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Ablative margin quantification using deformable versus rigid image registration in colorectal liver metastasis thermal ablation: a retrospective single-center study

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the correlation of minimal ablative margin (MAM) quantification using biomechanical deformable (DIR) versus intensity-based rigid image registration (RIR) with local outcomes following colorectal liver metastasis (CLM) thermal ablation.

Methods

This retrospective single-institution study included consecutive patients undergoing thermal ablation between May 2016 and October 2021. Patients who did not have intraprocedural pre- and post-ablation contrast-enhanced CT images for MAM quantification or follow-up period less than 1 year without residual tumor or local tumor progression (LTP) were excluded. DIR and RIR methods were used to quantify the MAM. The registration accuracy was compared using Dice similarity coefficient (DSC). Area under the receiver operating characteristic curve (AUC) was used to test MAM in predicting local tumor outcomes.

Results

A total of 72 patients (mean age 57; 44 men) with 139 tumors (mean diameter 1.5 cm ± 0.8 (SD)) were included. During a median follow-up of 29.4 months, there was one residual unablated tumor and the LTP rate was 17% (24/138). The ranges of DSC were 0.96–0.98 and 0.67–0.98 for DIR and RIR, respectively (p < 0.001). When using DIR, 27 (19%) tumors were partially or totally registered outside the liver, compared to 46 (33%) with RIR. Using DIR versus RIR, the corresponding median MAM was 4.7 mm versus 4.0 mm, respectively (p = 0.5). The AUC in predicting residual tumor and 1-year LTP for DIR versus RIR was 0.89 versus 0.72, respectively (p < 0.001).

Conclusion

Ablative margin quantified on intra-procedural CT imaging using DIR method outperformed RIR for predicting local outcomes of CLM thermal ablation.

Clinical relevance statement

The study supports the role of biomechanical deformable image registration as the preferred image registration method over rigid image registration for quantifying minimal ablative margins using intraprocedural contrast-enhanced CT images.

Key Points

• Accurate and reproducible image registration is a prerequisite for clinical application of image-based ablation confirmation methods.

• When compared to intensity-based rigid image registration, biomechanical deformable image registration for minimal ablative margin quantification was more accurate for liver registration using intraprocedural contrast-enhanced CT images.

• Biomechanical deformable image registration outperformed intensity-based rigid image registration for predicting local tumor outcomes following colorectal liver metastasis thermal ablation.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence interval

CLM:

Colorectal liver metastasis

DIR:

Deformable image registration

LTP:

Local tumor progression

MAM:

Minimal ablative margin

RIR:

Rigid image registration

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Funding

This study has received funding by National Institutes of Health-National Cancer Institute (R01CA235564, R01CA221971, P30CA016672).

Iwan Paolucci was supported by a Postdoc.Mobility Fellowship from the Swiss National Science Foundation (P2BEP3_195444).

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Yuan-Mao Lin, Iwan Paolucci, Jessica Albuquerque Marques Silva, Ketan Y. Shah, Mohamed E. Abdelsalam, Peiman Habibollahi & Bruno C. Odisio

  2. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Caleb S. O’Connor, Jun Hong, Kyle A. Jones & Kristy K. Brock

Authors
  1. Yuan-Mao Lin
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  2. Iwan Paolucci
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  3. Jessica Albuquerque Marques Silva
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  4. Caleb S. O’Connor
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  5. Jun Hong
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  6. Ketan Y. Shah
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  9. Kyle A. Jones
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  10. Kristy K. Brock
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  11. Bruno C. Odisio
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Corresponding author

Correspondence to Bruno C. Odisio.

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Guarantor

The scientific guarantor of this publication is Dr. Bruno C. Odisio.

Conflict of interest

Kristy K.Brock: Grants from the National Institutes of Health and RaySearch Laboratories; licensing agreement with RaySearch Laboratories; travel support from The American Association of Physicists in Medicine; patents planned, issued, or pending; advisory board, RaySearch Laboratories.

Bruno C.Odisio: Research grants from Siemens Healthineers and Johnson & Johnson; consulting fees from Siemens Healthineers.

Statistics and biometry

One of the authors (Iwan Paolucci) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Forty patients (29%) in the current study cohort overlap with a previous study reported in Radiology (doi: https://doi.org/10.1148/radiol.221373).

Methodology

• retrospective

• observational

• performed at one institution

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Lin, YM., Paolucci, I., Albuquerque Marques Silva, J. et al. Ablative margin quantification using deformable versus rigid image registration in colorectal liver metastasis thermal ablation: a retrospective single-center study. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10632-8

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  • DOI: https://doi.org/10.1007/s00330-024-10632-8

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