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Pu C, Wu T, Wang Q, Yang Y, Zhang K. Feasibility of novel intraoperative navigation for anatomical liver resection using real-time virtual sonography combined with indocyanine green fluorescent imaging technology. Biosci Trends 2024; 17:484-490. [PMID: 38092390 DOI: 10.5582/bst.2023.01265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
To analyze the feasibility and clinical effect of novel intraoperative navigation of real-time virtual sonography (RVS) combined with indocyanine green (ICG) fluorescent imaging technology in anatomical liver resection (ALR) for hepatocellular carcinoma. The clinical data of 41 patients who underwent ALR using RVS intraoperative navigation combined with ICG fluorescent imaging technology in the Department of Hepatobiliary Surgery of Peking University International Hospital from January 2020 to May 2022 were retrospectively analyzed. RVS was applied to guide the surgical plane through fusing real-time intraoperative ultrasound images with corresponding preoperative CT or MRI images. Operation methods, operation time, intraoperative blood loss, operative margin, hospital stay and postoperative complications were analyzed. The 1-year overall survival rate and tumor-free survival rate of patients were followed up by outpatient review or telephone calls. ALR surgery was performed on each of 41 patients. There were no deaths during perioperative period and postoperative complications occurred in 7 cases (17.1%). The postoperative pathological examinations demonstrated all cases of hepatocellular carcinoma and negative operative margins. The 41 patients were followed up for 12 to 20 months, with a median follow-up time of 14 months. The overall survival rate 1 year after surgery was 100.0% (41/41), 3 patients (7.3%) experienced tumor recurrence, and the tumor-free survival rate of 1 year after surgery was 92.7% (38/41). In conclusion, novel intraoperative navigation of RVS combined with ICG fluorescent imaging technology is safe and feasible in anatomical segmental hepatectomy of hepatocellular carcinoma.
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Affiliation(s)
- Changsheng Pu
- Department of General Surgery, Peking University First Hospital, Beijing, China
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
| | - Tiantian Wu
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
| | - Qiang Wang
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Keming Zhang
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
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Liang J, Zhang S, Han Z, Li Y, Sun H, Kim Y, Kim T. Comparative Study of Application of Computed Tomography/Ultrasound and Computed Tomography Imaging Guidance Methods in the Microwave Ablation of Liver Cancer. J Comput Assist Tomogr 2023; 47:24-30. [PMID: 36055224 PMCID: PMC9869958 DOI: 10.1097/rct.0000000000001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of the study is to assess the clinical value of the combined computed tomography (CT)/ultrasound (US) guidance in microwave ablation (MWA) for hepatocellular carcinoma (HCC). METHODS From July 16, 2016, to June 20, 2021, medical records of 150 HCC patients treated with MWA were retrospectively analyzed. Ninety-two patients with 115 liver tumors underwent MWA under combined CT/US guidance, and 58 patients with 73 liver tumors received MWA under CT guidance alone. The clinical efficacy of combined CT/US-guided MWA was analyzed. We compared the complications, procedure time, and CT scan times between the 2 groups. RESULTS The total complete ablation rate and complete ablation rate of high-risk location tumors were significantly higher in the group treated with combined CT/US guidance ( P = 0.0471 and P = 0.0347, respectively), the imaging guidance modality (odds ratio, 0.303; 95% confidence interval [CI], 0.095-0.970; P = 0.044) was an independent factor for ablation efficacy. These 2 groups also had significant differences in the procedure time ( P = 0.0171), the incidence rate of pneumothorax ( P = 0.0209), abdominal pain ( P = 0.0196), nausea or vomiting ( P = 0.0026), and intraoperative CT scan times ( P < 0.001). The overall complication rates ( P = 0.4023) and recurrence rates ( P = 0.5063) between the 2 groups were not statistically significant. However, CT/US group has a better short-term progressive free survival (log-rank P = 0.103, Breslow P = 0.030). In multivariate analysis, guidance modality (hazard ratio, 0.586; 95% CI, 0.368-0.934; P = 0.025) and Barcelona Clinic Liver Cancer stage (hazard ratio, 2.933; 95% CI, 1.678-5.127; P < 0.001) were risk factor for progressive free survival. CONCLUSIONS Percutaneous MWA under the combined CT/US guidance for HCC can improve clinical benefits.
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Affiliation(s)
| | | | | | - Ying Li
- From the Departments of Oncology
| | | | | | - Tiefeng Kim
- Pathology, Yanbian University Hospital, Yanji, China
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Afif AM, Laroco OD, Lau SMD, Teo SM, Rahman ASA, Too CW, Venkatanarasimha N, Gogna A. Usefulness of ultrasound fusion technology for hepatocellular carcinoma localisation, pre- and post-thermal ablation. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:194-200. [PMID: 35936962 PMCID: PMC9354184 DOI: 10.1177/1742271x211049525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/02/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Percutaneous thermal ablation of inconspicuous lesions can be challenging. Fusion ultrasound (FUS) allows the use of previously performed diagnostic imaging like computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET-CT) to localise hepatocellular carcinoma (HCC) for treatment. This paper illustrates FUS case studies of pre-, intra- and post-ablation imaging of inconspicuous HCC, supplemented by use of contrast-enhanced ultrasound (CEUS). METHOD Four prospective cases during September 2014 to October 2018, with HCC amenable to ablation, which were poorly identified on ultrasound, underwent FUS. FUS pre-screening was scheduled within three months of the previous CT or MRI, and between one to four weeks prior to the scheduled ablation date. Post-ablation imaging with FUS was performed between four to six weeks to coincide with their routine follow-up CT or MRI. FINDINGS There were potential benefits observed in the cases with combined techniques of FUS and CEUS for limiting circumstances such as heat sink effect, multiple lesions targeting, inconspicuous lesion detection and pre-ablation technical feasibility assessment. DISCUSSION The combined use of FUS and CEUS improves tumour visibility, increases operator imaging confidence and reduces heat sink effect during percutaneous thermal ablation. CONCLUSION FUS imaging is helpful in targeting poor conspicuity lesions that cannot be detected on grey-scale ultrasound. It facilitates in ensuring optimal treatment of hepatic lesions for improvement of patient prognosis and follow-up imaging.
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Affiliation(s)
- A Mohamed Afif
- A Mohamed Afif, Block 2, Level 1, Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
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Guo Y, Li M, Zhang X, Xie X, Zheng Y, Xu M, Kuang M, Yu K, Xie X, Huang G. The usefulness of three-dimensional ultrasound fusion imaging for precise needle placement in liver thermal ablation: a phantom and an in vivo simulation study. Int J Hyperthermia 2022; 39:564-571. [PMID: 35382659 DOI: 10.1080/02656736.2022.2057596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To investigate the value of three-dimensional ultrasound fusion imaging (3DUS-FI) in real-time guiding needle placement by phantom models and in vivo simulations. MATERIALS AND METHODS Two radiologists (beginner and expert) performed needle placement using two-dimensional ultrasound (2DUS) and 3DUS-FI, respectively. In the phantom study, single-needle placement was performed by puncturing the center point of each ball and assessed based on the specimen length. Multiple-needles placement was performed by placing three needles in each ball, and their locations were confirmed by computed tomography, and assessed based on the distance deviation between needles. In the in vivo simulation study, simulated-needle placement was performed by placing a virtual ablation needle in each liver tumor and assessed by the simulated ablative cover rate and margin. RESULTS Specimen length was significantly longer with 3DUS-FI in the beginner, whereas no significant difference was observed in the expert (2DUS vs. 3DUS-FI: beginner, 14.60 ± 2.60 mm vs. 16.25 ± 1.38 mm, p = .017; expert, 16.78 ± 1.40 mm vs. 16.95 ± 1.15 mm, p = .668). Distance deviation between needles was significantly smaller with 3DUS-FI (2DUS vs. 3DUS-FI: beginner, 25.06 ± 16.07 mm vs. 3.72 ± 1.99 mm, p < .001; expert, 11.70 ± 7.79 mm vs. 2.89 ± 1.52 mm, p < .001). The simulated ablative cover rate and margin were significantly larger with 3DUS-FI for the beginner, whereas only the latter was significantly larger for the expert (2DUS vs. 3DUS-FI: beginner, 73.55 ± 8.73% vs. 81.38 ± 11.84%, p = .001, 0.82 ± 0.97 mm vs. 2.65 ± 1.23 mm, p < .001; expert, 78.60 ± 9.91% vs. 83.24 ± 11.69%, p = .059; 1.65 ± 1.15 mm vs. 2.95 ± 1.13 mm, p < .001). CONCLUSIONS 3DUS-FI is useful for real-time guiding precise needle placement and may be further use to improve the efficacy of liver thermal ablation.
