Pan Feng, Do Thuy D, Vollherbst Dominik F, Pereira Philippe L, Richter Götz M, Faerber Michael, Weiss Karl H, Mehrabi Arianeb, Kauczor Hans U, Sommer Christof M
Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Cancers (Basel). 2021 Apr 22;13(9):2021. doi: 10.3390/cancers13092021.
To explore the feasibility, safety, and efficiency of ethiodized oil tumor marking combined with irreversible electroporation (IRE) for small hepatocellular carcinomas (HCCs) that were invisible on unenhanced computed tomography (CT).
A retrospective analysis of the institutional database was performed from January 2018 to September 2018. Patients undergoing ethiodized oil tumor marking to improve target-HCC visualization in subsequent CT-guided IRE were retrieved. Target-HCC visualization after marking was assessed, and the signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNR) were compared between pre-marking and post-marking CT images using the paired -test. Standard IRE reports, adverse events, therapeutic endpoints, and survival were summarized and assessed.
Nine patients with 11 target-HCCs (11.1-18.8 mm) were included. After marking, all target-HCCs demonstrated complete visualization in post-marking CT, which were invisible in pre-marking CT. Quantitatively, the SNR of the target-HCCs significantly increased after marking (11.07 ± 4.23 vs. 3.36 ± 1.79, = 0.006), as did the CNR (4.32 ± 3.31 vs. 0.43 ± 0.28, = 0.023). In sequential IRE procedures, the average current was 30.1 ± 5.3 A, and both the delta ampere and percentage were positive with the mean values of 5.8 ± 2.1 A and 23.8 ± 6.3%, respectively. All procedures were technically successful without any adverse events. In the follow-up, no residual unablated tumor (endpoint-1) was observed. The half-year, one-year, and two-year local tumor progression (endpoint-2) rate was 0%, 9.1%, and 27.3%. The two-year overall survival rate was 100%.
Ethiodized oil tumor marking enables to demarcate small HCCs that were invisible on unenhanced CT. It potentially allows a safe and complete ablation in subsequent CT-guided IRE.
探讨碘化油肿瘤标记联合不可逆电穿孔（IRE）技术应用于平扫计算机断层扫描（CT）不可见的小肝细胞癌（HCC）的可行性、安全性及有效性。
对2018年1月至2018年9月机构数据库进行回顾性分析。检索接受碘化油肿瘤标记以改善后续CT引导下IRE中目标HCC可视化的患者。评估标记后目标HCC的可视化情况，并使用配对t检验比较标记前和标记后CT图像的信噪比（SNR）和对比噪声比（CNR）。总结并评估标准IRE报告、不良事件、治疗终点和生存率。
纳入9例患者，共11个目标HCC（直径11.1 - 18.8mm）。标记后，所有目标HCC在标记后CT上均显示完全可视化，而在标记前CT上不可见。定量分析显示，标记后目标HCC的SNR显著增加（11.07±4.23对3.36±1.79，P = 0.006），CNR也显著增加（4.32±3.31对0.43±0.28，P = 0.023）。在连续IRE手术中，平均电流为30.1±5.3A，电流增量和百分比均为正值，平均值分别为5.8±2.1A和23.8±6.3%。所有手术在技术上均成功，无任何不良事件。随访期间，未观察到残留未消融肿瘤（终点1）。半年、一年和两年的局部肿瘤进展（终点2）率分别为0%、9.1%和27.3%。两年总生存率为100%。
碘化油肿瘤标记能够界定平扫CT不可见的小HCC。这可能使后续CT引导下的IRE实现安全、完全消融。
