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Volume 184, Issue 4, Pages (October 2010)

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1 Volume 184, Issue 4, Pages 1514-1520 (October 2010)
Magnetic Resonance Guided, Focal Laser Induced Interstitial Thermal Therapy in a Canine Prostate Model  R. Jason Stafford, Anil Shetty, Andrew M. Elliott, Sherry A. Klumpp, Roger J. McNichols, Ashok Gowda, John D. Hazle, John F. Ward  The Journal of Urology  Volume 184, Issue 4, Pages (October 2010) DOI: /j.juro Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

2 Figure 1 Subject 7. Planning applicator placement with template guidance, including perineal template (A) with site of 3 MR visible markers (1 to 3) for registration, actual template on perineum with 2 laser applicators (P and N) in prostate (B), 3 MR visible markers on 3D T1-weighted images (C), and prostate image without (D) and with (E) template grid overlay. The Journal of Urology  , DOI: ( /j.juro ) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

3 Figure 2 Subject 3. Prostate MR LITT, including real-time MRTI from thermal therapy system (A), Arrhenius estimation of thermal necrotic zone (B) and posttreatment 3D T1-weighted contrast enhanced imaging (C). Dotted green lines show edges of estimated damage projected on 2 images (B and C) for visual correlation. T1-weighted images (C) were reformatted (D) to better match region where slices were sampled for photographic pathological (E) and histological (F) evaluation. Arrows indicate applicator track (D to F). Ratio of distance to MZ edge to distance to prostate edge to correct for shrinkage was 0.70 vs 0.71 for pathological vs histological findings. Scale bar represents 1 cm. The Journal of Urology  , DOI: ( /j.juro ) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

4 Figure 3 Three-dimensional T1-weighted post-contrast measurements of LITT induced ablation size measured from outer edematous edge vs Arrhenius estimated tissue damage on MR. The Journal of Urology  , DOI: ( /j.juro ) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

5 Figure 4 Subject 3. Histological view of ablation zone cellular changes (A). Chromogen diaminobenzidine tetrahydrochloride allowed visualization of immunolabeling of immunostained endothelial cells (brown areas) (B). Immunopositive staining (rectangle) was due to endothelial cells lining intact blood vessel. Abnormally excessive immunostaining was seen adjacent to laser tract (LT) due to traumatic injury, and in CNZ and MZ due to thermally injured blood vessels resulting in edema derived from plasma and platelet leakage into interstitial areas. H&E (A) and vWF immunostaining (B), scale bar represents 1 mm. The Journal of Urology  , DOI: ( /j.juro ) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

6 Figure 5 Laser induced tissue damage (fig. 4, A, rectangle) at higher magnification. Sections show normal interstitium (I) composed of compact collagen (B), and interstitium with dilated vein and loosely woven collagen due to plasma leakage from thermally damaged vessels (C). MZ adjacent to CNZ had sloughed epithelial cells and red blood cells in glandular lumina (D). UZ was characterized by normal glandular and cellular architecture with open faced nuclei (E). H&E, scale bar represents 250 (A) and 50 (B to E) μ. The Journal of Urology  , DOI: ( /j.juro ) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

7 Figure 6 Effects of vascular damage in MZ, including loosely woven collagen and interstitial tissue expansion due to plasma leakage from damaged blood vessels (A), resulting in edema (fig. 2). I, interstitium. Slanted line divides MZ (left) and UZ (right) (B). Arrows indicate interstitial blood vessels. Note staining of endothelial cells (dark brown areas) lining dilated blood vessel (BV). Crenated red blood cells (cRBC) and plasma in glandular lumina were immunopositive for vWF. Immunopositive endothelial cells lined intact vein (rectangle) in UZ with no edema in interstitium (I). G, prostate. H&E (A) and vWF immunostaining (B), scale bar represents 50 μ. The Journal of Urology  , DOI: ( /j.juro ) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions


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