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Affiliation(s)
- Yuqing Guo
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Manying Li
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoer Zhang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohua Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanling Zheng
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming Xu
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming Kuang
- Department of Liver Surgery, Division of Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kaixin Yu
- Medical Imaging System Division, Shenzhen Mindray Bio-Medical Electronics Co. Ltd, Shenzhen, China
| | - Xiaoyan Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangliang Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Minami Y, Kudo M. Image Guidance in Ablation for Hepatocellular Carcinoma: Contrast-Enhanced Ultrasound and Fusion Imaging. Front Oncol 2021; 11:593636. [PMID: 33747913 PMCID: PMC7973273 DOI: 10.3389/fonc.2021.593636] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
The ultrasound (US) imaging technology, including contrast-enhanced US (CEUS) and fusion imaging, has experienced radical improvement, and advancement in technology thus overcoming the problem of poor conspicuous hepatocellular carcinoma (HCC). On CEUS, the presence or absence of enhancement distinguishes the viable portion from the ablative necrotic portion. Using volume data of computed tomography (CT) or magnetic resonance imaging (MRI), fusion imaging enhances the three-dimensional relationship between the liver vasculature and HCC. Therefore, CT/MR-US fusion imaging provides synchronous images of CT/MRI with real-time US, and US-US fusion imaging provides synchronous US images before and after ablation. Moreover, US-US overlay fusion can visualize the ablative margin because it focuses the tumor image onto the ablation zone. Consequently, CEUS and fusion imaging are helpful to identify HCC with little conspicuity, and with more confidence, we can perform ablation therapy. CEUS/fusion imaging guidance has improved the clinical effectiveness of ablation therapy in patients with poor conspicuous HCCs. Therefore; this manuscript reviews the status of CEUS/fusion imaging guidance in ablation therapy of poor conspicuous HCC.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
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Miyata A, Arita J, Kawaguchi Y, Hasegawa K, Kokudo N. Simulation and navigation liver surgery: an update after 2,000 virtual hepatectomies. Glob Health Med 2020; 2:298-305. [PMID: 33330824 PMCID: PMC7731191 DOI: 10.35772/ghm.2020.01045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 04/24/2023]
Abstract
The advent of preoperative 3-dimensional (3D) simulation software has made a variety of unprecedented surgical simulations possible. Since 2004, we have performed more than 2,000 preoperative simulations in the University of Tokyo Hospital, and they have enabled us to obtain a great deal of information, such as the detailed shape of liver segments, the precise volume of each segment, and the volume of hepatic venous drainage areas. As a result, we have been able to perform more aggressive and complicated surgery safely. The next step is to create a navigation system that will accurately reproduce the preoperative plan. Real-time virtual sonography (RVS) is a navigation system that provides fusion images of ultrasonography and reconstructed computed tomography images or magnetic resonance images. The RVS system facilitates the surgeon's understanding of interpretation of ultrasound images and the detection of tumors that are difficult to find by ultrasound alone. In the near future, surgical navigation systems may evolve to the point where they will be able to inform surgeons intraoperatively in real time about not only intrahepatic structures, such as vessels and tumors, but also the portal territory, hepatic vein drainage areas, and resection lines that have been planned preoperatively.
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Affiliation(s)
- Akinori Miyata
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
- Address correspondence to:Kiyoshi Hasegawa, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail:
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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Cathomas M, Mertineit N, Kim-Fuchs C, Lachenmayer A, Maurer MH. Value of MRI/CT Image Fusion for Targeting "invisible" Lesions in Stereotactic Microwave Ablation (SMWA) of Malignant Liver Lesions: A Retrospective Analysis. Cardiovasc Intervent Radiol 2020; 43:1505-1514. [PMID: 32642989 DOI: 10.1007/s00270-020-02565-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/20/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the technical feasibility of MRI/CT image fusion and completeness of ablation treatment for primary or metastatic liver lesions invisible on contrast-enhanced CT planning scans and outcome in patients treated with stereotactic microwave ablation (SMWA). MATERIALS AND METHODS The study was approved by the local ethics committee. Patients who underwent SMWA between January 2015 and December 2018 were retrospectively analyzed. All liver lesions for which MRI/CT fusion was performed due to invisibility on pre-interventional CT planning scans were included and reassessed. The outcome measurement was successful ablation of the lesion at first follow-up imaging. RESULTS During the study period, 236 patients underwent 312 SMWAs with ablation of 496 lesions. Twenty-four lesions in 15 patients (mean age, 62 years; range, 43-80 years) were included. Following MRI/CT image fusion, all 24 lesions could be sufficiently localized to perform SMWA. The first follow-up imaging showed complete ablation of 22 lesions. Two initially incompletely ablated lesions were hepatocellular carcinomas and were successfully re-ablated afterwards. CONCLUSION SMWA with MRI/CT image fusion is an accurate and safe treatment option for patients with liver lesions not detectable on contrast-enhanced CT planning scans. MRI/CT image fusion may allow more patients with malignant liver lesions to benefit from local ablation treatment even if their lesions are not visible on CT planning examinations.
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Affiliation(s)
- M Cathomas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - N Mertineit
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 10, 3010, Bern, Switzerland
| | - C Kim-Fuchs
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 10, 3010, Bern, Switzerland.
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Kim N, Cheng J, Jung I, Liang JD, Shih YL, Huang WY, Kimura T, Lee VHF, Zeng ZC, Zhenggan R, Kay CS, Heo SJ, Won JY, Seong J. Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma. J Hepatol 2020; 73:121-129. [PMID: 32165253 DOI: 10.1016/j.jhep.2020.03.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few studies have been conducted to compare the efficacies of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA). Thus, in this multinational study, we compared the effectiveness of SBRT and RFA in patients with unresectable HCC. METHODS The retrospective study cohort included 2,064 patients treated in 7 hospitals: 1,568 and 496 in the RFA and SBRT groups, respectively. More than half of the patients (56.5%) developed recurrent tumors, mainly after transarterial chemoembolization (44.8%). Propensity score matching was performed to adjust for clinical factors (n = 313 in each group). RESULTS At baseline, the SBRT group had unfavorable clinical features compared to the RFA group, including BCLC stage (B-C 65% vs. 16%), tumor size (median 3.0 cm vs. 1.9 cm), and frequent history of liver-directed treatment (81% vs. 49%, all p <0.001). With a median follow-up of 27.7 months, the 3-year cumulative local recurrence rates in the SBRT and RFA groups were 21.2% and 27.9%, respectively (p <0.001). After adjusting for clinical factors, SBRT was related to a significantly lower risk of local recurrence than RFA in both the entire (hazard ratio [HR] 0.45, p <0.001) and matched (HR 0.36, p <0.001) cohorts. In subgroup analysis, SBRT was associated with superior local control in small tumors (≤3 cm) irrespective of location, large tumors located in the subphrenic region, and those that progressed after transarterial chemoembolization. Acute grade ≥3 toxicities occurred in 1.6% and 2.6% of the SBRT and RFA patients, respectively (p = 0.268). CONCLUSIONS SBRT could be an effective alternative to RFA for unresectable HCC, particularly for larger tumors (>3 cm) in a subphrenic location and tumors that have progressed after transarterial chemoembolization. LAY SUMMARY It is currently not known what the best treatment option is for patients with unresectable hepatocellular carcinoma. Here, we show that stereotactic body radiation therapy provides better local control than radiofrequency ablation, with comparable toxicities. Stereotactic body radiation therapy appears to be an effective alternative to radiofrequency ablation that should be considered when there is a higher risk of local recurrence or toxicity after radiofrequency ablation.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Jason Cheng
- Department of Radiation Oncology, National Taiwan University Hospital, Taiwan
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ja Der Liang
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Yu Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Victor H F Lee
- Department of Radiation Oncology, The University of Hong Kong, Hong Kong
| | - Zhao Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, China
| | - Ren Zhenggan
- Department of Medical Hepatology, Zhongshan Hospital, Fudan University, China
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary Hospital, Republic of Korea
| | - Seok Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yoon Won
- Department of Interventional Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea.
