Abstract

Purpose: To evaluate whether ‘invisible’ liver tumors on CT can be treated by stereotactic radiofrequency ablation (SRFA) using fusion of pre-ablation MRI.

Methods: In this retrospective case–control study, 60 patients (14 with Hepatocellular carcinoma (HCC) and 46 with metastatic liver tumors) with CT ‘invisible’ lesions underwent SRFA using MRI-fusion between June 2005 and June 2018 (‘fusion group’). For comparison, 60 patients who underwent SRFA without image fusion were selected using nearest neighbor propensity score matching (‘control group’). Endpoints consisted of local tumor control, safety, overall and disease-free survival.

Results: Major complications occurred in 6/69 ablations (8.7%) in the fusion group and in 6/89 ablations (6.7%) in the control group (p = 0.434). Primary technical efficacy rate (i.e., successful initial ablation) was 96.6% (28/29) for HCC and 97.9% (166/170) for metastatic disease in the fusion group and 100% (33/33) and 93.3% (184/194) in the control group, respectively (p = 0.468 and 0.064). Local recurrence (LR) was observed in 1/29 (3.5%) HCCs and in 6/170 metastases (4.0%) in the fusion group and 1/33 (3.0%) and 21/196 (10.7%) in the control group, respectively. The LR rate of metastasis in the control group was significantly higher (p = 0.007), although differences in OS and DFS did not reach statistical significance.

Conclusions: Image fusion using pre-procedural MRI allows for ablation of CT-‘invisible’ liver tumors that are otherwise untreatable. Moreover, local oncological control was higher in metastatic liver tumors versus matched controls which suggests it could be useful tool for all stereotactic radiofrequency ablation procedures.

摘要

目的：评估是否可以通过立体定向射频消融术（SRFA）结合消融前MRI来治疗CT上的“隐形”肝肿瘤。

方法：在这项回顾性病例对照研究中，对2005年6月至2018年6月之间通过MRI融合术对60例CT“隐形”病变患者（14例肝细胞癌（HCC）和46例转移性肝肿瘤）进行了SRFA（“融合组”） ）。为了进行比较，使用最近邻倾向评分匹配法选择了60例未进行图像融合的SRFA患者（“对照组”）。终点包括局部肿瘤控制，安全性，总体生存率和无病生存期。

结果：融合组的主要并发症发生在6/69消融（8.7％）和对照组的6/89消融（6.7％）（p  = 0.434）。融合组的主要技术效率（即成功的初始消融）对肝癌为96.6％（28/29），对转移性疾病为97.9％（166/170），分别为100％（33/33）和93.3％（184 /对照组）（p  = 0.468和0.064）。在融合组中有1/29（3.5％）的HCC和6/170转移灶（4.0％）观察到局部复发（LR），在对照组中有1/33（3.0％）和21/196（10.7％）观察到局部复发（LR）。 ， 分别。 尽管OS和DFS的差异没有统计学意义，但对照组的LR转移率明显更高（p = 0.007）。

结论：使用术前MRI进行图像融合可消融原本无法治疗的CT隐性肝肿瘤。此外，转移性肝肿瘤中的局部肿瘤控制要高于匹配的对照，这表明它可能是用于所有立体定向射频消融手术的有用工具。