Evaluation of MRI T1-based treatment monitoring during laser-induced thermotherapy of liver metastases for necrotic size prediction

Abstract

Purpose: The aim of this study was to evaluate the accuracy of real-time magnetic resonance imaging (MRI) T1-based treatment monitoring for predicting volume of lesions induced by laser-induced thermotherapy (LITT) of liver metastases.

Materials and methods: This prospective study was approved by the institutional review board and informed consent from all included patients was obtained. In 151 patients, 237 liver metastases were ablated during 372 LITT procedures. 1.5T MRI treatment monitoring was performed based on longitudinal relaxation time (T1) using fast low-angle shot (FLASH) sequences. Patients underwent additional contrast-enhanced MRI directly after LITT, 24 h after the procedure and during follow-up at 3, 6 and 12 months. The amount of energy necessary to induce a defined necrotic area was investigated within the various liver segments.

Results: The total amount of energy applied during LITT varied from 6.12–225.32 kJ (mean 48.96 kJ). Ablation in liver segments 5 (2.12 kJ/cm³) and 8 (2.16 kJ/cm³) required the highest energy. The overall pre-ablative metastasis volume ranged from 0.5–51.94 cm³ (mean 1.99 cm³, SD 25.49 cm³) while the volume measured in the last available T1 image varied from 0.78–120 cm³ (mean 26.25 cm³, SD 25.66 cm³). Volumes measured via MRI T1-based treatment monitoring showed a stronger correlation with necrosis 24 h after LITT (r = 0.933, p < 0.001) than contrast-enhanced MRI directly after the procedure (r = 0.888, p < 0.001).

Conclusions: Real-time MRI T1-based treatment monitoring during LITT of liver metastases allows for precise estimation of the resulting lesion volume and improves control of the energy necessary during ablation.

• Laser-induced thermotherapy
• liver metastases
• magnetic resonance imaging
• thermoablation

Acknowledgements

The authors thank Zsuzsanna T. Varga, PhD, for her assistance in editing the manuscript.