Hendriks Pim, Boel Fleur, Oosterveer Timo Tm, Broersen Alexander, de Geus-Oei Lioe-Fee, Dijkstra Jouke, Burgmans Mark C
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
LKEB Laboratory of Clinical and Experimental Imaging, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Eur J Radiol Open. 2023 Jun 27;11:100501. doi: 10.1016/j.ejro.2023.100501. eCollection 2023 Dec.
To minimize the risk of local tumor progression after thermal ablation of liver malignancies, complete tumor ablation with sufficient ablation margins is a prerequisite. This has resulted in ablation margin quantification to become a rapidly evolving field. The aim of this systematic review is to give an overview of the available literature with respect to clinical studies and technical aspects potentially influencing the interpretation and evaluation of ablation margins.
The Medline database was reviewed for studies on radiofrequency and microwave ablation of liver cancer, ablation margins, image processing and tissue shrinkage. Studies included in this systematic review were analyzed for qualitative and quantitative assessment methods of ablation margins, segmentation and co-registration methods, and the potential influence of tissue shrinkage occurring during thermal ablation.
75 articles were included of which 58 were clinical studies. In most clinical studies the aimed minimal ablation margin (MAM) was ≥ 5 mm. In 10/31 studies, MAM quantification was performed in 3D rather than in three orthogonal image planes. Segmentations were performed either semi-automatically or manually. Rigid and non-rigid co-registration algorithms were used about as often. Tissue shrinkage rates ranged from 7% to 74%.
There is a high variability in ablation margin quantification methods. Prospectively obtained data and a validated robust workflow are needed to better understand the clinical value. Interpretation of quantified ablation margins may be influenced by tissue shrinkage, as this may cause underestimation.
为了将肝脏恶性肿瘤热消融后局部肿瘤进展的风险降至最低，实现具有足够消融边缘的完全肿瘤消融是一项先决条件。这使得消融边缘的量化成为一个快速发展的领域。本系统评价的目的是概述现有文献中有关可能影响消融边缘解读和评估的临床研究及技术方面的内容。
对Medline数据库进行检索，查找有关肝癌射频和微波消融、消融边缘、图像处理及组织收缩的研究。对纳入本系统评价的研究进行分析，以评估消融边缘的定性和定量评估方法、分割和配准方法，以及热消融过程中发生的组织收缩的潜在影响。
共纳入75篇文章，其中58篇为临床研究。在大多数临床研究中，目标最小消融边缘（MAM）≥5毫米。在10/31项研究中，MAM量化是在三维空间而非三个正交图像平面上进行的。分割操作采用半自动或手动方式。刚性和非刚性配准算法的使用频率大致相同。组织收缩率在7%至74%之间。
消融边缘量化方法存在很大差异。需要前瞻性获取的数据和经过验证的稳健工作流程，以更好地理解其临床价值。量化消融边缘的解读可能会受到组织收缩的影响，因为这可能导致低估。
