Cheng William Hong1,2, Lucy Chow3,4, Evrim B Turkbey5, Riccardo Lencioni6, Steven K Libutti7,8, Bradford J Wood9,10,11. 1. Center for Interventional Oncology, Clinical Center, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD, 20892, USA. williamhongcheng@gmail.com. 2. Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive MSC 1074, Bethesda, MD, 20892, USA. williamhongcheng@gmail.com. 3. Center for Interventional Oncology, Clinical Center, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD, 20892, USA. lucychow282@gmail.com. 4. Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive MSC 1074, Bethesda, MD, 20892, USA. lucychow282@gmail.com. 5. Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive MSC 1074, Bethesda, MD, 20892, USA. evrimbengi@yahoo.com. 6. Division of Diagnostic Imaging and Intervention, Department of Hepatology and Liver Transplantation, Pisa University Hospital, Via Paradisa 2, Building No. 29, 56124, Pisa, Italy. riccardo.lencioni@med.unipi.it. 7. Montefiore-Einstein Center for Cancer Care, Department of Surgery, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. slibutti@montefiore.org. 8. National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, GB 9609 MSC 9760, Bethesda, MD, 20892, USA. slibutti@montefiore.org. 9. Center for Interventional Oncology, Clinical Center, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD, 20892, USA. bwood@nih.gov. 10. Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive MSC 1074, Bethesda, MD, 20892, USA. bwood@nih.gov. 11. National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, GB 9609 MSC 9760, Bethesda, MD, 20892, USA. bwood@nih.gov.
Abstract
INTRODUCTION: The imaging features of unresectable hepatic malignancies in patients who underwent radiofrequency ablation (RFA) in combination with lyso-thermosensitive liposomal doxorubicin (LTLD) were determined. MATERIALS AND METHODS: A phase I dose escalation study combining RFA with LTLD was performed with peri- and post- procedural CT and MRI. Imaging features were analyzed and measured in terms of ablative zone size and surrounding penumbra size. The dynamic imaging appearance was described qualitatively immediately following the procedure and at 1-month follow-up. The control group receiving liver RFA without LTLD was compared to the study group in terms of imaging features and post-ablative zone size dynamics at follow-up. RESULTS: Post-treatment scans of hepatic lesions treated with RFA and LTLD have distinctive imaging characteristics when compared to those treated with RFA alone. The addition of LTLD resulted in a regular or smooth enhancing rim on T1W MRI which often correlated with increased attenuation on CT. The LTLD-treated ablation zones were stable or enlarged at follow-up four weeks later in 69% of study subjects as opposed to conventional RFA where the ablation zone underwent involution compared to imaging acquired immediately after the procedure. CONCLUSION: The imaging features following RFA with LTLD were different from those after standard RFA and can mimic residual or recurrent tumor. Knowledge of the subtle findings between the two groups can help avoid misinterpretation and proper identification of treatment failure in this setting. Increased size of the LTLD-treated ablation zone after RFA suggests the ongoing drug-induced biological effects.
INTRODUCTION: The imaging features of unresectable hepatic malignancies in patients who underwent radiofrequency ablation (RFA) in combination with lyso-thermosensitive liposomal doxorubicin (LTLD) were determined. MATERIALS AND METHODS: A phase I dose escalation study combining RFA with LTLD was performed with peri- and post- procedural CT and MRI. Imaging features were analyzed and measured in terms of ablative zone size and surrounding penumbra size. The dynamic imaging appearance was described qualitatively immediately following the procedure and at 1-month follow-up. The control group receiving liver RFA without LTLD was compared to the study group in terms of imaging features and post-ablative zone size dynamics at follow-up. RESULTS:Post-treatment scans of hepatic lesions treated with RFA and LTLD have distinctive imaging characteristics when compared to those treated with RFA alone. The addition of LTLD resulted in a regular or smooth enhancing rim on T1W MRI which often correlated with increased attenuation on CT. The LTLD-treated ablation zones were stable or enlarged at follow-up four weeks later in 69% of study subjects as opposed to conventional RFA where the ablation zone underwent involution compared to imaging acquired immediately after the procedure. CONCLUSION: The imaging features following RFA with LTLD were different from those after standard RFA and can mimic residual or recurrent tumor. Knowledge of the subtle findings between the two groups can help avoid misinterpretation and proper identification of treatment failure in this setting. Increased size of the LTLD-treated ablation zone after RFA suggests the ongoing drug-induced biological effects.
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