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Ultrasound fusion imaging technologies for guidance in ablation therapy for liver cancer. J Med Ultrason (2001) 2020; 47:257-263. [PMID: 32125577 DOI: 10.1007/s10396-020-01006-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/05/2020] [Indexed: 12/17/2022]
Abstract
With advances in imaging technology, images from ultrasound (US) and computed tomography (CT) or magnetic resonance imaging (MRI) can be displayed simultaneously and in real time, according to the angle of the transducer. CT/MR-US fusion imaging improves the visualization of inconspicuous hepatocellular carcinoma (HCC) and helps us to understand the three-dimensional relationship between the liver vasculature and HCC. US fusion imaging guidance facilitates improvement in the treatment response for HCC with poor conspicuity, and the rates of technical success of ablation and local tumor progression for inconspicuous HCC range from 94.4 to 100% and 0 to 8.3%, respectively. Moreover, the development of image fusion has made it possible to compare and overlay pre- and post-ablation US images. This US-US fusion imaging allows side-by-side comparison of the ablative margin, while US-US overlay fusion can visualize the ablative margin because the tumor image is projected onto the ablative hyperechoic zone. Thus, US-US overlay fusion guidance is highly effective for safety margin achievement in local ablation therapy for HCC, providing a lower risk of local tumor progression. This manuscript reviews the current status of ultrasound fusion imaging for percutaneous ablation therapy of HCC.
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Kawai S, Iijima H, Shinzaki S, Hiyama S, Yamaguchi T, Araki M, Iwatani S, Shiraishi E, Mukai A, Inoue T, Tsujii Y, Hayashi Y, Tsujii M, Takehara T. Usefulness of intestinal real-time virtual sonography in patients with inflammatory bowel disease. J Gastroenterol Hepatol 2019; 34:1743-1750. [PMID: 30932236 DOI: 10.1111/jgh.14670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/10/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Transabdominal ultrasonography (US) examination for the intestine is often difficult, and its precedence for intestinal examination depends on accessibility to experienced ultrasonographers. Real-time virtual sonography (RVS) assists examination of US as a fusion method by synchronizing US images with pre-captured computed tomography or magnetic resonance images. We aimed to evaluate the feasibility to use RVS for the examination of the intestine. METHODS The time to scan three parts of the intestine was compared between conventional US and RVS in seven participants without intestinal diseases. Whether RVS accurately synchronized US images with reference images of intestinal target lesions was judged in 20 patients with inflammatory bowel disease. RESULTS Examination time to scan the ascending colon and the ileocecum using intestinal RVS was significantly shorter than that using conventional US alone (36.7 vs 50.0 s [P = 0.0313] and 35.4 vs 66.4 s [P = 0.0156], respectively) in participants without intestinal diseases. Well-synchronized US images of the intestinal lesions, such as stenosis, with reference computed tomography/magnetic resonance images were obtained by RVS in all the lesions in the fixed parts of the colon (ascending and descending colon), and images of nine lesions in 12 lesions (75%) were well synchronized in the unfixed part of the intestine in Crohn's disease patients. CONCLUSION Real-time virtual sonography significantly reduced the examination time of intestinal US. Intestinal RVS can help the ultrasonographer to guide the US probe to detect and monitor intestinal lesions by synchronizing reference images, especially in inflammatory bowel disease patients (UMIN Clinical Trials Registry number: UMIN000011571).
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Affiliation(s)
- Shoichiro Kawai
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Hiyama
- Department of Gastroenterology and Hepatology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Toshio Yamaguchi
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Osaka, Japan
| | - Manabu Araki
- Department of Gastroenterology and Hepatology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Shuko Iwatani
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eri Shiraishi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akira Mukai
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Takahiro Inoue
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Tsujii
- Department of Gastroenterology and Hepatology, Higashiosaka City Medical Center, Higashi-osaka, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
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Miyata A, Arita J, Shirata C, Abe S, Akamatsu N, Kaneko J, Kokudo N, Hasegawa K. Quantitative Assessment of the Accuracy of Real-Time Virtual Sonography for Liver Surgery. Surg Innov 2019; 27:60-67. [PMID: 31516065 DOI: 10.1177/1553350619875301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Real-time virtual sonography (RVS) is a navigation system for liver surgery. In this study, the degree of misalignment of intraoperative RVS images with computed tomographic (CT) images was measured. Methods. Between December 2014 and July 2015, intraoperative RVS was performed in a total of 33 patients undergoing liver surgery. Reconstructed CT images, rendered like intraoperative ultrasonographic (IOUS) images, were adjusted with the IOUS images and visualized side by side. The degree of misalignment between the reconstructed CT images and IOUS images was measured at anterior section, posterior section, and left liver in each patient. Furthermore, the time required for the adjustment was measured as the "adjustment time." Results. The degree of misalignment between the images could potentially be measured for a total of 96 points in the 33 patients. Of these, the actual measurement could not be conducted for 35 points due to poor visualization of the intrahepatic vasculature (n = 20) or to a large misalignment that hampered continuation of further adjustment (n = 15). The median degree of misalignment was 9.8 mm (range = 2.4-37.6 mm) in the right anterior section, 9.8 mm (range = 2.7-71.5 mm) in the right posterior section, and 9.5 mm (range = 0.9-37.6 mm) in the left liver. The median adjustment time was 105 seconds (range = 51-245 seconds). Conclusions. Although some misalignment occurred, it might be acceptable for selected situations. Further investigation is needed to reduce the frequency of adjustment failure.
