Spatial Mapping and Analysis of Real-time MRI Thermometry for Highly Efficient liver tumor Ablation using inverse Thermal modelling – SMART-HEAT

In the intricate realm of oncology, the treatment of both oligometastatic liver disease and hepatocellular carcinoma (HCC) presents a challenge, demanding a nuanced exploration of tailored treatment strategies. Local ablation approaches, especially thermal techniques, play a crucial role as minimally invasive interventional strategies. Guidelines in various tumor entities recommend thermal ablation as first-line treatment, depending on the number and size of lesions. Interventional MRI can provide a comprehensive setting for microwave ablation (MWA) treatment of liver tumors and – unique to this modality – can non-invasively monitor and visualize the energy delivery using quantitative real-time MRI-based temperature mapping techniques.
The proposed project SMART-HEAT aims to provide major innovations in the clinical practice of MWA in the liver by combining experimental MR-based temperature mapping and an inverse modeling approach for visualizing the thermal response. The two primary objectives are: (1) Improve the (pre-interventional) planning of thermal ablation therapy and the optimization and personalization of device settings by providing personalized modeling of the temperature field prior to ablation. (2) Improve the safety of online monitoring (during ablation) and the prediction of the lesion size through improved real-time sub-voxel visualization of the treatment response. For these purposes, a comprehensive methodological framework based on optimized data acquisition, (numerical) model reduction, and real-time source estimation will be developed. This innovation has the potential to be transformative, combining the MWA system with a methodology capable of identifying the spatial and temporal distribution of heat sources within tissue at moderate (< 100°C) or high-power MWA settings (>100°C).
Methods will be validated first in vitro in realistic test phantoms, then in vivo in large animals during MWA ablation. Temperature precision and accuracy will be assessed, and the accumulated thermal dose as predictor of ablations will be evaluated. Finally, the method will be transferred to patients for retrospective and prospective evaluation of the new inverse-modeling thermometry approach in real clinical settings. Thus, a tool will be developed that meets patient safety criteria while also satisfying technological, ergonomic and regulatory requirements.
SMART-HEAT is a multidisciplinary project involving teams in Munich and Bordeaux with complementary expertise in interventional radiology, MRI thermometry, and inverse thermal modeling. SMART-HEAT aims at providing an objective therapeutic end-point based on quantitative, rapid, and spatially resolved thermal imaging. By improving the coverage of lesions within the ablation zone and mitigating the risk of heat-induced complications, SMART-HEAT is expected to improve local tumor control as well as procedural safety and might extend the limits of thermal ablation of liver tumors.