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Open Access Highly Accessed Study protocol

The use of PET-MRI in the follow-up after radiofrequency- and microwave ablation of colorectal liver metastases

Karin Nielsen1, Hester J Scheffer2, Indra C Pieters2, Aukje AJM van Tilborg2, Jan-Hein TM van Waesberghe2, Daniela E Oprea-Lager2, Martijn R Meijerink2, Geert Kazemier1, Otto S Hoekstra2, Hermien WH Schreurs3, Colin Sietses4, Sybren Meijer1, Emile FI Comans2 and Petrousjka MP van den Tol1*

Author Affiliations

1 Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

2 Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

3 Department of Surgery, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands

4 Department of Surgery, Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands

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BMC Medical Imaging 2014, 14:27  doi:10.1186/1471-2342-14-27

Published: 8 August 2014

Abstract

Background

Thermal ablation of colorectal liver metastases (CRLM) may result in local progression, which generally appear within a year of treatment. As the timely diagnosis of this progression allows potentially curative local treatment, an optimal follow-up imaging strategy is essential. PET-MRI is a one potential imaging modality, combining the advantages of PET and MRI. The aim of this study is evaluate fluorine-18 deoxyglucose positron emission tomography (FDG) PET-MRI as a modality for detection of local tumor progression during the first year following thermal ablation, as compared to the current standard, FDG PET-CT. The ability of FDG PET-MRI to detect new intrahepatic lesions, and the extent to which FDG PET-MRI alters clinical management, inter-observer variability and patient preference will also be included as secondary outcomes.

Methods/Design

Twenty patients undergoing treatment with radiofrequency or microwave ablation for (recurrent) CRLM will be included in this prospective trial. During the first year of follow-up, patients will be scanned at the VU University Medical Center at 3-monthly intervals using a 4-phase liver CT, FDG PET-CT and FDG PET-MRI. Patients treated with chemotherapy <6 weeks prior to scanning or with a contra-indication for MRI will be excluded. MRI will be performed using both whole body imaging (mDixon) and dedicated liver sequences, including diffusion-weighted imaging, T1 in-phase and opposed-phase, T2 and dynamic contrast-enhanced imaging. The results of all modalities will be scored by 4 individual reviewers and inter-observer agreement will be determined. The reference standard will be histology or clinical follow-up. A questionnaire regarding patients’ experience with both modalities will also be completed at the end of the follow-up year.

Discussion

Improved treatment options for local site recurrences following CRLM ablation mean that accurate post-ablation staging is becoming increasingly important. The combination of the sensitivity of MRI as a detection method for small intrahepatic lesions with the ability of FDG PET to visualize enhanced metabolism at the ablation site suggests that FDG PET-MRI could potentially improve the accuracy of (early) detection of progressive disease, and thus allow swifter and more effective decision-making regarding appropriate treatment.

Trial registration

Trial registration number: NCT01895673

Keywords:
Radiofrequency ablation; Liver neoplasms/secondary; Neoplasm recurrence; Local; Liver neoplasms/surgery; FDG-PET; PET-MRI; Magnetic resonance imaging/methods; Microwave ablation