MWA of five invisible liver lesions with MRI/CT fusion

A young woman with metastatic colorectal cancer presented with five invisible lesions. The lesions located in Liver Segments: VIII, VI/VIII, II/III, VIII and VIII were treated with the support of CAS-One IR. The MDT decided for Quality Ablation, because of its ability to simulate a treatment plan fused with the former MRI. AI-driven segmentation of the organs and vasculature made for a safer treatment.

Planning in Oblique MPR with multi-organ segmentation and planned trajectories on the right including AI driven organ and vasculature segmentation

Intra-operative ablation margin assessment with AblaSure showcasing a broader margin (>5mm) with 84% coverage. 

Video overview of the several planned trajectories 

Video of CAS-One IR showcasing its CT/MRI Fusion capabilities to treat invisible lesions 

Name: Christian Weiergang & Farida Hashimi

Institution: Sahlgrenska, Göteborg University Hospital

Patient age, sex:  53, Female

Initial condition:

• Patient with metastatic colorectal cancer diagnosed in October 2022
• Underwent resection of two liver metastasis in October 2022, but developed early local recurrence
  that was treated with chemotherapy (FOLFOX) after resection
• A liver specific MRI from February 2023 showed 5 new liver metastases of various sizes (between 4mm and 12mm)
• The pre-ablation MRI scan from May 2023 showed only two lesions were visible. Because the patient did not have a chemo-break in between it was decided to ablate all five lesions based on the MRI from February 2023

Treatment: 

• CAS-One IR was chosen as treatment option, because of its ability to fuse the planning CT with the previous MRI to visualize all five lesions (visible and invisible)
• The procedure was performed under general anesthesia with high-frequency jet-ventilation for optimal respiratory motion control
• Five single-needle trajectories were planned and simulated based on a CT-MRI Fusion
• The ablation of the lesions was performed with the HS AMICA system 
• Needle placement control scans showed that there was no need for needle replacement in any of the five needles
• After treatment, the AI-driven AblaSure was used to assess the success of the ablation
• In two of the lesions ablation margins were acceptable, but not optimal
• Re-ablation was not performed due to the high complexity of the case

Result:

• All lesions were successfully treated with sufficient ablation margins between 5mm-10mm.
• The patient was discharged from the hospital the day after, and no adverse events were reported
• Patient will have a follow-up MRI in December 2023