Complex hepatic surgery aided by a 1.5-tesla moveable magnetic resonance imaging system
Complex hepatic surgery aided by a 1.5-tesla moveable magnetic resonance imaging system
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DOI：
10.1016/j.amjsurg.2006.02.008
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发表时间：
2006-05-01
影响因子：
3
通讯作者：
Sutherland, Garnette
中科院分区：
文献类型：
--
作者：
Bathe, Oliver F.;Mahallati, Houman;Sutherland, Garnette
背景：切除是潜在可治愈的肝肿瘤的最佳治疗方法；射频消融术(RFA)是一种替代方法。RFA的治疗潜力可能会受到阻碍，因为烧伤的程度很难通过超声波来估计。我们推测，术中MRI(IMRI)可以更准确地评估消融的完整性。方法：我们在一个配备了独特的可伸缩的1.5-T磁铁的手术室里进行了开放肝脏手术。之所以选择患者，是因为预计RFA(切除或不切除)是可能的，而且iMRI可能有助于术中决策。在基线MRI之后，在开放手术时用超声进一步评估病变。结果：9例患者接受了手术治疗：1例为转移性类癌，4例为肝细胞癌，4例为结直肠癌肝转移。在4名患者中，iMRI对决策有影响。在5名患者中，有非局部复发，1名从未无病复发的患者出现了局部复发。必须确定其防止局部复发的能力。此外，必须明确这项技术在整体治疗医疗机构中的作用。(C)2006 Excerpta Medica Inc.保留所有权利。
Background: Resection represents the best treatment for potentially curable liver tumors; radiofrequency ablation (RFA) is an alternative. The curative potential of RFA may be hampered because the extent of burn is difficult to estimate by ultrasound. We postulated that intraoperative MRI (iMRI) would enable a more accurate assessment of ablation completeness.Methods: We performed open hepatic surgery in an operating room equipped with a unique, retractable 1.5-T magnet. Patients were selected because it was anticipated that RFA (with or instead of resection) was likelihood and that iMRI might be helpful in making intraoperative decisions. After baseline MRI, lesions were further assessed by ultrasound at the time of open surgery. Lesions were resected and/or ablated, and further imaging confirmed the margins of the procedure.Results: Nine patients underwent the procedure: I with metastatic carcinoid, 4 with hepatocellular carcinoma, and 4 with colorectal liver metastases. In 4 patients, iMRI had an effect on decision-making. In 5 individuals, there were nonlocal recurrences, and I patient who was never disease-free had a local recurrence.Comments: Intraoperative MRI could potentially impact operative decision-making when ablating extensive disease. Its ability to prevent local recurrences must be determined. Moreover, the role of this technology in the overall treatment armamentarium must be defined. (c) 2006 Excerpta Medica Inc. All rights reserved.