Репозиторий Университета

© 2019, European Society of Radiology. Objectives: Invasive treatment of tumors adjacent to large hepatic vessels is a continuous clinical challenge. The primary aim of this study was to examine the feasibility of ablating liver tissue adjacent to large hepatic and portal veins with magnetic resonance imaging–guided high-intensity focused ultrasound (MRgHIFU). The secondary aim was to compare sonication data for ablations performed adjacent to hepatic veins (HV) versus portal veins (PV). Materials and methods: MRgHIFU ablations were performed in six male land swine under general anesthesia. Ablation cells of either 4 or 8 mm diameter were planned in clusters (two/animal) adjacent either to HV (n = 6) or to PV (n = 6), with diameter ≥ 5 mm. Ablations were made using 200 W and 1.2 MHz. Post-procedure evaluation was made on contrast-enhanced MRI (T1w CE-MRI), histopathology, and ablation data from the HIFU system. Results: A total of 153 ablations in 81 cells and 12 clusters were performed. There were visible lesions with non-perfused volumes in all animals on T1w CE-MRI images. Histopathology showed hemorrhage and necrosis in all 12 clusters, with a median shortest distance to vessel wall of 0.4 mm (range 0–2.7 mm). Edema and endothelial swelling were observed without vessel wall rupture. In 8-mm ablations (n = 125), heat sink was detected more often for HV (43%) than for PV (19%; p = 0.04). Conclusions: Ablations yielding coagulative necrosis of liver tissue can be performed adjacent to large hepatic vessels while keeping the vessel walls intact. This indicates that perivascular tumor ablation in the liver is feasible using MRgHIFU. Key Points: • High-intensity focused ultrasound ablation is a non-invasive treatment modality that can be used for treatment of liver tumors. • This study shows that ablations of liver tissue can be performed adjacent to large hepatic vessels in an experimental setting. • Liver tumors close to large vessels can potentially be treated using this modality.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To demonstrate the effectiveness of volumetric multispiral computer tomography at the planning of focal liver masses treatment. To present visual 3D reconstructions of the liver, its vessels and focal masses. Material and methods. A group of patients included 25 patients with different focal liver masses. The age of the patients was from 29 to 83 years (mean age 62.1 years). Each patient had MSCT of abdomen with intravenous contrast injection. The following diagnoses were made according to the results of the examination, most of which were subsequently confirmed histologically: hemangioma-3 (12%), focal nodular hyperplasia-2 (8%), abscess-1 (4%), hepatocellular carcinoma-2 (8 %), cysts-4 (16%), metastases-13 (52%) cases. Results. Three-dimensional modeling allows effectively and without distortion to combine all the phases of contrasting in a single image, which gives complete information about the anatomical features affected by the pathological process of the liver. Conclusion. Processing DICOM images with the construction of 3D models of the liver helps the surgeon at the planning of surgical treatment, improves the spatial perception of the anatomical relationship of the organ, its vessels and pathological formations. However, three-dimensional modeling requires additional time and its clinical significance remains insufficiently studied.