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Choi Y, Jeong YS, Hwang JS, Kim HC, Chung JW, Choi JW. C-Arm Computed Tomographic Image Fusion for Repetitive Transarterial Chemoembolization of Hepatocellular Carcinoma. J Comput Assist Tomogr 2023; 47:682-688. [PMID: 37707396 DOI: 10.1097/rct.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the potential implications of fusion imaging with C-arm computed tomography (CACT) scans for repetitive conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma. MATERIALS AND METHODS Fifty-six cTACE sessions were performed using fusion CACT images from September 2020 to June 2021 in a tertiary referral center, and the data were retrospectively analyzed. Fusion of unenhanced and enhanced CACT images was considered when previously accumulated iodized oil hampered the identification of local tumor progression or intrahepatic distant metastasis (indication A), when a tumor was supplied by multiple arteries with different origins from the aorta and missing tumor enhancement was suspected (indication B), or when iodized oil distribution on immediate post-cTACE CACT images needed to be precisely compared with the pre-cTACE images (indication C). Fusion image quality, initial tumor response, time to local progression (TTLP) of index tumors, and time to progression (TTP) were evaluated. RESULTS The fusion quality was satisfactory with a mean misregistration distance of 1.4 mm. For the 40 patients with indication A, the initial tumor responses at 3 months were nonviable, equivocal, and viable in 27 (67.5%), 4 (10.0%), and 9 (22.5%) index tumors, respectively. The median TTLP and TTP were 14.8 months and 4.5 months, respectively. For 10 patients with indication B, the median TTLP and TTP were 8.3 months and 2.6 months, respectively. Among the 6 patients with indication C, 2 patients were additionally treated at the same cTACE session after confirming incomplete iodized oil uptake on fusion imaging. CONCLUSIONS Fusion CACT images are useful in patients with hepatocellular carcinoma undergoing repetitive cTACE.
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Affiliation(s)
- Yelim Choi
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Singh BS, Cazacu IM, Deza CA, Rigaud BS, Saftoiu A, Gruionu G, Guionu L, Brock KK, Koay EJ, Herman JM, Bhutani MS. Image Fusion Involving Real-Time Transabdominal or Endoscopic Ultrasound for Gastrointestinal Malignancies: Review of Current and Future Applications. Diagnostics (Basel) 2022; 12:diagnostics12123218. [PMID: 36553225 PMCID: PMC9777678 DOI: 10.3390/diagnostics12123218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Image fusion of CT, MRI, and PET with endoscopic ultrasound and transabdominal ultrasound can be promising for GI malignancies as it has the potential to allow for a more precise lesion characterization with higher accuracy in tumor detection, staging, and interventional/image guidance. We conducted a literature review to identify the current possibilities of real-time image fusion involving US with a focus on clinical applications in the management of GI malignancies. Liver applications have been the most extensively investigated, either in experimental or commercially available systems. Real-time US fusion imaging of the liver is gaining more acceptance as it enables further diagnosis and interventional therapy of focal liver lesions that are difficult to visualize using conventional B-mode ultrasound. Clinical studies on EUS guided image fusion, to date, are limited. EUS-CT image fusion allowed for easier navigation and profiling of the target tumor and/or surrounding anatomical structure. Image fusion techniques encompassing multiple imaging modalities appear to be feasible and have been observed to increase visualization accuracy during interventional and diagnostic applications.
