Prediction of the critical thermal zone during pulmonary cryoablation on computed tomography from correlated experimental and clinical findings
Prediction of the critical thermal zone during pulmonary cryoablation on computed tomography from correlated experimental and clinical findings
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DOI：
10.1016/j.jtcvs.2012.03.029
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发表时间：
2013-03-01
影响因子：
6
通讯作者：
Nomori, Hiroaki
中科院分区：
文献类型：
--
作者：
Hashimoto, Kohei;Izumi, Yotaro;Nomori, Hiroaki
目的：在冷冻消融过程中，细胞在低于20℃的温度下被破坏。通过计算机断层扫描(CT)、等温曲线和组织学观察，评估肺冷冻消融中局部肿瘤控制的决定因素。实验结果与临床CT结果对照，并外推至局部肿瘤控制结果。方法：在热监测下进行冷冻消融，将消融区域分为-20℃以下、-20℃~0℃和大于0℃3个区域，并与组织学结果进行比较。将36个结节多平面重建的CT表现与猪组织学结果进行对照分析。结果：98个结节的CT表现与3年局部肿瘤控制的关系。结果：3个同心热区分别为：-20℃以下，组织完全破坏(D区)，-20℃~0℃区(D区周围)，出血伴空气滞留，肺泡结构维持(H区)，>0℃区(最外)，肺泡结构持续肿胀(E区)。36个结节的CT表现为中央实质区、周围含气区和外实区，分别对应于D、H、E区。3年后，位于中央实质区的80个结节的局部肿瘤控制率显著高于非中央实质区的18个结节(82%比33%，P=.0002)。结论：肺冷冻消融术应该使肿瘤包含在CT上的中央实体区内，即低于-20℃的区域。(《胸心外科杂志》2013；145：832-8)
Objective: During cryoablation, cells are destroyed at temperatures less than 20 degrees C. The determining factors for local cancer control in pulmonary cryoablation were assessed using computed tomography (CT), isothermal curves, and histologic findings in pigs. Experimental findings were compared with clinical CT findings and were extrapolated to local cancer control outcomes.Methods: Cryoablation was performed with thermal monitoring, and the ablated areas were divided into 3 zones: less than -20 degrees C, -20 degrees C to 0 degrees C, and greater than 0 degrees C and were compared with histologic findings. CT findings with multiplanar reconstruction in 36 nodules were compared with the porcine histologic findings. The relationship between CT findings and 3-year local cancer control was evaluated in 98 nodules.Results: The 3 concentric thermal zones correlated with histologic findings as follows: less than -20 degrees C zone, complete tissue destruction (zone D); -20 degrees C to 0 degrees C zone (which surrounded zone D), hemorrhage with air trapping and maintenance of alveolar structures (zone H); and greater than 0 degrees C zone (outermost), edema with sustained alveolar structures (zone E). The CT findings in 36 nodules showed a central solid zone, a surrounding air-containing zone, and an outside solid zone, corresponding to zones D, H, and E, respectively. Local cancer control at 3 years in 80 nodules contained within the central solid zone was significantly greater compared with the 18 nodules that were not (82% vs 33%, P = .0002).Conclusions: Pulmonary cryoablation should be performed such that tumors are contained within the central solid zone on CT, which represents the less than -20 degrees C zone. (J Thorac Cardiovasc Surg 2013;145:832-8)