Abstract
Purpose
To assess the feasibility of US-18FDG-PET/CT fusion-guided microwave ablation of liver metastases either poorly visible or totally undetectable with US, CEUS and CT, but visualized by PET imaging.
Materials and Methods
Twenty-three patients with 58 liver metastases underwent microwave ablation guided by image fusion system that combines US with 18FDG-PET/CT images. In 28/58 tumors, 18FDG-PET/CT with contrast medium (PET/CECT) was used. The registration technical feasibility, registration time, rates of correct targeting, technical success at 24 h, final result at 1 year and complications were analyzed and compared between the PET/CT and PET/CECT groups.
Results
Registration was successfully performed in all cases with a mean time of 7.8 + 1.7 min (mean + standard deviation), (4.6 + 1.5 min for PET/CECT group versus 10.9 + 1.8 min for PET/CT group, P < 0.01). In total, 46/58 (79.3%) tumors were correctly targeted, while 3/28 (10.7%) and 9/30 (30%) were incorrectly targeted in PET/CT and PET/CECT group, respectively (P < 0.05). Complete ablation was obtained at 24 h in 70.0% of cases (n = 40 tumors), 23/28 (82.1%) in the PET/CECT group and 17/30 (56.7%) in the PET/CT group (P < 0.037). Fourteen tumors underwent local retreatment (11 ablations, 2 with resection and 1 with stereotactic body radiation therapy), while 4 tumors could not be retreated because of distant disease progression and underwent systemic therapy. Finally, 54/58 (93.1%) tumors were completely treated at 1 year. One major complication occurred, a gastrointestinal hemorrhage which required surgical repair.
Conclusions
Percutaneous ablation of 18FDG-PET-positive liver metastases using fusion imaging of real-time US and pre-acquired 18FDG-PET/CT images is feasible, safe and effective. Contrast-enhanced PET/CT improves overall ablation accuracy and shortens procedural duration time.
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Abbreviations
- CECT:
-
Contrast-enhanced computed tomography
- CEUS:
-
Contrast-enhanced ultrasound
- CT:
-
Computed tomography
- 18FDG-PET:
-
18Fluorodeoxyglucose positron emission tomography
- MRI:
-
Magnetic resonance imaging
- PET:
-
Positron emission tomography
- US:
-
Ultrasound
- SBRT:
-
Stereotactic body radiation therapy
References
Solbiati L, Ahmed M, Cova L, et al. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology. 2012;265:958–68. https://doi.org/10.1148/radiol.12111851.
Mauri G, Cova L, De Beni S, et al. Real-time US-CT/MRI image fusion for guidance of thermal ablation of liver tumors undetectable with US: results in 295 cases. Cardiovasc Intervent Radiol. 2015;38:143–51. https://doi.org/10.1007/s00270-014-0897-y.
Dong Y, Wang W-P, Mao F, et al. Application of imaging fusion combining contrast-enhanced ultrasound and magnetic resonance imaging in detection of hepatic cellular carcinomas undetectable by conventional ultrasound. J Gastroenterol Hepatol. 2016;31:822–8. https://doi.org/10.1111/jgh.13202.
Liu F-Y, Yu X-L, Liang P, et al. Microwave ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma undetectable by conventional ultrasonography. Eur J Radiol. 2012;81:1455–9. https://doi.org/10.1016/j.ejrad.2011.03.057.
Hakime A, Deschamps F, De Carvalho EGM, et al. Clinical evaluation of spatial accuracy of a fusion imaging technique combining previously acquired computed tomography and real-time ultrasound for imaging of liver metastases. Cardiovasc Intervent Radiol. 2011;34:338–44. https://doi.org/10.1007/s00270-010-9979-7.
Lee MW. Fusion imaging of real-time ultrasonography with CT or MRI for hepatic intervention. Ultrasonography. 2014;33:227–39. https://doi.org/10.14366/usg.14021.
Hustinx R, Bénard F, Alavi A. Whole-body FDG-PET imaging in the management of patients with cancer. Semin Nucl Med. 2002;32:35–46. https://doi.org/10.1053/snuc.2002.29272.
