Adrenal metastases: CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy

Abstract

The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age 65.0 years; range 58.7-75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months). All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators per tumour: 1.9 (range 1-4); mean applied laser energy 33 kJ (range 15.3-94.6 kJ), mean diameter of the laser-induced coagulation necrosis 4.5 cm (range 2.5-7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is a safe, minimally invasive and promising procedure for treating adrenal metastases.

Surgical management of adrenal metastases

“…Alternative ablation techniques, such as ethanol injection [103], ultrasound-guided percutaneous microwave [104], CT-guided laser-induced interstitial thermotherapy [105], cryoablation [1], or radiofrequency plus chemoembolization combined therapy [106] have been sporadically reported but experience is too limited to assess its value.…”

Laser-induced thermotherapy (LITT)—evaluation of a miniaturised applicator and implementation in a 1.0-T high-field open MRI applying a porcine liver model

“…MR-guided LITT is a percutaneous, minimally invasive technique to treat parenchymatous, soft tissue and musculoskeletal tumours [10,[18][19][20][21]. A wealth of experience has been gained in LITT of liver malignancies [1,[22][23][24][25].…”

“…In most cases, applicator positioning was guided with CT imaging [1,10]. Open MR systems offer direct access to the patient and improve the interventional workflow [11][12][13][14].…”

Needlescopic ablation of small adrenal masses

“…Vogl and colleagues [26] have reported on the use of CT-guided/magnetic resonance thermotherapy-controlled laser-induced interstitial thermotherapy for adrenal metastatic lesions in nine patients. Median follow-up time in this study was 14 months (mean, 10 months), and mean lesion diameter was 4.3 cm.…”