Accuracy of non-enhanced MRI to monitor histological lesion size during laser-induced interstitial thermotherapy

The purpose of this study was to assess the accuracy of non-enhanced MRI using a T1-weighted 2D turbo fast low-angle shot (FLASH) sequence during laser-induced interstitial thermotherapy (LITT) to determine histological lesion size of laser-induced hepatic lesions. The LITT was performed on pig liver samples at various power settings and durations. For MR monitoring during and after LITT a T1-weighted 2D turbo-FLASH sequence was applied. Lesions seen by MRI during and after LITT were correlated with histological lesion size. Histologically, a core zone of complete tissue ablation close to the tip of the applicator could be differentiated from an adjacent transitional zone showing incomplete necrosis. Magnetic resonance imaging right at the end of LITT (i.e., with maximum heating effects) grossly overestimated the core zone but accurately described the transitional zone. Magnetic resonance imaging after cooling of the tissue (therefore showing structural as opposed to thermal changes) exactly depicted the core zone of complete tissue ablation. Non-enhanced MRI using a T1-weighted 2D turbo FLASH sequence strongly overestimates the histological lesion size during LITT; however, structural changes of the tissue seen after cooling accurately define lesion size in LITT. For clinical purposes the lesion geometry seen during MR monitoring should therefore well extend the tumor margins.