Real-Time Split-Dose PET/CT-Guided Ablation Improves Colorectal Liver Metastasis Detection and Ablation Zone Margin Assessments without the Need for Repeated Contrast Injection.
Real-Time Split-Dose PET/CT-Guided Ablation Improves Colorectal Liver Metastasis Detection and Ablation Zone Margin Assessments without the Need for Repeated Contrast Injection.
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该研究表明，将PET添加到CLM的CT引导消融中可以改善肿瘤靶向检测，允许在消融期间重复肿瘤可视化以进行监测，并在治疗完成后评估消融区和边缘，同时消除了在消融之前和消融期间重复给予造影剂的需要。背景资料：实时分次剂量PET可以识别靶向结直肠肝转移（CLM），并消除在热消融（TA）之前和期间重复给予造影剂的需要。本研究旨在评估消融前实时分次剂量PET与非接触式CT结合在消融CLM检测以及消融区和边缘评价中的附加价值。方法：分析了来自IRB批准的两项前瞻性临床试验（使用PET/CT引导TA）的共190例CLM/125例受试者。基于TA前成像的检测，CLM被分类为可检测、不可检测和单独CT上的显著性差，以及初始剂量后PET/CT上的可检测、不可检测和低FDG亲合力。使用3D体积法评价靶向CLM周围的消融边缘。结果如下：我们发现，129/190（67.9%）CLM可单独在CT上检测到，61/190（32.1%）CLM无法检测到或显示不佳，无法单独通过CT进行准确描述和定位。因此，仅使用CT无法在这些肿瘤（32.1%）中定义理论上的5 mm和10 mm边缘。当获得并检查TA术中PET/CT图像（融合PET/CT）时，只有4例CLM（2.1%）无法检测或FDG亲和力较低。结论：将PET添加到非造影CT改善了消融靶向的CLM检测、边缘评估以及消融期间FDG avid CLM的连续描绘，而无需在术前和术中多次静脉注射造影剂。
This study showed that adding PET to CT-guided ablation of CLMs can improve tumor detection for targeting, allowing for repeated tumor visualization for monitoring during ablation and assessing the ablation zone and margins after treatment completion while eliminating the need for repeated contrast administration before and during the ablation. Background: Real-time split-dose PET can identify the targeted colorectal liver metastasis (CLM) and eliminate the need for repeated contrast administration before and during thermal ablation (TA). This study aimed to assess the added value of pre-ablation real-time split-dose PET when combined with non-contract CT in the detection of CLM for ablation and the evaluation of the ablation zone and margins. Methods: A total of 190 CLMs/125 participants from two IRB-approved prospective clinical trials using PET/CT-guided TA were analyzed. Based on detection on pre-TA imaging, CLMs were categorized as detectable, non-detectable, and of poor conspicuity on CT alone, and detectable, non-detectable, and low FDG-avidity on PET/CT after the initial dose. Ablation margins around the targeted CLM were evaluated using a 3D volumetric approach. Results: We found that 129/190 (67.9%) CLMs were detectable on CT alone, and 61/190 CLMs (32.1%) were undetectable or of poor conspicuity, not allowing accurate depiction and targeting by CT alone. Thus, the theoretical 5- and 10-mm margins could not be defined in these tumors (32.1%) using CT alone. When TA intraprocedural PET/CT images are obtained and inspected (fused PET/CT), only 4 CLM (2.1%) remained undetectable or had a low FDG avidity. Conclusions: The addition of PET to non-contrast CT improved CLM detection for ablation targeting, margin assessments, and continuous depiction of the FDG avid CLMs during the ablation without the need for multiple intravenous contrast injections pre- and intra-procedurally.
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影响因子：
4.7
作者：
Sandu RM;Paolucci I;Ruiter SJS;Sznitman R;de Jong KP;Freedman J;Weber S;Tinguely P
通讯作者：
Tinguely P
影响因子：
2.9
作者：
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通讯作者：
Mahnken, Andreas H.
影响因子：
19.7
作者：
Shyn, Paul B.;Casadaban, Leigh C.;Silverman, Stuart G.
通讯作者：
Silverman, Stuart G.
影响因子：
5.9
作者：
Calandri, Marco;Yamashita, Suguru;Odisio, Bruno C.
通讯作者：
Odisio, Bruno C.
影响因子：
4.7
作者：
Ruiter SJS;Tinguely P;Paolucci I;Engstrand J;Candinas D;Weber S;de Haas RJ;de Jong KP;Freedman J
通讯作者：
Freedman J