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F-18 FDG perfusion PET: intraprocedural assessment of the liver tumor ablation margin

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate 18F-fluorodeoxyglucose (FDG) perfusion PET during FDG PET/CT-guided liver tumor microwave ablation procedures for assessing the ablation margin and correlating minimum margin measurements with local progression.

Methods

This IRB-approved, HIPAA-compliant study included 20 adult patients (11 M, 9 F; mean age 65) undergoing FDG PET/CT-guided liver microwave ablation to treat 31 FDG-avid tumors. Intraprocedural FDG perfusion PET was performed to assess the ablation margin. Intraprocedural decisions regarding overlapping ablations were recorded. Two readers retrospectively interpreted intraprocedural perfusion PET and postprocedural contrast-enhanced MRI. Assessability of the ablation margin and minimum margin measurements were recorded. Imaging follow-up for local progression ranged from 30 to 574 days (mean 310). Regression modeling of minimum margin measurements was performed. Hazard ratios were calculated to correlate an ablation margin threshold of 5 mm with outcomes.

Results

Intraprocedural perfusion PET prompted additional overlapping ablations of two tumors, neither of which progressed. Incomplete ablation or local progression occurred in 8/31 (26%) tumors. With repeat ablation, secondary efficacy was 26 (84%) of 31. Both study readers deemed ablation margins fully assessable more often using perfusion PET than MRI (OR 69.7; CI 6.0, 806.6; p = 0.001). Minimum ablation margins ≥ 5 mm on perfusion PET correlated with a low risk of incomplete ablation/local progression by both study readers (HR 0.08 and 0.02, p < 0.001).

Conclusion

Intraprocedural FDG perfusion PET consistently enabled complete liver tumor microwave ablation margin assessments, and the perfusion PET minimum ablation margin measurements correlated well with local outcomes.

Clinical trial registration clinicaltrials.gov (NCT02018107).

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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.

Code availability (Software application or custom code)

Not applicable.

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Funding

Research funding was provided by Siemens Healthineers.

Author information

Authors and Affiliations

  1. Brigham and Women’s Hospital, Boston, MA, USA

    Paul B. Shyn, Alan J. Cubre, Leslie K. Lee, Hyewon Hyun, Kemal Tuncali, Julia G. Seol, Vincent M. Levesque, Victor H. Gerbaudo, Tina Kapur, Ryan T. Chao & Stuart G. Silverman

  2. Harvard Medical School, Boston, MA, USA

    Paul B. Shyn, Alan J. Cubre, Paul J. Catalano, Leslie K. Lee, Hyewon Hyun, Kemal Tuncali, Victor H. Gerbaudo, Tina Kapur & Stuart G. Silverman

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

    Paul J. Catalano

  4. Department of Radiology, Brigham and Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Paul B. Shyn

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  1. Paul B. Shyn
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  2. Alan J. Cubre
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  3. Paul J. Catalano
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  4. Leslie K. Lee
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  10. Tina Kapur
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Corresponding author

Correspondence to Paul B. Shyn.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The Institutional Review Board (IRB) reviewed and approved the study including review of health/medical records. The study was conducted in compliance with the Health Insurance Portability and Accountability Act.

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Informed consent was obtained from all study participants.

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Shyn, P.B., Cubre, A.J., Catalano, P.J. et al. F-18 FDG perfusion PET: intraprocedural assessment of the liver tumor ablation margin. Abdom Radiol 46, 3437–3447 (2021). https://doi.org/10.1007/s00261-021-02970-8

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  • DOI: https://doi.org/10.1007/s00261-021-02970-8

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