Cornelis Francois, Sotirchos Vlasios, Violari Elena, Sofocleous Constantinos T, Schoder Heiko, Durack Jeremy C, Siegelbaum Robert H, Maybody Majid, Humm John, Solomon Stephen B
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York Department of Radiology, Pellegrin Hospital, Bordeaux, France.
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
J Nucl Med. 2016 Jul;57(7):1052-7. doi: 10.2967/jnumed.115.171926. Epub 2016 Feb 23.
The rationale of this study was to examine whether (18)F-FDG PET/CT and contrast-enhanced CT performed immediately after percutaneous ablation of liver metastases are predictors of local treatment failure at 1 y.
This Health Insurance Portability and Accountability Act-compliant, Institutional Review Board-approved retrospective study reviewed 25 PET/CT-guided thermal ablations performed from September 2011 to March 2013 on 21 patients (11 women and 10 men; mean age, 56.8 y; range, 35-79 y) for the treatment of liver metastases (colorectal, n = 23; breast, n = 1; and sarcoma, n = 1). One to 3 tumors (mean size, 2.3 cm; range, 0.7-4.6 cm; mean SUVmax, 22.7; range, 9.5-77.1) were ablated using radiofrequency (n = 16) or microwave (n = 9) energy in a single session. Immediate-postablation enhanced CT and PET/CT scans were qualitatively evaluated by 2 reviewers independently, and the results were compared with clinical and imaging outcome at 1 y. The PET/CT scans were also analyzed to determine tissue radioactivity concentration (TRC) from 3-dimensional regions of interest in the ablation zone, the margin, and the surrounding normal liver to calculate a TRC ratio, which was then compared with outcome at 1 y. Receiver operating characteristics (ROC) were used, and the maximal-accuracy threshold in predicting recurrence was calculated.
Eleven (44%) of the 25 tumors recurred within 1 y. Enhanced CT did not significantly correlate with recurrence (P = 0.288). Accuracy was 64% (16/25), and the area under the ROC curve was 0.601 (95% confidence interval [95% CI], 0.387-0.789). The accuracy of the qualitative analysis of (18)F-FDG PET was 92% (23/25) (P < 0.001), and the area under the ROC curve was 0.929 (95% CI, 0.740-0.990). The mean TRC ratio was 40.6 in the recurrence group (SD, 9.2; range, 29.3-53.9) and 15.9 in the group without recurrence (SD, 7.3; range, 3-27.3). A TRC ratio of 28.3 predicted recurrence at 1 y with 100% accuracy (25/25) (P < 0.001), and the area under the ROC curve was 1 (95% CI, 0.863-1).
Immediate PET/CT accurately predicts the success of liver metastasis ablation at 1 y and is superior to immediate enhanced CT.
本研究的目的是探讨经皮消融肝转移瘤后立即进行的（18）F - FDG PET/CT和增强CT是否可作为1年局部治疗失败的预测指标。
本回顾性研究符合《健康保险流通与责任法案》要求，并经机构审查委员会批准。研究回顾了2011年9月至2013年3月对21例患者（11例女性和10例男性；平均年龄56.8岁；范围35 - 79岁）进行的25次PET/CT引导下的热消融治疗，以治疗肝转移瘤（结直肠癌，23例；乳腺癌，1例；肉瘤，1例）。在单次治疗中，使用射频（16例）或微波（9例）能量消融1至3个肿瘤（平均大小2.3 cm；范围0.7 - 4.6 cm；平均SUVmax 22.7；范围9.5 - 77.1）。两位阅片者独立对消融后立即进行的增强CT和PET/CT扫描进行定性评估，并将结果与1年时的临床和影像结果进行比较。还对PET/CT扫描进行分析，以确定消融区、边缘和周围正常肝脏三维感兴趣区域的组织放射性浓度（TRC），计算TRC比值，然后将其与1年时的结果进行比较。采用受试者操作特征（ROC）曲线，并计算预测复发的最大准确度阈值。
25个肿瘤中有11个（44%）在1年内复发。增强CT与复发无显著相关性（P = 0.288）。准确度为64%（16/25），ROC曲线下面积为0.601（95%置信区间[95%CI]，0.387 - 0.789）。（18）F - FDG PET定性分析的准确度为92%（23/25）（P < 0.001），ROC曲线下面积为0.929（95%CI，0.740 - 0.990）。复发组的平均TRC比值为40.6（标准差9.2；范围29.3 - 53.9），无复发组为15.9（标准差7.3；范围3 - 27.3）。TRC比值为28.3预测1年复发的准确度为100%（25/25）（P < 0.001），ROC曲线下面积为1（95%CI，0.863 - 1）。
立即进行的PET/CT能准确预测肝转移瘤消融1年时的成功情况，且优于立即进行的增强CT。
