Mauri Giovanni, Gennaro Nicolò, De Beni Stefano, Ierace Tiziana, Goldberg S Nahum, Rodari Marcello, Solbiati Luigi Alessandro
Department of Interventional Radiology, IEO, European Institute of Oncology IRCCS, via Ripamonti 435, Milan, Italy.
Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy.
Cardiovasc Intervent Radiol. 2019 Jan;42(1):60-68. doi: 10.1007/s00270-018-2082-1. Epub 2018 Oct 4.
To assess the feasibility of US-FDG-PET/CT fusion-guided microwave ablation of liver metastases either poorly visible or totally undetectable with US, CEUS and CT, but visualized by PET imaging.
Twenty-three patients with 58 liver metastases underwent microwave ablation guided by image fusion system that combines US with FDG-PET/CT images. In 28/58 tumors, FDG-PET/CT with contrast medium (PET/CECT) was used. The registration technical feasibility, registration time, rates of correct targeting, technical success at 24 h, final result at 1 year and complications were analyzed and compared between the PET/CT and PET/CECT groups.
Registration was successfully performed in all cases with a mean time of 7.8 + 1.7 min (mean + standard deviation), (4.6 + 1.5 min for PET/CECT group versus 10.9 + 1.8 min for PET/CT group, P < 0.01). In total, 46/58 (79.3%) tumors were correctly targeted, while 3/28 (10.7%) and 9/30 (30%) were incorrectly targeted in PET/CT and PET/CECT group, respectively (P < 0.05). Complete ablation was obtained at 24 h in 70.0% of cases (n = 40 tumors), 23/28 (82.1%) in the PET/CECT group and 17/30 (56.7%) in the PET/CT group (P < 0.037). Fourteen tumors underwent local retreatment (11 ablations, 2 with resection and 1 with stereotactic body radiation therapy), while 4 tumors could not be retreated because of distant disease progression and underwent systemic therapy. Finally, 54/58 (93.1%) tumors were completely treated at 1 year. One major complication occurred, a gastrointestinal hemorrhage which required surgical repair.
Percutaneous ablation of FDG-PET-positive liver metastases using fusion imaging of real-time US and pre-acquired FDG-PET/CT images is feasible, safe and effective. Contrast-enhanced PET/CT improves overall ablation accuracy and shortens procedural duration time.
评估超声-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（US-FDG-PET/CT）融合引导下对超声、对比增强超声（CEUS）和计算机断层扫描（CT）显示不佳或完全无法检测到，但正电子发射断层扫描（PET）成像可显示的肝转移瘤进行微波消融的可行性。
23例患有58个肝转移瘤的患者接受了由将超声与FDG-PET/CT图像相结合的图像融合系统引导的微波消融。在58个肿瘤中的28个中，使用了含造影剂的FDG-PET/CT（PET/CECT）。分析并比较了PET/CT组和PET/CECT组的配准技术可行性、配准时间、正确靶向率、24小时技术成功率、1年最终结果及并发症情况。
所有病例均成功完成配准，平均时间为7.8±1.7分钟（平均值±标准差），（PET/CECT组为4.6±1.5分钟，PET/CT组为10.9±1.8分钟，P<0.01）。总共58个肿瘤中的46个（79.3%）被正确靶向，而PET/CT组和PET/CECT组分别有3/28（10.7%）和9/30（30%）被错误靶向（P<0.05）。70.0%的病例（n = 40个肿瘤）在24小时时实现了完全消融，PET/CECT组为23/28（82.1%），PET/CT组为17/30（56.7%）（P<0.037）。14个肿瘤接受了局部再治疗（11次消融、2次手术切除和1次立体定向体部放射治疗），而4个肿瘤因远处疾病进展无法再治疗，接受了全身治疗。最终，58个肿瘤中的54个（93.1%）在1年时得到了完全治疗。发生了1例严重并发症，即需要手术修复的胃肠道出血。
使用实时超声与预先获取的FDG-PET/CT图像的融合成像对FDG-PET阳性肝转移瘤进行经皮消融是可行、安全且有效的。对比增强PET/CT提高了整体消融准确性并缩短了手术持续时间。
