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

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^*

^*Corresponding author for this work

Radiology

Research output: Contribution to journal › Article › peer-review

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Abstract

Purpose: Irreversible electroporation (IRE) is a promising new ablation method for hepa-tocellular 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.

Original language	English (US)
Pages (from-to)	543-553
Number of pages	11
Journal	Clinical and Experimental Gastroenterology
Volume	13
DOIs	https://doi.org/10.2147/CEG.S269163
State	Published - 2020

Funding

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

Keywords

Hepatocellular carcinoma
Irreversible electroporation
Liver cancer
Perfusion
Transcatheter intraarterial perfusion magnetic resonance imaging

ASJC Scopus subject areas

Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2147/CEG.S269163

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Shangguan, A. J., Zhou, K., Yang, J., Eresen, A., Wang, B., Sun, C., Pan, L., Hu, S., Khan, A. T., Mouli, S. K., Yaghmai, V., & Zhang, Z. (2020). Intraprocedural transcatheter intraarterial perfusion (Trip)-MRI for evaluation of irreversible electroporation therapy response in a rabbit liver tumor model. Clinical and Experimental Gastroenterology, 13, 543-553. https://doi.org/10.2147/CEG.S269163

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title = "Intraprocedural transcatheter intraarterial perfusion (Trip)-MRI for evaluation of irreversible electroporation therapy response in a rabbit liver tumor model",

abstract = "Purpose: Irreversible electroporation (IRE) is a promising new ablation method for hepa-tocellular 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, Ktrans, ve, and vp 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 AUCROC. 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",

author = "Shangguan, {Anna J.} and Kang Zhou and Jia Yang and Aydin Eresen and Bin Wang and Chong Sun and Liang Pan and Su Hu and Khan, {Ali T.} and Mouli, {Samdeep K.} and Vahid Yaghmai and Zhuoli Zhang",

note = "Funding Information: This study was supported by the National Cancer Institute (grants R01CA209886, R01CA196967, and R01CA241532), by 2019 Harold E. Eisenberg Foundation Scholar A ward, and by the Fishel Fellowship A ward at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University , and by SIR Foundation Pilot Grant (PR-0000000012). Publisher Copyright: {\textcopyright} 2020 Shangguan et al.",

year = "2020",

doi = "10.2147/CEG.S269163",

language = "English (US)",

volume = "13",

pages = "543--553",

journal = "Clinical and Experimental Gastroenterology",

issn = "1178-7023",

publisher = "Dove Medical Press Ltd.",

}

Shangguan, AJ, Zhou, K, Yang, J, Eresen, A, Wang, B, Sun, C, Pan, L, Hu, S, Khan, AT, Mouli, SK, Yaghmai, V & Zhang, Z 2020, 'Intraprocedural transcatheter intraarterial perfusion (Trip)-MRI for evaluation of irreversible electroporation therapy response in a rabbit liver tumor model', Clinical and Experimental Gastroenterology, vol. 13, pp. 543-553. https://doi.org/10.2147/CEG.S269163

TY - JOUR

T1 - Intraprocedural transcatheter intraarterial perfusion (Trip)-MRI for evaluation of irreversible electroporation therapy response in a rabbit liver tumor model

AU - Shangguan, Anna J.

AU - Zhou, Kang

AU - Yang, Jia

AU - Eresen, Aydin

AU - Wang, Bin

AU - Sun, Chong

AU - Pan, Liang

AU - Hu, Su

AU - Khan, Ali T.

AU - Mouli, Samdeep K.

AU - Yaghmai, Vahid

AU - Zhang, Zhuoli

N1 - Funding Information: This study was supported by the National Cancer Institute (grants R01CA209886, R01CA196967, and R01CA241532), by 2019 Harold E. Eisenberg Foundation Scholar A ward, and by the Fishel Fellowship A ward at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University , and by SIR Foundation Pilot Grant (PR-0000000012). Publisher Copyright: © 2020 Shangguan et al.

PY - 2020

Y1 - 2020

N2 - Purpose: Irreversible electroporation (IRE) is a promising new ablation method for hepa-tocellular 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, Ktrans, ve, and vp 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 AUCROC. 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.

AB - Purpose: Irreversible electroporation (IRE) is a promising new ablation method for hepa-tocellular 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, Ktrans, ve, and vp 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 AUCROC. 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.

KW - Hepatocellular carcinoma

KW - Irreversible electroporation

KW - Liver cancer

KW - Perfusion

KW - Transcatheter intraarterial perfusion magnetic resonance imaging

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UR - http://www.scopus.com/inward/citedby.url?scp=85097927457&partnerID=8YFLogxK

U2 - 10.2147/CEG.S269163

DO - 10.2147/CEG.S269163

M3 - Article

C2 - 33192084

AN - SCOPUS:85097927457

SN - 1178-7023

VL - 13

SP - 543

EP - 553

JO - Clinical and Experimental Gastroenterology

JF - Clinical and Experimental Gastroenterology

ER -

Intraprocedural transcatheter intraarterial perfusion (Trip)-MRI for evaluation of irreversible electroporation therapy response in a rabbit liver tumor model

Abstract

Funding

Keywords

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UN SDGs

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