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Affiliation(s)
- Akinori Miyata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chikara Shirata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Abe
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Bing F, Vappou J, Breton E, Enescu I, Garnon J, Gangi A. Accuracy of a CT-Ultrasound Fusion Imaging Guidance System Used for Hepatic Percutaneous Procedures. J Vasc Interv Radiol 2019; 30:1013-1020. [PMID: 30922795 DOI: 10.1016/j.jvir.2018.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/10/2018] [Accepted: 11/10/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the accuracy of a fusion imaging guidance system using ultrasound (US) and computerized tomography (CT) as a real-time imaging modality for the positioning of a 22-gauge needle in the liver. MATERIALS AND METHODS The spatial coordinates of 23 spinal needles placed at the border of hepatic tumors before radiofrequency thermal ablation were determined in 23 patients. Needles were inserted up to the border of the tumor with the use of CT-US fusion imaging. A control CT scan was carried out to compare real (x, y, z) and virtual (x', y', z') coordinates of the tip of the needle (D for distal) and of a point on the needle located 3 cm proximally to the tip (P for proximal). RESULTS The mean Euclidian distances were 8.5 ± 4.7 mm and 10.5 ± 5.3 mm for D and P, respectively. The absolute value of mean differences of the 3 coordinates (|x' - x|, |y' - y|, and |z' - z|) were 4.06 ± 0.9, 4.21 ± 0.84, and 4.89 ± 0.89 mm for D and 3.96 ± 0.60, 4.41 ± 0.86, and 7.66 ± 1.27 mm for P. X = |x' - x| and Y = |y' - y| coordinates were <7 mm with a probability close to 1. Z = |z' - z| coordinate was not considered to be larger nor smaller than 7 mm (probability >7 mm close to 50%). CONCLUSIONS Positioning errors with the use of US-CT fusion imaging used in this study are not negligible for the insertion of a 22-gauge needle in the liver. Physicians must be aware of such possible errors to adapt the treatment when used for thermal ablation.
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Affiliation(s)
- Fabrice Bing
- Department of Radiology, Hôpital d'Annecy, 1 avenue de l'Hôpital, 74374 Metz-Tessy, France; ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France.
| | - Jonathan Vappou
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Elodie Breton
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Iulian Enescu
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France; Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Huo J, Aloia TA, Xu Y, Chung TH, Sheu T, Tina Shih YC. Comparative Effectiveness of Computed Tomography- Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:284-292. [PMID: 30832966 PMCID: PMC6402784 DOI: 10.1016/j.jval.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/04/2018] [Accepted: 10/16/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND For patients with hepatocellular carcinoma (HCC) not eligible for surgical resection, radiofrequency ablation (RFA) is a promising technique that reduces the risk of disease progression. OBJECTIVES To evaluate whether the trend of image guidance for RFA is moving toward the more expensive computed tomography (CT) technology and to determine the clinical benefits of CT guidance over the ultrasound (US) guidance. METHODS A cohort of 463 patients was identified from the Surveillance, Epidemiology, and End Results and Medicare-linked database. The temporal trends in use of image guidance were assessed using the Cochrane-Armitage test. The associations between modality of image guidance and survival, complications, and costs were assessed using the Cox regression model, the logistic regression model, and the generalized linear model, respectively. RESULTS The use of CT-guided RFA increased sharply, from 20.7% in 2002 to 75.9% in 2011. Compared with CT-guided RFA, those who received US-guided RFA had comparable risk of periprocedural and delayed postprocedural complications. Stratified analyses by tumor size also showed no statistically significant difference. In adjusted survival analysis, no statistically significant difference was observed in overall and cancer-specific survival. Nevertheless, the cost of CT-guided RFA ($2847) was higher than that of US-guided RFA ($1862). CONCLUSIONS Despite its rapid adoption over time, CT-guided RFA incurred higher procedural costs than US-guided RFA but did not significantly improve postprocedural complications and survival. Echoing the American Board of Internal Medicine's Choosing Wisely campaign and the American Society of Clinical Oncology's Value of Cancer Care initiative, findings from our study call for critical evaluation of whether CT-guided RFA provides high-value care for patients with HCC.
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Affiliation(s)
- Jinhai Huo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tong Han Chung
- Healthcare Transformation Initiatives, University of Texas Health Science Center-Houston, Houston, TX, USA
| | - Tommy Sheu
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ya-Chen Tina Shih
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Hirooka M, Koizumi Y, Imai Y, Nakamura Y, Yukimoto A, Watanabe T, Yoshida O, Tokumoto Y, Abe M, Hiasa Y. Clinical utility of multipolar ablation with a 3-D simulator system for patients with liver cancer. J Gastroenterol Hepatol 2017; 32:1852-1858. [PMID: 28240420 DOI: 10.1111/jgh.13772] [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: 01/03/2017] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to confirm the efficacy of multipolar ablation with a new simulator system, three-dimensional (3-D) sim-Navigator, for patients with hepatocellular carcinoma by assessing relapse-free survival and shape of the ablation volume under clinical conditions. METHODS All participants provided written, informed consent, and study protocols were approved by the institutional ethics committee. Twenty-seven patients with 27 nodules were treated by no-touch ablation using the new simulator system. Another 21 patients with 21 nodules treated without the simulator system were enrolled as controls. Tumor progression and shape of ablation volume were assessed. Predictors of tumor progression were assessed by Cox proportional hazard model. RESULTS No significant differences in clinical characteristics were seen between groups. Mean sphericity was 0.48 ± 0.07 with 3-D sim-Navigator and 0.37 ± 0.07 without 3-D sim-Navigator (P < 0.001). Median surface-to-volume ratio and compactness were also significantly closer to those of a sphere with 3-D sim-Navigator (P = 0.017, P < 0.001). Relapse-free survival rates at 1 and 1.5 years were 94.1% and 82.4%, respectively, with 3-D sim-Navigator, compared with 83.2% and 55.5% without (P = 0.056). The only independent factor predicting relapse-free survival was use of 3-D sim-Navigator (hazard ratio, 0.12; 95%CI, 0.01-0.87; P = 0.035). CONCLUSIONS Ideal ablation area was acquired by this simulation and navigation system in clinics. This system improved local tumor progression by facilitating appropriate insertion of multiple electrodes.
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Affiliation(s)
- Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yusuke Imai
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yoshiko Nakamura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Atsushi Yukimoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Takao Watanabe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
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Management consensus guideline for hepatocellular carcinoma: 2016 updated by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2017; 117:381-403. [PMID: 29074347 DOI: 10.1016/j.jfma.2017.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. METHODS The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. RESULTS The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. CONCLUSION With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality.
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Toshikuni N, Matsue Y, Ozaki K, Yamada K, Hayashi N, Tsuchishima M, Tsutsumi M. An Image Fusion System for Estimating the Therapeutic Effects of Radiofrequency Ablation on Hepatocellular Carcinoma. Radiol Oncol 2017; 51:263-269. [PMID: 28959162 PMCID: PMC5611990 DOI: 10.1515/raon-2017-0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/29/2017] [Indexed: 12/27/2022] Open
Abstract
Background During ultrasound-guided radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC), high echoic areas due to RFA-induced microbubbles can help calculate the extent of ablation. However, these areas also decrease visualization of target tumors, making it difficult to assess whether they completely cover the tumors. To estimate the effects of RFA more precisely, we used an image fusion system (IFS). Patients and methods We enrolled patients with a single HCC who received RFA with or without the IFS. In the IFS group, we drew a spherical marker along the contour of a target tumor on reference images immediately after administering RFA so that the synchronized spherical marker represented the contour of the target tumor on real-time ultrasound images. When the high echoic area completely covered the marker, we considered the ablation to be complete. We compared outcomes between the IFS and control groups. Results We enrolled 25 patients and 20 controls, and the baseline characteristics were similar between the two groups. The complete ablation rates during the first RFA session were significantly higher in the IFS group compared with those in the control group (88.0% vs. 60.0%, P = 0.041). The number of RFA sessions was significantly smaller in the IFS group compared with that in the control group (1.1 ± 0.3 vs. 1.5 ± 0.7, P = 0.016). Conclusions The study suggested that the IFS enables a more precise estimation of the effects of RFA on HCC, contributing to enhanced treatment efficacy and minimized patient burden.
