MRI導引的腸內溫熱燒灼術對腎臟腫瘤有益


  Sept. 2, 2004 - 根據一項發表於9月號放射學期刊的第2期試驗結果顯示,核磁共振造影(MRI)導引的腸內電磁波(RF)溫熱燒灼術(ITA)在治療原發性腎臟腫瘤的成功率很高。
  
  馬里蘭巴爾的摩約翰霍普金斯醫院Jonathan S. Lewin醫師與其同事指出,在過去幾年,以MRI導引的最低侵襲性手術受到青睞,原因是其卓越的組織對比度、高空間解析度、多平面性能、高血管顯著性、與MRI可達到的溫度敏感度。
  
  牽涉目前以MRI導引的ITA(主要是肝臟與腦部)的試驗結果是令人振奮的,雖然許多研究人員已經在MRI導引下執行整個步驟,但這些試驗大部分需要在MR顯像單位外放置治療裝置。
  
  目前這個試驗,10位周邊腎臟細胞惡性腫瘤而且無法以手術治療患者,透過經皮下RF TIA由0.2T MR影像單位導引與監測;受試者年齡從25至83歲,腫瘤容積從0.63至16.90毫升,最大直徑從1.0至3.6公分。
  
  研究人員使用200-W RF摘除系統與自行組裝MR顯影相容冷卻性電極用於脈衝性RF電流,以單一或多重摘除週期,每次12至15分鐘;他們重複這項步驟直到整個腫瘤由T2-加權以及/或是短回復時間反轉-恢復影像的放大區域低訊號強度取代。
  
  所有病患,以MR「螢光鏡」引導成功的讓RF電極植入以及/或是重新定位進入腎臟腫瘤,連同以MRI定義完全的摘除,在21個電極位置執行10個步驟、30個摘除循環;10個腫瘤中有7個需要電極重新定位與額外的RF應用來達到完全摘除。
  
  在手術時或結束後並沒有觀察到併發症,除了兩個小的、自限性的周邊血腫外,在平均追蹤25±9.4月中,沒有發現如腎臟缺血、梗塞、尿瘤、或腫瘤復發的併發症。
  
  研究人員指出,雖然這項研究的發現是很早期的,達到完全摘除及沒有腫瘤復發的結果是令人振奮的,但進一步的追蹤與額外的病患收集正在進行中,而且效果結論性的估計還需要等待最後的分析。
  
  西門子醫療系統,放射部門、Whitaker基金會、美國癌症學會與國家衛生研究院協助贊助這項試驗。

MRI-Guided Interstitial Radiof

By Laurie Barclay, MD
Medscape Medical News

Sept. 2, 2004 — Magnetic resonance imaging (MRI)-guided interstitial radiofrequency (RF) thermal ablation (ITA) has a high success rate in primary kidney tumors, according to the results of a phase II trial published in the September issue of Radiology.

"During the past few years, there has been increased interest in MRI-guided minimally invasive therapy owing to the excellent soft-tissue contrast, high spatial resolution, multiplanar capabilities, high vascular conspicuity, and temperature sensitivity achievable with MRI," write Jonathan S. Lewin, MD, from Johns Hopkins Hospital in Baltimore, Maryland, and colleagues. "Results of studies involving MRI-guided ITA to date (primarily in the liver and brain) have been encouraging. Most of these studies required placement of the therapeutic device outside the MR imaging unit, although several investigators have performed the entire procedure with MRI guidance."

In the current trial, 10 men with peripheral renal cell carcinoma and contraindications to surgery were treated with percutaneous RF ITA entirely guided and monitored with a 0.2-T MR imaging unit. Age range was 25 to 83 years, and tumor size ranged from 0.63 to 16.90 mL in volume and 1.0 to 3.6 cm in maximum diameter.

The investigators used a 200-W RF ablation system and custom-fabricated MR imaging–compatible cool-tip electrodes to apply pulsed RF current for single or multiple ablation cycles, each for 12 to 15 minutes. They repeated this process until the entire tumor was replaced by an enlarging zone of low signal intensity on T2-weighted and/or short inversion time inversion-recovery images.

In all patients, direct MR "fluoroscopic" guidance allowed successful RF electrode insertion and/or repositioning into the kidney tumor, as well as complete ablation defined with MRI. During the 10 procedures, 30 ablation cycles were conducted at 21 electrode positions. Repositioning of the electrode and additional RF application were required in seven of 10 tumors to achieve complete ablation.

There were no complications observed during or after the procedure, other than two small, self-limited perirenal hematomas. During a mean follow-up period of 25 ± 9.4 months, there were no delayed complications such as renal ischemia, infarct, urinoma, or tumor recurrence.

"Although the findings of this investigation are preliminary, the high success rate in achieving complete ablation and the absence of tumor recurrence are very encouraging," the authors write. "Further follow-up and additional patient recruitment are ongoing, and a conclusive estimate of efficacy awaits final analysis."

Siemens Medical Systems, Radionics, the Whitaker Foundation, the American Cancer Society, and the National Institutes of Health helped support this study.

Radiology. 2004;232:835-845

Reviewed by Gary D. Vogin, MD

    
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