Article Figures & Data
Figures
- Fig 1.
Fiducial markers are placed (A) with follow-up registration imaging performed for confirmed localization (B). Alignment of the navigation probe within a precision aiming device is ensured before it is locked into position (C and D). Thermal localization is performed to estimate approximate temperatures to be reached during MRgLAC to ensure that the temperature does not exceed 90°C. This is demonstrated by color gradients representing measured temperature gradients (E). Sequential real-time images obtained during MRgLAC of the right cingulum are then acquired. Note placement and location of the probes in both gyri and a steadily increasing region of thermal ablation in the right cingulate (F).
- Fig 2.
The above owl eye–appearing lesions are recorded 24 hours post-laser ablation of the cingulate gyri in patient 1. Four discrete zones are noted, labeled 1–4 from central to peripheral. All patients who underwent MRgLAC demonstrated this zonal distribution of signal abnormality.
- Fig 3.
Imaging performed in patient 4 one year following MRgLAC demonstrates the persistent appearance of bilateral concentric zones of thermal ablation with a preserved owl eyes configuration. Note the lack of enhancement on postcontrast imaging, resolution of postprocedural edema, and T2-shinethrough on diffusion-weighted imaging.
- Fig 4.
The following gradient recalled-echo images from patient 4 demonstrate evolution of postprocedural gradient-echo imaging changes related to MRgLAC. There is an interval increase in the magnetic susceptibility signal in zone 3 between the immediate and post-24 hour images. Note is made of residual peripheral magnetic susceptibility 1 year following the procedure.
- Fig 5.
Coronal T1 postcontrast and sagittal STIR imaging performed on patient 4 one year following MRgLAC demonstrates 2 pairs of concentric rings in each cingulate. These correspond to the 2 adjacent areas of thermal ablation produced in each cingulum.
Tables
Patient demographics
Patient No. Age (yr) Sex Metastatic Neoplasm Post-MRgLAC Follow-Up 1 47 Female Liposarcoma 24 hours 2 38 Female Breast 24 hours 3 51 Female Colon 24 hours 4 82 Female Colon 1 year
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