Combined magnetic resonance imaging and optical surgical navigation system guidance of percutaneous liver cryoablation in a porcine model

The efficacy and safety of combining open-configuration magnetic resonance imaging (MRI) and an optical surgical navigation system (OSNS) for guidance of percutaneous liver cryoablation were evaluated in a pig model. This approach was successfully executed in eight test pigs under general anesthesia. Another two pigs spared from ablation served as controls. MRI studies, blood testing, and pathologic examinations were performed at various time points. MRI-determined minimal and maximal cryolesion diameters were 19.4 +/- 1.5 mm and 44.3 +/- 1.8 mm, respectively (mean volume, 8.32 +/- 2.41 cm(3)). The lesions were readily visible by MRI on postablation Days 2 and 7, all presenting as teardrop-shaped regions of low signal intensity in T1-weighted images and high signal intensity in T2-weighted images. Mean serum alanine aminotransferase concentration transiently increased postablation, and mean blood platelet count transiently declined (both, P < 0.05). The mean necrotic tissue volume generated by pathologic assessment was less than that determined by MRI (4.24 +/- 2.3 cm(3) vs. 8.32 +/- 2.41 cm(3), P < 0.05). Cell necrosis isotherms in MRI views were within 6.0 +/- 0.8 mm of cryolesion edges. Inflammatory cell infiltrates and exuberant granulation tissue surrounded necrotic areas on postablation Day 7. Combined open-configuration MRI and OSNS guidance of percutaneous liver cryoablation proved effective and safe in our animal model. This concept seems ideal for precision image-guided hepatic ablation in a clinical setting.