Abstract

PurposeTo validate a simulation environment for virtual planning of percutaneous cryoablation of renal tumors.Materials and MethodsProspectively collected data from 19 MR-guided procedures were used for validation of the simulation model. Volumetric overlap of the simulated ablation zone volume (Σ) and the segmented ablation zone volume (S; assessed on 1-month follow-up scan) was quantified. Validation metrics were DICE Similarity Coefficient (DSC; the ratio between twice the overlapping volume of both ablation zones divided by the sum of both ablation zone volumes), target overlap (the ratio between the overlapping volume of both ablation zones to the volume of S; low ratio means S is underestimated), and positive predictive value (the ratio between the overlapping volume of both ablation zones to the volume of Σ; low ratio means S is overestimated). Values were between 0 (no alignment) and 1 (perfect alignment), a value > 0.7 is considered good.ResultsMean volumes of S and Σ were 14.8 cm3 (± 9.9) and 26.7 cm3 (± 15.0), respectively. Mean DSC value was 0.63 (± 0.2), and ≥ 0.7 in 9 cases (47%). Mean target overlap and positive predictive value were 0.88 (± 0.11) and 0.53 (± 0.24), respectively. In 17 cases (89%), target overlap was ≥ 0.7; positive predictive value was ≥ 0.7 in 4 cases (21%) and < 0.6 in 13 cases (68%). This indicates S is overestimated in the majority of cases.ConclusionThe validation results showed a tendency of the simulation model to overestimate the ablation effect. Model adjustments are necessary to make it suitable for clinical use.

Highlights

  • Thermal ablative therapies for small renal masses (SRMs; \ 4 cm) are an alternative treatment for nephron-sparing surgery (NSS) [1]

  • In 17 cases (89%), target overlap was C 0.7; positive predictive value was C 0.7 in 4 cases (21%) and \ 0.6 in 13 cases (68%)

  • The validation results showed a tendency of the simulation model to overestimate the ablation effect

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Summary

Introduction

Thermal ablative therapies for small renal masses (SRMs; \ 4 cm) are an alternative treatment for nephron-sparing surgery (NSS) [1]. Obtaining full tumor coverage with enough margin is imperative and depends on the type, configuration, and the number of needles used. The physician makes these decisions based on the predicted ice ball formation from a single needle provided by the manufacturer and experience with the equipment used [10, 11]. Once the ablation has started and the ice ball is formed, the possibility of needle replacement is obliterated. This emphasizes the importance of pre-procedural planning to ensure radical treatment

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