Oriuchi N, Higuchi T, Ishikita T, et al. Present role and future prospects of positron emission tomography in clinical oncology. Cancer Sci. 2006;97:1291–7. https://doi.org/10.1111/j.1349-7006.2006.00341.x.
Pauwels EK, Ribeiro MJ, Stoot JH, et al. FDG accumulation and tumor biology. Nucl Med Biol. 1998;25:317–22.
Wiering B, Ruers TJM, Krabbe PFM, et al. Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. Ann Surg Oncol. 2007;14:818–26. https://doi.org/10.1245/s10434-006-9259-6.
Shyn PB. Interventional positron emission tomography/computed tomography: state-of-the-art. Tech Vasc Interv Radiol. 2013;16:182–90. https://doi.org/10.1053/j.tvir.2013.02.014.
Tatli S, Gerbaudo VH, Mamede M, et al. Abdominal masses sampled at PET/CT-guided percutaneous biopsy: initial experience with registration of prior PET/CT images. Radiology. 2010;256:305–11. https://doi.org/10.1148/radiol.10090931.
Shyn PB, Tatli S, Sahni VA, et al. PET/CT-guided percutaneous liver mass biopsies and ablations: targeting accuracy of a single 20 s breath-hold PET acquisition. Clin Radiol. 2014;69:410–5. https://doi.org/10.1016/j.crad.2013.11.013.
Ryan ER, Thornton R, Sofocleous CT, et al. PET/CT-guided interventions: personnel radiation dose. Cardiovasc Intervent Radiol. 2013;36:1063–7. https://doi.org/10.1007/s00270-012-0515-9.
Ryan ER, Sofocleous CT, Schöder H, et al. Split-dose technique for FDG PET/CT-guided percutaneous ablation: a method to facilitate lesion targeting and to provide immediate assessment of treatment effectiveness. Radiology. 2013;268:288–95. https://doi.org/10.1148/radiol.13121462.
Tatli S, Gerbaudo VH, Feeley CM, et al. PET/CT-guided percutaneous biopsy of abdominal masses: initial experience. J Vasc Interv Radiol. 2011;22:507–14. https://doi.org/10.1016/j.jvir.2010.12.035.
Cornelis F, Petre EN, Vakiani E, et al. Immediate post-ablation FDG-injection and corresponding standardized uptake value is a surrogate biomarker of local tumor progression after thermal ablation of colorectal carcinoma liver metastases. J Nucl Med. 2018. https://doi.org/10.2967/jnumed.117.194506.
Cornelis F, Sotirchos V, Violari E, et al. 18F-FDG PET/CT is an immediate imaging biomarker of treatment success after liver metastasis ablation. J Nucl Med. 2016;57:1052–7. https://doi.org/10.2967/jnumed.115.171926.
Sotirchos VS, Petrovic LM, Gönen M, et al. Colorectal cancer liver metastases: biopsy of the ablation zone and margins can be used to predict oncologic outcome. Radiology. 2016;280:949–59. https://doi.org/10.1148/radiol.2016151005.
Klaeser B, Mueller MD, Schmid RA, et al. PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: initial experiences. Eur Radiol. 2009;19:1780–5. https://doi.org/10.1007/s00330-009-1338-1.
Di Mauro E, Solbiati M, De Beni S, et al. Virtual navigator real-time ultrasound fusion imaging with positron emission tomography for liver interventions. Conf Proc IEEE Eng Med Biol Soc. 2013;2013:1406–9. https://doi.org/10.1109/EMBC.2013.6609773.
Venkatesan AM, Kadoury S, Abi-Jaoudeh N, et al. Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation. Radiology. 2011;260:848–56. https://doi.org/10.1148/radiol.11101985.
Appelbaum L, Solbiati L, Sosna J, et al. Evaluation of an electromagnetic image-fusion navigation system for biopsy of small lesions: assessment of accuracy in an in vivo swine model. Acad Radiol. 2013;20:209–17. https://doi.org/10.1016/j.acra.2012.09.020.
