Intraprocedural Transcatheter Intraarterial Perfusion (TRIP)-MRI for Evaluation of Irreversible Electroporation Therapy Response in a Rabbit Liver Tumor Model

• Main Authors: Shangguan AJ, Zhou K, Yang J, Eresen A, Wang B, Sun C, Pan L, Hu S, Khan AT, Mouli SK, Yaghmai V, Zhang Z
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-11-01
• Series: Clinical and Experimental Gastroenterology
• Subjects: hepatocellular carcinoma; irreversible electroporation; liver cancer; perfusion; transcatheter intraarterial perfusion magnetic resonance imaging
• Online Access: https://www.dovepress.com/intraprocedural-transcatheter-intraarterial-perfusion-trip-mri-for-eva-peer-reviewed-article-CEG

Anna J Shangguan,1,* Kang Zhou,2,* Jia Yang,1 Aydin Eresen,1 Bin Wang,3 Chong Sun,4 Liang Pan,5 Su Hu,6 Ali T Khan,1 Samdeep K Mouli,1 Vahid Yaghmai,7 Zhuoli Zhang1 1Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 2Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, People’s Republic of China; 3Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, People’s Republic of China; 4Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China; 5Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu, People’s Republic of China; 6Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 7Department of Radiological Sciences, School of Medicine, University of California Irvine, Irvine, CA, USA*These authors contributed equally to this workCorrespondence: Zhuoli ZhangDepartment of Radiology, Northwestern University, 737 N Michigan Ave, 16 th Floor, Chicago, IL 60611, USATel [phone]Fax [phone]Email [e-mail]: Irreversible electroporation (IRE) is a promising new ablation method for hepatocellular carcinoma (HCC) treatment with few side-effects; however, tissue perfusion and differentiation between treatment zones have not been sufficiently studied. In this project, we analyzed HCC tumor perfusion changes immediately after IRE treatment using transcatheter intraarterial perfusion (TRIP)-MRI to monitor treatment zone margins.Materials and Methods: All protocols were approved by the institutional animal care and use committee. A total of 34 rabbits were used for this prospective study: tumor liver group (n=17), normal liver group (n=14), and 3 for growing VX2 tumors. All procedures and imaging were performed under anesthesia. VX2 tumors were grown by injection of VX2 cells into rabbit hindlimbs. Liver tumors were induced by percutaneous US-guided injection of VX2 tumor fragments into liver. For digital subtraction angiography (DSA), a 2F catheter was advanced through left hepatic artery via femoral artery access, followed by contrast injection. All rabbits underwent baseline anatomic MRI, then IRE procedure or IRE probe placement only, and lastly post-procedure anatomic and TRIP-MRI. Liver tissues were dissected immediately after imaging for histology. All statistical analyses were performed on GraphPad Prism, with P< 0.05 considered significant.Results: IRE generated central IRE zone and peripheral reversible electroporation (RE) zone on anatomic MRI for both normal liver and liver tumor tissues. The semiquantitative analysis showed that IRE zone had the lowest AUC, PE, WIS, Ktrans, ve, and vp as well as the highest TTP, followed by RE zone, then untreated tissues. Receiver operating characteristic analysis showed that WIS and AUC60 had the highest AUCROC. Histologic analysis showed a positive correlation in viable area fraction between MRI and histologic measurements. IRE zone had the highest %apoptosis and lowest CD31+ staining.Conclusion: Our results demonstrated that intraprocedural TRIP-MRI can effectively differentiate IRE and RE zones after IRE ablation in normal liver and liver tumor tissues.Keywords: hepatocellular carcinoma, irreversible electroporation, liver cancer, perfusion, transcatheter intraarterial perfusion magnetic resonance imaging