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Rieder C, Schwenke M, Pätz T, Georgii J, Ballhausen H, Schwen LO, Haase S, Preusser T. Evaluation of a numerical simulation for cryoablation - comparison with bench data, clinical kidney and lung cases. Int J Hyperthermia 2021; 37:1268-1278. [PMID: 33198534 DOI: 10.1080/02656736.2020.1845402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The accuracy of a numerical simulation of cryoablation ice balls was evaluated in gel phantom data as well as clinical kidney and lung cases. MATERIALS AND METHODS To evaluate the accuracy, 64 experimental single-needle cryoablations and 12 multi-needle cryoablations in gel phantoms were re-simulated with the corresponding freeze-thaw-freeze cycles. The simulated temperatures were compared over time with the measurements of thermocouples. For single needles, temperature values were compared at each thermocouple location. For multiple needles, Euclidean distances between simulated and measured isotherms (10 °C, 0 °C, -20 °C, -40 °C) were computed. Furthermore, surface and volume of simulated 0 °C isotherms were compared to cryoablation-induced ice balls in 14 kidney and 13 lung patients. For this purpose, needle positions and relevant anatomical structures defining material parameters (kidney/lung, tumor) were reconstructed from pre-ablation CT images and fused with postablation CT images (from which ice balls were extracted by manual delineation). RESULTS The single-needle gel phantom cases showed less than 5 °C prediction error on average. Over all multiple needle experiments in gel, the mean and maximum isotherm distance were less than 2.3 mm and 4.1 mm, respectively. Average Dice coefficients of 0.82/0.63 (kidney/lung) and mean surface distances of 2.59/3.12 mm quantify the prediction performance of the numerical simulation. However, maximum surface distances of 10.57/10.8 mm indicate that locally larger errors have to be expected. CONCLUSION A very good agreement of the numerical simulations for gel experiments was measured and a satisfactory agreement of the numerical simulations with measured ice balls in patient data was shown.
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Affiliation(s)
- Christian Rieder
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Michael Schwenke
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Torben Pätz
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Joachim Georgii
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Hanne Ballhausen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Lars Ole Schwen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Sabrina Haase
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Tobias Preusser
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
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Post-ablation syndrome after percutaneous cryoablation of small renal tumors: A prospective study of incidence, severity, duration, and effect on lifestyle. Eur J Radiol 2020; 122:108750. [DOI: 10.1016/j.ejrad.2019.108750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 12/19/2022]
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Abstract
OBJECTIVE Imaging plays a key role in the assessment of patients before, during, and after percutaneous cryoablation of hepatic tumors. Intra-procedural and early post-procedure imaging with CT and MRI is vital to the assessment of technical success including adequacy of ablation zone coverage. Recognition of the normal expected post-procedure findings of hepatic cryoablation such as ice ball formation, hydrodissection, and the normal appearance of the ablation zone is crucial to be able to differentiate from complications including vascular, biliary, or non-target organ injury. Delayed imaging is essential for determination of clinical effectiveness and detection of unexpected findings such as residual unablated tumor and local tumor progression. The purpose of this article is to review the spectrum of expected and unexpected imaging findings that may occur during or after percutaneous cryoablation of hepatic tumors. CONCLUSION Differentiating expected from unexpected findings during and after hepatic cryoablation helps radiologists identify residual or recurrent tumor and detect procedure-related complications.
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Pulmonary Cryoablation Zones: More Aggressive Ablation Is Warranted In Vivo. AJR Am J Roentgenol 2019; 212:195-200. [DOI: 10.2214/ajr.18.19527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Expanding the borders: Image-guided procedures for the treatment of musculoskeletal tumors. Diagn Interv Imaging 2017; 98:635-644. [DOI: 10.1016/j.diii.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
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Shah TT, Arbel U, Foss S, Zachman A, Rodney S, Ahmed HU, Arya M. Modeling Cryotherapy Ice Ball Dimensions and Isotherms in a Novel Gel-based Model to Determine Optimal Cryo-needle Configurations and Settings for Potential Use in Clinical Practice. Urology 2016; 91:234-40. [PMID: 26902833 PMCID: PMC4850244 DOI: 10.1016/j.urology.2016.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/18/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
Objective To gain a better understanding of ice ball dimensions and temperature isotherms relevant for cell kill when using combinations of cryo-needles we set out to answer 4 questions: (1) what type of cryo-needle? (2) how many needles? (3) best spatial configuration? and (4) correct duty cycle percentage? Methods We conducted laboratory experiments to monitor ice ball dimensions and create multi-needle planar isotherm maps for 17G and 10G cryo-needles using a novel multi-needle thermocouple fixture within gel at body temperature. We tested configurations of 1-4 cryo-needles at duty cycles of 20%-100% with 1-2.5 cm spacing. Results Analysis of various combinations shows that a central core of ≤−40°C develops at a distance of ~1 cm around the cryo-needles. Temperature increases linearly from this point to the ice ball leading edge (0°C), which is a further ≈1 cm away. Thus, the −40°C isotherm is approximately 1 cm inside the leading edge of the ice ball. The optimum distance between cryo-needles was 1.5-2 cm, at duty cycle settings of 70%-100%. At distances further apart or with lower duty cycle settings, ice balls either had a central core >−40°C or had an hourglass shape. Conclusion In answer to questions 1-3, tumor length, diameter, and shape will ultimately determine the number of needles and their configuration. However, we propose a conservative distance for cryo-needle placement between 1 and 1.5 cm should be adopted for clinical practice. In answer to question 4, using low duty cycle settings runs the risk of incomplete −40°C isotherm coverage of the tumor, and thus in routine practice we suggest that settings of 70%-100% are most appropriate.
