MR monitoring of NaCl-enhanced radiofrequency ablations: observations on low- and high-field-strength MR images with pathologic correlation.
OBJECTIVE
To test the hypothesis that magnetic resonance (MR) imaging can be used to monitor both intraparenchymal injection of NaCl solution and subsequent radiofrequency ablation (RFA) within tissues pretreated with NaCl, report the low- and high-field-strength MR appearance of NaCl-enhanced RFAs, and compare MR findings with pathologic findings.


METHODS
Ten ex vivo calf liver specimens were injected with saturated NaCl (seven were mixed with methylene blue during MR fluoroscopic monitoring) and reexamined with fast imaging with steady-state progression (FISP), true FISP, reversed FISP (PSIF), and fast spin-echo T2-weighted MR sequences. The NaCl-to-liver contrast-to-noise ratio (CNR) was calculated for various sequences, and CNRs were compared with the Student t test. Distribution on MR images was compared with the results of pathologic analysis. Forty additional in vivo monopolar RFAs were performed in paraspinal muscles of seven minipigs after animal care committee approval (10 standard control ablations, 30 were preceded by direct injection of saturated NaCl at various volumes [3-9 mL] and rates [1 or 6mL/min]). Postablation low-field-strength (n = 20) and high-field-strength (n = 20) MR examinations consisted of T2-weighted imaging, short inversion time inversion-recovery (STIR) imaging, and contrast material-enhanced T1-weighted imaging. Ablation shape, conspicuity, volume, and signal intensity were compared between the two groups and with the results of pathologic analysis. The difference in volumes with and without NaCl injection was evaluated by using two-way analysis of variance.


RESULTS
Mean CNR was highest on fast spin-echo T2-weighted images and was significantly higher for PSIF than for FISP (P < .0001) or true FISP (P = .003). NaCl distribution on MR images corresponded with the results of pathologic analysis in ex vivo livers. Interactive in vivo monitoring of NaCl injection and electrode placement was feasible. NaCl-enhanced ablations had irregular shapes, a higher CNR, and significantly larger volumes (F = 22.0; df = 1, 90; P < .00001). All ablations had intermediate or low signal intensity with high-signal-intensity rims on all images. Fluid signals overlaid NaCl-enhanced ablations on fast spin-echo T2-weighted and STIR images, particularly on high-field-strength MR images.


CONCLUSIONS
MR imaging can be used to reliably monitor the distribution of injected NaCl solution in tissues. Interventional MR imaging techniques can be used to guide and monitor RFAs within NaCl pretreated tissues, with good correlation with pathologic results.
Nour
Sherif Gamal
SG
Department of Radiology, University Hospitals of Case Medical Center/Case Western Reserve University School of Medicine. sherif.nour@emoryhealthcare.org
Goldberg
S Nahum
SN
Wacker
Frank K
FK
Rafie
Shervin
S
Paul
Simi
S
Heidenreich
Jens O
JO
Rodgers
Mark
M
Abdul-Karim
Fadi W
FW
Duerk
Jeffrey L
JL
Lewin
Jonathan S
JS
D000704:Analysis of Variance; D000818:Animals; D017115:Catheter Ablation / Q000379:methods*; D002417:Cattle; D006801:Humans; D007267:Injections; D008099:Liver / Q000601:surgery*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D023421:Models, Animal; D012965:Sodium Chloride / Q000008:administration & dosage / Q000494:pharmacology*; D013552:Swine
D012965:Sodium Chloride