Abstract

Objectives

To assess the difficulties in the immediate judgment of treatment success after radiofrequency ablation (RFA) of liver tumors by visual inspection alone and to evaluate whether radiologist’s expertise affects the resultant judgment.

Methods

Peri-interventional CT-scans of nine patients with nine hepatocellular carcinomas with known outcomes after RFA were presented to 38 participants from 14 different countries. In a total of 342 reads, all interventional oncologists assessed the pre- and immediate post-interventional CT-scans through conventional side-by-side juxtapositioning of images and judged whether complete ablation (i.e., technical success and technique efficacy) was achieved. Results were compared regarding expertise in percutaneous tumor ablation (>50 interventions performed). An ‘overcall’ was defined as insufficient ablation that was misjudged as sufficient, and an ‘undercall’ as an erroneous assessment of complete ablation.

Results

Overall 3.97 ± 1.27 out of 9 (44.1%) cases per radiologist were misjudged. The mean number of overcalls and undercalls per radiologist were 0.74 ± 0.50 out of 2 (37.0%), and 3.24 ± 1.28 out of 7 (46.3%), respectively. 18/38 (47.4%) participants had considerable experience in percutaneous tumor ablation, with such expertise having no significant influence on the results (overall: p = 0.70; overcalls: p = 0.87; undercalls: p = 0.75).

Conclusions

Conventional side-by-side evaluation of treatment success after RFA of liver tumors by the juxtaposition of pre- and post-interventional CT-scans is very difficult for experienced radiologists. The implementation of advanced processing techniques such as rigid/non-rigid image fusion with the assessment of the periablational margin is thus likely needed in order to decrease errors and objectively evaluate technical success and predict technique efficacy of liver RFA.

中文翻译：

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仅凭肉眼检查就可以准确评估射频消融肝肿瘤后的治疗成功吗？38名介入肿瘤医师的盲目评估结果

摘要

目标

仅通过目视检查来评估肝肿瘤射频消融（RFA）后立即判断治疗成功的困难，并评估放射科医生的专业知识是否会影响最终判断。

方法

对来自14个国家的38名参与者进行了9例9例肝细胞癌的RF术后结果已知的围手术期CT扫描。在总共342次读取中，所有介入肿瘤学家通过常规的并排图像并置方式评估了介入前和介入后CT扫描，并判断是否达到了完全消融（即技术成功和技术效果）。比较了经皮肿瘤消融的专业知识（进行了> 50次干预）的结果。“过度呼叫”被定义为消融不足而被错误判断为足够的消融，而“过度呼叫”被定义为对完全消融的错误评估。

结果

每个放射科医生的9例（44.1％）病例中，总体错误率为3.97±1.27。每位放射科医生的平均呼出次数和呼出次数分别为0.74±0.50（占27.0％）和3.24±1.28（占7）（46.3％）。18/38（47.4％）参加者在经皮肿瘤消融相当的经验，与具有对结果没有影响显著这种专门知识（总：p  = 0.70;争叫：p  = 0.87; undercalls：p  = 0.75）。

结论

对于有经验的放射线医师而言，通过介入前后CT扫描的并置来进行肝肿瘤RFA治疗后常规常规评估是非常困难的。因此，可能需要采用先进的处理技术（例如刚性/非刚性图像融合）并评估消融周缘，以减少误差并客观地评估肝RFA的技术成功率并预测其技术功效。