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International Journal of Colorectal Disease

Erschienen in:

01.06.2011 | Original Article

In vivo validation of a therapy planning system for laser-induced thermotherapy (LITT) of liver malignancies

verfasst von: Kai Siegfried Lehmann, Bernd Benedikt Frericks, Christoph Holmer, Andrea Schenk, Andreas Weihusen, Verena Knappe, Urte Zurbuchen, Heinz Otto Peitgen, Heinz Johannes Buhr, Jörg Peter Ritz

Erschienen in: International Journal of Colorectal Disease | Ausgabe 6/2011

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Abstract

Purpose

In situ ablation is increasingly being used for the treatment of liver malignancies. The application of these techniques is limited by the lack of a precise prediction of the destruction volume. This holds especially true in anatomically difficult situations, such as metastases in the vicinity of larger liver vessels. We developed a three-dimensional (3D) planning system for laser-induced thermotherapy (LITT) of liver tumors. The aim of the study was to validate the system for calculation of the destruction volume.

Methods

LITT (28 W, 20 min) was performed in close contact to major hepatic vessels in six pigs. After explantation of the liver, the coagulation area was documented. The liver and its vascular structures were segmented from a pre-interventional CT scan. Therapy planning was carried out including the cooling effect of adjacent liver vessels. The lesions in vivo and the simulated lesions were compared with a morphometric analysis.

Results

The volume of lesions in vivo was 6,568.3 ± 3,245.9 mm³, which was not different to the simulation result of 6,935.2 ± 2,538.5 mm³ (P = 0.937). The morphometric analysis showed a sensitivity of the system of 0.896 ± 0.093 (correct prediction of destructed tissue). The specificity was 0.858 ± 0.090 (correct prediction of vital tissue).

Conclusions

A 3D computer planning system for the prediction of thermal lesions in LITT was developed. The calculation of the directional cooling effect of intrahepatic vessels is possible for the first time. The morphometric analysis showed a good correlation under clinical conditions. The pre-therapeutic calculation of the ablation zone might be a valuable tool for procedure planning.

Ritz JP, Isbert C, Roggan A, Buhr HJ, Germer CT (2004) Laser-induced thermotherapy of liver metastases. Front Radiat Ther Oncol 38:106–121PubMedCrossRef

Isbert C, Buhr HJ, Ritz JP, Hohenberger W, Germer CT (2007) Curative in situ ablation of colorectal liver metastases-experimental and clinical implementation. Int J Colorectal Dis 22:705–715PubMedCrossRef

Frericks BB, Ritz JP, Albrecht T, Valdeig S, Schenk A, Wolf KJ, Lehmann K (2008) Influence of intrahepatic vessels on volume and shape of percutaneous thermal ablation zones: in vivo evaluation in a porcine model. Invest Radiol 43:211–218PubMedCrossRef

Ritz JP, Lehmann KS, Zurbuchen U, Wacker F, Brehm F, Isbert C, Germer CT, Buhr HJ, Holmer C (2007) Improving laser-induced thermotherapy of liver metastases—effects of arterial microembolization and complete blood flow occlusion. Eur J Surg Oncol 33:608–615PubMedCrossRef

Goldberg SN, Hahn PF, Tanabe KK, Mueller PR, Schima W, Athanasoulis CA, Compton CC, Solbiati L, Gazelle GS (1998) Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 9:101–111PubMedCrossRef

Lehmann KS, Ritz JP, Valdeig S, Knappe V, Schenk A, Weihusen A, Rieder C, Holmer C, Zurbuchen U, Hoffmann P, Peitgen HO, Buhr HJ, Frericks BB (2009) Ex situ quantification of the cooling effect of liver vessels on radiofrequency ablation. Langenbecks Arch Surg 394:475–481PubMedCrossRef

Patterson EJ, Scudamore CH, Owen DA, Nagy AG, Buczkowski AK (1998) Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size. Ann Surg 227:559–565PubMedCrossRef

Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171PubMedCrossRef

Mulier S, Ni Y, Jamart J, Michel L, Marchal G, Ruers T (2008) Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol 15:144–157PubMedCrossRef

10.