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Affiliation(s)
- Taimur T Shah
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Whittington Hospital, London, UK.
| | | | | | | | - Simon Rodney
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manit Arya
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Princess Alexandra Hospital NHS Trust, Harlow, UK
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Hyodoh H, Ogura K, Sugimoto M, Suzuki Y, Kanazawa A, Murakami R, Shimizu J, Rokukawa M, Okazaki S, Mizuo K, Watanabe S. Frozen (iced) effect on postmortem CT – Experimental evaluation. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jofri.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Johnson A, Brace C. Heat transfer within hydrodissection fluids: An analysis of thermal conduction and convection using liquid and gel materials. Int J Hyperthermia 2015; 31:551-9. [DOI: 10.3109/02656736.2015.1037799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Alexander Johnson
- Department of Biomedical Engineering and Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Christopher Brace
- Department of Biomedical Engineering and Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
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Johnson A, Sprangers A, Cassidy P, Heyrman S, Hinshaw JL, Lubner M, Puccinelli J, Brace C. Design and validation of a thermoreversible material for percutaneous tissue hydrodissection. J Biomed Mater Res B Appl Biomater 2014; 101:1400-9. [PMID: 24591222 DOI: 10.1002/jbm.b.32959] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 03/14/2013] [Accepted: 03/27/2013] [Indexed: 12/21/2022]
Abstract
Interventional oncology procedures such as thermal ablation are becoming routine for many cancers. Hydrodissection-separating tissues with fluids-protects tissues near the treatment zone to improve ablation's safety and facilitate more aggressive treatments. However, currently used fluids such as normal saline and 5% dextrose in water (D5W) migrate in the peritoneum, reducing their protective efficacy. As a hydrodissection alternative, we investigated a thermoreversible poloxamer 407 (P407) solution. Such a material can be injected as a liquid which then forms a semi-solid gel at body temperature without syneresis. The desired gelation temperature of 32°C was achieved with 15.4 wt/wt % P407. Viscosity analysis revealed the lowest viscosity and ideal injection point was at 14°C. Solution viscosity increased during gelation, to a peak of 65 kPa*s at 40°C. The electrical impedance of P407 was significantly greater than isotonic saline, but lower than D5W, indicating its potential for electrical protection. The P407 gel was similar to other hydrodissection fluids at ultrasound and CT imaging. Ex vivo liver ablations showed that P407 protects neighboring tissues, but may require a thicker barrier for comparable protection to D5W. Overall, we found that the P407 solution is a feasible alternative to traditional hydrodissection fluids and warrants additional study.
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Affiliation(s)
- Alexander Johnson
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin; Department of Radiology, University of Wisconsin, Madison, Wisconsin
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Abstract
Owing to an increased use of diagnostic imaging for evaluating patients with other abdominal conditions, incidentally discovered kidney masses now account for a majority of renal tumors. Renal ablative therapy is assuming a more important role in patients with borderline renal impairment. Renal ablation uses heat or cold to bring about cell death. Radiofrequency ablation and cryoablation are two such procedures, and 5-year results are now emerging from both modalities. Renal biopsy at the time of ablation is extremely important in order to establish tissue diagnosis. Real-time temperature monitoring at the time of radiofrequency ablation is very useful to ensure adequacy of ablation.
