Threshold-based prediction of the coagulation zone in sequential temperature mapping in MR-guided radiofrequency ablation of liver tumours

Abstract

Objective: To evaluate different cut-off temperature levels for a threshold-based prediction of the coagulation zone in magnetic resonance (MR)-guided radiofrequency (RF) ablation of liver tumours.

Methods: Temperature-sensitive measurements were acquired during RF ablation of 24 patients with primary (6) and secondary liver lesions (18) using a wide-bore 1.5 T MR sytem and compared with the post-interventional coagulation zone. Temperature measurements using the proton resonance frequency shift method were performed directly subsequent to energy application. The temperature maps were registered on the contrast-enhanced follow-up MR images acquired 4 weeks after treatment. Areas with temperatures above 50°, 55° and 60°C were segmented and compared with the coagulation zones. Sensitivity and positive predictive value were calculated.

Results: No major complications occurred and all tumours were completely treated. No tumour recurrence was observed at the follow-up examination after 4 weeks. Two patients with secondary liver lesions showed local tumour recurrence after 4 and 7 months. The 60°C threshold level achieved the highest positive predictive value (87.7 ± 9.9) and the best prediction of the coagulation zone.

Conclusions: For a threshold-based prediction of the coagulation zone, the 60°C cut-off level achieved the best prediction of the coagulation zone among the tested levels.

Key points: • Temperature monitoring can be used to survey MR-guided radiofrequency ablation • The developing ablation zone can be estimated based on post-interventional temperature measurements • A 60°C threshold level can be used to predict the ablation zone • The 50°C and 55°C temperature zones tend to overestimate the ablation zone.