MR-guided interstitial laser-induced thermotherapy of hepatic metastasis combined with arterial blood flow reduction: Technique and first clinical results in an open MR system

Abstract

The feasibility and safety of percutaneous laser‐induced thermotherapy (LITT) of liver metastases in an open low‐field magnetic resonance imaging (MRI) system combined with microsphere‐modulated blood flow reduction were tested. Nd:YAG laser therapy with an internally cooled laser applicator was performed under local anesthesia on 20 patients with 34 liver metastases. To increase the effectivenes of LITT, degradable starch microspheres were injected into the proper hepatic artery through an MR‐visible catheter initially inserted under fluoroscopy. Near real‐time imaging was used for positioning the laser applicator. A T1‐weighted gradient‐echo breath‐hold sequence was used for catheter localization and temperature monitoring. The volumes of the liver metastases and the thermonecroses were determined. MRI‐guided LITT could be performed in all patients with no clinically relevant complications. Intraprocedural imaging underestimated the extent of thermonecrosis. In conclusion, percutaneous LITT of liver metastases after injection of starch microspheres is both technically feasible and safe in an open MRI system. J. Magn. Reson. Imaging 2001;13:31–36. © 2001 Wiley‐Liss, Inc.

Enhancement of the immune response to residual intrahepatic tumor tissue by laser‐induced thermotherapy (LITT) compared to hepatic resection

“…It is still unclear if and how far surgical resection itself can stimulate the growth of micrometastases. Laser-induced thermotherapy (LITT) like cryo-and radiofrequency ablation, is an in situ ablation procedure that is increasingly used for treating colorectal liver metastases [8][9][10][11]. Laser-induced thermotherapy (LITT) like cryo-and radiofrequency ablation, is an in situ ablation procedure that is increasingly used for treating colorectal liver metastases [8][9][10][11].…”

Laser‐induced thermotherapy (LITT) of liver metastases: MR‐guided percutaneous insertion of an MRI‐compatible irrigated microcatheter system using a closed high‐field unit

“…Despite the lower laser energy applied, the in vitro evaluation with the new catheter system showed similar maximal coagulation volumes compared with catheter systems with high‐flow circulating irrigation (2, 5–7, 14, 15). This result was possible due to the open irrigation system with a remarkably slower flow (0.75 mL/minute) compared with the closed system with an additional backflow channel inside the catheter and an irrigation flow of 60 mL/minute carrying a major proportion of the energy out of the lesion.…”

Repeated transarterial chemoembolisation using different chemotherapeutic drug combinations followed by MR-guided laser-induced thermotherapy in patients with liver metastases of colorectal carcinoma

“…By embolising the hepatic artery, the blood flow is reduced leading to ischaemia, which increases the contact time between the tumour cells and the chemotherapeutic agent (Heisterkamp et al , 1997; Albrecht et al , 1998; Wacker et al , 2001; Ritz et al , 2007). In addition, the thermal effect is increased, as the cooling effect of the blood flow, which results in a conservation of viable cells around larger vessels due to a local under heating (Whelan et al , 1995), is held off.…”