Division of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.
Georgetown University School of Medicine, Washington, District of Columbia, USA.
Oper Neurosurg (Hagerstown). 2021 Sep 15;21(4):265-269. doi: 10.1093/ons/opab225.
Commercial magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) systems utilize a generalized Arrhenius model to estimate the area of tissue damage based on the power and time of ablation. However, the reliability of these estimates in Vivo remains unclear.
To determine the accuracy and precision of the thermal damage estimate (TDE) calculated by commercially available MRgLITT systems using the generalized Arrhenius model.
A single-center retrospective review of pediatric patients undergoing MRgLITT for lesional epilepsy was performed. The area of each lesion was measured on both TDE and intraoperative postablation, postcontrast T1 magnetic resonance images using ImageJ. Lesions requiring multiple ablations were excluded. The strength of the correlation between TDE and postlesioning measurements was assessed via linear regression.
A total of 32 lesions were identified in 19 patients. After exclusion, 13 pairs were available for analysis. Linear regression demonstrated a strong correlation between estimated and actual ablation areas (R2 = .97, P < .00001). The TDE underestimated the area of ablation by an average of 3.92% overall (standard error (SE) = 4.57%), but this varied depending on the type of pathologic tissue involved. TDE accuracy and precision were highest in tubers (n = 3), with average underestimation of 2.33% (SE = 0.33%). TDE underestimated the lesioning of the single hypothalamic hamartoma in our series by 52%. In periventricular nodular heterotopias, TDE overestimated ablation areas by an average of 13% (n = 2).
TDE reliability is variably consistent across tissue types, particularly in smaller or periventricular lesions. Further investigation is needed to understand the accuracy of this emerging minimally invasive technique.
商业磁共振引导激光间质热疗（MRgLITT）系统利用广义阿仑尼乌斯模型根据消融的功率和时间来估计组织损伤的面积。然而，这些估计在体内的可靠性尚不清楚。
确定商业上可用的 MRgLITT 系统使用广义阿仑尼乌斯模型计算的热损伤估计（TDE）的准确性和精密度。
对接受 MRgLITT 治疗病变性癫痫的儿科患者进行单中心回顾性研究。使用 ImageJ 在 TDE 和术中消融后、对比后 T1 磁共振图像上测量每个病变的面积。排除需要多次消融的病变。通过线性回归评估 TDE 与病变后测量值之间的相关性强度。
共确定了 19 名患者的 32 个病变。排除后，有 13 对可供分析。线性回归显示，估计和实际消融面积之间存在很强的相关性（R2=0.97，P<0.00001）。总体而言，TDE 低估了消融面积平均 3.92%（标准误差（SE）=4.57%），但这取决于所涉及的病理组织类型。TDE 在结节（n=3）中的准确性和精密度最高，平均低估了 2.33%（SE=0.33%）。在我们的系列中，TDE 低估了单个下丘脑错构瘤的消融面积 52%。在室周结节性异位中，TDE 平均高估了消融面积 13%（n=2）。
TDE 的可靠性在组织类型之间存在差异，特别是在较小或室周病变中。需要进一步研究来了解这种新兴的微创技术的准确性。
