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MR Imaging-guided Percutaneous Cryotherapy of Liver Tumors: Initial Experience¹

¹ From the Departments of Radiology (S.G.S., K.T., D.F.A., E.v.S., K.H.Z., D.F.K., F.A.J.) and Surgery (P.R.M.), Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. From the 1999 RSNA scientific assembly. Received February 15, 2000; revision requested March 27; revision received May 5; accepted May 22. S.G.S. supported in part by a 1998 Toshiba America/RSNA Seed Grant (1), Galil Medical Systems, and GE Medical Systems. Address correspondence to S.G.S. (e-mail: sgsilverman@partners.org).

PURPOSE: To describe the cryoablation of liver tumors by using a percutaneous approach and intraprocedural magnetic resonance (MR) imaging monitoring and to assess the feasibility and safety of the procedure.

MATERIALS AND METHODS: Fifteen hepatic tumors (mean diameter, 2.9 cm) in 12 patients were treated (18 total cryoablations). Fourteen were metastases and one was a hemangioma; all were proved at biopsy. By using a 0.5-T open MR imaging system, cryoneedles were placed and lesions ablated by using real-time monitoring. Clinical signs and symptoms were assessed and laboratory tests performed. Intraprocedural depictions of iceballs were compared with contrast material–enhanced MR imaging–based estimates of cryonecrosis that were obtained 24 hours after cryoablation.

RESULTS: MR imaging–guided percutaneous cryotherapy resulted in no serious complications and no clinically important changes in serum liver enzymes or creatinine or myoglobin levels. Intraprocedural MR imaging demonstrated iceballs as sharply marginated regions of signal loss that expanded and engulfed tumors. The maximal iceball size was 4.9 x 2.2 x 2.2 cm with the use of one cryoneedle and 6.0 x 5.6 x 4.9 cm with three cryoneedles. Intraprocedural iceball depictions correlated well with postprocedural cryonecrosis estimates.

CONCLUSION: MR imaging–guided percutaneous cryotherapy of liver tumors is feasible and safe. MR imaging can be used to estimate cryotherapy effects and guide therapy intraprocedurally.

Index terms: Cryotherapy • Liver neoplasms, therapy, 761.1261 • Magnetic resonance (MR), guidance, 761.121411, 761.12412, 761.121415

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