热消融治疗结直肠肝转移瘤后消融区域的容积 3D 评估，以提高局部肿瘤进展预测的准确性。
Volumetric 3D assessment of ablation zones after thermal ablation of colorectal liver metastases to improve prediction of local tumor progression.
机构信息
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Room S1212B, New York, NY, 10065, USA.
Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
出版信息
Eur Radiol. 2019 May;29(5):2698-2705. doi: 10.1007/s00330-018-5809-0. Epub 2018 Nov 6.
PURPOSE
The goal of this study was to develop and evaluate a volumetric three-dimensional (3D) approach to improve the accuracy of ablation margin assessment following thermal ablation of hepatic tumors.
METHODS
The 3D margin assessment technique was developed to generate the new 3D assessment metrics: volumes of insufficient coverage (VICs) measuring volume of tissue at risk post-ablation. VICs were computed for the tumor and tumor plus theoretical 5- and 10-mm margins. The diagnostic accuracy of the 3D assessment to predict 2-year local tumor progression (LTP) was compared to that of manual 2D assessment using retrospective analysis of a patient cohort that has previously been reported as a part of an outcome-centered study. Eighty-six consecutive patients with 108 colorectal cancer liver metastases treated with radiofrequency ablation (2002-2012) were used for evaluation. The 2-year LTP discrimination power was assessed using receiver operating characteristic area under the curve (AUC) analysis.
RESULTS
A 3D assessment of margins was successfully completed for 93 out of 108 tumors. The minimum margin size measured using the 3D method had higher discrimination power compared with the 2D method, with an AUC value of 0.893 vs. 0.790 (p = 0.01). The new 5-mm VIC metric had the highest 2-year LTP discrimination power with an AUC value of 0.923 (p = 0.004).
CONCLUSIONS
Volumetric semi-automated 3D assessment of the ablation zone in the liver is feasible and can improve accuracy of 2-year LTP prediction following thermal ablation of hepatic tumors.
KEY POINTS
• More accurate prediction of local tumor progression risk using volumetric 3D ablation zone assessment can help improve the efficacy of image-guided percutaneous thermal ablation of hepatic tumors. • The accuracy of evaluation of ablation zone margins after thermal ablation of colorectal liver metastases can be improved using a volumetric 3D semi-automated assessment approach and the volume of insufficient coverage assessment metric. • The new 5-mm volume-of-insufficient-coverage metric, indicating the volume of tumor plus 5-mm margin that remained untreated, had the highest 2-year local tumor progression discrimination power.
目的
本研究旨在开发和评估一种容积式三维（3D）方法，以提高热消融治疗肝肿瘤后消融边界评估的准确性。
方法
开发了 3D 边界评估技术，以生成新的 3D 评估指标：消融后存在风险的组织体积不足（VIC）。计算了肿瘤和肿瘤加理论 5 毫米和 10 毫米边界的 VIC。使用回顾性分析先前已报告为以结果为中心的研究的一部分的患者队列，比较了 3D 评估对预测 2 年局部肿瘤进展（LTP）的诊断准确性与手动 2D 评估。使用射频消融（2002-2012 年）治疗的 86 例连续 108 例结直肠癌肝转移患者进行评估。使用受试者工作特征曲线（AUC）下面积（AUC）分析评估 2 年 LTP 区分能力。
结果
93 个肿瘤中的 108 个成功完成了 3D 边界评估。使用 3D 方法测量的最小边界尺寸与 2D 方法相比具有更高的区分能力，AUC 值为 0.893 对 0.790（p=0.01）。新的 5 毫米 VIC 指标具有最高的 2 年 LTP 区分能力，AUC 值为 0.923（p=0.004）。
结论
肝脏消融区域的容积半自动 3D 评估是可行的，可以提高热消融治疗肝肿瘤后 2 年 LTP 预测的准确性。
关键要点
• 使用容积 3D 消融区域评估更准确地预测局部肿瘤进展风险可以帮助提高经皮影像引导热消融治疗肝肿瘤的疗效。
• 使用容积式 3D 半自动评估方法和体积不足评估指标，可以提高结直肠肝转移热消融后消融区域边界评估的准确性。
• 新的 5 毫米体积不足覆盖度量，指示肿瘤加 5 毫米边界未治疗的体积，具有最高的 2 年局部肿瘤进展区分能力。
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