Magnetic Resonance-Guided Focused Ultrasound Ablation in Abdominal Moving Organs: A Feasibility Study in Selected Cases of Pancreatic and Liver Cancer

• DOI: 10.1007/s00270-014-0861-x
• Publication Date: 2014-03-04T17:27:38Z
• Authors: Michele Anzidei; Alessandro Napoli; Francesco Sandolo; Beatrice Cavallo ...; Michele Di Martino; Pasquale Berloco; Sandro Bosco; Mario Bezzi; Carlo Catalano
• Keywords: Male; Carcinoma, Hepatocellular; Liver Neoplasms; Contrast Media; Adenocarcinoma; Carcinoma, Hepatocellular; Contrast Media; Feasibility Studies; Female; Humans; Liver Neoplasms; Male; Middle Aged; Pain Measurement; Pancreatic Neoplasms; Patient Positioning; Quality of Life; High-Intensity Focused Ultrasound Ablation; Magnetic Resonance Imaging, Interventional; Adenocarcinoma; Middle Aged; Magnetic Resonance Imaging, Interventional; Patient Positioning; 3. Good health; Pancreatic Neoplasms; 03 medical and health sciences; 0302 clinical medicine; Quality of Life; Feasibility Studies; High-Intensity Focused Ultrasound Ablation; Humans; Female; Pain Measurement

This study was designed to evaluate preliminarily the feasibility and safety of magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of solid tumors in the upper abdomen.We enrolled one patient with hepatocellular carcinoma and two patients with pancreatic adenocarcinoma for MRgFUS ablation. Treatments were performed on a 3T scanner under controlled respiration. Treatment response was evaluated at 1, 3, and 6 months by assessing the nonperfused volume (NPV) of ablated tissue at MR and the degree of pain severity and pain interference.In the patient with HCC, NPV was 100% after treatment and 85% at 3 and 6 months follow-up. Histological analysis after liver transplantation showed fibrosis in the ablated area with minimal local tumor recurrence. In the two patients with pancreatic adenocarcinoma, NPV was 80 and 85% after treatment and 70 and 80% at 3 and 6 months follow-up. Pain severity and pain interference respectively decreased from a mean of 7 and 6.7 points, respectively, to a mean of 3 and 2 points after treatment.MRgFUS can be feasible and safe in selected patients with solid tumors in abdominal moving organs. However, this technique has several limitations due to the interposition of the rib cage or intestinal loops into the path of the ultrasonic beam, as well as to organ motion. Future technical developments are needed to implement advanced motion detection within the system to control organ and lesion position in real-time and keep the focus of the ultrasound beam on the targeted lesion.