Ablative Margins of Colorectal Liver Metastases Using Deformable CT                     Image Registration and Autosegmentation

Lin, Yuan-Mao; Paolucci, Iwan; O'Connor, Caleb S; Anderson, Brian; Rigaud, B.; Fellman, Bryan; Jones, A. Kyle; Brock, Kristy K.; Odisio, Bruno C.

doi:10.1148/radiol.221373

Cited by 31 publications

(31 citation statements)

References 34 publications

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“…For CLM, it has been shown that minimum ablation margins of at least 5 mm and ideally 10 mm are critical for prolonged local tumour progression-free survival, regardless of the thermal ablation modality used (RFA or MWA). 5,[12][13][14][15]17,18,[55][56][57][58] This is referred to as an A0 ablation, analogous to surgical resections with clear microscopic margins (R0) and is essential to provide local cure and serve as a surgical alternative, since the majority of intrahepatic micrometastases are within 1 cm of the gross tumour. 59 When a 10 mm minimal margin can be achieved, local tumour progression free-survival exceeds 95% and can offer a chance for local cure similar to surgery, without the associated morbidity.…”

Section: Ablation Marginsmentioning

confidence: 99%

“…Current practices include 3D software assessments of the ablation zone and margins. 16,18,55,[61][62][63] These assessments have higher discrimination power to detect areas of insufficient tumour coverage by the ablation zone than 2D imaging alone and can provide intraoperative feedback regarding areas with suboptimal coverage that can be re-ablated in the same setting. 16,55,[61][62][63] Although recent evidence indicates that the intraprocedural 3D assessment is more sensitive than the first post-ablation imaging for the detection of insufficient margins that can predict local tumour progression, 64 historically the technical efficacy of ablation relied on a 4-8 weeks postablation contrast-enhanced CT or MRI with contrast.…”

Section: Ablation Marginsmentioning

confidence: 99%

“…5,14,72 Though a wide range of local tumour progression rates have been reported in the early experience with ablation for CLM (2-60%), ablations with margins ≥5 mm and with histologically proven tumourfree ablation zones (as seen on immediate post-ablation biopsies) have local tumour progression rates that are similar to those reported for wedge or anatomic liver resections (0-7%). 13,14,18 A recent retrospective study showed zero cases of local tumour progression of CLM when a minimal ablation margin ≥5 mm was achieved, as quantified using 3D software with biomechanical deformable CT image registration. 18 A phase II randomized controlled clinical trial showed prolonged progression-free survival in patients with initially unresesctable CRC liver metastases undergoing RFA (with or without hepatic resection) plus standard of care chemotherapy (FOLFOX), compared to chemotherapy alone.…”

Section: Colorectal Liver Metastasesmentioning

confidence: 99%

“…13,14,18 A recent retrospective study showed zero cases of local tumour progression of CLM when a minimal ablation margin ≥5 mm was achieved, as quantified using 3D software with biomechanical deformable CT image registration. 18 A phase II randomized controlled clinical trial showed prolonged progression-free survival in patients with initially unresesctable CRC liver metastases undergoing RFA (with or without hepatic resection) plus standard of care chemotherapy (FOLFOX), compared to chemotherapy alone. 75 A subsequent study in the same cohort with longer follow-up demonstrated significantly prolonged overall survival in the combination arm, with 8-year survival rates of 36% versus 9% in the systemic treatment arm.…”

Section: Colorectal Liver Metastasesmentioning

confidence: 99%

“…10 With careful patient selection and appropriate technique allowing for the creation of ablation zones with adequate minimum ablation margins (≥5 mm, ideally ≥10 mm), local tumour control is similar to that observed after limited resection. 5,6,[11][12][13][14][15][16][17][18][19] The available evidence and outcomes following ablation of the most frequently encountered types of hepatic metastases in clinical practice are reviewed. Patient selection, ablative techniques, complications and follow-up considerations are discussed.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous image‐guided ablation for hepatic metastases

