Intraprocedural assessment of ablation margins using computed tomography co-registration in hepatocellular carcinoma treatment with percutaneous ablation

Intraprocedural assessment of ablation margins using computed tomography co-registration in hepatocellular carcinoma treatment with percutaneous ablation: IAMCOMPLETE study

Hendriks, P. (Leiden University Medical Center)
van Dijk, Kiki M. (Leiden University Medical Center)
Boekestijn, Bas (Leiden University Medical Center)
Broersen, Alexander (Leiden University Medical Center)
van Duijn-de Vreugd, Jacoba J. (Leiden University Medical Center)
Coenraad, Minneke J. (Leiden University Medical Center)
Dijkstra, J. (Leiden University Medical Center)
de Geus-Oei, L.F. (TU Delft RST/Radiation, Science and Technology; Leiden University Medical Center; University of Twente)
Burgmans, M.C. (Leiden University Medical Center)

RST/Radiation, Science and Technology

2023

Purpose: The primary objective of this study was to determine the feasibility of ablation margin quantification using a standardized scanning protocol during thermal ablation (TA) of hepatocellular carcinoma (HCC), and a rigid registration algorithm. Secondary objectives were to determine the inter- and intra-observer variability of tumor segmentation and quantification of the minimal ablation margin (MAM). Materials and methods: Twenty patients who underwent thermal ablation for HCC were included. There were thirteen men and seven women with a mean age of 67.1 ± 10.8 (standard deviation [SD]) years (age range: 49.1–81.1 years). All patients underwent contrast-enhanced computed tomography examination under general anesthesia directly before and after TA, with preoxygenated breath hold. Contrast-enhanced computed tomography examinations were analyzed by radiologists using rigid registration software. Registration was deemed feasible when accurate rigid co-registration could be obtained. Inter- and intra-observer rates of tumor segmentation and MAM quantification were calculated. MAM values were correlated with local tumor progression (LTP) after one year of follow-up. Results: Co-registration of pre- and post-ablation images was feasible in 16 out of 20 patients (80%) and 26 out of 31 tumors (84%). Mean Dice similarity coefficient for inter- and intra-observer variability of tumor segmentation were 0.815 and 0.830, respectively. Mean MAM was 0.63 ± 3.589 (SD) mm (range: -6.26–6.65 mm). LTP occurred in four out of 20 patients (20%). The mean MAM value for patients who developed LTP was -4.00 mm, as compared to 0.727 mm for patients who did not develop LTP. Conclusion: Ablation margin quantification is feasible using a standardized contrast-enhanced computed tomography protocol. Interpretation of MAM was hampered by the occurrence of tissue shrinkage during TA. Further validation in a larger cohort should lead to meaningful cut-off values for technical success of TA.

Ablation margin
Computed tomography
Hepatocellular carcinoma
Image processing
Thermal ablation

http://resolver.tudelft.nl/uuid:37b1d8f9-2ef4-4e22-be7e-1a7c0e553d7c

https://doi.org/10.1016/j.diii.2023.07.002

Diagnostic and Interventional Imaging, 105 (2), 57-64

Institutional Repository

journal article

© 2023 P. Hendriks, Kiki M. van Dijk, Bas Boekestijn, Alexander Broersen, Jacoba J. van Duijn-de Vreugd, Minneke J. Coenraad, J. Dijkstra, L.F. de Geus-Oei, M.C. Burgmans, More Authors