Real-Time US-18FDG-PET/CT Image Fusion for Guidance of Thermal Ablation of 18FDG-PET-Positive Liver Metastases: The Added Value of Contrast Enhancement
To assess the feasibility of US-18FDG-PET/CT fusion-guided microwave ablation of liver metastases either poorly visible or totally undetectable with US, CEUS and CT, but visualized by PET imaging.
Materials and Methods
Twenty-three patients with 58 liver metastases underwent microwave ablation guided by image fusion system that combines US with 18FDG-PET/CT images. In 28/58 tumors, 18FDG-PET/CT with contrast medium (PET/CECT) was used. The registration technical feasibility, registration time, rates of correct targeting, technical success at 24 h, final result at 1 year and complications were analyzed and compared between the PET/CT and PET/CECT groups.
Registration was successfully performed in all cases with a mean time of 7.8 + 1.7 min (mean + standard deviation), (4.6 + 1.5 min for PET/CECT group versus 10.9 + 1.8 min for PET/CT group, P < 0.01). In total, 46/58 (79.3%) tumors were correctly targeted, while 3/28 (10.7%) and 9/30 (30%) were incorrectly targeted in PET/CT and PET/CECT group, respectively (P < 0.05). Complete ablation was obtained at 24 h in 70.0% of cases (n = 40 tumors), 23/28 (82.1%) in the PET/CECT group and 17/30 (56.7%) in the PET/CT group (P < 0.037). Fourteen tumors underwent local retreatment (11 ablations, 2 with resection and 1 with stereotactic body radiation therapy), while 4 tumors could not be retreated because of distant disease progression and underwent systemic therapy. Finally, 54/58 (93.1%) tumors were completely treated at 1 year. One major complication occurred, a gastrointestinal hemorrhage which required surgical repair.
Percutaneous ablation of 18FDG-PET-positive liver metastases using fusion imaging of real-time US and pre-acquired 18FDG-PET/CT images is feasible, safe and effective. Contrast-enhanced PET/CT improves overall ablation accuracy and shortens procedural duration time.
KeywordsThermal ablation Fusion imaging Liver Metastasis Ultrasound PET
Contrast-enhanced computed tomography
18Fluorodeoxyglucose positron emission tomography
Magnetic resonance imaging
Positron emission tomography
Stereotactic body radiation therapy
Compliance with Ethical Standards
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Giovanni Mauri received consultancy fee from Elesta Srl, speaker honorarium from Guerbet and travel support from RGG. S. Nahum Goldberg performs unrelated consulting for Angiodynamics and Cosman Instruments.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Consent for Publication
Consent for publication was obtained from all individual participants included in the study.
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