Clinical Scorecard: Techniques Utilizing Imaging for Defining Ablation Zones and Assessing Volume Post-Laser Interstitial Thermal Therapy for Intracranial Lesions: A Comprehensive Review

At a Glance

Key Highlights

• LITT enables minimally invasive cytoreduction of intracranial lesions in challenging locations previously inaccessible to surgery
• Extent of ablation (EOA) correlates with prognosis but lacks standardized imaging-based volumetric assessment methods
• Post-LITT ablation zones are visualized on contrast-enhanced T1-weighted MRI as a necrotic core with a peripheral enhancing rim, which can be difficult to distinguish from residual tumor

Guideline-Based Recommendations

Diagnosis

• Use MRI guidance and real-time MR-thermometry during LITT to accurately target lesions
• Perform immediate post-procedural contrast-enhanced T1-weighted MRI to visualize ablation zones

Management

• Tailor ablation volume intraoperatively to maximize lesion cytoreduction while preserving surrounding healthy brain tissue
• Consider LITT for patients with deep-seated or eloquent-area intracranial lesions unsuitable for open surgery

Monitoring & Follow-up

• Assess ablation volume and extent of ablation using imaging modalities post-LITT
• Recognize challenges in differentiating ablation zone rim enhancement from residual tumor on MRI
• Use thermometry data and surgeon estimates as adjuncts for ablation volume assessment

Risks

• Potential damage to surrounding healthy brain tissue if ablation is not precisely controlled
• Difficulty in accurately delineating ablation zones may affect assessment of treatment efficacy

Patient & Prescribing Data

Patients undergoing LITT for intracranial lesions including tumors and epilepsy-related lesions

LITT offers a minimally invasive option with real-time monitoring to optimize ablation extent; however, standardized imaging protocols for post-treatment volume assessment are lacking

Clinical Best Practices

• Employ MRI guidance with real-time thermometry during LITT for precise ablation targeting
• Perform immediate post-LITT contrast-enhanced MRI to evaluate ablation zones
• Use a combination of imaging, thermometry data, and clinical judgment to estimate extent of ablation
• Recognize limitations in current imaging methods and advocate for development of standardized volumetric assessment protocols

References

• PRISMA guidelines
• PROSPERO registration CRD42024515809