Koen H M Verdonschot, Sjoerd F M Jenniskens, Peter B van den Boezem, Eric T T L Tjwa, Johannes H W de Wilt, Jurgen J Fütterer, Martijn W J Stommel, Christiaan G Overduin
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From October 2019, intraprocedural CT-CT deformable image fusion (IF) using dedicated software (Vitrea, Canon Medical) was introduced to the thermal ablation procedure workflow to visually assess applicator placement before ablation and ablation completeness posttreatment. Local tumor progression (LTP) was assessed on follow-up imaging. LTP-free survival (LTPFS) between groups with and without IF was estimated with the Kaplan-Meier method and risk factors for LTP were identified with Cox regression analysis.</p><p><strong>Results: </strong>A total of 113 patients treated in 139 sessions were included; 66 treatments for 86 tumors without use of IF (56 HCC; 30 CRLM) and 73 treatments for 92 tumors with use of IF (46 HCC; 46 CRLM). Two-year LTPFS was significantly improved with use of IF for both HCC (97% vs. 74%; p = .009) and CRLM (82% vs. 56%; p = .033). 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引用次数: 0
摘要
目的：比较ct引导下肝肿瘤热消融术中与不术中CT-CT图像融合的效果。材料和方法：本回顾性队列研究纳入了2017年1月至2023年4月在我院接受ct引导下经皮热消融治疗肝细胞癌（HCC）或结直肠癌肝转移（CRLM）的所有患者。从2019年10月开始，使用专用软件（Vitrea, Canon Medical）的术中CT-CT可变形图像融合（IF）被引入到热消融手术流程中，以直观地评估消融前的涂抹器放置和消融后的完整性。通过随访影像评估局部肿瘤进展（LTP）。用Kaplan-Meier法估计有和没有IF组之间的无LTP生存（LTPFS），用Cox回归分析确定LTP的危险因素。结果：139个疗程共纳入113例患者；86例肿瘤66例不使用干扰素治疗(肝癌56例；30例CRLM)和73例使用IF治疗92例肿瘤(46例HCC；46 CRLM)。使用IF治疗两种HCC的2年LTPFS均显著改善(97% vs. 74%；p = 0.009)和CRLM (82% vs. 56%；p = .033)。单因素回归分析显示，肝细胞癌（HR: 0.21, p = 0.037）和CRLM （HR: 0.38, p = 0.042）患者使用干扰素是与LTPFS改善显著相关的主要因素。结论：在这项单中心研究中，使用基于软件的术中CT-CT图像融合来评估涂抹器位置和消融完整性与ct引导的HCC和CRLM热消融后局部肿瘤无进展生存期的改善相关。证据等级：3；
CT-guided Thermal Ablation of Liver Tumors Using Intraprocedural CT-CT Fusion for Applicator Position and Ablation Completeness Assessment: a Single-Center Comparative Analysis.
Purpose: To compare outcomes of CT-guided thermal ablation of liver tumors with versus without use of intraprocedural CT-CT image fusion.
Materials and methods: This retrospective cohort study included all patients treated with CT-guided percutaneous thermal ablation for hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) between January 2017 and April 2023 at our institution. From October 2019, intraprocedural CT-CT deformable image fusion (IF) using dedicated software (Vitrea, Canon Medical) was introduced to the thermal ablation procedure workflow to visually assess applicator placement before ablation and ablation completeness posttreatment. Local tumor progression (LTP) was assessed on follow-up imaging. LTP-free survival (LTPFS) between groups with and without IF was estimated with the Kaplan-Meier method and risk factors for LTP were identified with Cox regression analysis.
Results: A total of 113 patients treated in 139 sessions were included; 66 treatments for 86 tumors without use of IF (56 HCC; 30 CRLM) and 73 treatments for 92 tumors with use of IF (46 HCC; 46 CRLM). Two-year LTPFS was significantly improved with use of IF for both HCC (97% vs. 74%; p = .009) and CRLM (82% vs. 56%; p = .033). On univariate regression analysis, use of IF was a predominant factor significantly associated with improved LTPFS in patients with HCC (HR: 0.21, p = .037) and CRLM (HR: 0.38, p = .042).
Conclusion: In this single-center study, the use of software-based intraprocedural CT-CT image fusion for applicator position and ablation completeness assessment was associated with improved local tumor progression-free survival after CT-guided thermal ablation of HCC and CRLM.
期刊介绍：
CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.
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