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Affiliation(s)
- Nobuyuki Toshikuni
- Department of Hepatology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Yasuhiro Matsue
- Department of Hepatology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Kazuaki Ozaki
- Department of Hepatology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Kaho Yamada
- Department of Hepatology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Nobuhiko Hayashi
- Department of Hepatology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Mutsumi Tsuchishima
- Department of Hepatology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Mikihiro Tsutsumi
- Department of Hepatology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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Tamai T, Oshige A, Tabu K, Tabu E, Ijyuin S, Sakae H, Onishi H, Muromachi K, Saisyoji A, Oda K, Kumagai K, Mawatari S, Moriuchi A, Sakurai K, Hori T, Ido A. Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma. Oncol Lett 2017; 14:3199-3206. [PMID: 28927066 DOI: 10.3892/ol.2017.6476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/30/2017] [Indexed: 01/13/2023] Open
Abstract
Percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) is an effective, standard therapy against small hepatocellular carcinoma (HCC). However, there is debate regarding the effectiveness of RFA combined with TACE (RFA/TACE) compared with RFA alone. These two approaches were compared for the treatment of early HCC. The present study examined 83 HCC tumors in 83 patients treated with RFA between April 2007 and August 2014 at three medical institutions. All HCCs were single hypervascular tumors, with a median diameter of 16 mm (range, 6-30 mm). The overall survival (OS) rate of all patients (n=83) was 97.5% at 1 year, 82.8% at 3 years and 48.6% at 5 years, and the local recurrence rate of all patients was 14.3% at 1 year, 32.3% at 3 years and 36.5% at 5 years. The tumor-free survival (TFS) rate of all patients was 95.1% at 1 year, 56.3% at 3 years and 23.4% at 5 years. Compared with RFA alone, RFA/TACE significantly improved OS (P<0.001), intrahepatic distant recurrence (IDR; P=0.038) and TFS (P=0.010). A univariate analysis of prognostic indicators revealed that age <70 years (P=0.008), aspartate transaminase <40 IU/l (P=0.003), alanine aminotransferase <40 IU/l (P=0.006) and platelet count >10×104/µl (P=0.05) were associated with a high survival rate. Multivariate analysis identified RFA/TACE [hazard ratio (HR), 0.108; P=0.001] as an independent prognostic indicator. RFA/TACE was identified as the only independent indicator of IDR (HR: 0.467; P=0.042) and TFS (HR: 0.452; P=0.012). RFA/TACE improved OS rate, IDR and TFS compared with RFA alone. The data suggested that RFA/TACE should be considered for the treatment of single hypervascular HCC.
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Affiliation(s)
- Tsutomu Tamai
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Akihiko Oshige
- Department of Gastroenterology and Hepatology, Kagoshima City Hospital, Kagoshima 890-8760, Japan
| | - Kazuaki Tabu
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Eriko Tabu
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Syo Ijyuin
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Haruka Sakae
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Hiroka Onishi
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Kaori Muromachi
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Akiko Saisyoji
- Department of Hepatology, Kagoshima Teishin Hospital, Kagoshima 890-8798, Japan
| | - Kohei Oda
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Kotaro Kumagai
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Seiichi Mawatari
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Akihiro Moriuchi
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Kazuhiro Sakurai
- Department of Hepatology, Kagoshima Teishin Hospital, Kagoshima 890-8798, Japan
| | - Tsuyoshi Hori
- Department of Gastroenterology and Hepatology, Kagoshima City Hospital, Kagoshima 890-8760, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
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Hakime A, Yevich S, Tselikas L, Deschamps F, Petrover D, De Baere T. Percutaneous Thermal Ablation with Ultrasound Guidance. Fusion Imaging Guidance to Improve Conspicuity of Liver Metastasis. Cardiovasc Intervent Radiol 2017; 40:721-727. [DOI: 10.1007/s00270-016-1561-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 12/14/2022]
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19
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Park AY, Seo BK. Real-Time MRI Navigated Ultrasound for Preoperative Tumor Evaluation in Breast Cancer Patients: Technique and Clinical Implementation. Korean J Radiol 2016; 17:695-705. [PMID: 27587958 PMCID: PMC5007396 DOI: 10.3348/kjr.2016.17.5.695] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/17/2016] [Indexed: 11/15/2022] Open
Abstract
Real-time magnetic resonance imaging (MRI) navigated ultrasound is an image fusion technique to display the results of both MRI and ultrasonography on the same monitor. This system is a promising technique to improve lesion detection and analysis, to maximize advantages of each imaging modality, and to compensate the disadvantages of both MRI and ultrasound. In evaluating breast cancer stage preoperatively, MRI and ultrasound are the most representative imaging modalities. However, sometimes difficulties arise in interpreting and correlating the radiological features between these two different modalities. This pictorial essay demonstrates the technical principles of the real-time MRI navigated ultrasound, and clinical implementation of the system in preoperative evaluation of tumor extent, multiplicity, and nodal status in breast cancer patients.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
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Comparison of conventional ultrasonography and ultrasonography-computed tomography fusion imaging for target identification using digital/real hybrid phantoms: a preliminary study. J Med Ultrason (2001) 2016; 43:327-35. [DOI: 10.1007/s10396-016-0704-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/28/2016] [Indexed: 11/26/2022]
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21
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Memeo R, de’Angelis N, de Blasi V, Cherkaoui Z, Brunetti O, Longo V, Piardi T, Sommacale D, Marescaux J, Mutter D, Pessaux P. Innovative surgical approaches for hepatocellular carcinoma. World J Hepatol 2016; 8:591-596. [PMID: 27168871 PMCID: PMC4858623 DOI: 10.4254/wjh.v8.i13.591] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/30/2016] [Accepted: 04/18/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, with an increasing diffusion in Europe and the United States. The management of such a cancer is continuously progressing and the objective of this paper is to evaluate innovation in the surgical treatment of HCC. In this review, we will analyze the modern concept of preoperative management, the role of laparoscopic and robotic surgery, the intrao-perative use of three dimensional models and augme-nted reality, as well as the potential application of fluore-scence.
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22
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Dong Y, Wang WP, Mao F, Ji ZB, Huang BJ. Application of imaging fusion combining contrast-enhanced ultrasound and magnetic resonance imaging in detection of hepatic cellular carcinomas undetectable by conventional ultrasound. J Gastroenterol Hepatol 2016; 31:822-8. [PMID: 26480287 DOI: 10.1111/jgh.13202] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/14/2015] [Accepted: 10/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to explore the value of volume navigation image fusion-assisted contrast-enhanced ultrasound (CEUS) in detection for radiofrequency ablation guidance of hepatocellular carcinomas (HCCs), which were undetectable on conventional ultrasound. METHODS From May 2012 to May 2014, 41 patients with 49 HCCs were included in this study. All lesions were detected by dynamic magnetic resonance imaging (MRI) and planned for radiofrequency ablation but were undetectable on conventional ultrasound. After a bolus injection of 2.4 ml SonoVue® (Bracco, Italy), LOGIQ E9 ultrasound system with volume navigation system (version R1.0.5, GE Healthcare, Milwaukee, WI, USA) was used to fuse CEUS and MRI images. The fusion time, fusion success rate, lesion enhancement pattern, and detection rate were analyzed. RESULTS Image fusions were conducted successfully in 49 HCCs, the technical success rate was 100%. The average fusion time was (9.2 ± 2.1) min (6-12 min). The mean diameter of HCCs was 25.2 ± 5.3 mm (mean ± SD), and mean depth was 41.8 ± 17.2 mm. The detection rate of HCCs using CEUS/MRI imaging fusion (95.9%, 47/49) was significantly higher than CEUS (42.9%, 21/49) (P < 0.05). For small HCCs (diameter, 1-2 cm), the detection rate using imaging fusion (96.9%, 32/33) was also significantly higher than CEUS (18.2%, 6/33) (P < 0.01). All HCCs displayed a rapid wash-in pattern in the arterial phase of CEUS. CONCLUSIONS Imaging fusion combining CEUS and MRI is a promising technique to improve the detection, precise localization, and accurate diagnosis of undetectable HCCs on conventional ultrasound, especially small and atypical HCCs.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Mao
- Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Zheng-Biao Ji
- Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Bei-Jian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Lin CC, Cheng YT, Chen M WT, Lin SM. The Effectiveness of Multiple Electrode Radiofrequency Ablation in Patients with Hepatocellular Carcinoma with Lesions More than 3 cm in Size and Barcelona Clinic Liver Cancer Stage A to B2. Liver Cancer 2016; 5:8-20. [PMID: 26989656 PMCID: PMC4789949 DOI: 10.1159/000367755] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Outcomes of hepatocellular carcinoma (HCC) lesions >3.0 cm in size including Barcelona Clinic Liver Cancer (BCLC) stage B after radiofrequency ablation (RFA) with a single electrode remain unsatisfactory. This study aimed to investigate the outcomes of RFA with multiple electrodes (ME-RFA) for HCC tumors 3.1-7.0 cm in size and BCLC stage B. This retrospective study included 70 consecutive patients with 58 medium- (3.1-5.0 cm) and 17 large- (5.1-7.0 cm) sized HCCs after ME-RFA using a controller. Outcomes in terms of complete response, primary technique effectiveness, local tumor progression, and overall survival were investigated. After 1-4 applications of ME-RFA, the rates of complete response and PTE in medium-sized tumors were 79.3% and 91.4%, respectively, and in large tumors were 76.5% and 94.1%, respectively. Overall, the major complication rate was 5.7%. After a median 21-month follow-up period, both two- and three-year estimated overall survival rates were above 80%. There were no significant differences in overall survival and local tumor progression rates between medium- and large-size tumors and among BCLC stages A, B1 and B2. A complete response to ME-RFA was the only significant factor associated with improved survival (p=0.008). In conclusion, ME-RFA can effectively treat 3.1-7.0-cm sized HCCs with a comparable outcome between medium- and large-size tumors and among BCLA stages A to B2.
