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Evolution of the Ablation Region After Magnetic Resonance–Guided High-Intensity Focused Ultrasound Ablation in a Vx2 Tumor Model

Wijlemans, Joost W. MD*; Deckers, Roel PhD; van den Bosch, Maurice A.A.J. MD, PhD*; Seinstra, Beatrijs A. MD*; van Stralen, Marijn PhD; van Diest, Paul J. MD, PhD; Moonen, Chrit T.W. PhD; Bartels, Lambertus W. PhD

doi: 10.1097/RLI.0b013e3182820257
Original Articles

Objectives Volumetric magnetic resonance (MR)–guided high-intensity focused ultrasound (HIFU) is a completely noninvasive image-guided thermal ablation technique. Recently, there has been growing interest in the use of MR-HIFU for noninvasive ablation of malignant tumors. Of particular interest for noninvasive ablation of malignant tumors is reliable treatment monitoring and evaluation of response. At this point, there is limited evidence on the evolution of the ablation region after MR-HIFU treatment. The purpose of the present study was to comprehensively characterize the evolution of the ablation region after volumetric MR-HIFU ablation in a Vx2 tumor model using MR imaging, MR temperature data, and histological data.

Materials and Methods Vx2 tumors in the hind limb muscle of New Zealand White rabbits (n = 30) were ablated using a clinical MR-HIFU system. Twenty-four animals were available for analyses. Magnetic resonance imaging was performed before and immediately after ablation; MR temperature mapping was performed during the ablation. The animals were distributed over 7 groups with different follow-up lengths. Depending on the group, animals were reimaged and then killed on day 0, 1, 3, 7, 14, 21, or 28 after ablation. For all time points, the size of nonperfused areas (NPAs) on contrast-enhanced T1-weighted (CE-T1-w) images was compared with lethal thermal dose areas (ie, the tissue area that received a thermal dose of 240 equivalent minutes or greater [EM] at 43°C) and with the necrotic tissue areas on histology sections.

Results The NPA on CE-T1-w imaging showed an increase in median size from 266 ± 148 to 392 ± 178 mm2 during the first day and to 343 ± 170 mm2 on day 3, followed by a gradual decrease to 113 ± 103 mm2 on day 28. Immediately after ablation, the NPA was 1.6 ± 1.4 times larger than the area that received a thermal dose of 240 EM or greater in all animals. The median size of the necrotic area on histology was 1.7 ± 0.4 times larger than the NPA immediately after ablation. After 7 days, the size of the NPA was in agreement with the necrotic tissue area on histology (ratio, 1.0 ± 0.2).

Conclusions During the first 3 days after MR-HIFU ablation, the ablation region increases in size, after which it gradually decreases in size. The NPA on CE-T1-w imaging underestimates the extent of tissue necrosis on histology in the initial few days, but after 1 week, the NPA is reliable in delineating the necrotic tissue area. The 240-EM thermal dose limit underestimates the necrotic tissue area immediately after MR-HIFU ablation. Reliable treatment evaluation techniques are particularly important for noninvasive, image-guided tumor ablation. Our results indicate that CE-T1-w imaging is reliable for MR-HIFU treatment evaluation after 1 week.

From the *Department of Radiology, †Image Sciences Institute, and ‡Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.

Received for publication September 30, 2012; and accepted for publication, after revision, December 6, 2012.

Conflicts of interest and sources of funding: This research was performed within the framework of the Center for Translational Molecular Medicine (, project VOLTA (grant 05T-201).

Reprints: Joost W. Wijlemans, MD, Department of Radiology, E01.132, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands. E-mail:

© 2013 by Lippincott Williams & Wilkins