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

Pim Hendriks; Kiki M van Dijk; Bas Boekestijn; Alexander Broersen; Jacoba J van Duijn-de Vreugd; Minneke J Coenraad; Maarten E Tushuizen; Arian R van Erkel; Rutger W van der Meer; Catharina Sp van Rijswijk; Jouke Dijkstra; Lioe-Fee de Geus-Oei; Mark C Burgmans

doi:10.1016/j.diii.2023.07.002

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

Diagn Interv Imaging. 2024 Feb;105(2):57-64. doi: 10.1016/j.diii.2023.07.002. Epub 2023 Jul 28.

Affiliations

¹ Department of Radiology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands. Electronic address: p.hendriks@lumc.nl.
² Department of Radiology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands.
³ LKEB Laboratory of Clinical and Experimental Imaging, Department of Radiology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands.
⁴ Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
⁵ Department of Radiology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands; Biomedical Photonic Imaging Group, TechMed Centre, University of Twente, 7522 NB, Enschede, the Netherlands; Department of Radiation Science & Technology, Delft University of Technology, 2628 CD, Delft, the Netherlands.

PMID: 37517969
DOI: 10.1016/j.diii.2023.07.002

Abstract

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.

Keywords: Ablation margin; Computed tomography; Hepatocellular carcinoma; Image processing; Thermal ablation.

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Hepatocellular* / diagnostic imaging
Carcinoma, Hepatocellular* / pathology
Carcinoma, Hepatocellular* / surgery
Catheter Ablation* / methods
Female
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / surgery
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed / methods
Treatment Outcome