Intraprocedural Ablation Margin Assessment by Using Ammonia Perfusion PET during FDG PET/CT–guided Liver Tumor Ablation: A Pilot Study

Purpose To prospectively determine whether nitrogen 13 (13N) ammonia perfusion positron emission tomography (PET) during fluorine 18 fluorodeoxyglucose (FDG) PET/computed tomography (CT)–guided liver tumor ablation can be used to intraprocedurally assess ablation margins. Materials and Methods Eight patients (five women and three men; age range, 36–74 years; mean age, 57 years) were enrolled in this pilot study and underwent FDG PET/CT–guided microwave ablation of 11 FDG-avid liver metastases (mean diameter, 22 mm; range, 11–34 mm). All procedures were performed between March 2014 and December 2016. Complete ablation margin visibility and minimum ablation margin thickness were assessed by using intraprocedural 13N-ammonia perfusion PET compared with 24-hour postprocedural MR imaging by two independent blinded radiologists. Local tumor progression for each ablated tumor was assessed at follow-up imaging for 3–38 months (median, 17.6 months). Descriptive analysis was performed. Results Eleven of 11 (100%) ablation margins were fully assessable by using intraprocedural perfusion PET by both readers; six of eleven (55%) margins were fully assessable by both readers at postprocedural 24-hour MR imaging. By using perfusion PET, one tumor that had been judged by both readers to have a minimum margin of 0 mm progressed locally. No tumors judged to have a minimum margin greater than 0 mm at perfusion PET progressed locally. Conclusion 13N-ammonia perfusion PET during FDG PET/CT–guided liver tumor ablations can potentially be used to intraprocedurally assess the entire ablation margin, including the minimum margin. © RSNA, 2018