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de Jager NS, van Oostenbrugge TJ, Pätz T, Jenniskens SFM, Fütterer JJ, Langenhuijsen JF, Overduin CG. Intraoperative MRI-derived volumetric ablation margins and initial correlation with local outcome after MRI-guided cryoablation of renal tumors. Cancer Imaging 2023; 23:31. [PMID: 36998028 PMCID: PMC10064595 DOI: 10.1186/s40644-023-00546-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To assess volumetric ablation margins derived from intraoperative pre- and post-ablation MRI after magnetic resonance imaging (MRI)-guided percutaneous cryoablation of renal tumors and explore its correlation with local treatment success. METHODS Retrospective analysis was performed on 30 patients (mean age 69y) who underwent percutaneous MRI-guided cryoablation between May 2014 and May 2020 for 32 renal tumors (size: 1.6-5.1 cm). Tumor and ice-ball volumes were segmented on intraprocedural pre- and post-ablation MR images using Software Assistant for Interventional Radiology (SAFIR) software. After MRI-MRI co-registration, the software automatically quantified the minimal treatment margin (MTM),defined as the smallest 3D distance between the tumor and ice-ball surface. Local tumor progression (LTP) after cryoablation was assessed on follow-up imaging. RESULTS Median follow-up was 16 months (range: 1-58). Local control after cryoablation was achieved in 26 cases (81%) while LTP occurred in 6 (19%). The intended MTM of ≥5 mm was achieved in 3/32 (9%) cases. Median MTM was significantly smaller for cases with (- 7 mm; IQR:-10 to - 5) vs. without LTP (3 mm; IQR:2 to 4) (P < .001). All cases of LTP had a negative MTM. All negative treatment margins occurred in tumors > 3 cm. CONCLUSIONS Determination of volumetric ablation margins from intraoperative MRI was feasible and may be useful in predicting local outcome after MRI-guided renal cryoablation. In our preliminary data, an intraoperative MRI-derived minimal margin extending at least 1 mm beyond the MRI-visible tumor led to local control and this was more difficult to achieve in tumors > 3 cm. Ultimately, online margin analysis may be a valuable tool to intraoperatively assess therapy success, but larger prospective studies are needed to establish a reliable threshold for clinical use.
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Affiliation(s)
- Nienke S de Jager
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Tim J van Oostenbrugge
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Torben Pätz
- Fraunhofer Institute for Digital Medicine, Max-von-Laue-Str. 2, 28359, Bremen, Germany
| | - Sjoerd F M Jenniskens
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Johan F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands.
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Cazzato RL, De Marini P, Leonard-Lorant I, Leclerc L, Auloge P, Tricard T, Dalili D, Garnon J, Lang H, Gangi A. Safety and Oncologic Outcomes of Magnetic Resonance Imaging-Guided Cryoablation of Renal Cell Carcinoma: A 10-Year Single-Center Experience. Invest Radiol 2021; 56:153-162. [PMID: 32897930 DOI: 10.1097/rli.0000000000000719] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Magnetic resonance imaging guidance has been sporadically reported for renal tumor cryoablation (CA); therefore, clinical experience with this modality is still limited.The aim of this study is to retrospectively analyze our 10-year experience with renal tumor CA performed on a 1.5 T magnetic resonance imaging unit with the intent of reporting procedural safety and oncologic outcomes. MATERIALS AND METHODS We included 143 patients (102 men; 41 women; median age, 73 years; range, 34-91 years) with 149 tumors (median size, 2.6 cm; range, 0.6-6.0 cm), treated between 2009 and 2019. Patient, tumor, procedure, and follow-up data were collected and analyzed. The Kaplan-Meier method was used to estimate local recurrence-free (LRFS), metastasis-free (MFS), disease-free (DFS), cancer-specific, and overall (OS) survival. Univariate and multivariate models were used to identify factors associated with complications, LRFS, MFS, DFS, and OS. RESULTS The overall complication rate was 10.7% (16/149 tumors), with 1 major (1/149 [0.7%]; 95% confidence interval, 0.0%-3.7%) hemorrhagic complication. Other minor complications (15/149 [10.1%]; 95% confidence interval, 0.6%-16.1%) did