A novel software platform for volumetric assessment of ablation completeness. (1st January 2019)

• Record Type: Journal Article
• Authors: Solbiati, Marco; Muglia, Riccardo; Goldberg, S. Nahum; Ierace, Tiziana; Rotilio, Alessandro; Passera, Katia M; Marre, Ilaria; Solbiati, Luigi
• Is Part Of: International journal of hyperthermia. Volume 36:Number 1(2019)
• Page Start: 336
• Page End: 342
• Publication Date: 2019-01-01
• Subjects: CT -- 3D rendering -- software -- image processing -- ablation; Thermotherapy -- Periodicals; 615.832
• DOI: 10.1080/02656736.2019.1569267
• Languages: English
• ISSNs: 0265-6736

Abstract

Abstract: Purpose: To retrospectively evaluate the accuracy of a novel software platform for assessing completeness of percutaneous thermal ablations. Materials & methods: Ninety hepatocellular carcinomas (HCCs) in 50 patients receiving percutaneous ultrasound-guided microwave ablation (MWA) that resulted in apparent technical success at 24-h post-ablation computed tomography (CT) and with ≥1-year imaging follow-up were randomly selected from a 320 HCC ablation database (2010–2016). Using a novel volumetric registration software, pre-ablation CT volumes of the HCCs without and with the addition of a 5 mm safety margin, and corresponding post-ablation necrosis volumes were segmented, co-registered and overlapped. These were compared to visual side-by-side inspection of axial images. Results: At 1-year follow-up, CT showed absence of local tumor progression (LTP) in 69/90 (76.7%) cases and LTP in 21/90 (23.3%). For HCCs classified by the software as "incomplete tumor treatments", LTP developed in 13/17 (76.5%) and all 13 (100%) of these LTPs occurred exactly where residual non-ablated tumor was identified by retrospective software analysis. HCCs classified as "complete ablation with <100% 5 mm ablative margins" had LTP in 8/49 (16.3%), while none of 24 HCCs with "complete ablation including 100% 5 mm ablative margins" had LTP. Differences in LTP between both partially ablated HCCs vs completely ablated HCCs, and ablated HCCs with <100% vs with 100% 5 mm margins were statistically significant ( p < .0001 and p = .036, respectively). Thus, 13/21 (61.9%) incomplete tumor treatments could have been detected immediately, were the software available at the time of ablation. Conclusions: A novel software platform for volumetric assessment of ablation completeness may increase the detection of incompletely ablated tumors, thereby holding the potential to avoid subsequent recurrences.