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MRI-Guided Percutaneous Cryotherapy for Soft-Tissue and Bone Metastases: Initial Experience

¹ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
² Department of Radiology, University of Massachusetts Medical Center, Worcester, MA.
³ Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁴ Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —MRI-compatible instruments for percutaneous cryotherapy. Photograph shows 6-mm bone biopsy system (Invivo, Daum) including trocar (right) and stylet (left).

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —MRI-compatible instruments for percutaneous cryotherapy. Photograph shows 13-gauge cryoneedle (Galil Medical) through trocar with ice ball.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —53-year-old man with difficulty urinating and erectile dysfunction due to recurrent rectal carcinoma invading prostate. Transverse 1.5-T T2-weighted fast spin-echo image (TR/TE, 5,400/96; number of excitations, 2; echo-train length, 8; slice thickness, 3 mm; field of view, 14 cm) obtained before procedure shows tumor (straight arrows) invading prostate close to prostatic urethra (curved arrow).

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —53-year-old man with difficulty urinating and erectile dysfunction due to recurrent rectal carcinoma invading prostate. Transverse 0.5-T T2-weighted fast spin-echo image (TR/TE, 4,000/108; number of excitations, 1; echo-train length, 8; slice thickness, 5 mm; field of view, 20 cm) obtained during procedure shows ice ball (straight arrows) covering tumor with indentation due to thermal sink effect caused by urethral warming catheter (curved arrow).

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —78-year-old woman with pain due to lung carcinoma metastatic to T9 vertebra. Transverse contrast-enhanced 1.5-T T1-weighted spin-echo image (TR/TE, 600/14; number of excitations, 1; echo-train length, 0; slice thickness, 4 mm; field of view, 24 cm) obtained before procedure shows tumor (straight arrows) invading right side of T9 close to spinal cord (curved arrow). A.L. = atelectatic lung.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —78-year-old woman with pain due to lung carcinoma metastatic to T9 vertebra. Transverse 0.5-T T2-weighted fast spin-echo image (TR/TE, 5,000/110; number of excitations, 1; echo-train length, 16; slice thickness, 5 mm; field of view, 16 cm) obtained during procedure shows partial coverage of tumor with ice ball (straight arrows) avoiding spinal cord (curved arrow). A.L. = atelectatic lung.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —78-year-old woman with pain due to lung carcinoma metastatic to T9 vertebra. Transverse contrast-enhanced 1.5-T T1-weighted fast spin-echo image (550/14; number of excitations, 1; echo-train length, 4; slice thickness, 4 mm; field of view, 20 cm) obtained 1 day after procedure shows zone of ablation (straight arrows) in tumor with preservation of spinal cord (curved arrow). A.L. = atelectatic lung.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —85-year-old man with recurrent colon carcinoma adjacent to colon and right kidney. Transverse contrast-enhanced 1.5-T T1-weighted spoiled gradient-recalled acquisition in the steady state image (TR/TE, 370/4.2; number of excitations, 1; echo train length, 0; flip angle, 75°; slice thickness, 6 mm; field of view, 40 cm) obtained before procedure shows tumor (straight arrows) adjacent to colon (curved arrow). K = kidney.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —85-year-old man with recurrent colon carcinoma adjacent to colon and right kidney. Transverse (B) and sagittal (C) 0.5-T T1-weighted fast spin-echo (800/23; number of excitations, 1; echo-train length, 8; slice thickness, 8 mm; field of view, 28 cm) images obtained during procedure show ice ball (straight arrows) covering tumor and avoiding adjacent colon (curved arrow). K = kidney.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —85-year-old man with recurrent colon carcinoma adjacent to colon and right kidney. Transverse (B) and sagittal (C) 0.5-T T1-weighted fast spin-echo (800/23; number of excitations, 1; echo-train length, 8; slice thickness, 8 mm; field of view, 28 cm) images obtained during procedure show ice ball (straight arrows) covering tumor and avoiding adjacent colon (curved arrow). K = kidney.

View larger version (184K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —22-year-old man with testicular teratoma metastatic to left external obturator muscle. Transverse 0.5-T T2-weighted fast spin-echo image (TR/TE, 6,000/110; number of excitations, 1; echo-train length, 16; slice thickness, 5 mm; field of view, 20 cm) obtained during procedure shows cystic teratoma (straight arrow) abutting ramus of left ischium and one cryoprobe (curved arrow) in place.

View larger version (192K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —22-year-old man with testicular teratoma metastatic to left external obturator muscle. Transverse 0.5-T T2-weighted fast spin-echo image (6,000/110; number of excitations, 1; echo-train length, 16; slice thickness, 5 mm; field of view, 20 cm) obtained during procedure shows ice ball (straight arrows) has eclipsed tumor but not adjacent tendinous attachment (curved arrow).

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —22-year-old man with testicular teratoma metastatic to left external obturator muscle. Transverse 1.5-T T2-weighted fast spin-echo image (3,800/104; number of excitations, 2; echo-train length, 16; slice thickness, 4 mm; field of view, 14 cm) obtained 18 months after procedure shows tumor regression (arrow).

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