Clinical evaluation of in silico planning and real-time simulation of hepatic radiofrequency ablation (ClinicIMPPACT Trial).
Objectives: To evaluate the accuracy and clinical integrability of a comprehensive simulation tool to plan and predict radiofrequency ablation (RFA) zones in liver tumors.Methods: Forty-five patients with 51 malignant hepatic lesions of different origins were included in a prospective multicenter tr...
| Publicado en: | European Radiology Vol. 30; no. 2; pp. 934 - 943 |
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| Autores principales: | , , , , , , , , , , , , , , , , |
| Formato: | clinical trial research Journal Article |
| Publicado: |
Springer Nature
Feb2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=141192305&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 141192305 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09387994 NPH jtl: European Radiology issn: 09387994 maglogo: N pubinfo: dt: Feb2020 vid: 30 iid: 2 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 141192305 141192305 NLM31471752 141192305 10.1007/s00330-019-06411-5 NLM31471752 141192305 ppf: 934 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Clinical evaluation of in silico planning and real-time simulation of hepatic radiofrequency ablation (ClinicIMPPACT Trial). aug: au: Moche, Michael Busse, Harald Futterer, Jurgen J. Hinestrosa, Camila A. Seider, Daniel Brandmaier, Philipp Kolesnik, Marina Jenniskens, Sjoerd Blanco Sequeiros, Roberto Komar, Gaber Pollari, Mika Eibisberger, Martin Portugaller, Horst Rupert Voglreiter, Philip Flanagan, Ronan Mariappan, Panchatcharam Reinhardt, Martin affil: Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Liebigstraße 20, 04103, Leipzig, Germany sug: subj: Catheter Ablation Methods Liver Neoplasms Surgery Carcinoma, Hepatocellular Surgery Male Computer Simulation Liver Surgery Aged Female Adolescence Tomography, X-Ray Computed Liver Pathology Carcinoma, Hepatocellular Pathology Prospective Studies Adult Liver Neoplasms Pathology Patient Care Plans Human Chemoembolization, Therapeutic Methods Middle Age Young Adult Clinical Trials Validation Studies Comparative Studies Evaluation Research Multicenter Studies Scales Aged: 65+ years Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Objectives: To evaluate the accuracy and clinical integrability of a comprehensive simulation tool to plan and predict radiofrequency ablation (RFA) zones in liver tumors.Methods: Forty-five patients with 51 malignant hepatic lesions of different origins were included in a prospective multicenter trial. Prior to CT-guided RFA, all patients underwent multiphase CT which included acquisitions for the assessment of liver perfusion. These data were used to generate a 3D model of the liver. The intra-procedural position of the RFA probe was determined by CT and semi-automatically registered to the 3D model. Size and shape of the simulated ablation zones were compared with those of the thermal ablation zones segmented in contrast-enhanced CT images 1 month after RFA; procedure time was compared with a historical control group.Results: Simulated and segmented ablation zone volumes showed a significant correlation (ρ = 0.59, p < 0.0001) and no significant bias (Wilcoxon's Z = 0.68, p = 0.25). Representative measures of ablation zone comparison were as follows: average surface deviation (absolute average error, AAE) with 3.4 ± 1.7 mm, Dice similarity coefficient 0.62 ± 0.14, sensitivity 0.70 ± 0.21, and positive predictive value 0.66 ± 0. There was a moderate positive correlation between AAE and duration of the ablation (∆t; r = 0.37, p = 0.008). After adjustments for inter-individual differences in ∆t, liver perfusion, and prior transarterial chemoembolization procedures, ∆t was an independent predictor of AAE (ß = 0.03 mm/min, p = 0.01). Compared with a historical control group, the simulation added 3.5 ± 1.9 min to the procedure.Conclusion: The validated simulation tool showed acceptable speed and accuracy in predicting the size and shape of hepatic RFA ablation zones. Further randomized controlled trials are needed to evaluate to what extent this tool might improve patient outcomes.Key Points: • More reliable, patient-specific intra-procedural estimation of the induced RFA ablation zones in the liver may lead to better planning of the safety margins around tumors. • Dedicated real-time simulation software to predict RFA-induced ablation zones in patients with liver malignancies has shown acceptable agreement with the follow-up results in a first prospective multicenter trial suggesting a randomized controlled clinical trial to evaluate potential outcome benefit for patients. pubtype: Academic Journal doctype: clinical trial research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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