists are aware of all the different appearances of the ablation area to be able to differentiate post-ablative tissue from local tumor recurrence
Several reports concerning the safety and efficacy of hepatic Irreversible electroporation (IRE) have been published in recent years [8,9,10,11,12], not much is known about the appearance of the ablation zone in postinterventional MRI
Summary
Surgical resection is considered as the most effective treatment method for primary and secondary hepatic malignancies, many patients are not candidates for surgery if the tumor is too advanced or if there are several comorbidities [1]. In these patients, tumor destruction can be achieved by various ablative techniques. The aim of this study was to evaluate the appearance and the size of the ablation zone in gadoxetic-acid-based MRI during the first year after undergoing IRE of primary or secondary hepatic malignancies. The relationship between the MRI appearance of the ablation area 1–3 days after IRE and several clinical features were analyzed
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