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Affiliation(s)
- Ben S. Singh
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Irina M. Cazacu
- Department of Oncology, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
| | - Carlos A. Deza
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bastien S. Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Adrian Saftoiu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Department of Gastroenterology, Ponderas Academic Hospital, 014142 Bucharest, Romania
| | - Gabriel Gruionu
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lucian Guionu
- Department of Mechanics, University of Craiova, 200585 Craiova, Romania
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joseph M. Herman
- Department of Radiation Medicine, Zucher School of Medicine, Hempstead, NY 11549, USA
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
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Choi MH, Choi JI, Lee YJ. Manual versus automated image fusion of real-time ultrasonography and MR/CT images for radiofrequency ablation of hepatic tumors: results of a randomized prospective trial (NCT02705118). Ultrasonography 2020; 40:237-247. [PMID: 32660211 PMCID: PMC7994745 DOI: 10.14366/usg.20052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/21/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study compared the technical parameters and clinical outcomes of manual and automatic image fusion techniques of ultrasonography and magnetic resonance imaging/computed tomography for radiofrequency ablation (RFA) of hepatic tumors. METHODS Seventy consecutive patients (male:female=47:23, 67.1±10.9 years old) who underwent RFA for hepatic tumors were prospectively enrolled and randomly assigned to the manual or automatic registration group. Two operators performed RFA with one of two imaging fusion techniques. Technical parameters (the registration error, time required for image registration, number of point registrations) and clinical outcomes (technical success, technical effectiveness, local tumor progression [LTP]-free survival, and progression-free survival [PFS]) were compared. RESULTS The automatic group contained 35 patients with hepatocellular carcinoma, while the manual group included 34 hepatocellular carcinoma patients and a patient with colon cancer liver metastasis. The registration error, time required for registration, and number of point registrations were 5.7±4.3 mm, 147.8±78.2 seconds, and 3.26±1.20 in the automatic group, and 6.3±5.0 mm, 150.3±89.7 seconds, and 3.20±1.13 in the manual group, respectively. The technical success and effectiveness rates were both 97.1% in the automatic group and both 100.0% in the manual group. The above differences were not significant. The LTP-free survival and PFS (28.3 and 21.2 months in the automatic group, and 29.0 and 24.9 months in the manual group, respectively) showed no significant between-group differences during a median 20.1-month follow-up period. CONCLUSION The technical parameters and clinical outcomes of automatic image fusion were not significantly different from those of manual image fusion for RFA of hepatic tumors.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute of the Catholic University of Korea, Seoul, Korea
| | - Joon-Il Choi
- Cancer Research Institute of the Catholic University of Korea, Seoul, Korea.,Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sanga K, Numata K, Nihonmatsu H, Ogushi K, Fukuda H, Chuma M, Hashimoto H, Koizumi N, Maeda S. Use of intra-procedural fusion imaging combining contrast-enhanced ultrasound using a perflubutane-based contrast agent and auto sweep three-dimensional ultrasound for guiding radiofrequency ablation and evaluating its efficacy in patients with hepatocellular carcinoma. Int J Hyperthermia 2020; 37:202-211. [DOI: 10.1080/02656736.2020.1729422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Katsuyuki Sanga
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiromi Nihonmatsu
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuaki Ogushi
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Hashimoto
- Ultrasound Systems Engineering, GE Healthcare Japan Corporation, Hino-shi, Japan
| | - Norihiro Koizumi
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, School of Informatics and Engineering, The University of Electro-Communications, Choufu-shi, Japan
| | - Shin Maeda
- Department of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Kang TW, Lee MW, Cha DI, Park HJ, Park JS, Bang WC, Kim SW. Usefulness of Virtual Expiratory CT Images to Compensate for Respiratory Liver Motion in Ultrasound/CT Image Fusion: A Prospective Study in Patients with Focal Hepatic Lesions. Korean J Radiol 2019; 20:225-235. [PMID: 30672162 PMCID: PMC6342754 DOI: 10.3348/kjr.2018.0320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To assess whether virtual expiratory (VE)-computed tomography (CT)/ultrasound (US) fusion imaging is more effective than conventional inspiratory (CI)-CT/US fusion imaging for hepatic interventional procedures. Materials and Methods This prospective study was approved by the Institutional Review Board, and informed consent was obtained from each patient. In total, 62 patients with focal hepatic lesions referred for hepatic interventional procedures were enrolled. VE-CT images were generated from CI-CT images to reduce the effects of respiration-induced liver motion. The two types of CT images were fused with real-time US images for each patient. The operators scored the visual similarity with the liver anatomy upon initial image fusion and the summative usability of complete image fusion using the respective five-point scales. The time required for complete image fusion and the number of point locks used were also compared. Results In comparison with CI-CT/US fusion imaging, VE-CT/US fusion imaging showed significantly higher visual similarity with the liver anatomy on the initial image fusion (mean score, 3.9 vs. 1.7; p < 0.001) and higher summative usability for complete image fusion (mean score, 4.0 vs. 1.9; p < 0.001). The required time (mean, 11.1 seconds vs. 22.5 seconds; p < 0.001) and the number of point locks (mean, 1.6 vs. 3.0; p < 0.001) needed for complete image fusion using VE-CT/US fusion imaging were significantly lower than those needed for CI-CT/US fusion imaging. Conclusion VE-CT/US fusion imaging is more effective than CI-CT/US fusion imaging for hepatic interventional procedures.