not include any cases of injury to nearby organs. There were no factors associated with complications.Five-year estimates of LRFS (primary/secondary), MFS, DFS, cancer-specific survival, and OS were 82.8%/91.5%, 91.1%, 75.1%, 98.2%, and 89.6%, respectively. Increasing tumor size (hazard radio [HR], 1.8; P = 0.02) and intraparenchymal tumor location (HR, 5.6; P < 0.01) were associated with lower LRFS; increasing patient's age (HR, 0.5; P = 0.01), high tumor grade (HR, 23.3; P < 0.01) and non-clear-cell/nonpapillary histology (HR, 20.1; P < 0.01) with metastatic disease; and high tumor grade (HR, 3.2; P = 0.04) with lower DFS. CONCLUSION Magnetic resonance imaging-guided CA of renal tumors is associated with acceptable morbidity and high survival estimates at 5-year follow-up. Given the absence of complications resulting from injuries to nearby organs, further studies are required to evaluate whether the potential reduced incidence of these adverse events justifies large-scale implementation of this interventional modality.
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Affiliation(s)
| | | | | | - Loïc Leclerc
- From the Departments of Interventional Radiology
| | | | | | | | | | - Hervé Lang
- Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- From the Departments of Interventional Radiology
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Weiss J, Winkelmann MT, Gohla G, Kübler J, Clasen S, Nikolaou K, Hoffmann R. MR-guided microwave ablation in hepatic malignancies: clinical experiences from 50 procedures. Int J Hyperthermia 2020; 37:349-355. [PMID: 32286087 DOI: 10.1080/02656736.2020.1750713] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose: To investigate technical success, technique efficacy, safety and outcome of MR-guided microwave ablation (MWA) in hepatic malignancies.Material and methods: In this prospective IRB-approved study, patients scheduled for percutaneous treatment of hepatic malignancies underwent MR-guided MWA in a closed-bore 1.5 T MR system. Technical success was assessed on post-procedural MR control imaging. Technique efficacy was evaluated 4 weeks after the procedure on multi-parametric MRI. Assessment of safety followed the Society of Interventional Radiology grading system. Kaplan-Meier survival estimates were calculated to evaluate overall survival (OS), time to local tumor progression (TLTP), and time to non-target progression (TNTP).Results: Between 2015 and 2019, 47 patients (60.5 ± 12.2 years; 39 male) underwent 50 procedures for 58 hepatic tumors (21 hepatocellular carcinomas; 37 metastases). Mean target tumor size was 16 ± 7mm (range: 6-39 mm). Technical success and technique efficacy were 100% and 98%, respectively. Lesions were treated using 2.6 applicator positions (range: 1-6). Mean energy, ablation duration per tumor, and procedure duration were 43.2 ± 23.5 kJ, 26.7 ± 13.1 min and 211.2 ± 68.7 min, respectively. 10 minor (20%) and 3 major (6%) complications were observed. Median post-interventional hospital admission was 1 day (range: 1-19 days). Median OS was 41.6 (IQR: 26.4-) months. Local recurrence occurred after 4 procedures (8%) with TLTP ranging between 3.1 and 41.9 months. Non-target recurrence was observed in 64% of patients after a median TNTP of 13.8 (IQR 2.3-) months.Conclusion: MR-guided MWA allows for safe and successful treatment of hepatic malignancies with a high technique efficacy however with relatively long procedure durations.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Moritz T Winkelmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Jens Kübler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
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Validation of a Web-Based Planning Tool for Percutaneous Cryoablation of Renal Tumors. Cardiovasc Intervent Radiol 2020; 43:1661-1670. [PMID: 32935141 PMCID: PMC7591419 DOI: 10.1007/s00270-020-02634-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/20/2020] [Indexed: 01/29/2023]
Abstract
