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Malignant Liver Tumors Treated with MR Imaging–guided Laser-induced Thermotherapy: Experience with Complications in 899 Patients (2,520 lesions)¹

¹ From the Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. Received July 10, 2001; revision requested August 3; final revision received February 20, 2002; accepted March 14. Address correspondence to T.J.V. (e-mail: t.vogl@em.uni-frankfurt.de).

View larger version (123K): [in a new window]   Figure 1a. (a) Transverse T2-weighted spin-echo MR image (repetition time msec/echo time msec, 3,300/128) obtained in a 59-year-old woman shows large necrotic lesions filled with fluid (f) and air (a). Flow artifact in the portal vein is seen, with no thrombosis. Liver abscess was confirmed by the clinical findings combined with the shown imaging findings. (b) Transverse contrast-enhanced CT scan (soft-tissue window) obtained 4 weeks after LITT of a segment 4 lesion in a 75-year-old man with liver metastasis from colon carcinoma. Note the large fluid-filled intrahepatic space, with air (arrow) in and compression of the normal liver parenchyma. The CT morphologic features facilitated the diagnosis of abscess formation, although no clinical or blood signs of infection were apparent. (c) Transverse CT scan (soft-tissue window) obtained in the patient described in b shows necrosis with drainage. Aspirate analysis revealed no bacterial invasion. The final microbiologic diagnosis was sterile necrosis.

View larger version (128K): [in a new window]   Figure 1b. (a) Transverse T2-weighted spin-echo MR image (repetition time msec/echo time msec, 3,300/128) obtained in a 59-year-old woman shows large necrotic lesions filled with fluid (f) and air (a). Flow artifact in the portal vein is seen, with no thrombosis. Liver abscess was confirmed by the clinical findings combined with the shown imaging findings. (b) Transverse contrast-enhanced CT scan (soft-tissue window) obtained 4 weeks after LITT of a segment 4 lesion in a 75-year-old man with liver metastasis from colon carcinoma. Note the large fluid-filled intrahepatic space, with air (arrow) in and compression of the normal liver parenchyma. The CT morphologic features facilitated the diagnosis of abscess formation, although no clinical or blood signs of infection were apparent. (c) Transverse CT scan (soft-tissue window) obtained in the patient described in b shows necrosis with drainage. Aspirate analysis revealed no bacterial invasion. The final microbiologic diagnosis was sterile necrosis.

View larger version (136K): [in a new window]   Figure 1c. (a) Transverse T2-weighted spin-echo MR image (repetition time msec/echo time msec, 3,300/128) obtained in a 59-year-old woman shows large necrotic lesions filled with fluid (f) and air (a). Flow artifact in the portal vein is seen, with no thrombosis. Liver abscess was confirmed by the clinical findings combined with the shown imaging findings. (b) Transverse contrast-enhanced CT scan (soft-tissue window) obtained 4 weeks after LITT of a segment 4 lesion in a 75-year-old man with liver metastasis from colon carcinoma. Note the large fluid-filled intrahepatic space, with air (arrow) in and compression of the normal liver parenchyma. The CT morphologic features facilitated the diagnosis of abscess formation, although no clinical or blood signs of infection were apparent. (c) Transverse CT scan (soft-tissue window) obtained in the patient described in b shows necrosis with drainage. Aspirate analysis revealed no bacterial invasion. The final microbiologic diagnosis was sterile necrosis.

View larger version (152K): [in a new window]   Figure 2a. (a) Transverse CT scan (soft-tissue window) obtained in a 66-year-old woman shows liver metastasis in segments 2-3 of the left liver lobe treated with two laser applicators in an anterior approach. (b) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in the same patient shows that a large area of hemorrhagic coagulation necrosis (N) with a reliable safety margin has been created. The area is hyperintense. Note the edema in the left lobe and the subcapsular fluid collection (arrow) in the left margin. Due to a transient increase in laboratory values, the lesion was judged to represent a local infarction of liver segments 2 and 3. No clinical or serologic signs of inflammation or abscess were identified. The scout view (box) obtained for better orientation shows the section location.

View larger version (139K): [in a new window]   Figure 2b. (a) Transverse CT scan (soft-tissue window) obtained in a 66-year-old woman shows liver metastasis in segments 2-3 of the left liver lobe treated with two laser applicators in an anterior approach. (b) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in the same patient shows that a large area of hemorrhagic coagulation necrosis (N) with a reliable safety margin has been created. The area is hyperintense. Note the edema in the left lobe and the subcapsular fluid collection (arrow) in the left margin. Due to a transient increase in laboratory values, the lesion was judged to represent a local infarction of liver segments 2 and 3. No clinical or serologic signs of inflammation or abscess were identified. The scout view (box) obtained for better orientation shows the section location.

