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Abstract
ObjectiveTo evaluate the potency of Gd-EOB-DTPA to support hepatic catheter placement in laser ablation procedures by quantifying time-dependent delineation effects for instrumentation and target tumor within liver parenchyma. Monitoring potential influence on online MR thermometry during the ablation procedure is a secondary aim.Materials and Methods30 cases of MR-guided laser ablation were performed after i.v. bolus injection of gadoxetic acid (0.025 mmol/Kg Gd-EOB-DTPA; Bayer Healthcare, Berlin, Germany). T1-weighted GRE sequences were used for applicator guidance (FLASH 3D) in the catheter placement phase and for therapy monitoring (FLASH 2D) in the therapy phase. SNR and consecutive CNR values were measured for elements of interest plotted over time both for catheter placement and therapy phase and compared with a non-contrast control group of 19 earlier cases. Statistical analysis was realized using the paired Wilcoxon test.ResultsSustainable signal elevation of liver parenchyma in the contrast-enhanced group was sufficient to silhouette both target tumor and applicator against the liver. Differences in time dependent CNR alteration were highly significant between contrast-enhanced and non-contrast interventions for parenchyma and target on the one hand (p = 0.020) and parenchyma and instrument on the other hand (p = 0.002). Effects lasted for the whole procedure (monitoring up to 60 min) and were specific for the contrast-enhanced group. Contrasting maxima were seen after median 30 (applicator) and 38 (tumor) minutes, in the potential core time of a multineedle procedure. Contrast influence on T1 thermometry for real-time monitoring of thermal impact was not significant (p = 0.068–0.715).ConclusionResults strongly support anticipated promotive effects of Gd-EOB-DTPA for MR-guided percutaneous liver interventions by proving and quantifying the delineating effects for therapy-relevant elements in the procedure. Time benefit, cost effectiveness and oncologic outcome of the described beneficiary effects will have to be part of further investigations.
Highlights
Image-guided tumor ablation in the liver has become an accepted high-end technical approach in multimodal cancer therapy [1,2,3,4,5]
Intravenous employment of Gd-EOB-DTPA for periinterventional contrast enhancement in MR-guided diagnostic liver interventions has been reported in the literature [24, 25]
The procedural setting is primarily determined by the need of high spatial resolution, for the intended laser ablation is being controlled through realtime MR thermometry within the target zone
Summary
Image-guided tumor ablation in the liver has become an accepted high-end technical approach in multimodal cancer therapy [1,2,3,4,5]. At the same time MR-guided tumor ablation is a labor-intensive and time-consuming procedure, which is especially relevant when it comes to profitable practice in outpatient centers. With respect to both criteria, profitability and quality, a great demand for standardization on the one hand and simplification on the other hand has been noticed in the community of interventional radiologists [13]. Standardization and simplification both promote procedure automating needs currently addressed by the healthcare industry
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