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jung Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jun Sung Park
- Medical Imaging R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Seoul, Korea
| | - Won Chul Bang
- Medical Imaging R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Seoul, Korea
| | - Seon Woo Kim
- Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
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Chang W, Lee JM, Lee DH, Yoon JH, Kim YJ, Yoon JH, Han JK. Comparison of switching bipolar ablation with multiple cooled wet electrodes and switching monopolar ablation with separable clustered electrode in treatment of small hepatocellular carcinoma: A randomized controlled trial. PLoS One 2018; 13:e0192173. [PMID: 29420589 PMCID: PMC5805261 DOI: 10.1371/journal.pone.0192173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/16/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE A randomized controlled trial was conducted to prospectively compare the therapeutic effectiveness of switching bipolar (SB) radiofrequency ablation (RFA) using cooled-wet electrodes and switching monopolar (SM) RFA using separable clustered (SC) electrodes in patients with hepatocellular carcinomas (HCCs). MATERIALS AND METHODS This prospective study was approved by our Institutional Review Board. Between April 2014 and January 2015, sixty-nine patients with 74 HCCs were randomly treated with RFA using either internally cooled-wet (ICW) electrodes in SB mode (SB-RFA, n = 36) or SC electrodes in SM mode (SM-RFA, n = 38). Technical parameters including the number of ablations, ablation time, volume, energy delivery, and complications were evaluated. Thereafter, 1-year and 2-year local tumor progression (LTP) free survival rates were compared between the two groups using the Kaplan-Meier method. RESULTS In the SB-RFA group, less number of ablations were required (1.72±0.70 vs. 2.31±1.37, P = 0.039), the ablation time was shorter (10.9±3.9 vs.14.3±5.0 min, p = 0.004), and energy delivery was smaller (13.1±6.3 vs.23.4±12.8 kcal, p<0.001) compared to SM-RFA. Ablation volume was not significantly different between SB-RFA and SM-RFA groups (61.8±24.3 vs.54.9±23.7 cm3, p = 0.229). Technical failure occurred in one patient in the SM-RFA group, and major complications occurred in one patient in each group. The 1-year and 2-year LTP free survival rates were 93.9% and 84.3% in the SB-RFA group and 94.4% and 88.4% in the SM-RFA group (p = 0.687). CONCLUSION Both SB-RFA using ICW electrodes and SM-RFA using SC electrodes provided comparable LTP free survival rates although SB-RFA required less ablations and shorter ablation time.
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Affiliation(s)
- Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
- * E-mail:
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Yoon Jun Kim
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Jung Hwan Yoon
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
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Mechanism of accommodation assessed by change in precisely registered ocular images associated with concurrent change in auto-refraction. Graefes Arch Clin Exp Ophthalmol 2017; 256:395-402. [PMID: 29147767 DOI: 10.1007/s00417-017-3843-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/27/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Our purpose was to determine the changes in anterior chamber depth (ACD) and central lens thickness (CLT) during pharmacologically induced accommodation. METHODS Following pupillary dilation with phenylephrine 10%, baseline auto-refractions and swept-source optical coherence tomographic biometric images (Zeiss IOLMaster 700) were obtained from the right eyes of 25 subjects aged 19 to 24 years. Pilocarpine 4% and phenylephrine 10% were then instilled into these right eyes. One hour later, auto-refractions and biometric imaging were repeated. Only data from eight of 25 subjects met the following stringent criteria to be included in the study analysis: pre and post-pilocarpine biometric foveal images were registerable, the images of the corneal centers were shifted by ≤100 μm, pupils >5 mm and the pharmacologically induced refractive change was ≥ -7 diopters. RESULTS The mean auto-refractive accommodative change for the eight included subjects was -12.45 diopters (± 3.45 diopters). The mean change in CLT was 81 μm (± 54 μm) and the mean change in ACD was -145 μm (± 86 μm). Superimposition of the registered pre and post-pilocarpine biometric images of the sagittal sections of the whole eye from each subject demonstrated that the position of the whole lens did not shift either anteriorly, posteriorly or vertically during pharmacologically induced accommodation. CONCLUSIONS A small increase in lens thickness was associated with a large change in accommodative amplitude and no significant change in lens position as predicted by the Schachar theory.
