[Minimally invasive therapy under image guidance--emphasizing MRI-guided cryotherapy]

Abstract

Cryotherapy may provide a method for the focal destruction of cancerous tissue while preserving most of the surrounding normal tissue. The mechanisms of tissue injury in cryotherapy are 1) intracellular ice formation, 2) dehydration of cells, and 3) stagnation of microcirculation. MR images were superior to CT and ultrasound in monitoring interstitial cryotherapy, because the very short T2 relaxation time of ice affords excellent contrast between the ice and surrounding tissue, allowing an accurate depiction of the entire extent of the iceball. MR imaging demonstrates the iceball as sharply marginated regions of signal loss that expanded and engulfed the renal and hepatic masses with clear contrast between the iceball and surrounding tissue. Recently, a fast Joule-Thomson cryocycling device for MR-compatible cryotherapy application was developed and clinical trials under MRI-guided monitoring were performed in several sites of the body. In our series, cryotherapy was performed in 14 cases of renal tumor and 4 cases of hepatic malignancy under the guidance of a horizontal open MR system. Fourteen of the 18 cases were discharged a day after cryotherapy. One of the residual tumors at the margin of a renal cancer required re-cryoablation. All cryoablated tumors resolved and there were no serious complications and no clinically significant changes-during the follow-up study.