Ge Benjamin H, Guzzo Thomas J, Nadolski Gregory J, Soulen Michael C, Clark Timothy W I, Malkowicz Stanley B, Wein Alan J, Hunt Stephen J, Stavropoulos S William
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104.
Department of Urology, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein, Philadelphia, PA 19104.
J Vasc Interv Radiol. 2016 Mar;27(3):403-9. doi: 10.1016/j.jvir.2015.11.035. Epub 2016 Jan 2.
To determine if CT characteristics of intraprocedural ice balls correlate with outcomes after cryoablation.
A retrospective review was performed on 63 consecutive patients treated with renal cryoablation. Preprocedural and intraprocedural images were used to identify the size and location of renal tumors and ice balls as well as the tumor coverage and ice-ball margins. Review of follow-up imaging (1 mo and then 3-6-mo intervals) distinguished successful ablations from cases of residual tumor.
Patients who underwent successful ablation (n = 50; 79%) had a mean tumor diameter of 2.5 cm (range, 0.9-4.3 cm) and mean ice-ball margin of 0.4 cm (range, 0.2-1.2 cm). Patients with residual tumor (n = 13; 21%) had a mean tumor diameter of 3.8 cm (range, 1.8-4.5 cm) and mean ice-ball margin of -0.4 cm (range, -0.9 to 0.4 cm). Residual and undertreated tumors were larger and had smaller ice-ball margins than successfully treated tumors (P < .01). Ice-ball diameters were significantly smaller after image reformatting (P < .01). Ice-ball margins of 0.15 cm had 90% sensitivity, 92% specificity, and 98% positive predictive value for successful ablation. Success was independent of tumor location or number of cryoprobes.
Ice-ball margin and real-time intraprocedural reformatting could be helpful in predicting renal cryoablation outcomes. Although a 0.5-cm margin is preferred, a well-centered ice ball with a short-axis margin greater than 0.15 cm strongly correlated with successful ablation.
确定术中冰球的CT特征是否与冷冻消融术后的结果相关。
对63例接受肾脏冷冻消融治疗的连续患者进行回顾性研究。术前和术中图像用于确定肾肿瘤和冰球的大小及位置，以及肿瘤覆盖范围和冰球边缘。通过对随访影像（术后1个月，然后每隔3 - 6个月）的复查，区分成功消融病例与残留肿瘤病例。
成功消融的患者（n = 50；79%）肿瘤平均直径为2.5 cm（范围0.9 - 4.3 cm），冰球边缘平均为0.4 cm（范围0.2 - 1.2 cm）。有残留肿瘤的患者（n = 13；21%）肿瘤平均直径为3.8 cm（范围1.8 - 4.5 cm），冰球边缘平均为 - 0.4 cm（范围 - 0.9至0.4 cm）。残留和治疗不充分的肿瘤比成功治疗的肿瘤更大，冰球边缘更小（P < 0.01）。图像重新格式化后冰球直径显著变小（P < 0.01）。冰球边缘为0.15 cm时，成功消融的敏感度为90%，特异度为92%，阳性预测值为98%。消融成功与肿瘤位置或冷冻探针数量无关。
冰球边缘和术中实时重新格式化有助于预测肾脏冷冻消融的结果。虽然首选0.5 cm的边缘，但短轴边缘大于0.15 cm且位于中心的冰球与成功消融密切相关。