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Affiliation(s)
| | | | | | - Shi-Ming Lin
- *Shi-Ming Lin, MD, Division of Hepatology, Liver Research Unit, Department of Gastroenterology, and Hepatology, Chang Gung Memorial Hospital, Lin-Kuo, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan 333 (ROC), Tel. 886 3 3281200 Ext. 8107, E-Mail
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Du J, Li HL, Zhai B, Chang S, Li FH. Radiofrequency ablation for hepatocellular carcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in guiding and assessing early therapeutic response and short-term follow-up results. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2400-2411. [PMID: 26055968 DOI: 10.1016/j.ultrasmedbio.2015.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to assess the efficacy of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in guiding and assessing early therapeutic response to radiofrequency (RF) ablation for hepatocellular carcinomas (HCCs; up to 3 lesions, each ≤3 cm in diameter) and to report the short-term follow-up results. Between September 2011 and January 2013, 63 patients with 78 HCCs (≤3 cm) underwent conventional US- and CEUS-guided percutaneous RF ablation. CEUS was repeated after 20-30 min to assess therapeutic response, and local efficacy was further confirmed by contrast-enhanced magnetic resonance imaging (MRI) 1 mo after tumor ablation. Patients were followed periodically to look for local tumor or disease progression. Survival probability was estimated with the Kaplan-Meier method. Complete ablation was achieved for 76 (97.4%) of 78 HCCs in one (n = 73) or two (n = 3) sessions. No major complications were observed in any patient. The overall concordance in assessment of therapeutic efficacy of RF ablation between CEUS and MRI was 97.4% (76/78 tumors). The concordance test gave a value of κ = 0.74 (p < 0.001), indicating that CEUS had a high diagnostic agreement with MRI. During a mean follow-up of 20 mo, the local tumor progression rate was 5.3% (4/76 tumors). The 1-, 1.5- and 2-y cumulative survival rates were 98.4%, 96.1% and 92.6%, respectively. Although CEUS has some intrinsic limitations, the combined use of conventional US and CEUS provides a safe and efficient tool to guide RF ablation for HCCs 3 cm or smaller, with encouraging results in terms of survival rate and minimal complications. Moreover, the immediate post-procedural CEUS can be a reliable alternative to contrast-enhanced MRI for assessing the early therapeutic response to RF ablation.
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Affiliation(s)
- Jing Du
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Li Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Samuel Chang
- Department of Radiology, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Feng-Hua Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Di Mauro E, Solbiati M, De Beni S, Forzoni L, D'Onofrio S, Solbiati L. Virtual navigator real-time ultrasound fusion imaging with positron emission tomography for liver interventions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:1406-9. [PMID: 24109960 DOI: 10.1109/embc.2013.6609773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Real-time fusion imaging technologies are increasingly being used among interventional radiologists, mostly Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) dataset, fused with Ultrasound (US) imaging. In addition, fusion of Positron Emission Tomography (PET) and CT is increasingly diffused in clinical practice, due to the wide availability of PET scanners and the capability to make either a direct (acquisitions performed within the same system) or an indirect (procedure performed on an external workstation, merging the two different sets of acquired data) fusion with CT data. The present work describes the feasibility of real-time fusion imaging directly between PET data and US imaging, with CT scans being used only for PET-US fusion registration. Data on multimodality registration precision and clinical applications are presented as well.
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Lee CH, Chen WT, Lin CC, Teng W, Lin SM, Chiu CT. Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations. Kaohsiung J Med Sci 2015; 31:413-9. [DOI: 10.1016/j.kjms.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 01/06/2023] Open
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CT-guided liver biopsy with electromagnetic tracking: results from a single-center prospective randomized controlled trial. AJR Am J Roentgenol 2015; 203:W715-23. [PMID: 25415738 DOI: 10.2214/ajr.13.12061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the effectiveness of electromagnetic tracking in assisting CT-guided liver biopsies. MATERIALS AND METHODS This was a single-center prospective randomized controlled trial comparing nonfluoroscopic CT-guided liver biopsy using an advance-and-scan technique with and without electromagnetic tracking. Fifty patients with a liver lesion referred for biopsy (women, 52%; mean age, 59.7 years; mean lesion size, 3.6 cm) were enrolled in the study and were randomly assigned to either arm. The primary and secondary objectives were to assess and quantify differences in the number of intraprocedural scans, cumulative effective radiation dose, number of needle manipulations, and procedure time from skin-stick to the target lesion with and without assistance. RESULTS Electromagnetic tracking significantly decreased the number of scans, effective radiation dose, number of manipulations per procedure, and time from skin-stick to the target lesion. The ratio of the number of scans (electromagnetic tracking to control) was 0.55 (95% CI, 0.42-0.73; p<0.0001). The mean difference in effective radiation dose (electromagnetic tracking-control) was -4.7 mSv (95% CI, -7.01 to -2.44 mSv; p=0.0001), and the median difference was -5.1 mSv (95% CI, -7.01 to -3.56 mSv; p<0.0001). The ratio of the number of manipulations (electromagnetic tracking to control) was 0.36 (95% CI, 0.24-0.54; p<0.0001). The mean difference for the time from skin-stick to the target lesion was -247.6 seconds (95% CI, -394.34 to -100.83 seconds; p=0.0014) and the median difference was -253.0 seconds (95% CI, -325.00 to -124.00 seconds; p=0.0001). CONCLUSION Electromagnetic tracking assistance has the potential to decrease the number of intraprocedural CT scans and needle manipulations and to reduce patient radiation dose during CT-guided liver biopsy.
