Irreversible electroporation of the lumbar vertebrae in a porcine model: is there clinical-pathologic evidence of neural toxicity?
OBJECTIVE
To evaluate the effects of irreversible electroporation (IRE) in the porcine spine.


METHODS
This study was approved by the institutional animal care and use committee. Twenty computed tomographically guided IRE ablations in either a transpedicular location or directly over the posterior cortex were performed in the lumbar vertebrae of 10 pigs by a single operator. T1- and T2-weighted magnetic resonance (MR) imaging was performed with and without contrast material 2 or 7 days after ablation. Mathematical modeling was performed to estimate the extent of ablation. Clinical, radiologic, pathologic, and simulation findings were analyzed. The Miller low-bias back transformation was used to construct 95% confidence intervals for the mean absolute percentage difference between the maximum length and width of the ablation zone on MR images and pathologic measurements by using square-root-transformed data.


RESULTS
Bipolar IRE electrode placement and ablation were successful in all cases. The mean distances from the IRE electrode to the posterior wall of the vertebral body or the exiting nerve root were 2.93 mm ± 0.77 (standard deviation) and 7.87 mm ± 1.99, respectively. None of the animals had neurologic deficits. Well-delineated areas of necrosis of bone, bone marrow, and skeletal muscle adjacent to the vertebral body were present. Histopathologic changes showed outcomes that matched with simulation-estimated ablation zones. The percentage absolute differences in the ablation measurements between MR imaging and histopathologic examination showed the following average errors: 24.2% for length and 28.8% for width measurements on T2-weighted images, and 26.1% for length and 33.3% for width measurements on T1-weighted contrast material-enhanced images.


CONCLUSIONS
IRE ablation in the porcine spine is feasible and safe and produces localized necrosis with minimal neural toxicity. Signal intensity changes on images acquired with standard MR imaging sequences demonstrate the ablation zone to be larger than that at histopathologic examination.
From the Departments of Interventional Radiology (A.L.T., M.E.A., K.D., A.M., R.A., M.J.W., S.G.), Veterinary Medicine and Surgery (M.G., J.J.M.), and Biostatistics and Applied Mathematics (J.E.E.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.M., M.A., S.N.G.); Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); Radiochemistry and Imaging Science Service and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (G.S.); and Interventional Radiology Service and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (S.B.S.).
Alda L
AL
Tam
Mohamed E
ME
Abdelsalam
Mihai
M
Gagea
Joe E
JE
Ensor
Marwan
M
Moussa
Muneeb
M
Ahmed
S Nahum
SN
Goldberg
Katherine
K
Dixon
Amanda
A
McWatters
Jennifer J
JJ
Miller
Govindarajan
G
Srimathveeravalli
Stephen B
SB
Solomon
Rony
R
Avritscher
Michael J
MJ
Wallace
Sanjay
S
Gupta
D055011:Ablation Techniques / Q000009:adverse effects* / Q000379:methods*; D000818:Animals; D004195:Disease Models, Animal; D018274:Electroporation / Q000379:methods*; D005260:Female; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000209:etiology*; D025321:Surgery, Computer-Assisted / Q000379:methods; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome