Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation
Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation
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DOI：
10.1007/s00330-019-06609-7
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发表时间：
2020-01-30
影响因子：
5.9
通讯作者：
Bale, Reto
中科院分区：
文献类型：
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作者：
Laimer, Gregor;Schullian, Peter;Bale, Reto
目的通过术中消融前后对比增强CT图像的融合，评估最小消融边缘(MAM)是否能独立预测局部肿瘤进展(LTP)。此外，为了确定可以确定立体定向射频消融(SRFA)成功的MAM，从而将其用作术中评估治疗成功的工具。方法对110例(女性20例，男性90例；平均年龄63.7±10.2岁)176例肝细胞癌患者的临床资料进行回顾性分析。MAM是通过使用商用刚性成像配准软件对术中消融前后图像进行图像融合来确定的。LTP在增强CT或MR扫描中每隔3-6个月评估一次。结果MAM是LTP的唯一有意义的独立预测因子(p=0.036)。MAM每增加1 mm，发生LTP的相对风险降低30%(OR=0.70，95%CI0.5~0.98，p=0.036)。在MAM和GT；5 mm的皮损中未检测到LTP。患者层面的总LTP发生率为9/110(8.2%)，病变层面的LTP发生率为10/173(5.7%)。中位MAM为3.4(1.7~6.9)mm。平均总随访期为26.0+/-10.3个月。结论即时评估最小消融边缘(MAM)可作为一种术中评估立体定向RFA治疗成功的工具。必须达到MAM>；5 mm才能认为消融成功。
Objectives To assess the minimal ablative margin (MAM) by image fusion of intraprocedural pre- and post-ablation contrast-enhanced CT images and to evaluate if it can predict local tumor progression (LTP) independently. Furthermore, to determine a MAM with which a stereotactic radiofrequency ablation (SRFA) can be determined successful and therefore used as an intraprocedural tool to evaluate treatment success. Methods A total of 110 patients (20 women, 90 men; mean age 63.7 +/- 10.2) with 176 hepatocellular carcinomas were assessed by retrospective analysis of prospectively collected data. The MAM was determined through image fusion of intraprocedural pre- and post-ablation images using commercially available rigid imaging registration software. LTP was assessed in contrast-enhanced CTs or MR scans at 3-6-month intervals. Results The MAM was the only significant independent predictor of LTP (p = 0.036). For each millimeter increase of the MAM, a 30% reduction of the relative risk for LTP was found (OR = 0.7, 95% CI 0.5-0.98, p = 0.036). No LTP was detected in lesions with a MAM > 5 mm. The overall LTP rate was 9 of 110 (8.2%) on a patient level and 10 of 173 (5.7%) on a lesion level. The median MAM was 3.4 (1.7-6.9) mm. The mean overall follow-up period was 26.0 +/- 10.3 months. Conclusions An immediate assessment of the minimal ablative margin (MAM) can be used as an intraprocedural tool to evaluate the treatment success in patients treated with stereotactic RFA. A MAM > 5 mm has to be achieved to consider an ablation as successful.