title: Gd-EOB-DTPA-enhanced MR guidance in thermal ablation of liver malignancies.
abstract: OBJECTIVE
  To evaluate the potency of Gd-EOB-DTPA to support hepatic catheter placement in laser ablation procedures by quantifying time-dependent delineation effects for instrumentation and target tumor within liver parenchyma. Monitoring potential influence on online MR thermometry during the ablation procedure is a secondary aim.
  
  
  METHODS
  30 cases of MR-guided laser ablation were performed after i.v. bolus injection of gadoxetic acid (0.025 mmol/Kg Gd-EOB-DTPA; Bayer Healthcare, Berlin, Germany). T1-weighted GRE sequences were used for applicator guidance (FLASH 3D) in the catheter placement phase and for therapy monitoring (FLASH 2D) in the therapy phase. SNR and consecutive CNR values were measured for elements of interest plotted over time both for catheter placement and therapy phase and compared with a non-contrast control group of 19 earlier cases. Statistical analysis was realized using the paired Wilcoxon test.
  
  
  RESULTS
  Sustainable signal elevation of liver parenchyma in the contrast-enhanced group was sufficient to silhouette both target tumor and applicator against the liver. Differences in time dependent CNR alteration were highly significant between contrast-enhanced and non-contrast interventions for parenchyma and target on the one hand (p = 0.020) and parenchyma and instrument on the other hand (p = 0.002). Effects lasted for the whole procedure (monitoring up to 60 min) and were specific for the contrast-enhanced group. Contrasting maxima were seen after median 30 (applicator) and 38 (tumor) minutes, in the potential core time of a multineedle procedure. Contrast influence on T1 thermometry for real-time monitoring of thermal impact was not significant (p = 0.068-0.715).
  
  
  CONCLUSIONS
  Results strongly support anticipated promotive effects of Gd-EOB-DTPA for MR-guided percutaneous liver interventions by proving and quantifying the delineating effects for therapy-relevant elements in the procedure. Time benefit, cost effectiveness and oncologic outcome of the described beneficiary effects will have to be part of further investigations.
authors.affiliation: Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rosenberg
authors.affiliation: Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Jahn
authors.affiliation: Clinic of Internal Medicine, Division of Gastroenterology, Endocrinology and Nutritive Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Pickartz
authors.affiliation: Clinic of Internal Medicine, Division of Gastroenterology, Endocrinology and Nutritive Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wahnschaffe
authors.affiliation: Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Patrzyk
authors.affiliation: Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hosten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D053685:Laser Therapy / Q000295:instrumentation* / Q000379:methods; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA