Stereotactically-navigated percutaneous Irreversible Electroporation (IRE) compared to conventional IRE: a prospective trial.
Stereotactically-navigated percutaneous Irreversible Electroporation (IRE) compared to conventional IRE: a prospective trial.
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作者：
Beyer LP;Pregler B;Nießen C;Schicho A;Haimerl M;Jung EM;Stroszczynski C;Wiggermann P
目的.本研究旨在比较CT导航立体定向IRE（SIRE）穿刺针置入与非导航常规IRE（CIRE）用于肝脏恶性肿瘤经皮消融的情况。材料和方法。进行了一项前瞻性试验，共纳入20例患者，每组10例患者。IRE手术使用CT透视（CIRE）或立体定向计划和导航系统（SIRE）引导。主要终点为手术时间。次要终点是针放置的准确性、技术成功率、并发症发生率和剂量长度乘积（DLP）。结果共进行了20次IRE手术以消融肝脏恶性肿瘤（16例HCC，4例肝转移瘤），每组10次。SIRE中放置IRE电极的平均时间为27 ± 8 min，而CIRE为87 ± 30 min（p < 0.001）。SIRE的针放置准确性高于CIRE（2.2 mm与3.3 mm平均偏差，p < 0.001）。SIRE的总DLP和透视DLP显著低于CIRE。两组的技术成功率和并发症发生率相等。结论与CIRE相比，SIRE证明了手术时间的显著缩短和更高的准确性。与CIRE相比，立体定向导航有可能减少患者和放射科医生的辐射剂量，而不会增加并发症风险或损害技术成功。
Purpose. The purpose of this study was to compare CT-navigated stereotactic IRE (SIRE) needle placement to non-navigated conventional IRE (CIRE) for percutaneous ablation of liver malignancies. Materials and Methods. A prospective trial including a total of 20 patients was conducted with 10 patients in each arm of the study. IRE procedures were guided using either CT fluoroscopy (CIRE) or a stereotactic planning and navigation system (SIRE). Primary endpoint was procedure time. Secondary endpoints were accuracy of needle placement, technical success rate, complication rate and dose-length product (DLP). Results. A total of 20 IRE procedures were performed to ablate hepatic malignancies (16 HCC, 4 liver metastases), 10 procedures in each arm. Mean time for placement of IRE electrodes in SIRE was significantly shorter with 27 ± 8 min compared to 87 ± 30 min for CIRE (p < 0.001). Accuracy of needle placement for SIRE was higher than CIRE (2.2 mm vs. 3.3 mm mean deviation, p < 0.001). The total DLP and the fluoroscopy DLP were significantly lower in SIRE compared to CIRE. Technical success rate and complication rates were equal in both arms. Conclusion. SIRE demonstrated a significant reduction of procedure length and higher accuracy compared to CIRE. Stereotactic navigation has the potential to reduce radiation dose for the patient and the radiologist without increasing the risk of complications or impaired technical success compared to CIRE.