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Schachar RA, Mani M, Schachar IH. Image registration reveals central lens thickness minimally increases during accommodation. Clin Ophthalmol 2017; 11:1625-1636. [PMID: 28979092 PMCID: PMC5602687 DOI: 10.2147/opth.s144238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate anterior chamber depth, central crystalline lens thickness and lens curvature during accommodation. Setting California Retina Associates, El Centro, CA, USA. Design Healthy volunteer, prospective, clinical research swept-source optical coherence biometric image registration study of accommodation. Methods Ten subjects (4 females and 6 males) with an average age of 22.5 years (range: 20–26 years) participated in the study. A 45° beam splitter attached to a Zeiss IOLMaster 700 (Carl Zeiss Meditec Inc., Jena, Germany) biometer enabled simultaneous imaging of the cornea, anterior chamber, entire central crystalline lens and fovea in the dilated right eyes of subjects before, and during focus on a target 11 cm from the cornea. Images with superimposable foveal images, obtained before and during accommodation, that met all of the predetermined alignment criteria were selected for comparison. This registration requirement assured that changes in anterior chamber depth and central lens thickness could be accurately and reliably measured. The lens radii of curvatures were measured with a pixel stick circle. Results Images from only 3 of 10 subjects met the predetermined criteria for registration. Mean anterior chamber depth decreased, −67 μm (range: −0.40 to −110 μm), and mean central lens thickness increased, 117 μm (range: 100–130 μm). The lens surfaces steepened, anterior greater than posterior, while the lens, itself, did not move or shift its position as appeared from the lack of movement of the lens nucleus, during 7.8 diopters of accommodation, (range: 6.6–9.7 diopters). Conclusion Image registration, with stable invariant references for image correspondence, reveals that during accommodation a large increase in lens surface curvatures is associated with only a small increase in central lens thickness and no change in lens position.
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Affiliation(s)
- Ronald A Schachar
- Department of Physics, University of Texas at Arlington, Arlington, TX
| | | | - Ira H Schachar
- Byers Eye Institute of Stanford University, Palo Alto, CA, USA
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Comparison Between CT and MR Images as More Favorable Reference Data Sets for Fusion Imaging-Guided Radiofrequency Ablation or Biopsy of Hepatic Lesions: A Prospective Study with Focus on Patient's Respiration. Cardiovasc Intervent Radiol 2017; 40:1567-1575. [PMID: 28462444 DOI: 10.1007/s00270-017-1666-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/22/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify the more accurate reference data sets for fusion imaging-guided radiofrequency ablation or biopsy of hepatic lesions between computed tomography (CT) and magnetic resonance (MR) images. MATERIALS AND METHODS This study was approved by the institutional review board, and written informed consent was received from all patients. Twelve consecutive patients who were referred to assess the feasibility of radiofrequency ablation or biopsy were enrolled. Automatic registration using CT and MR images was performed in each patient. Registration errors during optimal and opposite respiratory phases, time required for image fusion and number of point locks used were compared using the Wilcoxon signed-rank test. RESULTS The registration errors during optimal respiratory phase were not significantly different between image fusion using CT and MR images as reference data sets (p = 0.969). During opposite respiratory phase, the registration error was smaller with MR images than CT (p = 0.028). The time and the number of points locks needed for complete image fusion were not significantly different between CT and MR images (p = 0.328 and p = 0.317, respectively). CONCLUSION MR images would be more suitable as the reference data set for fusion imaging-guided procedures of focal hepatic lesions than CT images.
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