Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Int J Hyperthermia. 2022;39(1):880-887. doi: 10.1080/02656736.2022.2055795.
To determine the feasibility and prognostic value of 3D measuring of the ablation margins using a dedicated image registration software.
This retrospective study included 104 colorectal liver metastases in 68 consecutive patients that underwent microwave ablation between 08/2012 and 08/2019. The minimal ablation margin (MM) was measured in 2D using anatomic landmarks on contrast enhanced CT(CECT) 4-8 weeks post-ablation, and in 3D using an image registration software and immediate post-ablation CECT. Local tumor progression (LTP) was assessed by imaging up to 24 months after ablation. A blinded interventional radiologist provided feedback on the possibility of additional ablation after examining the 3D-margin measurements.
The 3D-margin assessment was completed in 79/104 (76%) tumors without the need for target manipulation. In 25/104 (24%) tumors, manipulation was required due to image misregistration. LTP was observed in 40/104 (38.5%) tumors: 92.5% vs 7.5% for those with margin <5mm vs ≥5mm, respectively ( = 0.0001). The 2D and 3D-assessments identified margin <5mm in 17/104 (16%), and in 74/104 (71%) ablated tumors, respectively ( < 0.01). The sensitivity and specificity of the 3D software for predicting LTP was 93% (37/40) and 42% (27/64), respectively. Additional ablation to achieve a MM of 5 mm would have been offered in 26/37 cases if the 3D-margin assessment was available intraoperatively.
Image registration software can measure ablation margins and detect MM under 5 mm intraoperatively, with significantly higher sensitivity than the 2D technique using landmarks on the post-ablation CECT. The identification of a margin under 5 mm is strongly associated with LTP.
利用专用图像配准软件确定 3D 测量消融边界的可行性和预后价值。
本回顾性研究纳入了 2012 年 8 月至 2019 年 8 月期间接受微波消融治疗的 68 例连续患者的 104 例结直肠肝转移瘤。在消融后 4-8 周，使用对比增强 CT（CECT）上的解剖学标志在 2D 中测量最小消融边界（MM），并使用图像配准软件和即时消融后 CECT 在 3D 中测量。通过消融后 24 个月的影像学评估局部肿瘤进展（LTP）。一位盲法介入放射科医生在检查了 3D 边界测量值后，就进一步消融的可能性提供了反馈。
在 79/104（76%）个肿瘤中，无需进行目标操作即可完成 3D 边界评估。在 25/104（24%）个肿瘤中，由于图像配准错误，需要进行操作。在 40/104（38.5%）个肿瘤中观察到 LTP：边界 <5mm 的肿瘤分别为 92.5%和 7.5%，边界≥5mm（ = 0.0001）。2D 和 3D 评估分别在 17/104（16%）和 74/104（71%）个消融肿瘤中识别出边界 <5mm（ < 0.01）。3D 软件预测 LTP 的敏感性和特异性分别为 93%（37/40）和 42%（27/64）。如果术中可获得 3D 边界评估，将在 26/37 例中提供额外消融以达到 5mm 的 MM。
图像配准软件可以在术中测量消融边界并检测 MM 低于 5mm，其敏感性明显高于使用消融后 CECT 上的解剖学标志的 2D 技术。边界低于 5mm 的识别与 LTP 密切相关。
