Patel Nitesh V, Jethwa Pinakin R, Barrese James C, Hargreaves Eric L, Danish Shabbar F
Division of Neurosurgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08902, USA.
Lasers Surg Med. 2013 Aug;45(6):362-9. doi: 10.1002/lsm.22151. Epub 2013 Jun 14.
MR-guided Laser Induced Thermal Therapy (LITT) is a procedure for intracranial tumors. Minimal data exists regarding post-procedure lesion volume changes.
We aim to analyze changes in lesion volume during the post-LITT period using polygonal tracing with fusion. Additionally, we investigated the role of lesion histopathology on LITT parameters and volume dynamics.
Sixteen patients with intracranial neoplasms received LITT. Using OsiriX DICOM Viewer, three raters computed lesion volumes at the following: pre-ablation (PreA), immediate post-ablation (IPA), 24 hours post-ablation (24PA), and first follow-up post-ablation (FPA), which ranged from 4 to 11 weeks post-ablation. Statistical analyses for volume changes between time points and inter-rater reliability were performed. Additionally, comparisons were made between metastatic versus non-metastatic and small versus large lesions in terms of operative parameters and volume changes.
There was an acute increase in volume at IPA with a decrease in size by 24PA. ANOVA among inter-rater datasets showed no significant difference at any time point (highest F(1,15) = 0.225, P > 0.80, for IPA). GLM repeated measures, for Intra-Rater analysis, demonstrated statistically significant differences across time points (lowest F(1,15) = 13.297, P = 0.003). IPA volumes were larger than those at PreA, 24PA, and FPA (average volume increase [95% CI]: 281% [157-404%], 167% [134-201%], 187% [154-219%], respectively; all P < 0.004). Correlation analysis showed lower inter-rater reliability at IPA versus other time points (all P < 0.03). Larger lesions (>2.5 cm³ ) versus smaller (<2.5 cm³ ) did not demonstrate a difference in percent volume increase. Operative parameters and volume dynamics were not different between metastatic and non-metastatic groups.
The response of intracranial lesions to LITT demonstrates a peak in volume at the IPA time point with decreased IPA inter-rater reliability. We recommend that conclusions about intracranial lesion size post-LITT be made at least 24 hours post-LITT rather than immediately after LITT.
磁共振引导激光诱导热疗（LITT）是一种用于治疗颅内肿瘤的方法。关于术后病变体积变化的数据极少。
我们旨在使用融合多边形追踪分析LITT术后病变体积的变化。此外，我们研究了病变组织病理学对LITT参数和体积动态变化的作用。
16例颅内肿瘤患者接受了LITT治疗。使用OsiriX DICOM Viewer，三名评估者在以下时间点计算病变体积：消融前（PreA）、消融后即刻（IPA）、消融后24小时（24PA）以及消融后首次随访（FPA），FPA时间范围为消融后4至11周。对各时间点之间的体积变化进行统计分析以及评估者间可靠性分析。此外，在手术参数和体积变化方面，对转移性病变与非转移性病变以及大病变与小病变进行了比较。
IPA时体积急性增加，到24PA时体积减小。评估者间数据集的方差分析显示在任何时间点均无显著差异（IPA时最高F(1,15) = 0.225，P > 0.80）。对于评估者内分析，广义线性模型重复测量显示各时间点之间存在统计学显著差异（最低F(1,15) = 13.297，P = 0.003）。IPA时的体积大于PreA、24PA和FPA时的体积（平均体积增加[95%可信区间]：分别为281% [157 - 404%]、167% [134 - 201%]、187% [154 - 219%]；所有P < 0.004）。相关性分析显示，与其他时间点相比，IPA时评估者间可靠性较低（所有P < 0.03）。较大病变（>2.5 cm³）与较小病变（<2.5 cm³）在体积增加百分比方面无差异。转移性病变组和非转移性病变组在手术参数和体积动态变化方面无差异。
颅内病变对LITT的反应在IPA时间点显示体积达到峰值，且IPA时评估者间可靠性降低。我们建议，关于LITT术后颅内病变大小得出结论应在LITT术后至少24小时，而非LITT后即刻。