View larger version (143K): [in a new window]   Figure 3a. (a) Transverse nonenhanced T1-weighted spin-echo MR image (450/13) obtained in a 60-year-old man shows a subcapsular hematoma that developed during the LITT intervention. The hematoma appears as a hypointense, concave mass (arrow) around the liver. The hematoma developed after treatment of a subcapsular liver metastasis, which was hypervascular at pretreatment MR imaging. (b) Sagittal T1-weighted gradient-echo MR image (140/12) obtained in the same patient shows a hypointense hematoma (h) and compression of the liver parenchyma anteriorly. (c) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in the same patient 3 months after LITT shows a small area of hyperintensity (arrow) in the hematoma depicted in b.

View larger version (170K): [in a new window]   Figure 3b. (a) Transverse nonenhanced T1-weighted spin-echo MR image (450/13) obtained in a 60-year-old man shows a subcapsular hematoma that developed during the LITT intervention. The hematoma appears as a hypointense, concave mass (arrow) around the liver. The hematoma developed after treatment of a subcapsular liver metastasis, which was hypervascular at pretreatment MR imaging. (b) Sagittal T1-weighted gradient-echo MR image (140/12) obtained in the same patient shows a hypointense hematoma (h) and compression of the liver parenchyma anteriorly. (c) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in the same patient 3 months after LITT shows a small area of hyperintensity (arrow) in the hematoma depicted in b.

View larger version (154K): [in a new window]   Figure 3c. (a) Transverse nonenhanced T1-weighted spin-echo MR image (450/13) obtained in a 60-year-old man shows a subcapsular hematoma that developed during the LITT intervention. The hematoma appears as a hypointense, concave mass (arrow) around the liver. The hematoma developed after treatment of a subcapsular liver metastasis, which was hypervascular at pretreatment MR imaging. (b) Sagittal T1-weighted gradient-echo MR image (140/12) obtained in the same patient shows a hypointense hematoma (h) and compression of the liver parenchyma anteriorly. (c) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in the same patient 3 months after LITT shows a small area of hyperintensity (arrow) in the hematoma depicted in b.

View larger version (148K): [in a new window]   Figure 4a. (a) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in a 56-year-old woman shows a biloma (b) within a laser-induced area of necrosis (arrow). The lesion resolved completely within 2 years, as verified on the follow-up MR images. There were no clinical symptoms of inflammation. (b) Corresponding transverse T2-weighted spin-echo MR image (3,300/128) obtained in the same patient. (c) Transverse T2-weighted spin-echo MR image (3,300/128) obtained in a 56-year-old man shows biloma (arrow) with homogeneous, greatly increased signal intensity. The spherical and sharply delineated shape is typical of a necrotic area filled with bile fluid.

View larger version (150K): [in a new window]   Figure 4b. (a) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in a 56-year-old woman shows a biloma (b) within a laser-induced area of necrosis (arrow). The lesion resolved completely within 2 years, as verified on the follow-up MR images. There were no clinical symptoms of inflammation. (b) Corresponding transverse T2-weighted spin-echo MR image (3,300/128) obtained in the same patient. (c) Transverse T2-weighted spin-echo MR image (3,300/128) obtained in a 56-year-old man shows biloma (arrow) with homogeneous, greatly increased signal intensity. The spherical and sharply delineated shape is typical of a necrotic area filled with bile fluid.

View larger version (156K): [in a new window]   Figure 4c. (a) Transverse nonenhanced T1-weighted gradient-echo MR image (130/12) obtained in a 56-year-old woman shows a biloma (b) within a laser-induced area of necrosis (arrow). The lesion resolved completely within 2 years, as verified on the follow-up MR images. There were no clinical symptoms of inflammation. (b) Corresponding transverse T2-weighted spin-echo MR image (3,300/128) obtained in the same patient. (c) Transverse T2-weighted spin-echo MR image (3,300/128) obtained in a 56-year-old man shows biloma (arrow) with homogeneous, greatly increased signal intensity. The spherical and sharply delineated shape is typical of a necrotic area filled with bile fluid.

View larger version (157K): [in a new window]   Figure 5. Sagittal T1-weighted gradient-echo MR image (140/12) obtained in a 52-year-old man. The close relationship between the metastatic liver lesion (m) and the diaphragm (arrow) is depicted on this pretreatment MR image because during percutaneous insertion of the laser catheter, a pneumothorax occurred.