MRI-guided Microwave Ablation of Liver Tumors

MRI导向下肝肿瘤微波消融术

MRI-guided Microwave Ablation of Liver Tumors

安徽硕金医疗设备有限公司

Anhui SJ Healthcare Co., Ltd

林征宇：大家好，我是福建医科大学附属第一医院介入科林振宇，那么今天呢，为大家来演示一台磁共振引导下的肝癌的消融手术

Lin Zhengyu: Hello, everyone, I'm Lin Zhengyu from the Invasive Technology Department of the First Affiliated Hospital of Fujian Medical University. Today, I will demonstrate the MRI-guided ablation of liver cancer

一术前准备，根据术前两周内肝脏CT或MRI平扫加增强，检查明确肿瘤数目部位大小及临近重要脏器的关系，无磁化消融设备主机放置在磁体间，进入MRI磁体间前去移除患者身上所有金属物品，根据术前扫描图像评估，选择合适的体位，体表粘贴标记物如鱼肝油，鱼肝油矩阵或MRI专用定位器，选择快速扫描序列fs-T2WI，40秒-60秒，层厚5毫米,行全肝扫描，行靶区域屏气扫描，选择合适的穿刺路径，测量进针的深度及角度，初步制定治疗计划

I. Preoperative Preparation. Examine and determine the number, location and size of tumors and the relationship between adjacent important organs according to the liver CT or MRI plain scan and enhancement within two weeks before operation, and remove all metal objects from the patient before entering the MRI magnet room that has a demagnetized ablation device host. Select the appropriate position and paste markers on the body surface (cod liver oil, cod liver oil matrix or MRI special locator) according to the preoperative scan image evaluation, and select the fast scan sequence fs-T2WI with 40-60 s and 5 mm thick layer to perform the whole liver scan and the breath holding scan in the target area. Select the appropriate puncture path, measure the depth and angle of the inserting needle, and initially formulate the treatment plan.

二，手术步骤，确定皮肤穿刺点后以色笔标记。术者穿无菌手术衣手套常规消毒，套线圈无菌罩，铺巾，局麻。尖刀片于穿刺点处做2~3毫米皮肤小切口，进针前再次确认消融针为MRI兼容性。进针时嘱患者屏气，可通过呼吸门控辅助判断患者屏气状态是否与扫描时一致，采用步进式穿刺进针方法，消融针在MRI各序列上均呈低信号，穿刺过程中，多次行3D-T1WI快速扫描以确保竞争方向正确，确认消融针布针满意后，退出扫描床，启动水冷循环，连接同轴电缆设定适当的消融参数后进行消融治疗，进行屏蔽，扼流处理的微波消融设备，可行术中准时时扫描FS-T2WI扫描监控消融过程，实现可视化消融，

II. Operating Procedures. Determine and mark the skin puncture point with a marker. The surgeon shall wear sterile surgical gowns and gloves after routine disinfection, put a coil sterile cover, spread a surgical drape, and apply local anesthesia. Make a small incision of 2~3 mm on the skin at the puncture point with the sharp blade, and confirm that the ablation needle is MRI compatible before insertion. Ask the patient to hold his/her breath during the needle insertion, and determine whether the patient's breath holding state is consistent with that during the scanning with the aid of respiratory gating. Use the step-by-step puncturing method, which shows low signal on each sequence of MRI. In the puncture process, perform 3D-T1WI fast scan for many times to ensure the correct competition direction. After confirming that the ablation needle is correct, remove the scanning table, start the water-cooling cycle, connect the coaxial cable, set the appropriate ablation parameters, and then perform the ablation treatment. Use the microwave ablation equipment for shielding and choke treatment to carry out FS-T2WI scanning during the operation to monitor the ablation process and realize visual ablation.

三，及时疗效评价,

III. Evaluation of Immediate Curative Effect.

消融后再次行MRI扫描，评价即时疗效完全消融，T1WI上表现为特征性”靶征“， 外围高信号环（消融的正常肝组织）， 完全包绕中央低信号区（原病灶）并超出病灶边缘0.5厘米至一厘米，消融完成后行针道消融后撤针，术后行全肝FS-T2WI扫描观察是否有即刻并发症。

After ablation, perform MRI scan again to evaluate the immediate curative effect of ablation. T1WI shows characteristic "target sign", the peripheral high signal ring (ablated normal liver tissue) completely surrounds the central low signal area (original lesion) and exceeds the edge of the lesion by 0.5-1 cm. Temove the needle after ablation and perform the whole liver FS-T2WI scan after operation to observe whether there are immediate complications.

陈锦：本手术使用的是安徽硕金医疗的磁共振微波消融系统，该系统的磁兼容性能优异，其微波主机是可以在磁共振近距离使用的。其磁共振微波针呢，具有显影清晰，图像伪影小等优势，是磁共振引导消融治疗的理想选择，

Chen Jin: In this operation, the MRI microwave ablation system of Anhui SJ Healthcare Co., Ltd is used, which has excellent magnetic compatibility, and the microwave host can be used in the close range of MRI. Its MRI microwave needle has the advantages of clear development and small image artifacts, which is an ideal choice for MRI-guided ablation treatment.

林征宇：这一次呢手术就顺利完成了，磁共振作为肝肿瘤微波消融的引导手段具有很多独到的优势，首先磁共振没有电离辐射，其次病灶显示非常清楚，然后呢，它还具有多方位，多参数的成像能力，在术中可以精准的准实时的监控消融的范围，那么术后呢，可以精准的实时评价疗效，那么是肿瘤消融未来的发展方向之一

Lin Zhengyu: The operation has been successfully completed here. As a guide for microwave ablation of liver tumors, MRI has many unique advantages, such as no ionizing radiation and clear display, etc. Moreover, it also has multi-directional and multi-parameter imaging capabilities, and can accurately monitor the ablation range in quasi real time during the operation. After the operation, it can accurately evaluate the immediate curative effect, so it is one of the future development directions of tumor ablation.