Quantitative margin assessment of radiofrequency ablation of a solitary colorectal hepatic metastasis using MIRADA RTx on CT scans: a feasibility study
Quantitative margin assessment of radiofrequency ablation of a solitary colorectal hepatic metastasis using MIRADA RTx on CT scans: a feasibility study
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DOI：
10.1186/s12880-019-0360-2
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发表时间：
2019-08-20
影响因子：
2.7
通讯作者：
Burgmans, M. C.
中科院分区：
文献类型：
--
作者：
Mulder, B. G. Sibinga;Hendriks, P.;Burgmans, M. C.
背景：与外科手术相比，射频消融（RFA）治疗结直肠癌肝转移（CRLM）与更高的局部复发率相关。一般建议宽切缘（至少5mm）以防止LR，但评估消融切缘的最佳方法尚未建立。本研究的目的是利用MIRADA软件评估CT-CT联合登记的可行性和可重复性，以评估CRLM患者的消融边缘。方法在这项回顾性研究中，对29例经皮RFA治疗单发CRLM患者的消融前后对比增强CT扫描进行了联合登记。根据靠近肿瘤的静脉结构，由两名独立的放射科医生进行联合登记。确定了CT-CT联合登记的可行性和观察者间对再现性和消融边界的一致意见。此外，在随访期间，将最小消融边缘与LR的发生进行比较。结果18例患者（61%为男性，63.1（+/- 10.9）岁）的联合登记被认为是可行的，消融的完全性在观察者间有完美的一致性：kappa = 1.0（p < 0.001）。测量最小裕度（= 5 mm）的观察者间一致性：kappa = 0.723（p值< 0.001）。9例未完全消融的CRLM中有8例（88.9%）发生LR， 9例完全消融的CRLM中有1例（11.1%）发生LR。结论MIRADA共登记具有可重复性，是确定技术成功的潜在有价值的工具。如果扫描不一致，联合登记消融前后CT扫描的可行性是次优的。共同登记可能有助于预测经皮消融后的LR。
Background Compared to surgery, radiofrequency ablation(RFA) for colorectal liver metastasis(CRLM) is associated with higher local recurrence(LR) rates. A wide margin (at least 5 mm) is generally recommended to prevent LR, but the optimal method to assess ablation margins is yet to be established. The aim of our study was to evaluate the feasibility and reproducibility of CT-CT co-registration, using MIRADA software, in order to assess ablation margins of patients with CRLM. Methods In this retrospective study, pre- and post-ablation contrast-enhanced CT scans of 29 patients, treated with percutaneous RFA for a solitary CRLM, were co-registered. Co-registration was performed by two independent radiologist, based on venous structures in proximity to the tumor. Feasibility of CT-CT co-registration and inter-observer agreement for reproducibility and ablation margins was determined. Furthermore, the minimal ablation margin was compared with the occurrence of LR during follow-up. Results Co-registration was considered feasible in 18 patients (61% male, 63.1(+/- 10.9) year), with a perfect inter-observer agreement for completeness of ablation: kappa = 1.0(p < 0.001). And substantial inter-observer agreement for measurement of the minimal margin (= 5 mm): kappa = 0.723(p-value < 0.001). LR occurred in eight of nine(88.9%) incompletely ablated CRLM and in one of the nine completely ablated CRLM(11.1%). Conclusion Co-registration using MIRADA is reproducible and potentially a valuable tool in defining technical success. Feasibility of co-registration of pre- and post-ablation CT scans is suboptimal if scans are not acquired concordantly. Co-registration may potentially aid in the prediction of LR after percutaneous ablation.