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Thyroid Tissue: US-guided Percutaneous Laser Thermal Ablation¹

¹ From the Departments of Radiology and Diagnostic Imaging (C.M.P., G.B., A.B., A.C., S.P.) and Endocrine, Metabolic, and Digestive Diseases (R.G., E.P.), Ospedale Regina Apostolorum, Via San Francesco 50, 00041 Albano Laziale, Rome, Italy; Department of Physiopathology, La Sapienza University 2nd Campus, Rome, Italy (V.T.); and Surgery Unit of Neck Pathologies, Ospedale Santa Maria del Popolo degli Incurabili, Naples, Italy (S.S.). Received October 21, 2002; revision requested January 7, 2003; final revision received October 23; accepted November 17. Address correspondence to C.M.P. (e-mail: cmpacel@katamail.com).

View larger version (18K): [in a new window]   Figure 1. Scatterplot shows relationship between energy delivered and volume reduction (r2 = 0.75, P < .001).

View larger version (152K): [in a new window]   Figure 2a. Transverse CT scans in neck of 75-year-old woman with anaplastic carcinoma. (a) Nonenhanced CT scan obtained before LTA treatment shows large hypoattenuating area (arrows) in left thyroid lobe, with coarse calcifications (arrowhead) in lower aspect of tumor mass. (b) Contrast material-enhanced CT scan obtained after LTA treatment shows large homogeneous hypoattenuating area as a result of coagulation necrosis in center of infiltrating tumor mass. Tumor displaces surrounding structures of upper neck and invades outer contiguous margin of trachea. Small rim (arrows) of lesion around central coagulation zone remained untreated (partial response; energy delivered, 7,200 J).

View larger version (155K): [in a new window]   Figure 2b. Transverse CT scans in neck of 75-year-old woman with anaplastic carcinoma. (a) Nonenhanced CT scan obtained before LTA treatment shows large hypoattenuating area (arrows) in left thyroid lobe, with coarse calcifications (arrowhead) in lower aspect of tumor mass. (b) Contrast material-enhanced CT scan obtained after LTA treatment shows large homogeneous hypoattenuating area as a result of coagulation necrosis in center of infiltrating tumor mass. Tumor displaces surrounding structures of upper neck and invades outer contiguous margin of trachea. Small rim (arrows) of lesion around central coagulation zone remained untreated (partial response; energy delivered, 7,200 J).

View larger version (138K): [in a new window]   Figure 3a. US images in neck of 60-year-old woman. (a) Before LTA, longitudinal US image shows solid nodule (arrows) in left thyroid lobe. (b) At 60 seconds after laser irradiation, transverse US image shows two roughly spherical hyperhechoic areas (arrowheads) with associated acoustic shadowing. Areas were 1.0 cm apart in center of nodule. (c) At 360 seconds after LTA procedure, transverse US image shows two large hyperhechoic areas (arrowheads) with ill-defined borders around fiber tips with acoustic shadowing in center of nodule. (d) At 6 months after LTA, longitudinal US image shows marked volume reduction of nodule (arrows). In center of nodule is ill-defined hyperechoic zone with hypoechoic halo due to scar tissue. Scale is in centimeters.

View larger version (126K): [in a new window]   Figure 3b. US images in neck of 60-year-old woman. (a) Before LTA, longitudinal US image shows solid nodule (arrows) in left thyroid lobe. (b) At 60 seconds after laser irradiation, transverse US image shows two roughly spherical hyperhechoic areas (arrowheads) with associated acoustic shadowing. Areas were 1.0 cm apart in center of nodule. (c) At 360 seconds after LTA procedure, transverse US image shows two large hyperhechoic areas (arrowheads) with ill-defined borders around fiber tips with acoustic shadowing in center of nodule. (d) At 6 months after LTA, longitudinal US image shows marked volume reduction of nodule (arrows). In center of nodule is ill-defined hyperechoic zone with hypoechoic halo due to scar tissue. Scale is in centimeters.

View larger version (123K): [in a new window]   Figure 3c. US images in neck of 60-year-old woman. (a) Before LTA, longitudinal US image shows solid nodule (arrows) in left thyroid lobe. (b) At 60 seconds after laser irradiation, transverse US image shows two roughly spherical hyperhechoic areas (arrowheads) with associated acoustic shadowing. Areas were 1.0 cm apart in center of nodule. (c) At 360 seconds after LTA procedure, transverse US image shows two large hyperhechoic areas (arrowheads) with ill-defined borders around fiber tips with acoustic shadowing in center of nodule. (d) At 6 months after LTA, longitudinal US image shows marked volume reduction of nodule (arrows). In center of nodule is ill-defined hyperechoic zone with hypoechoic halo due to scar tissue. Scale is in centimeters.

View larger version (131K): [in a new window]   Figure 3d. US images in neck of 60-year-old woman. (a) Before LTA, longitudinal US image shows solid nodule (arrows) in left thyroid lobe. (b) At 60 seconds after laser irradiation, transverse US image shows two roughly spherical hyperhechoic areas (arrowheads) with associated acoustic shadowing. Areas were 1.0 cm apart in center of nodule. (c) At 360 seconds after LTA procedure, transverse US image shows two large hyperhechoic areas (arrowheads) with ill-defined borders around fiber tips with acoustic shadowing in center of nodule. (d) At 6 months after LTA, longitudinal US image shows marked volume reduction of nodule (arrows). In center of nodule is ill-defined hyperechoic zone with hypoechoic halo due to scar tissue. Scale is in centimeters.

View larger version (144K): [in a new window]   Figure 4a. Longitudinal US scans in neck of 50-year-old woman at 24 hours after LTA. (a) US scan shows, from center of thermal lesion outward, small central hypoechoic cavity caused by vaporization surrounded by hyperechoic rim (arrowheads) caused by carbonization. Rim represents debris in margin of central cavity. Broad hypoechoic zone (arrows) is caused by coagulation necrosis. (b) Longitudinal color Doppler US scan shows no sign of vascularization in treated area (arrows). Proximal and upper areas of nodule remained untreated. Scale is in centimeters.

View larger version (133K): [in a new window]   Figure 4b. Longitudinal US scans in neck of 50-year-old woman at 24 hours after LTA. (a) US scan shows, from center of thermal lesion outward, small central hypoechoic cavity caused by vaporization surrounded by hyperechoic rim (arrowheads) caused by carbonization. Rim represents debris in margin of central cavity. Broad hypoechoic zone (arrows) is caused by coagulation necrosis. (b) Longitudinal color Doppler US scan shows no sign of vascularization in treated area (arrows). Proximal and upper areas of nodule remained untreated. Scale is in centimeters.