A novel use of biomechanical model-based deformable image registration (DIR) for assessing colorectal liver metastases ablation outcomes.
A novel use of biomechanical model-based deformable image registration (DIR) for assessing colorectal liver metastases ablation outcomes.
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结直肠癌是美国第三大最常见的癌症，其中高达60%的患者会发生肝转移。虽然肝切除术是治愈性治疗的选择，但在诊断时只有20%的患者是候选的。虽然经皮热消融（PTA）的总体5年生存率为24%-51%，但由于目前的2D距离测量方法无法确保3D最小切距，因此确保足够的消融切距（5mm）可能具有挑战性。我们假设基于生物力学模型的可变形图像配准（DIR）可以减少空间不确定性，并区分局部肿瘤进展（LTP）患者和非LTP患者。我们回顾性地获得了30例患者（16例LTP和14例无LTP），他们在我们的机构接受了PTA，并在治疗前和消融后进行了对比增强CT扫描。手工分割肝脏、病变、消融区。在治疗前和消融后的CT之间基于生物力学模型的DIR将总体肿瘤体积映射到消融区，并测量3D最小传递边界（MDM）。一个内部的锥跟踪算法确定是否进展定性地配置与不足5毫米的余量实现。Mann-Whitney U检验显示，LTP组和无LTP组的MDM差异有统计学意义（p < 0.01）。共有93%（13/14）的LTP患者的进展与切缘体积减少5mm之间存在相关性。生物力学DIR能够减少空间不确定性，并允许测量交付的3D MDM。这个最小的余量可以帮助确保足够的消融递送，我们的工作流程可以在临床有用的时间框架内提供有价值的信息。
Colorectal cancer is the third most common form of cancer in the United States, and up to 60% of these patients develop liver metastasis. While hepatic resection is the curative treatment of choice, only 20% of patients are candidates at the time of diagnosis. While percutaneous thermal ablation (PTA) has demonstrated 24%–51% overall 5-year survival rates, assurance of sufficient ablation margin delivery (5 mm) can be challenging, with current methods of 2D distance measurement not ensuring 3D minimum margin. We hypothesized that biomechanical model-based deformable image registration (DIR) can reduce spatial uncertainties and differentiate local tumor progression (LTP) patients from LTP-free patients. We retrospectively acquired 30 patients (16 LTP and 14 LTP-free) at our institution who had undergone PTA and had a contrast-enhanced pre-treatment and post-ablation CT scan. Liver, disease, and ablation zone were manually segmented. Biomechanical model-based DIR between the pre-treatment and post-ablation CT mapped the gross tumor volume onto the ablation zone and measured 3D minimum delivered margin (MDM). An in-house cone-tracing algorithm determined if progression qualitatively collocated with insufficient 5 mm margin achieved. Mann–Whitney U test showed a significant difference (p < 0.01) in MDM from the LTP and LTP-free groups. A total of 93% (13/14) of patients with LTP had a correlation between progression and missing 5 mm of margin volume. Biomechanical DIR is able to reduce spatial uncertainty and allow measurement of delivered 3D MDM. This minimum margin can help ensure sufficient ablation delivery, and our workflow can provide valuable information in a clinically useful timeframe.
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DOI：
10.1002/bjs.10490
发表时间：
2017-05
期刊：
The British journal of surgery
影响因子：
--
作者：
Odisio BC;Yamashita S;Huang SY;Harmoush S;Kopetz SE;Ahrar K;Shin Chun Y;Conrad C;Aloia TA;Gupta S;Hicks ME;Vauthey JN
通讯作者：
Vauthey JN
影响因子：
4.8
作者：
Fujioka, Chikako;Horiguchi, Jun;Ito, Katsuhide
通讯作者：
Ito, Katsuhide
影响因子：
5
作者：
Kim, Kyung Won;Lee, Jeong Min;Choi, Byung Ihn
通讯作者：
Choi, Byung Ihn
影响因子：
45.3
作者：
Berber, E;Pelley, R;Siperstein, AE
通讯作者：
Siperstein, AE
影响因子：
2.7
作者：
Mulder, B. G. Sibinga;Hendriks, P.;Burgmans, M. C.
通讯作者：
Burgmans, M. C.