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Affiliation(s)
- Rajan Ramanathan
- Division of Endourology, Laparoscopy and Minimally Invasive Surgery, Department of Urology, Jackson Memorial Hospital, University of Miami School of Medicine, Miami, FL, USA
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Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications. AJR Am J Roentgenol 2011; 196:935-9. [PMID: 21427348 DOI: 10.2214/ajr.10.5182] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of collecting system and hemorrhagic complications resulting from CT-guided percutaneous cryoablation of renal tumors in which the radiographic ice ball abuts or involves the renal sinus. MATERIALS AND METHODS From November 2005 through July 2009 at our institution, we performed 129 CT-guided percutaneous cryoablation procedures on 107 patients (mean age, 64 years) with renal masses suspicious of being renal cell carcinoma. Radiographic ice balls that abutted or overlapped the renal sinus were classified as central; the other lesions were classified as noncentral. Medical records and follow-up images were retrospectively reviewed for hemorrhage requiring intervention and for evidence of collecting system injury. The mean follow-up period was 9.3 months. RESULTS The radiographic ice ball was classified as central in 67 cases. In these central ablations, the mean sinus involvement was 6.2 mm (range, 0-19 mm), 41 ice balls overlapping the renal sinus by 6 mm or more (mean, 9.4 mm). No cases of collecting system injury were identified for any ablation. Overall, there was only one hemorrhagic complication requiring intervention, and it occurred in a noncentral ablation. CONCLUSION CT-guided percutaneous cryoablation of renal masses with ice ball overlap of the renal sinus resulted in no cases of collecting system injury or serious hemorrhagic complications in our series.
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Novel application of percutaneous cryotherapy for the treatment of recurrent oral bleeding from a noninvoluting congenital hemangioma involving the right buccal space and maxillary tuberosity. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S277-81. [PMID: 20593285 DOI: 10.1007/s00270-010-9931-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 05/28/2010] [Indexed: 10/19/2022]
Abstract
Cryotherapy is the application of varying extremes of cold temperatures to destroy abnormal tissue. The intent of this article is to describe a novel technique using percutaneous cryotherapy for treating a noninvoluting congenital craniofacial hemangioma (NICH). An 18-year-old woman with type 1 von Willebrand's disease, as well as a qualitative platelet aggregation disorder, presented with multiple recurrent episodes of oral bleeding from a NICH involving the right buccal space and maxillary tuberosity. The patient was initially treated with a combination of endovascular particulate embolization, percutaneous sclerotherapy, tissue cauterization, and laser therapy between the ages of 4 and 8 years of age. At 18 years of age, the patient presented with recurrent episodes of oral bleeding related to the NICH. Endovascular embolization was performed using particulate and a liquid embolic agent with limited success. Due to the refractory nature of this bleeding, the patient underwent successful lesion ablation using percutaneous cryotherapy. At 9-month follow-up, the patient is asymptomatic with no episodes of recurrent bleeding.
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Blezek DJ, Carlson DG, Cheng LT, Christensen JA, Callstrom MR, Erickson BJ. Cell accelerated cryoablation simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2010; 98:241-252. [PMID: 19854531 DOI: 10.1016/j.cmpb.2009.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 08/17/2009] [Accepted: 09/03/2009] [Indexed: 05/28/2023]
Abstract
Tumor cryoablation is a clinical procedure where supercooled probes are used to destroy cancerous lesions. Cryoablation is a safe and effective palliative treatment for skeletal metastases, providing immediate and long term pain relief, increasing mobility and improving quality of life. Ideally, lesions are encompassed by an ice ball and frozen to a sufficiently low temperature to ensure cell death. "Lethal ice" is the term used to describe regions within the ice ball where cell death occurs. Failure to achieve lethal ice in all portions of a lesion may explain the high recurrence rate currently observed. Tracking growth of lethal ice is critical to success of percutaneous ablations, however, no practical methods currently exist for non-invasive temperature monitoring. Physicians lack planning tools which provide accurate estimation of the ice formation. Simulation of ice formation, while possible, is computationally demanding and too time consuming to be of clinical utility. We developed the computational framework for the simulation, acceleration strategies for multicore Intel x86 and IBM Cell architectures, and performed preliminary validation of the simulation. Our results demonstrate that the streaming SIMD implementation has better performance and scalability. Both accelerated and non-accelerated algorithms demonstrate good agreement between simulation and manually identified ice ball boundaries in phantom and patient images. Our results show promise for the development of novel cryoablation planning tools with real-time monitoring capability for clinical use.
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Affiliation(s)
- Daniel J Blezek
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
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Affiliation(s)
- Jennifer L. Young
- Department of Urology, University of California Irvine, Orange, California
| | - Ralph V. Clayman
- Department of Urology, University of California Irvine, Orange, California
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Abstract
PURPOSE OF REVIEW To review the evolution and current status of cryoablation for renal tumors. RECENT FINDINGS Cryoablation is the most evaluated probe ablative method for the treatment of small renal masses. It is associated with high efficacy and low morbidity. New data on intermediate and long-term oncological outcomes are now available. Five and 10-year cancer-specific survival are 93 and 81%, respectively. Renal cryoablation is most commonly performed percutaneously or laparoscopically. Recently, single-port laparoscopic and natural orifice transluminal endoscopic surgery approaches have also been employed for renal cryotherapy. SUMMARY With careful patient selection, the intermediate-term and long-term oncologic outcomes after cryoablation for kidney tumors are satisfactory. Combination with new technologies and further development of imaging techniques can potentially expand the range of indications of the procedure.
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