Roggan A, Knappe V, Ritz J, Germer C, Isbert C, Wacker F, Mueller G (2000) 3D radiation planning for laser-induced thermotherapy (LITT). Z Med Phys 10:157–167

11.

Ritz JP, Isbert C, Roggan A, Germer CT, Albrecht D, Buhr HJ (1998) [Thermal laser dosimetry in treatment of liver tumors–correlation of optical tissue parameters with in vivo temperature distribution in VX-2 tumors and healthy liver tissue]. Langenbecks Arch Surg 115:1445–1447

12.

Frericks BB, Kirchhoff TD, Shin HO, Stamm G, Merkesdal S, Abe T, Schenk A, Peitgen HO, Klempnauer J, Galanski M, Nashan B (2006) Preoperative volume calculation of the hepatic venous draining areas with multi-detector row CT in adult living donor liver transplantation: Impact on surgical procedure. Eur Radiol 16:2803–2810PubMedCrossRef

13.

Radtke A, Sotiropoulos GC, Molmenti EP, Schroeder T, Peitgen HO, Frilling A, Broering DC, Broelsch CE, Malago M (2010) Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8-year period. Ann Surg 252:876–883PubMedCrossRef

14.

Tanaka K, Matsumoto C, Takakura H, Matsuo K, Nagano Y, Endo I, Togo S, Shimada H, Bourquain H, Peitgen HO (2010) Technique of right hemihepatectomy preserving ventral right anterior section guided by area of hepatic venous drainage. Surgery 147:450–458PubMedCrossRef

15.

Endo I, Shimada H, Sugita M, Fujii Y, Morioka D, Takeda K, Sugae S, Tanaka K, Togo S, Bourquain H, Peitgen HO (2007) Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery 142:666–675PubMedCrossRef

16.

Radtke A, Nadalin S, Sotiropoulos GC, Molmenti EP, Schroeder T, Valentin-Gamazo C, Lang H, Bockhorn M, Peitgen HO, Broelsch CE, Malagó M (2007) Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein. World J Surg 31:175–185PubMedCrossRef

17.

Lang H, Radtke A, Hindennach M, Schroeder T, Frühauf NR, Malagó M, Bourquain H, Peitgen H-O, Oldhafer KJ, Broelsch CE (2005) Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection. Arch Surg 140:629–638PubMedCrossRef

18.

Lehmann KS, Ritz J-P, Valdeig S, Schenk A, Holmer C, Peitgen H-O, Buhr H-J, Frericks BB (2008) Portal vein segmentation of a 3D-planning system for liver surgery—in vivo evaluation in a porcine model. Ann Surg Oncol 15:1899–1907PubMedCrossRef

19.

Wald C, Bourquain H (2006) Role of new three-dimensional image analysis techniques in planning of live donor liver transplantation, liver resection, and intervention. J Gastrointest Surg 10:161–165PubMedCrossRef

20.

Peitgen HO, Bourquain H, Broelsch CE, Klaus KJ, Pomfret EA, Tanaka K (2004) New methods for computer aided preoperative determination of donor risks in living donor liver transplantation. Liver Transplant 10:C22

21.

Roggan A, Mesecke-von Rheinbaben I, Knappe V, Vogl T, Mack MG, Germer C, Albrecht D, Müller G (1997) [Applicator development and irradiation planning in laser-induced thermotherapy (LITT)]. Biomed Tech (Berl) 42 Suppl:332–333

22.

Ritz J-P (1999) Correlation of intrahepatic light and temperature distribution in laser-induced thermotherapy of liver tumors and liver tissue. In: Proceedings of SPIE, Stockholm, Sweden, 1999, pp 18–23

23.

Wilson BC, Adam G (1983) A Monte Carlo model for the absorption and flux distributions of light in tissue. Med Phys 10:824–830PubMedCrossRef

24.

