Purpose: To utilize a microwave coagulator for MR-guided interstitial thermal therapy of liver tumors as a clinically feasible heating device. Materials and Methods:MR-guided microwave thermocoagulation therapy was carried out 34 times in 30 patients with liver tumors (eight hepatocellular carcinoma, 22 metastatic tumors) using a 0.5 T open configuration MR system.Results: Percutaneous puncture could be accomplished both accurately and safely while monitoring real-time magnetic resonance imaging (MRI). Using a notch filter, MR images could be observed without electromagnetic interference even during microwave ablation. Temperature monitoring during ablation was possible using the proton resonance frequency method. All procedures could be successfully carried out without any complications, and the therapeutic effects were deemed satisfactory. Conclusion:MR-guided microwave thermocoagulation therapy could be one promising procedure of minimally invasive treatment for liver tumors.
Since we first successfully performed magnetic resonance (MR)-guided microwave coagulation therapy for liver tumors in January 2000, we have developed new MR-compatible instruments, laparoscopy and thoracoscopy, which have enabled us to approach liver tumors located just below the diaphragm and in contact with other organs. We have customized software for an MR gradient-based tracking system for the easy detection of the location and orientation of treatment area and for the real-time display of MR temperature maps with a scale bar. Navigation software was customized to enable real-time image navigation. The reformatted images in the two perpendicular planes complemented the limitations of real-time MR imaging. Evaluation software, "FootPrint," was useful for distinguishing treated areas from untreated areas and improved the evaluation of treatment accuracy. These newly developed MR-guided systems that utilize microwave have played important roles in more accurate, safer, and easier treatment for liver tumors. We have treated 184 patients using these new techniques without major complications.
This ICG fluorescence imaging technique is feasible and safe for detecting SLN in a less invasive manner than conventional mapping, with real-time observations.
We obtained clear and reproducible MR fluoroscopic images and temperature maps for MR image-guided microwave ablation of liver tumors under general anesthesia without suspending the artificial ventilation. Respiratory information was directly obtained from air-way pressure without a sensor on the chest wall. The trigger signal started scanning of one whole image with a spoiled gradient echo sequence. The delay time before the start of scanning was adjusted to acquire the data corresponding to the k-space center at the maximal expiratory phase. The triggered images were apparently clearer than the nontriggered ones and the location of the liver was consistent, which made targeting of the tumor easy. MR temperature images, which were highly susceptible to the movement of the liver, during microwave ablation using a proton resonance frequency method, could be obtained without suspending the artificial ventilation. Respiratory triggering technique was found to be useful for MR fluoroscopic images and MR temperature monitoring in MR-guided microwave ablation of liver tumors under general anesthesia.
A carcinoma displaying undifferentiated features with dense lymphoplasmacytic infiltration is defined as a lymphoepithelioma-like carcinoma (LEC), and some of LEC is associated with Epstein-Barr virus (EBV). All of the 13 previously reported cases of LEC of the biliary system were intrahepatic in location. Herein, we describe the first case of LEC of the inferior common bile duct. A 68-year-old Japanese man, who had been previously treated for hepatocellular carcinoma using microwave coagulation therapy, was found to have tumors of the common bile duct and pancreas head. Histopathological study of the resected tumor showed solid or cohesive nests of large undifferentiated cells with irregular large vesicular nuclei and nucleoli. Around the tumor cell nests, dense lymphoplasmacytic infiltration was observed. Focal glandular differentiation (approximately 5%) was also present. These histopathological features corresponded morphologically to LEC. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, CK 19 and CA19-9, but negative for CK 20 and Hep Par 1. In situ hybridization for Epstein Barr virus early small RNAs disclosed no nuclear signal in tumor cells. Therefore, a diagnosis of non-EBV-associated LEC of the inferior common bile duct was made. Although the prognosis of the biliary LEC is thought to be better than that of conventional cholangiocarcinoma, the differences in prognosis between EBV-positive and -negative cases have not yet been established. Therefore, additional case studies will be needed to clarify the clinicopathological features of LEC of the biliary tract.
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