Realtime monitoring of radiofrequency ablation of liver肝射频消融术的实时监测.pptVIP

Real-time monitoring of radiofrequency ablation of liver tumors using thermal dose calculation by MR temperature imaging: initial results in nine patients, including follow-up M. Lepetit-Coiffe, H. Laumonier, O. Seror, B. Quesson, M-B. Sesay, C. T. W. Moonen, N. Grenier, H. Trillaud Eur Radiol, 71(3), 2009 Background Goal of thermal ablation: Destroy target tissue by raising to lethal temperatures (above 50 °C) Modalities: RF current, laser, ultrasound, microwave Thermal dosimetry – how hot is hot enough? Tissue damage is complex function of time-temperature history Sapareto-Dewey thermal isoeffective dose: Compares time required for thermal injury to reference. For most soft tissue, above 43 °C, time required to cause thermal injury halves for each 1 °C rise in temperature Arrhenius damage: Models thermal injury as first-order, irreversible kinetics process Sensitive to parameter values, difficult to measure for all tissue types Real-time monitoring of ablation treatments Why monitor? Ensure complete coverage of target Blood perfusion is a substantial heat-sink, very difficult to model Ultrasound, contrast-enhanced US, CT, MRI MR thermometry with PRF shift technique: Spatial measurement of temperature/thermal dose in real-time Objective Assess the practical feasibility and effectiveness of real-time MR temperature monitoring of RF liver ablation Methods 9 patients – 8 HCC, 1 colorectal metastases Tumor dimensions: 5-28 × 14-50 mm Perform single 12 min RF ablation with cool-tip system Position RF electrode under MR guidance If thermal dose covers target ? done If entire target not covered, reposition device and perform another ablation until target covered Use 240 CEM43 as threshold for adequate thermal-damage Follow-up every 45 days after procedure, check for residual tumor Results Results Results Conclusions Thermal-dose maps are a good method to monitor thermal coverage of lesion during ablation Care needs to be taken to determine whic