T1-weighted MR image contrast around a cryoablation iceball: a phantom study and initial comparison with in vivo...

To correlate T1-weighted (T1w) magnetic resonance (MR) image contrast around a cryoablation iceball with temperature in a phantom study and to compare this to its in vivo appearance during MR-guided focal cryoablation of prostate cancer.

A MR-compatible cryoneedle was inserted into identical gel phantoms (n = 3) on a 1.5 T MR system. Two fiber-optic temperature sensors were placed parallel to the needle. A fast 3D T1w gradient echo (GRE) sequence (TR/TE/FA = 4.81/1.98/6°) was used to monitor iceball progression. Normalized signal intensity (SI) was correlated with temperature. The same T1w sequence was used during MR-guided prostate cryoablation in ten consecutive patients at the authors' institution. In vivo findings were quantitatively compared to the phantom data.

In the phantom study, the cryoablation iceball appeared in the T1w MR images as a sharply delineated signal void. A 2.2 ± 0.2 mm wide hyperintense rim directly surrounded the iceball at cooled but nonfreezing temperatures (<20 °C) in the gel. Normalized SI was maximum at 8.4 ± 2.4 °C, showing a 35.6%-43.0% (mean 40.5%) increase with respect to baseline before cooling. In the clinical procedures, the same image contrast was observed in vivo in all patients. In vivo, width of the hyperintense rim was 1.6 ± 0.6 mm. Normalized SI increases with respect to nontreated prostate ranged 28.4%-55.6% (mean 36.8%). On quantitative analysis, normalized SI changes along a linear region of interest from surrounding tissue onto the iceball center were similar between the patients and phantom setting (root mean square difference 0.06).

The hyperintense rim around the iceball in fast T1w GRE images corresponded to cooled but nonfreezing temperatures (<20 °C) proximal to the frozen zone. The same image contrast was observed both in a phantom study as well as in vivo in the human prostate during cryotherapy. Potentially, monitoring of this rim could be useful in order to maintain a safe margin from at-risk tissues during MR-guided prostate cryoablation procedures.