Purpose To validate a simulation environment for virtual planning of percutaneous cryoablation of renal tumors. Materials and Methods Prospectively collected data from 19 MR-guided procedures were used for validation of the simulation model. Volumetric overlap of the simulated ablation zone volume (Σ) and the segmented ablation zone volume (S; assessed on 1-month follow-up scan) was quantified. Validation metrics were DICE Similarity Coefficient (DSC; the ratio between twice the overlapping volume of both ablation zones divided by the sum of both ablation zone volumes), target overlap (the ratio between the overlapping volume of both ablation zones to the volume of S; low ratio means S is underestimated), and positive predictive value (the ratio between the overlapping volume of both ablation zones to the volume of Σ; low ratio means S is overestimated). Values were between 0 (no alignment) and 1 (perfect alignment), a value > 0.7 is considered good. Results Mean volumes of S and Σ were 14.8 cm3 (± 9.9) and 26.7 cm3 (± 15.0), respectively. Mean DSC value was 0.63 (± 0.2), and ≥ 0.7 in 9 cases (47%). Mean target overlap and positive predictive value were 0.88 (± 0.11) and 0.53 (± 0.24), respectively. In 17 cases (89%), target overlap was ≥ 0.7; positive predictive value was ≥ 0.7 in 4 cases (21%) and < 0.6 in 13 cases (68%). This indicates S is overestimated in the majority of cases. Conclusion The validation results showed a tendency of the simulation model to overestimate the ablation effect. Model adjustments are necessary to make it suitable for clinical use.
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Shono N, Ninni B, King F, Kato T, Tokuda J, Fujimoto T. Simulated accuracy assessment of small footprint body-mounted probe alignment device for MRI-guided cryotherapy of abdominal lesions. Med Phys 2020; 47:2337-2349. [PMID: 32141080 PMCID: PMC7889307 DOI: 10.1002/mp.14116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI)-guided percutaneous cryotherapy of abdominal lesions, an established procedure, uses MRI to guide and monitor the cryoablation of lesions. Methods to precisely guide cryotherapy probes with a minimum amount of trial-and-error are yet to be established. To aid physicians in attaining precise probe alignment without trial-and-error, a body-mounted motorized cryotherapy-probe alignment device (BMCPAD) with motion compensation was clinically tested in this study. The study also compared the contribution of body motion and organ motion compensation to the guidance accuracy of a body-mounted probe alignment device. METHODS The accuracy of guidance using the BMCPAD was prospectively measured during MRI-guided percutaneous cryotherapies before insertion of the probes. Clinical parameters including patient age, types of anesthesia, depths of the target, and organ sites of target were collected. By using MR images of the target organs and fiducial markers embedded in the BMCPAD, we retrospectively simulated the guidance accuracy with body motion compensation, organ motion compensation, and no compensation. The collected data were analyzed to test the impact of motion compensation on the guidance accuracy. RESULTS Thirty-seven physical guidance of probes were prospectively recorded for sixteen completed cases. The accuracy of physical guidance using the BMCPAD was 13.4 ± 11.1 mm. The simulated accuracy of guidance with body motion compensation, organ motion compensation, and no compensation was 2.4 ± 2.9 mm, 2.2 ± 1.6 mm, and 3.5 ± 2.9 mm, respectively. Data analysis revealed that the body motion compensation and organ motion compensation individually impacted the improvement in the accuracy of simulated guidance. Moreover, the difference in the accuracy of guidance either by body motion compensation or organ motion compensation was not statistically significant. The major clinical parameters impacting the accuracy of guidance were the body and organ motions. Patient age, types of anesthesia, depths of the target, and organ sites of target did not influence the accuracy of guidance using BMCPAD. The magnitude of body surface movement and organ movement exhibited mutual statistical correlation. CONCLUSIONS The BMCPAD demonstrated guidance accuracy comparable to that of previously reported devices for CT-guided procedures. The analysis using simulated motion compensation revealed that body motion compensation and organ motion compensation individually impact the improvement in the accuracy of device-guided cryotherapy probe alignment. Considering the correlation between body and organ movements, we also determined that body motion compensation using the ring fiducial markers in the BMCPAD can be solely used to address both body and organ motions in MRI-guided cryotherapy.
