Abstract
IntroductionTherapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization. However, these techniques are invasive with possible complications and require hospitalization. We present a novel non-invasive technique, i.e., magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, for the treatment of a vascular malformation in a patient. This technique applies high-intensity sound waves transcutaneously to the body and is fully non-invasive. MRI guidance is the novel aspect of HIFU treatments and is used for exquisite delineation and localization of the lesion and accurate real-time temperature monitoring during tissue ablation. MR-HIFU is a well-established treatment option for uterine fibroids and is currently being investigated for, e.g., bone tumors, breast cancer, prostate cancer, and liver cancer. MR-HIFU of vascular malformations has not been a topic of research yet.Case descriptionVolumetric MR-HIFU ablation of a vascular malformation in the lower extremity of an 18-year-old male patient was performed. Temperatures of 62–80 °C were reached in the target lesion with sonications of 4 × 4 × 8 mm using powers of 200 W for <20 s. At 1-month follow-up, the patient reported qualitatively sustained reduction of pain and normal motor function. Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume. After 13 months, pain score was reduced to <2 after extreme exertion for several hours and to 0 for daily activities.Discussion and evaluationRadiofrequency ablation and cryoablation are minimally invasive techniques that have been tried on low-flow vascular malformations with inconsistent results. Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization. Since MR-HIFU is truly non-invasive, these risks are negligible.ConclusionsIn conclusion, we reported a successful non-invasive treatment of a vascular malformation with MR-HIFU in a clinical patient including long-term follow-up data for the first time. The patient reported qualitatively sustained pain reduction up to 13 months post treatment.
Highlights
Therapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization
In conclusion, we reported a successful non-invasive treatment of a vascular malformation with magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) in a clinical patient including long-term follow-up data for the first time
We report for the first time MR-HIFU ablation of a venous malformation in the lower extremity in a clinical patient including follow-up of over 1 year post treatment
Summary
We demonstrated the feasibility and efficacy of the non-invasive MR-HIFU ablation of a venous malformation in a patient for the first time with follow-up data of up to 1 year. It was observed in five cases that unorganized abnormal vasculature can recruit new, small and low current feeding vessels from a distant location that form a reorganized (A)VM at the original site, which presents as regrowth of the (A)VM [17, 18] Another possible explanation is the action of multiple cell-derived and extracellular factors and in particular vasogenic factors [19,20,21,22,23]. The advantage of HIFU over minimally invasive techniques such as RFA and cryoablation is the real-time guidance and feedback with MRI during the procedure, which provides accurate lesion delineation and temperature feedback resulting in more accurate heating. This eliminates the heat-sink effect by blood and secondly, the vessel wall can be thermally coagulated by consequent sonications
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