University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO166YD, England, UK.
Abdom Radiol (NY). 2016 Aug;41(8):1611-7. doi: 10.1007/s00261-016-0711-1.
Percutaneous microwave ablation (MWA) is increasingly utilized in the treatment of primary and secondary hepatic malignancy. As an in-situ treatment appreciation of any signs of recurrence is critical for improving long-term oncological outcomes. Volumetry has been recognized as having advantages over orthogonal measurements in the response assessment of malignant lesions. Our study set out to look at the normal involution of an ablation zone (AZ) both volumetrically and morphologically to see if this information might aid the detection of local tumor progression.
Cases were identified retrospectively from our database of liver MWA. We identified 34 AZs in total, 18 AZs in 16 hepatocellular carcinoma (HCC) patients with cirrhosis on imaging grounds and 13 AZs in patients with metastatic colorectal cancer. How these AZs developed over time was analyzed both morphologically and quantitatively using Siemens Syngo Via post-processing software. We used the software to produce volume measurements and short axis orthogonal measurements. A baseline measurement was taken on the first <30 day post-ablation scan and the chronological changes were then plotted.
We saw differences between the cirrhotic and non-cirrhotic patients both in terms of morphological and volumetric changes. 12/13 non-cirrhotic AZs had a volume of <50% of the baseline scan within the first year. The cirrhotic patients were less predictable, but 14/18 still shrunk to less than 50% of baseline volume in the first year. Orthogonal measurements were less useful in both groups. Qualitatively, there was initially a slightly less well-defined border to the AZ in the first 3 months, which became better defined over time and certainly over the first year of AZ involution.
Volumetric analysis is a useful adjunct to conventional measurements and qualitative analysis of AZs. This can be reassuring when orthogonal measurements are static or difficult to interpret. Our preliminary data suggest that the normal pattern in a non-cirrhotic liver is that the AZ volume should drop below 50% of baseline at 1 year. Volumes in cirrhotic livers are less predictable, but the majority will still follow a similar pattern. Future studies could evaluate if failure to follow these patterns correlates with local tumor progression.
经皮微波消融（MWA）在原发性和继发性肝恶性肿瘤的治疗中应用越来越广泛。作为一种原位治疗，评估任何复发迹象对于改善长期肿瘤学结果至关重要。体积测量在评估恶性病变的反应方面已被认为优于正交测量。我们的研究旨在从体积和形态上观察消融区（AZ）的正常退化，以了解这些信息是否有助于检测局部肿瘤进展。
我们从肝脏 MWA 的数据库中回顾性地确定了病例。我们总共确定了 34 个 AZ，其中 18 个 AZ 位于 16 例肝硬化的肝细胞癌（HCC）患者的影像学上，13 个 AZ 位于转移性结直肠癌患者。使用西门子 Syngo Via 后处理软件从形态和定量两方面分析这些 AZ 随时间的发展。我们使用该软件生成体积测量值和短轴正交测量值。在消融后 30 天内的第一次扫描中进行基线测量，然后绘制随时间的变化。
我们观察到肝硬化和非肝硬化患者在形态和体积变化方面存在差异。13 例非肝硬化 AZ 在第一年中体积均小于基线扫描的 50%。肝硬化患者的情况则不太可预测，但 18 例中仍有 14 例在第一年中缩小到小于基线体积的 50%。在两组中，正交测量值都不太有用。定性上，在最初的 3 个月内，AZ 的边界稍不清晰，随着时间的推移，边界变得更加清晰，当然在 AZ 退化的第一年中更是如此。
体积分析是对 AZ 进行常规测量和定性分析的有用辅助手段。当正交测量值静止或难以解释时，这一点尤为有用。我们的初步数据表明，在非肝硬化肝脏中，AZ 体积应在 1 年内下降到基线的 50%以下。肝硬化肝脏中的体积变化不可预测，但大多数仍遵循类似模式。未来的研究可以评估未能遵循这些模式是否与局部肿瘤进展相关。
