Magnetic resonance guidance of percutaneous ethanol injection in liver

Percutaneous ethanol injection (PEI) is used as a form of treatment for cancer, particularly malignant hepatic tumors. Little is known about the intratumoral distributions of ethanol following PEI. We assessed, using magnetic resonance (MR) imaging, the distribution of ethanol in liver and the concentration of ethanol needed to kill tumor cells in vivo.

MR imaging studies were performed using phantoms of alcohol, ex vivo bovine liver, and healthy human volunteers. A variety of pulse sequences were tested for their ability to maximize the signal intensity from alcohol while minimizing the signal from liver tissues as well as the regions of necrosis following ethanol injection. A cell culture model of in vitro cytotoxicity was developed to predict the target concentration of alcohol necessary for killing tumor cells.

At 1.5 T, we found that an inversion-recovery spin-echo sequence using an inversion time of 250 msec and an echo time of 150 msec in combination with water saturation pulses effectively suppressed the tissue water signal from human liver while obtaining a clear signal from the ethanol. The cytotoxicity experiments suggested that a concentration of 20% or more ethanol is sufficient to completely kill all the tumor cells.

A critical concentration of ethanol (e.g., 10%) is necessary for full tumoricidal effect. MR imaging should be able to determine the volume of distribution and the intratumoral concentrations of ethanol, thus potentially allowing researchers to achieve the requisite concentrations for maximal tumoricidal effects.