Abi-Jaoudeh Nadine, Venkatesan Aradhana M, Van der Sterren William, Radaelli Alessandro, Carelsen Bart, Wood Bradford J
Department of Radiology and Imaging Sciences, National Institutes of Health, Room 1C365 Building 10 MSC 1182, 9000 Rockville Pike, Bethesda, MD 20892.
Department of Radiology and Imaging Sciences, National Institutes of Health, Room 1C365 Building 10 MSC 1182, 9000 Rockville Pike, Bethesda, MD 20892.
J Vasc Interv Radiol. 2015 Feb;26(2):214-9. doi: 10.1016/j.jvir.2014.10.049.
To describe clinical use and potential benefits of cone-beam computed tomography (CT) navigation to perform image-guided percutaneous tumor ablation.
All ablations performed between February 2011 and February 2013 using cone-beam CT navigation were included. There were 16 patients who underwent 20 ablations for 29 lesions. Cone-beam CT ablation planning capabilities include multimodality image fusion and tumor segmentation for visualization, depiction of the predicted ablation zones for intraprocedural planning, and segmentation of the ablated area for immediate verification after treatment. Number and purpose of cone-beam CT scans were examined. The initial ablation plan, defined as number of probes and duration of energy delivery, was recorded for the 20 of the 29 lesions ablated. Technical success and local recurrences were recorded. Primary and secondary effectiveness rates were calculated.
Image fusion was used for 16 lesions, and intraprocedural ultrasound was used for 4 lesions. Of the 20 ablations, where the ablation plans were recorded, there was no deviation from the plan in 14 ablations. In the remaining 6 ablations, iterative planning was needed for complete tumor coverage. An average of 8.7 cone-beam CT scans ± 3.2 were performed per procedure, including 1.3 ± 0.5 for tumor segmentation and planning, 1.7 ± 0.7 for probe position confirmation, and 3.9 ± 2 to ensure complete coverage. Mean follow-up time was 18.6 months ± 6.5. Ablations for 28 of 29 lesions were technically successful (96.5%). Of ablations performed with curative intent, technical effectiveness at 1 month was 25 of 26 lesions (96.1%) and 22 of 26 lesions (84.6%) at last follow-up. Local tumor progression was observed in 11.5% (3 of 26 lesions).
Cone-beam CT navigation may add information to assist and improve ablation guidance and monitoring.
描述锥形束计算机断层扫描（CT）导航在图像引导下经皮肿瘤消融中的临床应用及潜在益处。
纳入2011年2月至2013年2月期间使用锥形束CT导航进行的所有消融手术。16例患者因29个病灶接受了20次消融。锥形束CT消融计划功能包括多模态图像融合和肿瘤分割以进行可视化、描绘术中计划的预测消融区域以及分割消融区域以在治疗后立即进行验证。检查了锥形束CT扫描的次数和目的。记录了29个消融病灶中20个病灶的初始消融计划，定义为探针数量和能量传递持续时间。记录技术成功率和局部复发情况。计算主要和次要有效率。
16个病灶使用了图像融合，4个病灶使用了术中超声。在记录了消融计划的20次消融中，14次消融未偏离计划。在其余6次消融中，需要进行迭代计划以完全覆盖肿瘤。每次手术平均进行8.7次±3.2次锥形束CT扫描，包括1.3次±0.5次用于肿瘤分割和计划，1.7次±0.7次用于确认探针位置，以及3.9次±2次用于确保完全覆盖。平均随访时间为18.6个月±6.5个月。29个病灶中的28个病灶消融技术成功（96.5%）。以治愈为目的进行的消融，1个月时的技术有效率为26个病灶中的25个（96.1%），最后随访时为26个病灶中的22个（84.6%）。11.5%（26个病灶中的3个）观察到局部肿瘤进展。
锥形束CT导航可能会增加信息以辅助和改善消融引导及监测。
