Authors (including presenting author) :
Dr. JB Chiang, Dr. WL Poon, Dr. P Kwok, Dr. D Fung, Dr. LF Chiu, Dr. KW Tang
Affiliation :
Department of Radiology and Imaging, Queen Elizabeth Hospital
Introduction :
Percutaneous tumour ablation has been an increasingly important pillar in the treatment of both palliative and curative diseases, allowing minimally invasive treatment in tumour destruction and pain control. Percutaneous tumour ablation is frequently performed under ultrasound (“US”) or computed tomography (“CT”) guidance, both of which have significant limitations. For example, US has limited visualization of deep structures and is readily deflected by overlying gas and bone. CT on the other hand, does not real time imaging and has limited soft tissue special resolution, making it difficult to visualize the tumour and important surrounding structures. More importantly, both modes of imaging guidance do not allow visualization of ablation zones. Queen Elizabeth Hospital recently opened the first MRI guided ablation unit, which is also the first of such in Hong Kong. MRI guidance has definite benefits over pre-existing image guidance by allowing superior soft tissue contrast, real time imaging during needle insertion and accurate visualization of ablation zone. This technique allows a safer, precise and radiation free guidance for percutaneous ablation.
Objectives :
Evaluate the technical success, safety and early results of MRI guided intervention in Queen Elizabeth Hospital.
Methodology :
Review of patient information on Clinical Management System who has had MRI guided ablation between 1 May 2019 – 31 Dec 2019. Information collected include patient details, tumour characteristics, procedure details and follow up imaging.
Result & Outcome :
Since commencement of MRI guided intervention in May 2020, we have performed 13 cases: 10 primary renal cell carcinoma 1 liver with recurrent hepatocellular carcinoma 1 adrenal metastasis from hepatocellular carcinoma 1 external iliac lymph node metastasis from rectal cancer All cases have been technically successful with adequate iceball coverage of the tumour intraoperatively. Two minor complications occurred in the earlier cases (minor wound infection recovered with antibiotics and small frostbite requiring debridement which recovered without complications). For those who have had follow up imaging, all showed tumour coverage with no residual/recurrence. MRI guidance provides allows accurate tumour visualization, real time needle puncture and precise delineation of ablation zone.
