Early Assessment of Response to Radiofrequency Ablation With CT Perfusion Imaging in Rabbit VX2 Liver Tumor Model.

Xiaofei Yue,Xiaofei Yue,Xiaofei Yue,Osamah Alwalid,Osamah Alwalid,Osamah Alwalid,Mengting Huang,Mengting Huang,Mengting Huang,Yanqiao Ren,Yanqiao Ren,Yanqiao Ren,Xiangjun Dong,Xiangjun Dong,Xiangjun Dong,Hongli Yang,Hongli Yang,Hongli Yang,Changhong Yi,Qian Li,Qian Li,Qian Li,Ping Han,Ping Han,Ping Han,Kun Qian,Kun Qian,Kun Qian

doi:10.3389/fonc.2021.728781

Abstract

ObjectivesTo discriminate viable tumors from benign periablational enhancement (BPE) in early stage after radiofrequency ablation (RFA) is a major confounding problem. The goal of this study is to evaluate quantitative assessment and diagnostic value of CT perfusion between viable tumors and BPE after RFA in the rabbit liver VX2 tumor model, with pathological results as the standard.MethodsTwenty-eight VX2 liver tumors were treated with RFA, on days 1, 3, 7, and 14, seven rabbits were randomly chosen for CT perfusion and performed pathology examinations immediately. The perfusion parameters along with the profile of time-density curves (TDCs) and pseudo-color images of the parameters were observed in both BPE and viable tumors, then compared with the pathology results. The perfusion parameters included blood flow (BF), blood volume (BV), time to peak (TTP), permeability (P), arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI).ResultsA total of 26/28 rabbits successfully underwent CT perfusion, while 6/26 lesions were confirmed to be viable tumors. The TDCs of BPE were mainly speed-up platform curves (15/26), while the viable tumors showed mainly speed-up speed-down (3/6) and speed-up platform (2/6) curves. The PVP values were significantly higher, and the HPI values were significantly lower for BPE at all time points than viable tumors (P < 0.05). Both of PVP value and HPI value have high efficiency for the differential diagnosis of the viable tumors and BPE at each time point. These characteristics of CT perfusion parameters were consistent with pathological changes.ConclusionsThe TDCs, PVP and HPI have the potential to indicate BPE and viable tumors effectively early after RFA treatment, the results were highly consistent with pathology. CT perfusion has advantages with great efficacy in monitoring the therapeutic effect early after RFA treatment.

Highlights

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China, and its incidence and mortality rates rank first worldwide
There were 26 local ablation lesions, among which 6 viable tumors were confirmed by histopathology
Viable tumors were found in 6 of the 26 lesions, which appeared as pale, rubbery nodular tissues located at the periphery of the radiofrequency ablation (RFA) region in gross morphology observation

Summary

Introduction

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China, and its incidence and mortality rates rank first worldwide. As confirmed by the use of tissue biopsy controls [8,9,10], the rates of detecting residual tumors after RFA by CT and MRI are only 36-86%, which encourages the development of functional imaging techniques. Among those choices, fluorine 18 fluorodeoxyglucose positron emission tomography (PET)CT is the most accurate detection method that directly reflects the functional activity of lesions [11], but it cannot be used clinically as a routine tool because of disadvantages such as the need for special equipment, long scanning times and high cost

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