Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome

 

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Abstract

Purpose Small hepatic malignancies scheduled for CT-guided percutaneous ablation may have been identified in the hepatobiliary phase of liver MRI or in a specific phase of multi-phase CT but may be occult on unenhanced CT used to guide the ablation. We investigated whether the detectability of the target lesion would impact the efficacy of CT-guided hepatic tumor ablations.

Materials and Methods We included 69 patients with 99 malignant liver lesions (25 primary, 44 metastases) who underwent IRE (n = 35), RFA (n = 41), or MWA (n = 23) between 01/2015 and 06/2018. All procedures were performed under CT guidance. Lesions not detectable on CT (NDL) were targeted through identification of anatomical landmarks on preinterventional contrast-enhanced CT or MRI. Rates of incomplete ablation, size of ablation zone, local tumor recurrence, intrahepatic progression-free survival (ihPFS), and adverse event rates were compared for detectable lesions (DL) vs. NDL.

Results 40 lesions were NDL, and 59 lesions were DL on unenhanced CT. The mean follow-up was 16.2 months (14.8 for DL and 18.2 for NDL). The mean diameter of NDL and DL was similar (12.9 mm vs. 14.9 mm). The mean ablation zone size was similar (37.1 mm vs. 38.8 mm). Incomplete ablation did not differ between NDL vs. DL (5.0 % [2/40; 0.6–16.9 %] vs. 3.4 % [2/59; 0.4–11.7 %]), nor did local tumor recurrence (15.4 % [6/39; 5.7 %–30.5 %] vs. 16.9 % [10/59; 8.4–29.0 %]), or median ihPFS (15.5 months vs. 14.3 months).

Conclusion Target lesion detectability on interventional CT does not have a significant impact on outcome after percutaneous liver ablation when anatomical landmarks are used to guide needle placement.

Key Points: 

• Liver tumors can be successfully ablated even if they are not detectable on the navigational CT scan.

• Anatomical landmarks should be used and compared to preinterventional imaging.

Citation Format

• Barzakova E, Senthilvel N, Bruners P et al. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome . Fortschr Röntgenstr 2022; 194: 515 – 520

Zusammenfassung

Ziel Intrahepatische maligne Läsionen, geplant für CT-gesteuerte perkutane Ablation, können MR-tomographisch oder CT-graphisch in einer bestimmten Kontrastmittelphase abgrenzbar sein, jedoch okkult in der nativen CT-Untersuchung, genutzt zur Planung der Ablation. Ziel dieser Studie ist zu untersuchen, ob die Abgrenzbarkeit der Zielläsion in der Planungsuntersuchung einen Einfluss auf das kurz- und mittelfristige Ablationsergebnis hat.

Material und Methoden Es wurden 69 Patienten mit insgesamt 99 malignen Leberläsionen (25 Primärtumoren, 44 Metastasen) eingeschlossen, die zwischen 01/2015 und 06/2018 irreversibler Elektroporation (n = 35), Radiofrequenzablation (n = 41) oder Mikrowellenablation (n = 23) unterzogen wurden. Alle Verfahren wurden unter CT-Führung durchgeführt. Läsionen, die in der Planungs-CT nicht nachweisbar waren (NDL), wurden durch die Korrelation zu anatomischen Landmarken in der kontrastverstärkten CT oder MRT-Voruntersuchung lokalisiert. Es wurden die Raten unvollständiger Ablation, lokalen Tumorrezidivs, die Größe der Ablationszone, das intrahepatische progressfreie Überleben (ihPFS) und die Komplikationsraten für nachweisbare Läsionen (DL) gegenüber NDL verglichen.

Ergebnisse 40 Läsionen waren NDL, 59 Läsionen waren DL auf die native Planungs-CT. Die mittlere Beobachtungsdauer war 16,2 Monate (14,8 für DL und 18,2 für NDL). Die mittleren Durchmesser von NDL und DL waren ähnlich (12,9 mm vs. 14,9 mm). Die mittleren Ablationszonengrößen waren ähnlich (37,1 mm vs. 38,8 mm). Es zeigten sich keine wesentlichen Unterschiede zwischen NDL und DL bezüglich der Häufigkeit unvollständiger Ablationen (5,0 % [2/40; 0,6 %–16,9 %] gegenüber 3,4 % [2/59; 0,4 %–11,7]), des Auftretens eines lokalen Tumorrezidivs (15,4 % [6/39; 5,7 %–30,5 %] gegenüber 16,9 % [10/59; 8,4 %–29,0]) oder des medianen ihPFS (15,5 Monate gegenüber 14,3 Monate).

Schlussfolgerung Die Nachweisbarkeit der Zielläsion in dem periinterventionellen Planungs-CT hat keinen signifikanten Einfluss auf das Ergebnis nach perkutanen Leberablationen, wenn anatomische Landmarken zur Nadelplatzierung genutzt werden.

Kernaussagen: 

• Lebertumoren können erfolgreich abladiert werden, auch wenn sie in dem nativen Planungs-CT nicht nachweisbar sind.

• Anatomische Landmarken sollten verwendet und mit der präinterventionellen Bildgebung verglichen werden.

Publication History

Received: 18 April 2021

Accepted: 07 October 2021

Article published online:
18 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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