3.0T MRI for long-term observation of lung nodules post cryoablation: A pilot study

Abstract

Background: The purpose of this study was to use serial magnetic resonance imaging (MRI) examinations to observe changes in malignant lung tumors over time post-cryoablation. Methods: The study protocol was approved by Institutional Review Board, and written informed consent was obtained from each participant in accordance with the Declaration of Helsinki. Patients with primary or metastatic lung tumors eligible for cryoablation were included in this prospective study. Cryoablation was performed according to standard procedures. Unenhanced and dynamic contrast-enhanced MRI scans were performed pre-cryoablation and at 1 day, 1 week, and 3-, 6-, and 12 months after cryoablation. At each time point, the signal intensity of the ablated zone on both T1WI and T2WI images, and volume and characteristics of the ablation zone were examined, and changes over time analyzed. Results: A total of 26 nodules in 23 patients were included in the study. The mean patient age was 53.7 ± 13.6 years, and 57.7% were males. Ablation zone volume increased to 1 week after the procedure, and then returned to baseline by 3 months. Cavitation post-cryoablation was found in 34.6% (9/26) of the nodules 1 month after treatment. Two types of time-signal intensity curves post-cryoablation were found: a straight line representing no definite enhancement from 1-day to 1-month, and an inflow curve representing mild delayed enhancement from month 3 to month 12. Local progression was associated with an incomplete hypointense rim around the ablation zone and absence of cavitation post-treatment. Conclusions: Characteristic changes are present on MRI after cryoablation of lung tumors. A complete hypointense rim and cavitation may be signs of adequate treatment and that local tumor progression is less likely.