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Optimizing microwave ablation planning with the ablation success ratio.

Christina A Neizert1, Hoang N C Do2, Miriam Zibell3

  • 1Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. christina.neizert@charite.de.

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Summary

A new Ablation Success Ratio (ASR) model predicts hepatic microwave ablation (MWA) success. The ASR accounts for liver vessel cooling, improving prediction accuracy for MWA procedures.

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Area of Science:

  • Hepatobiliary Surgery
  • Minimally Invasive Oncology
  • Medical Physics

Background:

  • Hepatic microwave ablation (MWA) efficacy is challenged by unpredictable tumor size reduction due to localized vascular cooling.
  • Accurate prediction of MWA outcomes is crucial for effective liver tumor treatment planning.
  • Existing models often do not fully incorporate the significant impact of hepatic vasculature on ablation zones.

Purpose of the Study:

  • To introduce and validate a simplified predictive model, the Ablation Success Ratio (ASR), for hepatic MWA.
  • To assess the ASR's ability to predict successful ablation outcomes considering vascular cooling effects.
  • To establish a reliable metric for estimating the minimum ablation radius (r3Dmin) in the presence of simulated vascular flow.

Main Methods:

  • Development of the ASR model based on the three-dimensional minimum ablation radius (r3Dmin).
  • Standardized MWAs (100 W, 5 min) performed on an ex vivo porcine liver model (n=148).
  • Simulation of vascular cooling effects using a glass tube with varying flow rates (0-500 ml/min) and antenna-to-vessel distances (2.5-10.0 mm).

Main Results:

  • The ASR model accurately predicted ablation success across different simulated vascular cooling conditions.
  • Without cooling, 100% ASR was achieved for ablation diameters up to 20 mm.
  • With simulated vascular cooling, 100% ASR was limited to ablation diameters up to 12 mm, demonstrating the model's sensitivity to cooling effects.

Conclusions:

  • The Ablation Success Ratio (ASR) is a promising, simplified model for predicting hepatic MWA success.
  • The ASR effectively integrates the impact of liver vascular cooling on ablation zone size.
  • This model offers a valuable tool for improving the predictability and clinical success of hepatic MWA procedures.