Purpose: Liver metastases presenting as small hyperintense foci on diffusion-weighted imaging (DWI) pose a therapeutic challenge. Ablation is generally not possible since these lesions are often occult on ultrasound and CT. The purpose of this prospective study was to assess if small liver metastases (≤10 mm) detected on DWI can be successfully localized and ablated with the Hepatic Arteriography and C-Arm CT-Guided Ablation technique (HepACAGA). Materials and Methods: All consecutive patients with small liver metastases (≤10 mm), as measured on DWI, referred for ablation with HepACAGA between 1 January 2021, and 31 October 2023, were included. Re-ablations and ablations concomitant with another local treatment were excluded. The primary outcome was the technical success rate, defined as the intraprocedural detection and subsequent successful ablation of small liver metastases using HepACAGA. Secondary outcomes included the primary and secondary local tumor progression (LTP) rates and the complication rate. Results: A total of 15 patients (26 tumors) were included, with liver metastases from colorectal cancer (73%), neuro-endocrine tumors (15%), breast cancer (8%) and esophageal cancer (4%). All 26 tumors were successfully identified, punctured and ablated (a technical success rate of 100%). After a median follow-up of 9 months, primary and secondary LTP were 4% and 0%, respectively. No complications occurred. Conclusion: In this proof-of-concept study, the HepACAGA technique was successfully used to detect and ablate 100% of small liver metastases identified on DWI with a low recurrence rate and no complications. This technique enables the ablation of subcentimeter liver metastases detected on MRI.
目的：弥散加权成像（DWI）上表现为小高信号灶的肝转移瘤在治疗上存在挑战。由于这些病灶在超声和CT上常呈隐匿性，通常无法进行消融治疗。本前瞻性研究旨在评估通过肝动脉造影联合C臂CT引导消融技术（HepACAGA）能否成功定位并消融DWI检测到的小肝转移瘤（≤10毫米）。 材料与方法：研究纳入了2021年1月1日至2023年10月31日期间所有经DWI测量为小肝转移瘤（≤10毫米）并转诊接受HepACAGA消融的连续患者。排除再次消融及联合其他局部治疗的消融病例。主要结局指标为技术成功率，定义为术中通过HepACAGA成功检测并完成消融。次要结局指标包括原发性和继发性局部肿瘤进展率以及并发症发生率。 结果：共纳入15例患者（26个肿瘤），肝转移瘤原发灶包括结直肠癌（73%）、神经内分泌肿瘤（15%）、乳腺癌（8%）和食管癌（4%）。所有26个肿瘤均被成功识别、穿刺并消融（技术成功率100%）。中位随访9个月后，原发性和继发性局部肿瘤进展率分别为4%和0%。未发生并发症。 结论：在这项概念验证研究中，HepACAGA技术成功实现了对DWI检测到的小肝转移瘤100%的检出与消融，且复发率低、无并发症。该技术为MRI检出的亚厘米级肝转移瘤提供了可行的消融治疗方案。
肿瘤(癌症)患者之家