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

Anna J Shangguan; Kang Zhou; Jia Yang; Aydin Eresen; Bin Wang; Chong Sun; Liang Pan; Su Hu; Ali T Khan; Samdeep K Mouli; Vahid Yaghmai; Zhuoli Zhang

doi:10.2147/CEG.S269163

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

Clin Exp Gastroenterol. 2020 Nov 6:13:543-553. doi: 10.2147/CEG.S269163. eCollection 2020.

Authors

Anna J Shangguan^#¹, Kang Zhou^#², Jia Yang¹, Aydin Eresen¹, Bin Wang³, Chong Sun⁴, Liang Pan⁵, Su Hu⁶, Ali T Khan¹, Samdeep K Mouli¹, Vahid Yaghmai⁷, Zhuoli Zhang¹

Affiliations

¹ Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
² Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, People's Republic of China.
³ Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, People's Republic of China.
⁴ Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China.
⁵ Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu, People's Republic of China.
⁶ Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
⁷ Department of Radiological Sciences, School of Medicine, University of California Irvine, Irvine, CA, USA.

^# Contributed equally.

Abstract

Purpose: 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, K^trans, v_e , and v_p 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 AUC_ROC. 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.

Grants and funding

This study was supported by the National Cancer Institute (grants R01CA209886, R01CA196967, and R01CA241532), by 2019 Harold E. Eisenberg Foundation Scholar Award, and by the Fishel Fellowship Award at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and by SIR Foundation Pilot Grant (PR-0000000012).