The Value of Proton Magnetic Resonance Spectroscopy in High-Intensity Focused Ultrasound Treatment of Experimental Liver Cancer Zhuo-yue Tang, Jian-nong.

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The Value of Proton Magnetic Resonance Spectroscopy in High-Intensity Focused Ultrasound Treatment of Experimental Liver Cancer Zhuo-yue Tang, Jian-nong Zhao, Wei-jia Zhong, Yin-deng Luo, Wei Wu, Wei-juan Chen, Yu-bing Dai Translational Oncology Volume 8, Issue 3, Pages 163-168 (June 2015) DOI: 10.1016/j.tranon.2015.03.007 Copyright © 2015 The Authors Terms and Conditions

Figure 1 The MRI and MRS of normal liver before and after HIFU ablation. (A) T1WI of normal liver shows no mass in the left lobe of the liver. (B) T2WI of normal liver shows no mass in the left lobe of the liver. (C) MRS of normal liver shows that the Cho peak appeared at 3.2 ppm and Lip peak appeared at 1.3 ppm; the measured Cho/Lip ratio is 0.03 ± 0.00. (D) The H&E-stained section shows normal liver architecture before HIFU. (E) On T1WI after HIFU ablation, a lower intensity signal appeared in the left lobe of normal liver. (F) On T2WI after HIFU ablation, a slightly high intensity signal appeared in the left lobe of normal liver. The arrows indicate the ablated region on T1WI and T2WI. (G) The MRS after HIFU shows a similar pattern to that before HIFU, and the Cho resonance is at 3.2 ppm with no significant changes in amplitude; the lipid resonance at 1.3 ppm increased, and the Cho/Lip ratio after HIFU is 0.02 ± 0.00. (H) The H&E-stained section shows lysed membranes, poorly delineated cells, pycnotic nuclei, nuclear fragmentation, and heavy staining of hepatocyte cytoplasm after HIFU ablation. Translational Oncology 2015 8, 163-168DOI: (10.1016/j.tranon.2015.03.007) Copyright © 2015 The Authors Terms and Conditions

Figure 2 The MRI and MRS of liver VX2 tumor before and after complete and partial HIFU ablation. (A and I) Lesions of rabbit VX2 tumor were visible in the middle lobe of the liver 2 weeks after implantation, lesions appeared as slightly low intense nodules on T1WI images. (B and J) On T2WI, the lesions appeared hyperintense signals. (C and K) The Cho peak at 3.2 ppm is significantly increased in liver VX2 tumor (3.16 ± 0.58), and the Cho/Lip ratio is 0.22 ± 0.03. (D and L) The H&E-stained sections show untreated VX2 liver before HIFU. (E) On T1WI after complete HIFU ablation, the lesion shows a slightly low intensity signal. (F) On T2WI after complete HIFU ablation, the lesion shows a slightly hyperintense signal. (G) The MRS after complete HIFU ablation shows a significant decrease in Cho resonance at 3.2 ppm with no significant changes in amplitude; the amplitude of the lipid resonance at 1.3 ppm increased, and the Cho/Lip ratio after HIFU is 0.02 ± 0.00. (H) The H&E-stained section shows poorly delineated cells, lysed membranes, pycnotic nuclei, and nuclear fragmentation after complete HIFU ablation; viable tumor cells cannot be observed. (M) On T1WI after partial HIFU ablation, the lesion shows a slightly low intensity signal. (N) On T2WI after partial HIFU ablation, the lesion shows a slightly hyperintense signal. (O) The MRS after partial HIFU ablation shows a reduction in Cho resonance, but the amplitude is still higher than normal liver or tumor after complete ablation. (P) The H&E-stained section shows coagulative necrosis in the region of ablation, but viable tumor cells can be found adjacent to the necrosis. The arrows indicate the tumor mass on T1WI and T2WI. Translational Oncology 2015 8, 163-168DOI: (10.1016/j.tranon.2015.03.007) Copyright © 2015 The Authors Terms and Conditions

Figure 3 Comparison of Cho, Lip, and Cho/Lip ratio in normal liver and liver VX2 tumor before and after HIFU ablation. (A) Cho value in non-tumor, tumor complete HIFU, and tumor partial HIFU groups before and after HIFU ablation. (B) Lip value in non-tumor, tumor complete HIFU, and tumor partial HIFU groups before and after HIFU ablation. (C) Cho/Lip ratio in non-tumor, tumor complete HIFU, and tumor partial HIFU groups before and after HIFU ablation. ***P < .001, **P < .01, and *P < .05. Translational Oncology 2015 8, 163-168DOI: (10.1016/j.tranon.2015.03.007) Copyright © 2015 The Authors Terms and Conditions