Lars Frich

Experimental application of thermosensitive paramagnetic liposomes for monitoring magnetic resonance imaging guided thermal ablation.

The use of a liposomal paramagnetic agent with a T1‐relaxivity that increases markedly at temperatures above the phase transition temperature (Tm) of the liposomal membrane was evaluated during magnetic resonance imaging (MRI) guided hyperthermia ablation. A neodymium‐yttrium aluminum garnet (Nd‐YAG) laser unit and a radiofrequency ablation system were used for tissue ablation in eight rabbit livers in vivo. One ablation was made in each animal prior to administration of the liposomal agent. Liposomes with a Tm of 57°C containing gadodiamide (GdDTPA‐BMA) were injected iv, and two additional ablations were performed. T1‐weighted scans were performed in heated tissue, after tissue temperature had normalized, and 15–20 min after normalization of tissue temperature. Increase in signal intensity (ΔSI) for ablations prior to injection of the agent was 13.0% (SD = 5.7) for the laser group and 9.1% (SD = 7.9) for the radiofrequency group. Signal intensity after administration of the agent unrelated to heating was not statistically significant (ΔSI = 1.4%, P = 0.35). For ablations made after injection of the agent, a significant increase was found in the laser (ΔSI = 34.5%, SD = 11.9) and radiofrequency group (ΔSI = 21.6%, SD = 22.7). The persistent signal enhancement found in areas exposed to a temperature above the threshold temperature above Tm allows thermal monitoring of MRI guided thermal ablation. Magn Reson Med 52:1302–1309, 2004.

Impedance-based tissue discrimination for needle guidance

Measurement of electrical impedance can discriminate between tissues of different electrical properties. A measurement system with adequate spatial resolution focused on a volume around the tip of a needle or other invasive clinical equipment can be used to determine in which type of tissue the tip is positioned. We have measured the sensitivity zone of a needle electrode with an active electrode area of 0.3 mm(2), and measured impedance spectra in porcine tissue in vivo. Small electrode impedance data will be influenced by electrode polarization impedance (EPI) at low frequencies. To refine existing methods for needle guidance with higher spatial resolution, we have used multivariate analysis and new interpretations of EPI, and tissue data gathered with selected needle electrodes. The focus of this study is on discrimination between muscle and fat/subdermis for drug administration, but our results also indicate that these refinements will facilitate new clinical applications for impedance-based needle guidance in general.

Liver tumor cryoablation: a commentary on the need of improved procedural monitoring.

Cryoablation is a method used for in situ destruction of liver tumors not eligible for surgical resection. Local recurrences following such treatment have been reported at rates of 5–44%. Insufficient procedural monitoring of the ablation is one plausible explanation for these recurrences. The cryoablative procedure is usually monitored by ultrasonography, but acoustic shadowing and loss of signals, compromise visualisation of the cryolesion circumference. Other monitoring modalities such as computer tomography and invasive methods like the use of thermocouples and impedance measurements have also been studied, but are not in common clinical use as single monitoring modalities. Thermodynamic conditions assumed adequate for tumor eradication are likely to occur only in parts of the cryolesion. This tumoricidal part of the cryolesion is not adequately depicted using any of these modalities. Magnetic resonance imaging (MRI) provides a clear delineation of the cryolesion circumference. Noninvasive temperature measurements assisted by MRI indicate which parts of the cryolesion that may be subject to complete necrosis. In this article MRI monitored cryoablation of liver tumors is discussed. Improved peroperative monitoring as offered by MRI may reduce the rates of local recurrences after treatment, but further technological improvements are required.

Intraoperative contrast-enhanced MR-imaging as predictor of tissue damage during cryoablation of porcine liver

This study evaluate intraoperative Magnetic Resonance Imaging (MRI) as predictor of tissue damage following cryoablation of porcine liver with and without concomitant hepatic vascular inflow occlusion. Inflow occlusion was used during freezing in 6 of 12 pigs included. The volumes of the procedural ice-balls were estimated from MR images. Immediately after thawing contrast (MnDPDP) enhanced MRI was performed to estimate the volume of the cryolesion. Four days after ablation MRI was repeated of the in-vivo and the ex-vivo liver. Photography was performed of the sliced liver specimens to estimate the volumes of the lesions. The intraoperative volume of the cryolesion as shown by contrast enhanced MRI corresponded well to the ice-ball volume for lesions made without vascular occlusion (difference 0.3 +/- 0.9 cm(3), p = 0.239). For lesions made during occlusion the volume of the intraoperative cryolesion was larger than the corresponding ice-ball (difference 7.5 +/- 3.3 cm(3), p = 0.003). The volume of the cryolesions as estimated from histopathology four days after freezing and contrast enhanced MRI immediately after freezing corresponded well for lesions made with (difference -2.6 +/- 4.5 cm(3), p = 0.110) and without vascular occlusion (difference -0.5 +/- 2.3 cm(3), p = 0.695). Intraoperative MnDPDP-enhanced MRI of the cryolesion is predictive of the tissue damage induced during cryoablation of porcine liver. The procedural ice-ball is not, if induced during inflow occlusion.