Sotirchos,

Petre,

Sofocleous

2023

J Med Imag Rad Onc

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SummaryThe presence of hepatic metastases indicates advanced disease and is associated with significant morbidity and mortality, especially when the hepatic disease is not amenable to locoregional treatments. The primary tumour of origin, the distribution and extent of metastatic disease, the underlying liver reserve, the patient performance status and the presence of comorbidities are factors that determine whether a patient will benefit from hepatectomy or local curative‐intent treatments. For patients with metastatic colorectal cancer, the most common primary cancer that spreads to the liver, several studies have demonstrated a survival benefit for patients who can be treated with hepatectomy and/or percutaneous ablation, compared to those treated with chemotherapy alone. Despite advances in surgical techniques increasing the percentage of patients eligible for surgery, most patients have unresectable disease or are poor surgical candidates. Percutaneous ablation can be used to provide local disease control and prolong survival for both surgical and non‐surgical candidates. This is typically offered to patients with small hepatic metastases that can be ablated with optimal (≥10 mm) or at least adequate minimum ablation margins (≥5 mm), as high local tumour control rates can be achieved for these patients which are comparable to surgical resection. This review summarizes available evidence and outcomes following percutaneous ablation of the most frequently encountered types of hepatic metastases in the clinical practice of interventional oncology. Patient selection, technical considerations, follow‐up protocols and oncologic outcomes are presented and discussed.

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Section: Ablation Marginsmentioning

confidence: 99%

Section: Ablation Marginsmentioning

confidence: 99%

Section: Colorectal Liver Metastasesmentioning

confidence: 99%

Section: Colorectal Liver Metastasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous image‐guided ablation for hepatic metastases

Sotirchos,

Petre,

Sofocleous

2023

J Med Imag Rad Onc

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Locoregional treatment for colorectal liver metastases aiming for precision medicine

Maki

Jain

Haddad

et al. 2023

Annals of Gastroent Surgery

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Precise ablation zone segmentation on CT images after liver cancer ablation using semi‐automatic CNN‐based segmentation

Le,

Pham,

van Walsum

et al. 2024

Medical Physics

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BackgroundAblation zone segmentation in contrast‐enhanced computed tomography (CECT) images enables the quantitative assessment of treatment success in the ablation of liver lesions. However, fully automatic liver ablation zone segmentation in CT images still remains challenging, such as low accuracy and time‐consuming manual refinement of the incorrect regions.PurposeTherefore, in this study, we developed a semi‐automatic technique to address the remaining drawbacks and improve the accuracy of the liver ablation zone segmentation in the CT images.MethodsOur approach uses a combination of a CNN‐based automatic segmentation method and an interactive CNN‐based segmentation method. First, automatic segmentation is applied for coarse ablation zone segmentation in the whole CT image. Human experts then visually validate the segmentation results. If there are errors in the coarse segmentation, local corrections can be performed on each slice via an interactive CNN‐based segmentation method. The models were trained and the proposed method was evaluated using two internal datasets of post‐interventional CECT images ( = 22, = 145; 62 patients in total) and then further tested using an external benchmark dataset ( = 12; 10 patients).ResultsTo evaluate the accuracy of the proposed approach, we used Dice similarity coefficient (DSC), average symmetric surface distance (ASSD), Hausdorff distance (HD), and volume difference (VD). The quantitative evaluation results show that the proposed approach obtained mean DSC, ASSD, HD, and VD scores of 94.0%, 0.4 mm, 8.4 mm, 0.02, respectively, on the internal dataset, and 87.8%, 0.9 mm, 9.5 mm, and −0.03, respectively, on the benchmark dataset. We also compared the performance of the proposed approach to that of five well‐known segmentation methods; the proposed semi‐automatic method achieved state‐of‐the‐art performance on ablation segmentation accuracy, and on average, 2 min are required to correct the segmentation. Furthermore, we found that the accuracy of the proposed method on the benchmark dataset is comparable to that of manual segmentation by human experts ( = 0.55, ‐test).ConclusionsThe proposed semi‐automatic CNN‐based segmentation method can be used to effectively segment the ablation zones, increasing the value of CECT for an assessment of treatment success. For reproducibility, the trained models, source code, and demonstration tool are publicly available at https://github.com/lqanh11/Interactive_AblationZone_Segmentation.

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Ablative Margins of Colorectal Liver Metastases Using Deformable CT Image Registration and Autosegmentation

Cited by 31 publications

References 34 publications

Percutaneous image‐guided ablation for hepatic metastases

Percutaneous image‐guided ablation for hepatic metastases

Locoregional treatment for colorectal liver metastases aiming for precision medicine

Precise ablation zone segmentation on CT images after liver cancer ablation using semi‐automatic CNN‐based segmentation

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