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Cost-effectiveness of navigated radiofrequency ablation for hepatocellular carcinoma in China. Int J Technol Assess Health Care 2015; 30:400-8. [PMID: 25682956 DOI: 10.1017/s0266462314000452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Real-time virtual sonography (RVS) is a promising navigation technique for percutaneous radiofrequency ablation (RFA) treatment, especially in ablating nodules poorly visualized on conventional ultrasonography (US). However, its cost-effectiveness has not been established. The purpose of this study is to evaluate the cost-effectiveness of RVS navigated RFA (RVS-RFA) relative to US guided RFA (US-RFA) in patients with small hepatocellular carcinoma (HCC) in China, from the modified societal perspective. METHODS A state-transition Markov model was created using TreeAge Pro™ 2012. The parameters used in the model, including natural history of HCC patients, procedure efficacy and related costs, were obtained from a systematic search of literature through PubMed, EMBASE, and Science Citation Index databases. The simulated cohort was patients with solitary, small HCC (<3 cm in diameter) and Child-Pugh class A or B, whose tumors are poorly visualized in B-mode US but clearly detectable by CT or MRI. RESULTS In this cohort of difficult cases, RVS-RFA was a preferred strategy saving 2,467 CNY ($392) throughout the patient's life while gaining additional 1.4 QALYs compared with conventional US guidance. The results were sensitive to the efficacy of US-RFA and RVS-RFA including complete ablation rate and local recurrence rate, the median survival for patients with progressive HCC, the probability of performing RFA for recurrent HCC, and the cost of RVS navigation, disposable needle or hospitalization. CONCLUSIONS RVS-RFA is a dominant strategy for patients with small HCC unidentifiable in B-mode US, in terms of cost savings and QALYs gained, relative to the conventional US-guided method.
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Toshikuni N, Tsutsumi M, Takuma Y, Arisawa T. Real-time image fusion for successful percutaneous radiofrequency ablation of hepatocellular carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2005-2010. [PMID: 25336489 DOI: 10.7863/ultra.33.11.2005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Percutaneous radiofrequency ablation (RFA) is an established nonsurgical curative treatment for hepatocellular carcinoma (HCC). Because of its efficiency and safety, sonography is the most commonly used imaging modality when performing RFA. However, the presence of HCC nodules that are inconspicuous when using conventional sonography is a major drawback of RFA and limits its feasibility as a treatment for HCC. However, a new technology has been developed that synthesizes high-resolution multiplanar reconstruction images using 3-dimensional data and is combined with a position-tracking system using magnetic navigation. With this technology, real-time sonograms can be fused with corresponding computed tomographic, magnetic resonance imaging, or even sonographic volume data; this process is known as real-time image fusion. In this article, we describe this novel imaging method as a useful tool for successful RFA treatment of HCC.
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Affiliation(s)
- Nobuyuki Toshikuni
- Departments of Gastroenterology (N.T., T.A.) and Hepatology (M.T.), Kanazawa Medical University, Ishikawa, Japan (M.T.); and Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan (Y.T.).
| | - Mikihiro Tsutsumi
- Departments of Gastroenterology (N.T., T.A.) and Hepatology (M.T.), Kanazawa Medical University, Ishikawa, Japan (M.T.); and Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan (Y.T.)
| | - Yoshitaka Takuma
- Departments of Gastroenterology (N.T., T.A.) and Hepatology (M.T.), Kanazawa Medical University, Ishikawa, Japan (M.T.); and Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan (Y.T.)
| | - Tomiyasu Arisawa
- Departments of Gastroenterology (N.T., T.A.) and Hepatology (M.T.), Kanazawa Medical University, Ishikawa, Japan (M.T.); and Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan (Y.T.)
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Dong Y, Wang WP, Gan YH, Huang BJ, Ding H. Radiofrequency ablation guided by contrast-enhanced ultrasound for hepatic malignancies: Preliminary results. Clin Radiol 2014; 69:1129-35. [DOI: 10.1016/j.crad.2014.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 06/06/2014] [Accepted: 06/16/2014] [Indexed: 01/07/2023]
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Minami Y, Kudo M. Ultrasound fusion imaging of hepatocellular carcinoma: a review of current evidence. Dig Dis 2014; 32:690-5. [PMID: 25376285 DOI: 10.1159/000368001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
With advances in technology, imaging techniques that entail fusion of sonography and CT or MRI have been introduced in clinical practice. Ultrasound fusion imaging provides CT or MRI cross-sectional multiplanar images that correspond to the sonographic images, and fusion imaging of B-mode sonography and CT or MRI can be displayed simultaneously and in real time according to the angle of the transducer. Ultrasound fusion imaging helps us understand the three-dimensional relationship between the liver vasculature and tumors, and can detect small liver tumors with poor conspicuity. This fusion imaging is attracting the attention of operators who perform radiofrequency ablation (RFA) for the treatment of hepatic malignancies because this real-time, multimodality comparison can increase monitoring and targeting confidence during the procedure. When RFA with fusion imaging was performed on small hepatocellular carcinomas (HCCs) with poor conspicuity, it was reported that the rates of technical success and local tumor progression were 94.4-100% and 0-8.3%. However, there have been no studies comparing fusion imaging guidance and contrast-enhanced sonography, CT or MRI guidance in ablation. Fusion imaging-guided RFA has proved to be effective for HCCs that are poorly defined on not only conventional B-mode sonography but also contrast-enhanced sonography. In addition, fusion imaging could be useful to assess the treatment response of RFA because of three-dimensional information. Here, we give an overview of the current status of ultrasound fusion imaging for clinical application in the liver.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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Xu ZF, Xie XY, Kuang M, Liu GJ, Chen LD, Zheng YL, Lu MD. Percutaneous radiofrequency ablation of malignant liver tumors with ultrasound and CT fusion imaging guidance. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:321-330. [PMID: 24615771 DOI: 10.1002/jcu.22141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 08/22/2013] [Accepted: 01/16/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND To evaluate the feasibility, accuracy, and utility of sonography (US) and CT fusion imaging guidance for radiofrequency ablation (RFA) of malignant liver tumors not visualized on conventional US. METHODS Seventy-seven patients with hepatocellular carcinoma and 15 patients with metastatic liver cancer with a total of 136 lesions underwent RFA with US and CT fusion imaging guidance. The mean number of punctures, success rate of a single ablation session, local tumor progression rates, and long-term outcome were evaluated. Treatment efficacy was evaluated by dynamic CT and contrast-enhanced US 1 month after RFA. RESULTS RFA was technically feasible in all patients, and no major complications occurred. The mean ± SD time needed to synchronize US and CT images was 13.9 ± 11.9 minutes (range, 5-55 minutes). The success rate of a single ablation session was 83.8% (114/136), and tumor residue was present in 7.4% of lesions (10/136). The mean number of treatment sessions was 1.2 ± 0.5 sessions. During follow-up, local tumor progression was observed for 15 (11.9%) lesions. Distant tumor recurrence was found in 51 (55.4%) patients. CONCLUSIONS US and CT fusion-assisted RFA is a safe and efficacious treatment for patients with hepatocellular carcinoma and metastatic liver cancer.
