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Mathy RM, Giannakis A, Franke M, Winiger A, Kauczor HU, Chang DH. Factors Impacting Microwave Ablation Zone Sizes: A Retrospective Analysis. Cancers (Basel) 2024; 16:1279. [PMID: 38610957 PMCID: PMC11011160 DOI: 10.3390/cancers16071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/01/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Evaluation of the influence of intrinsic and extrinsic conditions on ablation zone volumes (AZV) after microwave ablation (MWA). METHODS Retrospective analysis of 38 MWAs of therapy-naïve liver tumours performed with the NeuWave PR probe. Ablations were performed either in the 'standard mode' (65 W, 10 min) or in the 'surgical mode' (95 W, 1 min, then 65 W, 10 min). AZV measurements were obtained from contrast-enhanced computed tomography immediately post-ablation. RESULTS AZVs in the 'standard mode' were smaller than predicted by the manufacturer (length 3.6 ± 0.6 cm, 23% below 4.7 cm; width 2.7 ± 0.6, 23% below 3.5 cm). Ablation zone past the tip was limited to 6 mm in 28/32 ablations. Differences in AZV between the 'surgical mode' and 'standard mode' were not significant (15.6 ± 7.8 mL vs. 13.9 ± 8.8 mL, p = 0.6). AZVs were significantly larger in case of hepatocellular carcinomas (HCCs) (n = 19) compared to metastasis (n = 19; 17.8 ± 9.9 mL vs. 10.1 ± 5.1 mL, p = 0.01) and in non-perivascular tumour location (n = 14) compared to perivascular location (n = 24, 18.7 ± 10.4 mL vs. 11.7 ± 6.1 mL, p = 0.012), with both factors remaining significant in two-way analysis of variance (HCC vs. metastasis: p = 0.02; perivascular vs. non-perivascular tumour location: p = 0.044). CONCLUSION Larger AZVs can be expected in cases of HCCs compared with metastases and in non-perivascular locations. Using the 'surgical mode' does not increase AZV significantly.
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Affiliation(s)
- René Michael Mathy
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
| | - Athanasios Giannakis
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
- 2nd Department of Radiology, University General Hospital, “ATTIKON” Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Mareike Franke
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
| | - Alain Winiger
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
| | - De-Hua Chang
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
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Hendriks P, Boel F, Oosterveer TTM, Broersen A, de Geus-Oei LF, Dijkstra J, Burgmans MC. Ablation margin quantification after thermal ablation of malignant liver tumors: How to optimize the procedure? A systematic review of the available evidence. Eur J Radiol Open 2023; 11:100501. [PMID: 37405153 PMCID: PMC10316004 DOI: 10.1016/j.ejro.2023.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction 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. Methods 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. Results 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%. Conclusions 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.
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Affiliation(s)
- Pim Hendriks
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fleur Boel
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Timo TM Oosterveer
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander Broersen
- LKEB Laboratory of Clinical and Experimental Imaging, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, the Netherlands
| | - Jouke Dijkstra
- LKEB Laboratory of Clinical and Experimental Imaging, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. First validation of a model-based hepatic percutaneous microwave ablation planning on a clinical dataset. Sci Rep 2023; 13:16862. [PMID: 37803064 PMCID: PMC10558472 DOI: 10.1038/s41598-023-42543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actual ablation ground truth from a clinical dataset in liver. The biophysical model uses a simplified formulation of heat deposition on the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined to assess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model prediction compared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculature shortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermal prediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be used as liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermal ablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate its integration into the clinical workflow.
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Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands.
