Wimmer Thomas, Srimathveeravalli Govindarajan, Gutta Narendra, Ezell Paula C, Monette Sebastien, Kingham T Peter, Maybody Majid, Durack Jeremy C, Fong Yuman, Solomon Stephen B
Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, The Rockefeller University, 444 East 68th Street, New York, NY 10065; Department of Radiology, Medical University of Graz, Graz, Austria.
J Vasc Interv Radiol. 2013 Nov;24(11):1709-18. doi: 10.1016/j.jvir.2013.05.056. Epub 2013 Jul 23.
To investigate the reliability of simulations for planning pancreatic irreversible electroporation (IRE) ablations compared with computed tomography (CT) and pathology outcomes in an animal model.
Simulations were performed varying treatment parameters, including field strength (1.5-2.5 kV/cm), pulse number (70-90 pulses), and pulse length (70-100 µs). Pancreatic IRE was performed in six pigs under CT guidance. Two animals each were sacrificed for histology after 1 day, 14 days, and 28 days. Follow-up CT scans were performed on day 0, day 1, day 14, and day 28. Biochemical markers were collected before the procedure, 1 day after the procedure, and 14 days after the procedure.
All ablation zones could be visualized on CT scan immediately after the procedure and on day 1 follow-up CT scan, and all animals survived until the designated endpoints. Histopathology revealed necrosis and edema on day 1 and fibrosis and glandular atrophy after 28 days. Blood vessels close to the ablation zone appeared normal. Laboratory analysis indicated mild to moderate amylasemia and lipasemia with normalization after 14 days. The ablation size on CT scan measured a mean (± SD) 146% ± 18 (day 0, P < .126) and 168% ± 18 (day 1, P < .026) of the simulation and on pathology measured 119% ± 10 (day 1, not significant) of the simulation.
Results from simulations for planning IRE ablations, CT, and pathology may differ from each other. Ablation zones on CT and pathology appear larger than simulated, suggesting that clinically used treatment planning may underestimate the ablation size in the pancreas.
在动物模型中，研究与计算机断层扫描（CT）及病理结果相比，胰腺不可逆电穿孔（IRE）消融术规划模拟的可靠性。
通过改变治疗参数进行模拟，这些参数包括场强（1.5 - 2.5 kV/cm）、脉冲数（70 - 90个脉冲）和脉冲长度（70 - 100 µs）。在CT引导下对6头猪进行胰腺IRE。分别在术后1天、14天和28天处死2头动物进行组织学检查。在第0天、第1天、第14天和第28天进行随访CT扫描。在术前、术后1天和术后14天收集生化指标。
术后即刻及术后第1天的随访CT扫描均能显示所有消融区，所有动物均存活至指定终点。组织病理学显示术后1天有坏死和水肿，28天后有纤维化和腺萎缩。靠近消融区的血管外观正常。实验室分析表明存在轻度至中度的淀粉酶血症和脂肪酶血症，14天后恢复正常。CT扫描测得的消融大小在第0天平均（±标准差）为模拟值的146% ± 18（P < 0.126），第1天为168% ± 18（P < 0.026），病理测得的消融大小在第1天为模拟值的119% ± 10（无显著差异）。
IRE消融术规划模拟、CT及病理的结果可能彼此不同。CT和病理显示的消融区比模拟的大，这表明临床使用的治疗规划可能低估了胰腺的消融大小。
