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Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report.

van Breugel JM, Nijenhuis RJ, Ries MG, Toorop RJ, Vonken EJ, Wijlemans JW, van den Bosch MA - J Ther Ultrasound (2015)

Bottom Line: Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume.Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization.The patient reported qualitatively sustained pain reduction up to 13 months post treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Introduction: Therapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization. However, these techniques are invasive with possible complications and require hospitalization. We present a novel non-invasive technique, i.e., magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, for the treatment of a vascular malformation in a patient. This technique applies high-intensity sound waves transcutaneously to the body and is fully non-invasive. MRI guidance is the novel aspect of HIFU treatments and is used for exquisite delineation and localization of the lesion and accurate real-time temperature monitoring during tissue ablation. MR-HIFU is a well-established treatment option for uterine fibroids and is currently being investigated for, e.g., bone tumors, breast cancer, prostate cancer, and liver cancer. MR-HIFU of vascular malformations has not been a topic of research yet.

Case description: Volumetric MR-HIFU ablation of a vascular malformation in the lower extremity of an 18-year-old male patient was performed. Temperatures of 62-80 °C were reached in the target lesion with sonications of 4 × 4 × 8 mm using powers of 200 W for <20 s. At 1-month follow-up, the patient reported qualitatively sustained reduction of pain and normal motor function. Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume. After 13 months, pain score was reduced to <2 after extreme exertion for several hours and to 0 for daily activities.

Discussion and evaluation: Radiofrequency ablation and cryoablation are minimally invasive techniques that have been tried on low-flow vascular malformations with inconsistent results. Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization. Since MR-HIFU is truly non-invasive, these risks are negligible.

Conclusions: In conclusion, we reported a successful non-invasive treatment of a vascular malformation with MR-HIFU in a clinical patient including long-term follow-up data for the first time. The patient reported qualitatively sustained pain reduction up to 13 months post treatment.

No MeSH data available.


Related in: MedlinePlus

Contrast enhanced scans (axial view in a, c, e and sagittal view in b, d, f) several months prior to treatment (a, b), directly after treatment showing a non-perfused volume (c, d), and at 3 months follow-up showing a reduction in size of the malformation (e, f)
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Fig1: Contrast enhanced scans (axial view in a, c, e and sagittal view in b, d, f) several months prior to treatment (a, b), directly after treatment showing a non-perfused volume (c, d), and at 3 months follow-up showing a reduction in size of the malformation (e, f)

Mentions: Several months prior to treatment, ultrasound examination was performed, as well as screening MR scans including contrast enhanced scans (T1 TSE spectral presaturation with inversion recovery (SPIR), Fig. 1a, b), and a digital subtraction angiogram (MRA) (Fig. 2). The lesion had a volume of 1.9 mL. Contrast injection showed inhomogeneous enhancement. An additional X-ray did not show any calcifications within the lesion. The swelling was characterized as a soft tissue mass of the musculus tibialis posterior with a feeding vessel branching from the arteria tibialis posterior and shunting to the vena tibialis posterior. No connection with the nervus tibialis posterior was observed. The malformation was characterized as an venous malformation in the lower limb (Hamburg’s classification). Biopsy of the lesion confirmed this diagnosis. The position of the vascular malformation with respect to nerves and main vessels (>2 mm) and the skin (>2 cm) was decided to be suitable for non-invasive treatment with MR-HIFU. The patient did not want to undergo surgery or an embolization procedure and signed informed consent for the MR-HIFU treatment described in this report.Fig. 1


Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report.

van Breugel JM, Nijenhuis RJ, Ries MG, Toorop RJ, Vonken EJ, Wijlemans JW, van den Bosch MA - J Ther Ultrasound (2015)

Contrast enhanced scans (axial view in a, c, e and sagittal view in b, d, f) several months prior to treatment (a, b), directly after treatment showing a non-perfused volume (c, d), and at 3 months follow-up showing a reduction in size of the malformation (e, f)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696245&req=5

Fig1: Contrast enhanced scans (axial view in a, c, e and sagittal view in b, d, f) several months prior to treatment (a, b), directly after treatment showing a non-perfused volume (c, d), and at 3 months follow-up showing a reduction in size of the malformation (e, f)
Mentions: Several months prior to treatment, ultrasound examination was performed, as well as screening MR scans including contrast enhanced scans (T1 TSE spectral presaturation with inversion recovery (SPIR), Fig. 1a, b), and a digital subtraction angiogram (MRA) (Fig. 2). The lesion had a volume of 1.9 mL. Contrast injection showed inhomogeneous enhancement. An additional X-ray did not show any calcifications within the lesion. The swelling was characterized as a soft tissue mass of the musculus tibialis posterior with a feeding vessel branching from the arteria tibialis posterior and shunting to the vena tibialis posterior. No connection with the nervus tibialis posterior was observed. The malformation was characterized as an venous malformation in the lower limb (Hamburg’s classification). Biopsy of the lesion confirmed this diagnosis. The position of the vascular malformation with respect to nerves and main vessels (>2 mm) and the skin (>2 cm) was decided to be suitable for non-invasive treatment with MR-HIFU. The patient did not want to undergo surgery or an embolization procedure and signed informed consent for the MR-HIFU treatment described in this report.Fig. 1

Bottom Line: Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume.Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization.The patient reported qualitatively sustained pain reduction up to 13 months post treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Introduction: Therapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization. However, these techniques are invasive with possible complications and require hospitalization. We present a novel non-invasive technique, i.e., magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, for the treatment of a vascular malformation in a patient. This technique applies high-intensity sound waves transcutaneously to the body and is fully non-invasive. MRI guidance is the novel aspect of HIFU treatments and is used for exquisite delineation and localization of the lesion and accurate real-time temperature monitoring during tissue ablation. MR-HIFU is a well-established treatment option for uterine fibroids and is currently being investigated for, e.g., bone tumors, breast cancer, prostate cancer, and liver cancer. MR-HIFU of vascular malformations has not been a topic of research yet.

Case description: Volumetric MR-HIFU ablation of a vascular malformation in the lower extremity of an 18-year-old male patient was performed. Temperatures of 62-80 °C were reached in the target lesion with sonications of 4 × 4 × 8 mm using powers of 200 W for <20 s. At 1-month follow-up, the patient reported qualitatively sustained reduction of pain and normal motor function. Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume. After 13 months, pain score was reduced to <2 after extreme exertion for several hours and to 0 for daily activities.

Discussion and evaluation: Radiofrequency ablation and cryoablation are minimally invasive techniques that have been tried on low-flow vascular malformations with inconsistent results. Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization. Since MR-HIFU is truly non-invasive, these risks are negligible.

Conclusions: In conclusion, we reported a successful non-invasive treatment of a vascular malformation with MR-HIFU in a clinical patient including long-term follow-up data for the first time. The patient reported qualitatively sustained pain reduction up to 13 months post treatment.

No MeSH data available.


Related in: MedlinePlus