Department of General, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Int J Colorectal Dis. 2011 Jun;26(6):799-808. doi: 10.1007/s00384-011-1175-y. Epub 2011 Mar 15.
In situ ablation is increasingly being used for the treatment of liver malignancies. The application of these techniques is limited by the lack of a precise prediction of the destruction volume. This holds especially true in anatomically difficult situations, such as metastases in the vicinity of larger liver vessels. We developed a three-dimensional (3D) planning system for laser-induced thermotherapy (LITT) of liver tumors. The aim of the study was to validate the system for calculation of the destruction volume.
LITT (28 W, 20 min) was performed in close contact to major hepatic vessels in six pigs. After explantation of the liver, the coagulation area was documented. The liver and its vascular structures were segmented from a pre-interventional CT scan. Therapy planning was carried out including the cooling effect of adjacent liver vessels. The lesions in vivo and the simulated lesions were compared with a morphometric analysis.
The volume of lesions in vivo was 6,568.3 ± 3,245.9 mm(3), which was not different to the simulation result of 6,935.2 ± 2,538.5 mm(3) (P = 0.937). The morphometric analysis showed a sensitivity of the system of 0.896 ± 0.093 (correct prediction of destructed tissue). The specificity was 0.858 ± 0.090 (correct prediction of vital tissue).
A 3D computer planning system for the prediction of thermal lesions in LITT was developed. The calculation of the directional cooling effect of intrahepatic vessels is possible for the first time. The morphometric analysis showed a good correlation under clinical conditions. The pre-therapeutic calculation of the ablation zone might be a valuable tool for procedure planning.
在原位消融术越来越多地被用于治疗肝脏恶性肿瘤。这些技术的应用受到破坏体积精确预测的限制。在解剖困难的情况下尤其如此，例如靠近较大肝血管的转移灶。我们开发了一种用于激光诱导热疗（LITT）治疗肝脏肿瘤的三维（3D）规划系统。本研究的目的是验证该系统用于计算破坏体积的能力。
在 6 头猪的大肝血管附近进行 LITT（28 W，20 分钟）。肝切除后，记录凝固区。从术前 CT 扫描中分割肝脏及其血管结构。进行治疗计划，包括相邻肝血管的冷却效应。对体内病变和模拟病变进行形态计量学分析比较。
体内病变体积为 6568.3 ± 3245.9 mm3，与模拟结果 6935.2 ± 2538.5 mm3 无差异（P = 0.937）。形态计量学分析显示该系统的灵敏度为 0.896 ± 0.093（正确预测破坏组织），特异性为 0.858 ± 0.090（正确预测存活组织）。
开发了一种用于预测 LITT 热损伤的 3D 计算机规划系统。首次实现了对肝内血管定向冷却效应的计算。形态计量学分析在临床条件下显示出良好的相关性。消融区域的术前计算可能是一种有价值的手术规划工具。
