title: Comparison of simulation-based treatment planning with imaging and pathology outcomes for percutaneous CT-guided irreversible electroporation of the porcine pancreas: a pilot study.
abstract: OBJECTIVE
  To investigate the reliability of simulations for planning pancreatic irreversible electroporation (IRE) ablations compared with computed tomography (CT) and pathology outcomes in an animal model.
  
  
  METHODS
  Simulations were performed varying treatment parameters, including field strength (1.5-2.5 kV/cm), pulse number (70-90 pulses), and pulse length (70-100 µs). Pancreatic IRE was performed in six pigs under CT guidance. Two animals each were sacrificed for histology after 1 day, 14 days, and 28 days. Follow-up CT scans were performed on day 0, day 1, day 14, and day 28. Biochemical markers were collected before the procedure, 1 day after the procedure, and 14 days after the procedure.
  
  
  RESULTS
  All ablation zones could be visualized on CT scan immediately after the procedure and on day 1 follow-up CT scan, and all animals survived until the designated endpoints. Histopathology revealed necrosis and edema on day 1 and fibrosis and glandular atrophy after 28 days. Blood vessels close to the ablation zone appeared normal. Laboratory analysis indicated mild to moderate amylasemia and lipasemia with normalization after 14 days. The ablation size on CT scan measured a mean (± SD) 146% ± 18 (day 0, P < .126) and 168% ± 18 (day 1, P < .026) of the simulation and on pathology measured 119% ± 10 (day 1, not significant) of the simulation.
  
  
  CONCLUSIONS
  Results from simulations for planning IRE ablations, CT, and pathology may differ from each other. Ablation zones on CT and pathology appear larger than simulated, suggesting that clinically used treatment planning may underestimate the ablation size in the pancreas.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, The Rockefeller University, 444 East 68th Street, New York, NY 10065; Department of Radiology, Medical University of Graz, Graz, Austria. Electronic address: thomas.wimmer@medunigraz.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wimmer
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Srimathveeravalli
authors.forename: Narendra
authors.initials: N
authors.lastname: Gutta
authors.forename: Paula C
authors.initials: PC
authors.lastname: Ezell
authors.forename: Sebastien
authors.initials: S
authors.lastname: Monette
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Majid
authors.initials: M
authors.lastname: Maybody
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Durack
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D055011:Ablation Techniques; D000818:Animals; D015415:Biomarkers / Q000097:blood; D003198:Computer Simulation; D018274:Electroporation; D004798:Enzymes / Q000097:blood; D023421:Models, Animal; D009716:Numerical Analysis, Computer-Assisted; D010179:Pancreas / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D015641:Radiography, Interventional / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D004798:Enzymes
keywords: AST; IRE; LDH; aspartate transaminase; irreversible electroporation; lactate dehydrogenase