Real-time magnetic resonance imaging (MRI)–guided cryoablation has been investigated in open MRI systems with low magnetic fields (0.2–0.5 T). More advanced imaging techniques and faster imaging rates are possible at higher magnetic fields, which often require a closed-bore magnet design. However, there is very little experience with real-time interventions in closed-bore 1.5-T MRI units. Herein, we report our initial experience with real-time MRI-guided cryoablation of small renal tumors using a prototype balanced steady-state free precession imaging sequence in a closed-bore 1.5-T MRI system.
From August 2008 to April 2012, 18 patients underwent MRI-guided cryoablation of small renal tumors. A 1.5-T cylindrical MRI scanner with a 125 cm × 70 cm bore and a prototype balanced steady-state free precession sequence (BEAT interactive real-time tip tracking) were used to guide the placement of 17-gauge cryoprobes in real time. Ice ball formation was monitored every 3 minutes in 1 or more imaging planes. Each ablation consisted of 2 freeze-thaw cycles. Contrast-enhanced MRI was performed after the second active thaw period. Follow-up consisted of clinical evaluation and renal protocol computed tomography (CT) or MRI performed at 1, 6, 12, 18, and 24 months and annually thereafter.
During the study period, we successfully ablated 18 tumors in 18 patients in 18 sessions. The mean tumor size was 2.2 cm (median, 2 cm; range, 1.2–4.4 cm). The number of cryoprobes used per patient was determined based on tumor size. The mean number of cryoprobes used per patient was 3 (median, 3 cryoprobes; range, 2–4 cryoprobes). Fifty-six cryoprobes, 9 biopsy needles, and 2 hydrodissection needles were successfully placed under real-time MRI guidance using BEAT interactive real-time tip tracking sequence. Hydrodissection under MRI guidance was successfully performed in 4 patients. In each patient, contrast-enhanced MRI performed after the second active thaw period revealed a sharply defined avascular zone surrounding the targeted tumor, which confirmed complete ablation of the tumor with adequate margins. Although contrast media slowly accumulated in the targeted tumor in 9 patients immediately after the procedure, follow-up imaging studies performed at a mean of 16.7 months revealed no contrast enhancement within the ablation zone in these patients. Disease-specific, metastasis-free, and local recurrence-free survival rates were all 100%.
Real-time placement and manipulation of cryoprobes during MRI-guided cryoablation of small renal tumors in a closed-bore, high–magnetic field scanner are feasible. Technical and clinical success rates are similar to those of patients who undergo CT-guided radiofrequency ablation or cryoablation of small renal tumors. Our findings suggest that MRI-guided ablation has several advantages over CT-guided ablation, including real-time guidance for probe placement, multiplanar imaging, exquisite soft tissue contrast, and lack of ionizing radiation.
From the *Section of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX; †Siemens Corporate Research and Technology, Baltimore, MD; and Departments of ‡Biostatistics, §Urology, and ∥Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Received for publication July 29, 2012; and accepted for publication, after revision October 27, 2012.
Conflicts of interest and sources of funding: L.P. is a staff scientist at Siemens Corporate Research and Technology.
This research was supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant CA016672.
Reprints: Kamran Ahrar, MD, 1515 Holcombe Boulevard, Unit 1471, Houston, TX 77030. E-mail: firstname.lastname@example.org.