Lack of Anatomical Concordance between Preablation and Postablation CT Images: A Risk Factor Related to Ablation Site Recurrence.
Lack of Anatomical Concordance between Preablation and Postablation CT Images: A Risk Factor Related to Ablation Site Recurrence.
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DOI：
10.1155/2012/870306
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发表时间：
2012
影响因子：
1.8
通讯作者：
de Jong KP
中科院分区：
文献类型：
--
作者：
Kele PG;Van der Jagt EJ;Krabbe PF;de Jong KP
Objective.消融前和消融后CT图像之间肝脏位置的变化阻碍了对结直肠肝转移（CRLM）治疗的评估。本研究的目的是检验消融前和消融后成像不一致与更多消融部位复发（ASR）相关的假设。方法.纳入CRLM患者。通过CT扫描获得肿瘤大小、位置、数量、RFA入路和消融边缘。对消融前和消融后CT图像进行“定位相似性评分”（SiPS）。确定了合适的截止值。将图像分类为相同（SiPS-id）或不相同（SiPS-diff）。在随访成像中前瞻性识别ASR。结果47例患者（97个肿瘤）接受了64次RFA手术（39例患者/63个肿瘤开放性RFA，25例患者/34个肿瘤CT靶向RFA，12例患者接受了>1次RFA）。52个（54%）消融部位的图像被归类为SiPS-id，45个（46%）被归类为SiPS-diff。指数-肿瘤大小、肿瘤位置和数量、伴随的部分肝切除术和RFA方法不影响SiPS。ASR在11/47（23%）例患者和20/97（21%）例肿瘤中发生。开放性RFA术后ASR发生率低于CT靶向RFA（P < 0.001）。ASR与较大的指数肿瘤大小相关（18.9与12.8 mm，P = 0.011）。考克斯比例风险模型证实SiPS-diff、指数肿瘤大小>20 mm和CT靶向RFA是ASR的独立风险因素。结论消融前和消融后图像之间解剖结构一致性的变化、索引肿瘤大小和CT靶向方法是CRLM中ASR的风险因素。
Objective. Variation in the position of the liver between preablation and postablation CT images hampers assessment of treatment of colorectal liver metastasis (CRLM). The aim of this study was to test the hypothesis that discordant preablation and postablation imaging is associated with more ablation site recurrences (ASRs). Methods. Patients with CRLM were included. Index-tumor size, location, number, RFA approachs and ablative margins were obtained on CT scans. Preablation and postablation CT images were assigned a “Similarity of Positioning Score” (SiPS). A suitable cutoff was determined. Images were classified as identical (SiPS-id) or nonidentical (SiPS-diff). ASR was identified prospectively on follow-up imaging. Results. Forty-seven patients with 97 tumors underwent 64 RFA procedures (39 patients/63 tumors open RFA, 25 patients/34 tumours CT-targeted RFA, 12 patients underwent >1 RFA). Images of 52 (54%) ablation sites were classified as SiPS-id, 45 (46%) as SiPS-diff. Index-tumor size, tumor location and number, concomitant partial hepatectomy, and RFA approach did not influence the SiPS. ASR developed in 11/47 (23%) patients and 20/97 (21%) tumours. ASR occurred less frequently after open RFA than after CT targeted RFA (P < 0.001). ASR was associated with larger index-tumour size (18.9 versus 12.8 mm, P = 0.011). Cox proportional hazard model confirmed SiPS-diff, index-tumour size >20 mm and CT-targeted RFA as independent risk factors for ASR. Conclusion. Variation in anatomical concordance between preablation and postablation images, index-tumor size, and a CT-targeted approach are risk factors for ASR in CRLM.