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Applicators for Magnetic Resonance–Guided Ultrasonic Ablation of Benign Prostatic Hyperplasia

Sommer, Graham MD*; Pauly, Kim Butts PhD*; Holbrook, Andrew PhD*; Plata, Juan MS*; Daniel, Bruce MD*; Bouley, Donna PhD, DVM; Gill, Harcharan MD; Prakash, Punit PhD§; Salgaonkar, Vasant PhD§; Jones, Peter BS§; Diederich, Chris PhD§

doi: 10.1097/RLI.0b013e31827fe91e
Original Articles
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Objectives The aims of this study were to evaluate in a canine model applicators designed for ablation of human benign prostatic hyperplasia (BPH) in vivo under magnetic resonance imaging (MRI) guidance, including magnetic resonance thermal imaging (MRTI), determine the ability of MRI techniques to visualize ablative changes in prostate, and evaluate the acute and longer term histologic appearances of prostate tissue ablated during these studies.

Materials and Methods An MRI-compatible transurethral device incorporating a tubular transducer array with dual 120° sectors was used to ablate canine prostate tissue in vivo, in zones similar to regions of human BPH (enlarged transition zones). Magnetic resonance thermal imaging was used for monitoring of ablation in a 3-T environment, and postablation MRIs were performed to determine the visibility of ablated regions. Three canine prostates were ablated in acute studies, and 2 animals were rescanned before killing at 31 days postablation. Acute and chronic appearances of ablated prostate tissue were evaluated histologically and were correlated with the MRTI and postablation MRI scans.

Results It was possible to ablate regions similar in size to enlarged transition zone in human BPH in 6 to 18 minutes. Regions of acute ablation showed a central “heat-fixed” region surrounded by a region of more obvious necrosis with complete disruption of tissue architecture. After 31 days, ablated regions demonstrated complete apparent resorption of ablated tissue with formation of cystic regions containing fluid. The inherent cooling of the urethra using the technique resulted in complete urethral preservation in all cases.

Conclusions Prostatic ablation of zones of size and shape corresponding to human BPH is possible using appropriate transurethral applicators using MRTI, and ablated tissue may be depicted clearly in contrast-enhanced magnetic resonance images. The ability accurately to monitor prostate tissue heating, the apparent resorption of ablated regions over 1 month, and the inherent urethral preservation suggest that the magnetic resonance–guided techniques described are highly promising for the in vivo ablation of symptomatic human BPH.

From the Departments of *Radiology, †Comparative Medicine, and ‡Urology, Stanford University School of Medicine, Stanford; and §Department of Radiation Oncology, University of California, San Francisco, CA.

Received for publication July 2, 2012; and accepted for publication, after revision, November 2, 2012.

Conflicts of interest and sources of funding: The work described in this article was supported by grants R01 CA11198, R01 CA122276, R21 CA137472, P01 CA159992, and R01 CA121163 from the National Institutes of Health.

The authors report no conflicts of interest.

Reprints: Graham Sommer, MD, Department of Radiology, Room H1307, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305. E-mail: gsommer@stanford.edu.

© 2013 by Lippincott Williams & Wilkins