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Assessing ablation margins of FDG-avid liver tumors during PET/CT-guided thermal ablation procedures: a retrospective study

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Abstract

Background

To retrospectively assess liver tumor ablation margins using intraprocedural PET/CT images from FDG PET/CT-guided microwave or cryoablation procedures and to correlate minimum margin measurements with local progression outcomes.

Methods

Fifty-six patients (ages 36 to 85, median 62; 32 females) with 77 FDG-avid liver tumors underwent 60 FDG PET/CT guided, percutaneous microwave, or cryoablation procedures. Single breath-hold PET/CT images were used for intraprocedural assessment of the tumor ablation margin: liver tumors remained visible on PET immediately following ablation; microwave ablation zones were visible using contrast-enhanced CT; cryoablation zones (ice balls) were visible using unenhanced CT. Two readers retrospectively determined ablation margin assessability and measured the minimum ablation margin on intraprocedural PET/CT (n = 77) and postprocedural MRI (n = 56). Local tumor progression was assessed on all available follow-up imaging (1–49 months, mean 15). Local tumor progression was correlated with PET/CT minimum margin measurements using clustered survival models for 61 tumors.

Results

Minimum ablation margins were more often assessable using intraprocedural PET/CT (≥ 73/77 tumors, 95%) than postprocedural MRI (≤ 35/56 tumors, 63%). In 61 tumors with PET/CT-assessable margins (excluding tumors with overlapping ablations after PET/CT), there was a 6-fold increased risk of local tumor progression [hazard ratio (HR) 6.05; P = 0.004] for minimum ablation margins < 5 mm.

Conclusion

Breath-hold PET/CT scans, during PET/CT-guided microwave or cryoablation procedures for FDG-avid liver tumors, enable reliable intraprocedural assessment of the entire tumor ablation margin; a minimum PET/CT ablation margin threshold of 5 mm correlates well with local tumor progression outcomes.

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Data availability

The datasets generated and analyzed during the current study are not publicly available as the data are contained within our hospital electronic medical record but are available from the corresponding author on reasonable request.

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Materials availability

The datasets generated and analyzed during the current study are not publicly available as the data are contained within our hospital electronic medical record but are available from the corresponding author on reasonable request.

Code availability

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Author information

Author notes

  1. Victor H. Gerbaudo and Paul B. Shyn are co-senior authors.

Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Leigh C. Casadaban, Leslie K. Lee, Hyewon Hyun, Kemal Tuncali, Victor H. Gerbaudo & Paul B. Shyn

  2. Harvard Medical School, Boston, MA, USA

    Leigh C. Casadaban, Paul J. Catalano, Leslie K. Lee, Hyewon Hyun, Kemal Tuncali, Victor H. Gerbaudo & Paul B. Shyn

  3. Dana Farber Cancer Institute, Boston, MA, USA

    Paul J. Catalano

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  1. Leigh C. Casadaban
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Correspondence to Paul B. Shyn.

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The Institutional Review Board (IRB) reviewed and approved the study. The study was conducted in compliance with the Health Insurance Portability and Accountability Act. The need for informed consent was waived by the IRB due to the retrospective nature of this study.

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The authors declare no competing interests.

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Casadaban, L.C., Catalano, P.J., Lee, L.K. et al. Assessing ablation margins of FDG-avid liver tumors during PET/CT-guided thermal ablation procedures: a retrospective study. Eur J Nucl Med Mol Imaging 48, 2914–2924 (2021). https://doi.org/10.1007/s00259-021-05206-5

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