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Affiliation(s)
- Naoyuki Shono
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Brian Ninni
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Canon Healthcare Optics Research Laboratory Boston, Cambridge, MA 02139, USA
| | - Franklin King
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Takahisa Kato
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Canon Healthcare Optics Research Laboratory Boston, Cambridge, MA 02139, USA
| | - Junichi Tokuda
- Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Kyoto 606-8507, Japan
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Ridouani F, Srimathveeravalli G. Percutaneous image-guided ablation: From techniques to treatments. Presse Med 2019; 48:e219-e231. [PMID: 31447333 DOI: 10.1016/j.lpm.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Image-guided ablation is performed by percutaneously introducing ablation probes to deliver energy into a tumor to destroy it in a controlled and localized fashion. Ablation modalities can be broadly classified as thermal or non-thermal based on the mechanism of tumor destruction and are performed using different types of image guidance for planning, delivering and follow-up of the treatment. Ablation is performed in a minimally invasive fashion, providing greater residual organ preservation with minimal morbidity to the patient. Image-guided ablation is being used in the clinic for the treatment of primary and metastatic tumors, and this article reviews state of the art for the treatment of malignancies in the liver, lung, kidney and musculoskeletal tissue.
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Affiliation(s)
- Fourat Ridouani
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, USA
| | - Govindarajan Srimathveeravalli
- University of Massachusetts, Institute for Applied Life Sciences, Department of Mechanical and Industrial Engineering, Amherst, USA.
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Lamid-Ochir O, Nakajima T, Miyazaki M, Zhang X, Erdene K, Murakami T, Tsushima Y. Bioluminescence Image as a Quantitative Imaging Biomarker for Preclinical Evaluation of Cryoablation in a Murine Model. J Vasc Interv Radiol 2018; 29:1034-1040. [PMID: 29884506 DOI: 10.1016/j.jvir.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/22/2018] [Accepted: 03/07/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To employ bioluminescence imaging (BLI) as a quantitative imaging biomarker to assess preclinical evaluation of cryoablation in a murine model. MATERIALS AND METHODS In vitro, Colon26-Luc (C26-Luc) cells were seeded at 6 different concentrations in 35-mm dishes. These were divided into 6 groups: group 0 (G0), a control group without treatment; and groups 1-5 (G1-G5) according to the number of freeze-thaw cycles, with each cycle consisting of freezing at -80°C for 10 min followed by thawing at room temperature for 5 minutes. BLI and flow-cytometric analysis were performed after cryotherapy. In vivo, 20 tumor-bearing mice with C26-Luc cells were divided into 4 groups: group 0 (G0), a control group; and groups 1-3 (G1-G3) according to the number of freeze-thaw cycles. Each cryoablation procedure was performed for 30 seconds with liquid nitrogen (-170°C) applied with cotton-tipped applicators. BLI was acquired at 6 hours and 1, 3, and 7 days after treatments. RESULTS In vitro, BLI signal showed a negative correlation with the number of freeze-thaw cycles (r = -0.86, P = .02). In vivo, there was no difference in tumor volume at 1 day after cryoablation among all groups, but the BLI signals were significantly different between G0 and G2/G3 (P = .03 and P = .02, respectively) and between G1 and G3 (P = .04). BLI signals reflected tumor growth speed and survival ratio. CONCLUSIONS This study demonstrates the direct validation of BLI as a quantitative tool for the early assessment of therapeutic effects of cryoablation.
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Affiliation(s)
- Oyunbold Lamid-Ochir
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takahito Nakajima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Masaya Miyazaki
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Xieyi Zhang
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Khongorzul Erdene
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takashi Murakami
- Department of Microbiology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan; Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research, Maebashi, Japan
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