Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, 25124, Brescia, Italy.
Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
Cardiovasc Intervent Radiol. 2019 Dec;42(12):1718-1725. doi: 10.1007/s00270-019-02296-5. Epub 2019 Jul 31.
Renal ablation is a recognized treatment modality for small renal masses. Cone-beam CT (CBCT) has been recently used in interventional oncology as a promising new guidance device, but this technology still needs to be validated for renal ablations. We aimed to assess the technical success of CBCT applications in renal ablative treatments.
Between March 2016 and June 2018, 14 patients (mean age 69, range 54-83, 7F, 7M) underwent 21 renal ablations for histologically proven renal cell carcinoma (RCC). All treatments were performed with ultrasound (US) and CBCT guidance under general anesthesia in a dedicated angiography room setting. CBCT was mainly used to assess needle placement and to exclude complications at the end of the procedure. In two small lesions (< 1 cm), pre-acquired CBCT was co-registered with real-time US to obtain a US-CBCT fusion image guidance for tumor ablation.
Whether used alone or in combination with other imaging modalities, CBCT was proven to be technically successful in all 21 procedures to guide or assist tumor ablation. A primary technical efficacy of thermal ablation was achieved in 19/21 ablations (90.1%) at 1 month. Mean procedure duration was 100.2 min (range 160-64). Mean length of hospital stay was 2 days (range 1-10 days). All patients are still under active surveillance for a mean follow-up of 14.5 months (range 4-26 months).
CBCT for renal ablation guidance is a viable tool. Larger series are needed to compare it to MDCT.
肾脏消融术是治疗小肾肿瘤的一种公认的治疗方法。锥形束 CT（CBCT）最近已在介入肿瘤学中用作一种很有前途的新引导设备，但这项技术仍需在肾脏消融术中得到验证。我们旨在评估 CBCT 在肾消融治疗中的技术成功率。
2016 年 3 月至 2018 年 6 月，14 名患者（平均年龄 69 岁，范围 54-83 岁，7 名女性，7 名男性）接受了 21 例经组织学证实的肾细胞癌（RCC）的肾脏消融治疗。所有治疗均在全身麻醉下，在专用的血管造影室环境中使用超声（US）和 CBCT 引导进行。CBCT 主要用于评估针的位置，并在手术结束时排除并发症。在两个小病灶（<1cm）中，使用预采集的 CBCT 与实时 US 进行配准，以获得用于肿瘤消融的 US-CBCT 融合图像引导。
无论单独使用还是与其他成像方式联合使用，CBCT 在指导或辅助肿瘤消融的所有 21 个程序中均被证明是技术上成功的。在 1 个月时，19/21 例（90.1%）消融达到了热消融的主要技术疗效。平均手术时间为 100.2 分钟（范围 160-64 分钟）。平均住院时间为 2 天（范围 1-10 天）。所有患者仍在积极随访中，平均随访时间为 14.5 个月（范围 4-26 个月）。
CBCT 用于肾脏消融引导是一种可行的工具。需要更大的系列来将其与 MDCT 进行比较。
