Abstract
Objectives
To evaluate post-ablation MRI for the detection of incompletely treated spinal osseous metastases (SOM) after cryoablation and to propose a post-ablation imaging classification.
Methods
After IRB consent, all patients treated with cryoablation of SOM between 2011 and 2017 having at least 1-year minimum follow-up and a spine MRI within 4 months after cryoablation were retrospectively included. A classification of MRI images into four types was set up. The primary endpoint of our study was to assess the diagnostic performance of the post-ablation MRI. The secondary endpoints were the 1-year complete treatment rate (CTR) and complications.
Results
Fifty-four SOMs in 39 patients were evaluated. Post-ablation MRI was performed with a median delay of 25 days after cryoablation. Images were evaluated by two independent readers according to the pre-established image classification. Sensitivity and specificity for the detection of residual tumor were 77.3% (95%CI = 62.2–88.5) and 85.9% (95%CI = 75.0–93.4), respectively. Types I, II, III, and IV of the classification were associated with a 1-year complete treatment in 100%, 83.3%, 35.7%, and 10% of cases, respectively. The 1-year CTR was 59.3% for all 54 metastases, and 95.8% for metastases measuring less than 25 mm and at least 2 mm or more away from the spinal canal. Two grade 3 and two grade 2 adverse events according to the CTCAE were reported.
Conclusions
MRI after cryoablation is useful for the evaluation of the ablation efficacy. The classification of post-cryoablation MRI provides reliable clues for the prediction of complete treatment at 1 year.
Key Points
• MRI performed 25 days after cryoablation is useful to evaluate the efficacy.
• The proposed classification provides a reliable clue for complete cryoablation.
• Percutaneous cryoablation of spinal metastases is highly effective for lesions less than 25 mm in diameter and of at least 2 mm away from the spinal canal.
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Abbreviations
- CTR:
-
Complete treatment rate
- PMMA:
-
Polymethylmethacrylate
- SOM:
-
Spinal osseous metastases
- SBRT:
-
Stereotactic body radiotherapy
References
Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12:6243s–6249s
Fornasier VL, Horne JG (1975) Metastases to the vertebral column. Cancer 36:590–594
Deschamps F, Farouil G, de Baere T (2014) Percutaneous ablation of bone tumors. Diagn Interv Imaging 95:659–663
Munk PL, Murphy KJ, Gangi A, Liu DM (2011) Fire and ice: percutaneous ablative therapies and cement injection in management of metastatic disease of the spine. Semin Musculoskelet Radiol 15:125–134
Deschamps F, Farouil G, Ternes N et al (2014) Thermal ablation techniques: a curative treatment of bone metastases in selected patients? Eur Radiol 24:1971–1980
Gravel G, Leboulleux S, Tselikas L et al (2018) Prevention of serious skeletal-related events by interventional radiology techniques in patients with malignant paraganglioma and pheochromocytoma. Endocrine 59:547–554
Yang H-L, Liu T, Wang X-M et al (2011) Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol 21:2604–2617
Vanel D, Bittoun J, Tardivon A (1998) MRI of bone metastases. Eur Radiol 8:1345–1351
Lecouvet FE, Larbi A, Pasoglou V et al (2013) MRI for response assessment in metastatic bone disease. Eur Radiol 23:1986–1997
National Cancer Institute (2018) Common Terminology Criteria for Adverse Events (CTCAE). Available via https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed 20 Sep 2018
Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458
Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Buhmann Kirchhoff S, Becker C, Duerr HR et al (2009) Detection of osseous metastases of the spine: comparison of high resolution multi-detector-CT with MRI. Eur J Radiol 69:567–573
Thibault I, Chang EL, Sheehan J et al (2015) Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro-Oncology (SPINO) group. Lancet Oncol 16:e595–e603
Constantinidou A, Martin A, Sharma B, Johnston SRD (2011) Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital. Ann Oncol 22:307–314
De Giorgi U, Mego M, Rohren EM et al (2010) 18F-FDG PET/CT findings and circulating tumor cell counts in the monitoring of systemic therapies for bone metastases from breast cancer. J Nucl Med 51:1213–1218
Deandreis D, Leboulleux S, Dromain C et al (2011) Role of FDG PET/CT and chest CT in the follow-up of lung lesions treated with radiofrequency ablation. Radiology 258:270–276
Tomasian A, Wallace A, Northrup B et al (2016) Spine cryoablation: pain palliation and local tumor control for vertebral metastases. AJNR Am J Neuroradiol 37:189–195
de Baere T, Elias D, Dromain C et al (2000) Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. AJR Am J Roentgenol 175:1619–1625
de Baère T, Aupérin A, Deschamps F et al (2015) Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol 26:987–991
Vidoni A, Grainger M, James S (2018) Experience of neuroprotective air injection during radiofrequency ablation (RFA) of spinal osteoid osteoma. Eur Radiol 10:4146–415023
Wang XS, Rhines LD, Shiu AS et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol 13:395–402
Yamada Y, Bilsky MH, Lovelock DM et al (2008) High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys 71:484–490
Boehling NS, Grosshans DR, Allen PK et al (2012) Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine 16:379–386
Rose PS, Laufer I, Boland PJ et al (2009) Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol 27:5075–5079
Myrehaug S, Sahgal A, Hayashi M et al (2017) Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review. J Neurosurg Spine 27:428–435
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The scientific guarantor of this publication is Dr. Frederic Deschamps.
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Gravel, G., Tselikas, L., Moulin, B. et al. Early detection with MRI of incomplete treatment of spine metastases after percutaneous cryoablation. Eur Radiol 29, 5655–5663 (2019). https://doi.org/10.1007/s00330-019-06040-y
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DOI: https://doi.org/10.1007/s00330-019-06040-y