Radiofrequency Ablation of Liver Metastases-Software-Assisted Evaluation of the Ablation Zone in MDCT: Tumor-Free Follow-Up Versus Local Recurrent Disease
Radiofrequency Ablation of Liver Metastases-Software-Assisted Evaluation of the Ablation Zone in MDCT: Tumor-Free Follow-Up Versus Local Recurrent Disease
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DOI：
10.1007/s00270-009-9681-9
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发表时间：
2010-04-01
影响因子：
2.9
通讯作者：
Mahnken, Andreas H.
中科院分区：
文献类型：
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作者：
Keil, Sebastian;Bruners, Philipp;Mahnken, Andreas H.
本研究的目的是通过专用的肝脏病灶自动评估软件，研究CT引导下射频消融（RFA）治疗肝转移瘤后，随访期间局部复发区和无瘤区的大小和CT值变化的差异。32例乳腺癌或结直肠癌肝转移患者共54处，在CT引导RFA前和介入治疗后随访时，进行了三相对比增强多排计算机断层扫描（MDCT），以评价肝转移的扩散和定位。其中16例患者（65.1 +/- A 10.3岁）有30个转移灶，保持无肿瘤（第1组），而另一组（n = 16，24个转移灶; 62.0 +/- A 13.8岁）患有局部复发性疾病（第2组）。应用自动化软件工具（SyngoCT Oncology; Siemens Healthcare，Forchheim，德国），在RFA治疗前、治疗后1天和治疗后28天测量病变内的尺寸参数（体积、RECIST、WHO）和衰减。计算RFA治疗后1天与28天体积商的自然对数（ln）：lnQ 1//28/0（体积）。类似地，计算RECIST、WHO和衰减的ln比值，并通过重复测量ANOVA进行统计学评价。第2组中的1处病变因自动误分割而被排除在进一步评价之外。在初始体积、RECIST和WHO方面观察到两组之间的统计学显著差异（p < 0.05）。此外，与体积、RECIST和WHO对应的ln比值在两组之间存在显著差异。衰减评价显示无显著差异，但参数lnQ 28/0（衰减）存在衰减评估趋势（p = 0.0527），显示第1组（-0.4 +/- A 0.3）的值高于第2组（-0.2 +/- A 0.2）。总之，无肿瘤消融区和局部复发消融区的肝转移瘤及其RFA后凝固性坏死区在相应尺寸参数方面存在显著差异。引入了一个新的参数（lnQ 1//28/0（体积/RECIST/WHO/衰减）），该参数似乎在早期随访CT时具有预后价值。
The purpose of this study was to investigate differences in change of size and CT value between local recurrences and tumor-free areas after CT-guided radiofrequency ablation (RFA) of hepatic metastases during follow-up by means of dedicated software for automatic evaluation of hepatic lesions. Thirty-two patients with 54 liver metastases from breast or colorectal cancer underwent triphasic contrast-enhanced multidetector-row computed tomography (MDCT) to evaluate hepatic metastatic spread and localization before CT-guided RFA and for follow-up after intervention. Sixteen of these patients (65.1 +/- A 10.3 years) with 30 metastases stayed tumor-free (group 1), while the other group (n = 16 with 24 metastases; 62.0 +/- A 13.8 years) suffered from local recurrent disease (group 2). Applying an automated software tool (SyngoCT Oncology; Siemens Healthcare, Forchheim, Germany), size parameters (volume, RECIST, WHO) and attenuation were measured within the lesions before, 1 day after, and 28 days after RFA treatment. The natural logarithm (ln) of the quotient of the volume 1 day versus 28 days after RFA treament was computed: lnQ1//28/0(volume). Analogously, ln ratios of RECIST, WHO, and attenuation were computed and statistically evaluated by repeated-measures ANOVA. One lesion in group 2 was excluded from further evaluation due to automated missegmentation. Statistically significant differences between the two groups were observed with respect to initial volume, RECIST, and WHO (p < 0.05). Furthermore, ln ratios corresponding to volume, RECIST, and WHO differed significantly between the two groups. Attenuation evaluations showed no significant differences, but there was a trend toward attenuation assessment for the parameter lnQ28/0(attenuation) (p = 0.0527), showing higher values for group 1 (-0.4 +/- A 0.3) compared to group 2 (-0.2 +/- A 0.2). In conclusion, hepatic metastases and their zone of coagulation necrosis after RFA differed significantly between tumor-free and local-recurrent ablation zones with respect to the corresponding size parameters. A new parameter (lnQ1//28/0(volume/RECIST/WHO/attenuation)) was introduced, which appears to be of prognostic value at early follow-up CT.