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
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Varble NA, Bakhutashvili I, Reed SL, Delgado J, Tokoutsi Z, Frackowiak B, Baragona M, Karanian JW, Wood BJ, Pritchard WF. Morphometric characterization and temporal temperature measurements during hepatic microwave ablation in swine. PLoS One 2023; 18:e0289674. [PMID: 37540658 PMCID: PMC10403086 DOI: 10.1371/journal.pone.0289674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE Heat-induced destruction of cancer cells via microwave ablation (MWA) is emerging as a viable treatment of primary and metastatic liver cancer. Prediction of the impacted zone where cell death occurs, especially in the presence of vasculature, is challenging but may be achieved via biophysical modeling. To advance and characterize thermal MWA for focal cancer treatment, an in vivo method and experimental dataset were created for assessment of biophysical models designed to dynamically predict ablation zone parameters, given the delivery device, power, location, and proximity to vessels. MATERIALS AND METHODS MWA zone size, shape, and temperature were characterized and monitored in the absence of perfusion in ex vivo liver and a tissue-mimicking thermochromic phantom (TMTCP) at two power settings. Temperature was monitored over time using implanted thermocouples with their locations defined by CT. TMTCPs were used to identify the location of the ablation zone relative to the probe. In 6 swine, contrast-enhanced CTs were additionally acquired to visualize vasculature and absence of perfusion along with corresponding post-mortem gross pathology. RESULTS Bench studies demonstrated average ablation zone sizes of 4.13±1.56cm2 and 8.51±3.92cm2, solidity of 0.96±0.06 and 0.99±0.01, ablations centered 3.75cm and 3.5cm proximal to the probe tip, and temperatures of 50 ºC at 14.5±13.4s and 2.5±2.1s for 40W and 90W ablations, respectively. In vivo imaging showed average volumes of 9.8±4.8cm3 and 33.2±28.4cm3 and 3D solidity of 0.87±0.02 and 0.75±0.15, and gross pathology showed a hemorrhagic halo area of 3.1±1.2cm2 and 9.1±3.0cm2 for 40W and 90W ablations, respectfully. Temperatures reached 50ºC at 19.5±9.2s and 13.0±8.3s for 40W and 90W ablations, respectively. CONCLUSION MWA results are challenging to predict and are more variable than manufacturer-provided and bench predictions due to vascular stasis, heat-induced tissue changes, and probe operating conditions. Accurate prediction of MWA zones and temperature in vivo requires comprehensive thermal validation sets.
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Affiliation(s)
- Nicole A. Varble
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Philips, Best, The Netherlands
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Sheridan L. Reed
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Jose Delgado
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, United States of America
| | | | | | | | - John W. Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Bioengineering and National Cancer Institute Center, Bethesda, Maryland, United States of America
| | - William F. Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
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Oosterveer TTM, van Erp GCM, Hendriks P, Broersen A, Overduin CG, van Rijswijk CSP, van Erkel AR, van der Meer RW, Tushuizen ME, Moelker A, Meijerink MR, van Delden OM, de Jong KP, van der Leij C, Smits MLJ, Urlings TAJ, Braak JPBM, Meershoek-Klein Kranenbarg E, van Duijn-de Vreugd B, Zeijdner E, Goeman JJ, Fütterer JJ, Coenraad MJ, Dijkstra J, Burgmans MC. Study Protocol PROMETHEUS: Prospective Multicenter Study to Evaluate the Correlation Between Safety Margin and Local Recurrence After Thermal Ablation Using Image Co-registration in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2022; 45:606-612. [PMID: 35233662 PMCID: PMC9018632 DOI: 10.1007/s00270-022-03075-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
Purpose The primary objective is to determine the minimal ablation margin required to achieve a local recurrence rate of < 10% in patients with hepatocellular carcinoma undergoing thermal ablation. Secondary objectives are to analyze the correlation between ablation margins and local recurrence and to assess efficacy. Materials and Methods This study is a prospective, multicenter, non-experimental, non-comparative, open-label study. Patients > 18 years with Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma (or B with a maximum of two lesions < 5 cm each) are eligible. Patients will undergo dual-phase contrast-enhanced computed tomography directly before and after ablation. Ablation margins will be quantitatively assessed using co-registration software, blinding assessors (i.e. two experienced radiologists) for outcome. Presence and location of recurrence are evaluated independently on follow-up scans by two other experienced radiologists, blinded for the quantitative margin analysis. A sample size of 189 tumors (~ 145 patients) is required to show with 80% power that the risk of local recurrence is confidently below 10%. A two-sided binomial z-test will be used to test the null hypothesis that the local recurrence rate is ≥ 10% for patients with a minimal ablation margin ≥ 2 mm. Logistic regression will be used to find the relationship between minimal ablation margins and local recurrence. Kaplan–Meier estimates are used to assess local and overall recurrence, disease-free and overall survival. Discussion It is expected that this study will result in a clear understanding of the correlation between ablation margins and local recurrence. Using co-registration software in future patients undergoing ablation for hepatocellular carcinoma may improve intraprocedural evaluation of technical success. Trial registration The Netherlands Trial Register (NL9713), https://www.trialregister.nl/trial/9713.
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Affiliation(s)
- Timo T M Oosterveer
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Gonnie C M van Erp
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Pim Hendriks
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Alexander Broersen
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carla S P van Rijswijk
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Arian R van Erkel
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rutger W van der Meer
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Koert P de Jong
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Maarten L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs A J Urlings
- Department of Radiology, Haaglanden Medical Center, Hague, The Netherlands
| | - Jeffrey P B M Braak
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bianca van Duijn-de Vreugd
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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