Holmer C, Lehmann KS, Risk J, Roggan A, Germer C-T, Reissfelder C, Isbert C, Buhr HJ, Ritz J-P (2006) Colorectal tumors and hepatic metastases differ in their optical properties-relevance for dosimetry in laser-induced interstitial thermotherapy. Lasers Surg Med 38:296–304PubMedCrossRef

25.

Ritz JP, Roggan A, Germer CT, Isbert C, Muller G, Buhr HJ (2001) Continuous changes in the optical properties of liver tissue during laser-induced interstitial thermotherapy. Lasers Surg Med 28:307–312PubMedCrossRef

26.

Ritz JP, Roggan A, Isbert C, Muller G, Buhr HJ, Germer CT (2001) Optical properties of native and coagulated porcine liver tissue between 400 and 2400 nm. Lasers Surg Med 29:205–212PubMedCrossRef

27.

Pennes HH (1998) Analysis of tissue and arterial blood temperatures in the resting human forearm. J Appl Physiol 85:5–34PubMed

28.

Welch A (1984) The thermal response of laser irradiated tissue. IEEE J Quantum Electron 20:1471–1481CrossRef

29.

Ng KK, Lam CM, Poon RT, Shek TW, Yu WC, To JY, Wo YH, Lau CP, Tang TC, Ho DW, Fan ST (2005) Porcine liver: morphologic characteristics and cell viability at experimental radiofrequency ablation with internally cooled electrodes. Radiology 235:478–486PubMedCrossRef

30.

Pereira PL, Trübenbach J, Schenk M, Subke J, Kroeber S, Schaefer I, Remy CT, Schmidt D, Brieger J, Claussen CD (2004) Radiofrequency ablation: in vivo comparison of four commercially available devices in pig livers. Radiology 232:482–490PubMedCrossRef

31.

Isbert C, Roggan A, Ritz JP, Muller G, Buhr HJ, Lehmann KS, Germer CT (2001) Laser-induced thermotherapy: intra- and extralesionary recurrence after incomplete destruction of experimental liver metastasis. Surg Endosc 15:1320–1326PubMedCrossRef

32.

Clasen S, Pereira PL (2008) Magnetic resonance guidance for radiofrequency ablation of liver tumors. J Magn Reson Imaging 27:421–433PubMedCrossRef

33.

Bitsch RG, Dux M, Helmberger T, Lubienski A (2006) Effects of vascular perfusion on coagulation size in radiofrequency ablation of ex vivo perfused bovine livers. Invest Radiol 41:422–427PubMedCrossRef

34.

Lu DS, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, Sayre J (2003) Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 14:1267–1274PubMed

35.

Welp C, Siebers S, Ermert H, Werner J (2006) Investigation of the influence of blood flow rate on large vessel cooling in hepatic radiofrequency ablation. Biomed Tech 51:337–346CrossRef

36.

Mohammed Y, Verhey JF (2005) A finite element method model to simulate laser interstitial thermo therapy in anatomical inhomogeneous regions. Biomed Eng Online 4:2PubMedCrossRef

37.

Verhey JF, Mohammed Y, Ludwig A, Giese K (2003) Implementation of a practical model for light and heat distribution using laser-induced thermotherapy near to a large vessel. Phys Med Biol 48:3595–3610PubMedCrossRef

38.

Puccini S, Bär N-K, Bublat M, Kahn T, Busse H (2003) Simulations of thermal tissue coagulation and their value for the planning and monitoring of laser-induced interstitial thermotherapy (LITT). Magn Reson Med 49:351–362PubMedCrossRef

Titel: In vivo validation of a therapy planning system for laser-induced thermotherapy (LITT) of liver malignancies
verfasst von: Kai Siegfried Lehmann
Bernd Benedikt Frericks
Christoph Holmer
Andrea Schenk
Andreas Weihusen
Verena Knappe
Urte Zurbuchen
Heinz Otto Peitgen
Heinz Johannes Buhr
Jörg Peter Ritz
Publikationsdatum: 01.06.2011
Verlag: Springer-Verlag
Erschienen in: International Journal of Colorectal Disease / Ausgabe 6/2011
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1175-y

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