Shady W, Petre EN, Gonen M, et al. Percutaneous radiofrequency ablation of colorectal cancer liver metastases: factors affecting outcomes–a 10-year experience at a single center. Radiology. 2016;278:601–11. https://doi.org/10.1148/radiol.2015142489.
Shady W, Petre EN, Do KG, et al. Percutaneous microwave versus radiofrequency ablation of colorectal liver metastases: ablation with clear margins (A0) provides the best local tumor control. J Vasc Interv Radiol. 2018;29(268–275):e1. https://doi.org/10.1016/j.jvir.2017.08.021.
Calandri M, Yamashita S, Gazzera C, et al. Ablation of colorectal liver metastasis: interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival. Eur Radiol. 2018;28:2727–34. https://doi.org/10.1007/s00330-017-5273-2.
Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update. Radiology. 2014;273:241–60. https://doi.org/10.1148/radiol.14132958.
Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6. https://doi.org/10.1007/s00270-017-1703-4.
Mauri G, Cova L, Tondolo T, et al. Percutaneous laser ablation of metastatic lymph nodes in the neck from papillary thyroid carcinoma: preliminary results. J Clin Endocrinol Metab. 2013;98:E1203–7. https://doi.org/10.1210/jc.2013-1140.
Gadaleta CD, Solbiati L, Mattioli V, et al. Unresectable lung malignancy: combination therapy with segmental pulmonary arterial chemoembolization with drug-eluting microspheres and radiofrequency ablation in 17 patients. Radiology. 2013;267:627–37. https://doi.org/10.1148/radiol.12120198.
Hakime A, Yevich S, Tselikas L, et al. Percutaneous thermal ablation with ultrasound guidance. fusion imaging guidance to improve conspicuity of liver metastasis. Cardiovasc Intervent Radiol. 2017;40:721–7. https://doi.org/10.1007/s00270-016-1561-5.
Mauri G, Porazzi E, Cova L, et al. Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment. Insights Imaging. 2014;5:209–16. https://doi.org/10.1007/s13244-014-0315-7.
Solbiati L, Ierace T, Tonolini M, Cova L. Guidance and monitoring of radiofrequency liver tumor ablation with contrast-enhanced ultrasound. Eur J Radiol. 2004;51(Suppl):S19–23.
Shyn PB, Mauri G, Alencar RO, et al. Percutaneous imaging-guided cryoablation of liver tumors: predicting local progression on 24-hour MRI. AJR Am J Roentgenol. 2014;203:W181–91. https://doi.org/10.2214/AJR.13.10747.
Rempp H, Waibel L, Hoffmann R, et al. MR-guided radiofrequency ablation using a wide-bore 1.5-T MR system: clinical results of 213 treated liver lesions. Eur Radiol. 2012;22:1972–82. https://doi.org/10.1007/s00330-012-2438-x.
Shady W, Petre EN, Vakiani E, et al. Kras mutation is a marker of worse oncologic outcomes after percutaneous radiofrequency ablation of colorectal liver metastases. Oncotarget. 2017;8:66117–27. https://doi.org/10.18632/oncotarget.19806.
Odisio BC, Yamashita S, Huang SY, et al. Local tumour progression after percutaneous ablation of colorectal liver metastases according to RAS mutation status. Br J Surg. 2017;104:760–8. https://doi.org/10.1002/bjs.10490.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Giovanni Mauri received consultancy fee from Elesta Srl, speaker honorarium from Guerbet and travel support from RGG. S. Nahum Goldberg performs unrelated consulting for Angiodynamics and Cosman Instruments.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Mauri, G., Gennaro, N., De Beni, S. et al. Real-Time US-18FDG-PET/CT Image Fusion for Guidance of Thermal Ablation of 18FDG-PET-Positive Liver Metastases: The Added Value of Contrast Enhancement. Cardiovasc Intervent Radiol 42, 60–68 (2019). https://doi.org/10.1007/s00270-018-2082-1
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DOI: https://doi.org/10.1007/s00270-018-2082-1