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British Journal of Radiology (2009) 82, 412-420
© 2009 British Institute of Radiology
doi: 10.1259/bjr/18470679
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British Journal of Radiology 82 (2009),412-420 ©2009 The British Institute of Radiology

The use of time to maximum enhancement to indicate areas of ablation following the treatment of liver tumours with high-intensity focused ultrasound

O NOTERDAEME, MEng, DPhil 1 T A LESLIE, BSc, MBChB, MRCS 2 J E KENNEDY, MA, MBBS, DPhil 2 R R PHILLIPS, FRCP, DCH, FRCR 3 and M Brady, FRS, FREng, FMedSci 1

1 Department of Engineering Science, Wolfson Medical Vision Laboratory, Oxford,, Departments of 2 Urology and 3 Radiology, The Churchill Hospital, Oxford, UK

Correspondence: O. Noterdaeme, Department of Engineering Science, Wolfson Medical Vision Laboratory, Oxford, UK. E-mail: olivier{at}robots.ox.ac.uk

The aim of this study was to investigate the use of time to maximum enhancement (tmax) for each voxel in contrast-enhanced MRI (CE-MRI) as a non-invasive tool to determine areas of necrosis following treatment of liver tumours with high-intensity focused ultrasound (HIFU) and, having established the utility of tmax maps, to develop a three-dimensional (3-D) representation to display this information concisely. 3-D T1 weighted fast spoiled gradient echo images of the liver were acquired before and after administration of contrast agent. The CE-MR images were aligned to the pre-contrast volume and an estimate of tmax was obtained for each voxel. Such pre- and post-contrast image sets were acquired before and after ablation. The tmax maps before and after HIFU treatment were correlated with the procedure notes, radiological reports and gross histological specimen. Finally, 3-D tmax maps of the whole liver were reconstructed to show all areas of abnormal tissue perfusion. Normal, healthy liver tissue uniformly enhances maximally after approximately 1 min. The computed tmax maps accurately delineated areas of abnormal contrast agent uptake, corresponding to tumour deposits. Changes in tmax and non-enhancing voxels after treatment correlate well with volumes targeted during ablation and the necrotic regions seen on gross histological specimens. Alignment of the contrast-enhanced images with the pre-contrast volume greatly improved the conspicuity of the tmax maps. We conclude that tmax maps and their 3-D views can be used as a non-invasive tool to assess and potentially to quantify the success of HIFU ablation, and concisely represent the large number of CE-MRI data.






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