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Affiliation(s)
- Zuo-Feng Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
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Prada F, Del Bene M, Mattei L, Casali C, Filippini A, Legnani F, Mangraviti A, Saladino A, Perin A, Richetta C, Vetrano I, Moiraghi A, Saini M, DiMeco F. Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery. J Ultrasound 2014; 17:243-51. [PMID: 25177400 DOI: 10.1007/s40477-014-0111-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 06/02/2014] [Indexed: 12/19/2022] Open
Abstract
The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Luca Mattei
- Università degli Studi di Milano, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Assunta Filippini
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Federico Legnani
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | | | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Alessandro Perin
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Carla Richetta
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Ignazio Vetrano
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Alessandro Moiraghi
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Marco Saini
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Department of Neurosurgery, Johns Hopkins University, Baltimore, USA
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Subject-specific real-time respiratory liver motion compensation method for ultrasound-MRI/CT fusion imaging. Int J Comput Assist Radiol Surg 2014; 10:517-29. [DOI: 10.1007/s11548-014-1085-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/29/2014] [Indexed: 11/26/2022]
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Yamakado K, Takaki H, Nakatsuka A, Yamaknaka T, Fujimori M, Hasegawa T, Uraki J. Radiofrequency ablation for hepatocellular carcinoma. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mauri G, Cova L, De Beni S, Ierace T, Tondolo T, Cerri A, Goldberg SN, Solbiati L. Real-time US-CT/MRI image fusion for guidance of thermal ablation of liver tumors undetectable with US: results in 295 cases. Cardiovasc Intervent Radiol 2014; 38:143-51. [PMID: 24806953 DOI: 10.1007/s00270-014-0897-y] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/17/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE This study was designed to assess feasibility of US-CT/MRI fusion-guided ablation in liver tumors undetectable with US. METHODS From 2002 to 2012, 295 tumors (162 HCCs and 133 metastases; mean diameter 1.3 ± 0.6 cm, range 0.5-2.5 cm) detectable on contrast-enhanced CT/MRI, but completely undetectable with unenhanced US and either totally undetectable or incompletely conspicuous with contrast-enhanced US (CEUS), were treated in 215 sessions using either internally cooled radiofrequency or microwave with standard ablation protocols, guided by an image fusion system (Virtual Navigation System, Esaote S.p.A., Genova, Italy) that combines US with CT/ MRI images. Correct targeting and successful ablation of tumor were verified after 24 hours with CT or MRI. RESULTS A total of 282 of 295 (95.6 %) tumors were correctly targeted with successful ablation achieved in 266 of 295 (90.2 %). Sixteen of 295 (5.4 %) tumors were correctly targeted, but unsuccessfully ablated, and 13 of 295 (4.4 %) tumors were unsuccessfully ablated due to inaccurate targeting. There were no perioperative deaths. Major complications were observed in 2 of the 215 treatments sessions (0.9 %). CONCLUSIONS Real-time virtual navigation system with US-CT/MRI fusion imaging is precise for targeting and achieving successful ablation of target tumors undetectable with US alone. Therefore, a larger population could benefit from ultrasound guided ablation procedures.
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Affiliation(s)
- Giovanni Mauri
- Unit of Interventional Oncologic Radiology, Department of Diagnostic Imaging, Azienda Ospedaliera Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Varese, Italy,
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Min J, Lee M, Rhim H, Cha D, Lim S, Choi SY, Lim H. Local tumour progression after loco-regional therapy of hepatocellular carcinomas: Value of fusion imaging-guided radiofrequency ablation. Clin Radiol 2014; 69:286-93. [DOI: 10.1016/j.crad.2013.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 01/20/2023]
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Tomonari A, Tsuji K, Yamazaki H, Aoki H, Kang JH, Kodama Y, Sakurai Y, Maguchi H. Feasibility of the virtual needle tracking system for percutaneous radiofrequency ablation of hepatocellular carcinoma. Hepatol Res 2013; 43:1352-5. [PMID: 23510148 DOI: 10.1111/hepr.12096] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the feasibility of the real-time virtual needle tracking system for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). METHODS An electromagnetic field created by an ultrasound (US) machine detected the tracking bracket mounted onto the RFA needle. When the needle tip was confirmed to be in the accurate plane extracorporeally, the needle was inserted into the liver using the virtual navigation US system, and RFA was performed. Eight patients with eight liver lesions underwent percutaneous RFA under ultrasound for HCC from October to November 2012 using the real-time electromagnetic virtual needle tracking system (VirtuTRAX). RESULTS The average size of the tumors was 11.5 mm with one lesion in S4, two in S5, two in S7 and three in S8. Sufficient margins were obtained in a single session in all cases. Using only B-mode, the needle tip was obscured due to the condition of the surrounding liver or subcutaneous fat tissue, but it was identifiable with the use of the virtual needle tracking device in all cases. In one case where the lesion was large, the needle was placed twice deliberately, but the second puncture was made difficult by the ablation artifact of the first puncture. With the tracking device, however, it was possible to perform the second puncture accurately. CONCLUSION The virtual tracking system is useful in cases where the needle tip is obscured due to surrounding liver conditions or when multiple punctures are necessary due to the ablation artifact's obscuring the needle tip. Freehand puncturing may be possible in the future using this technique with further improvements in the system.
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Affiliation(s)
- Akiko Tomonari
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
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Sofuni A, Itoi T, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Tanaka R, Umeda J, Tonozuka R, Honjo M, Mukai S, Moriyasu F. Real-time virtual sonography visualization and its clinical application in biliopancreatic disease. World J Gastroenterol 2013; 19:7419-7425. [PMID: 24259973 PMCID: PMC3831224 DOI: 10.3748/wjg.v19.i42.7419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/14/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the usefulness of real-time virtual sonography (RVS) in biliary and pancreatic diseases.
METHODS: This study included 15 patients with biliary and pancreatic diseases. RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography (CT) image, using pre-scanned CT volume data. The ultrasound used was EUB-8500 with a convex probe EUP-C514. The RVS images were evaluated based on 3 levels, namely, excellent, good and poor, by the displacement in position.
RESULTS: By combining the objectivity of CT with free scanning using RVS, it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures. The resulting evaluation levels of the RVS images were 12 excellent (pancreatic cancer, bile duct cancer, cholecystolithiasis and cholangiocellular carcinoma) and 3 good (pancreatic cancer and gallbladder cancer). Compared with conventional B-mode ultrasonography and CT, RVS images achieved a rate of 80% superior visualization and 20% better visualization.
CONCLUSION: RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.
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Miyazaki M, Shibuya K, Tokue H, Tsushima Y. Percutaneous transhepatic biliary drainage assisted by real-time virtual sonography: a retrospective study. BMC Gastroenterol 2013; 13:127. [PMID: 23941632 PMCID: PMC3751649 DOI: 10.1186/1471-230x-13-127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 08/13/2013] [Indexed: 01/20/2023] Open
Abstract
Background Real-time virtual sonography (RVS) is a diagnostic imaging support system that can synchronize with ultrasound images in conjunction with computed tomography or magnetic resonance images using magnetic navigation system. RVS has been applied in clinical practice to perform such procedures as radiofrequency ablation and biopsy; however, the application of RVS for percutaneous transhepatic biliary drainage (PTBD) is rare. Methods Between 2007 and 2012, RVS-assisted PTBD was performed for 30 patients (19 males and 11 females; age range, 41 to 89 years; mean age, 66.9 years) with obstructive jaundice. The targeted bile duct was determined using the RVS system before the procedure. The intervention was considered to be successful when the targeted bile duct was punctured and the drainage catheter was placed in the bile duct. Complications were evaluated according to the Society of Interventional Radiology Clinical Practice Guidelines. Results A total of 37 interventions were performed for 30 patients. The interventions were successful in 35 (95%) of 37 interventions. The targeted bile ducts were: B3 (n = 24), B5 (n = 7), B8 (n = 3), B6 (n = 1), and the anterior (n = 1) and posterior (n = 1) branches of the right bile duct. The mean targeted bile duct diameter was 4.9 mm (1.9 to 8.2 mm). PTBD was able to be accomplished in all patients because the non-targeted bile ducts were successfully punctured alternatively. No major complications were observed in relation to the interventional procedure. Conclusions RVS-assisted PTBD is a feasible and safe procedure. Accurate puncture of targeted bile ducts can be achieved using this method.
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Farouil G, Deschamps F, Hakime A, de Baere T. Coil-assisted RFA of poorly visible liver tumors: effectiveness and risk factors of local tumor progression. Cardiovasc Intervent Radiol 2013; 37:716-22. [PMID: 23925920 DOI: 10.1007/s00270-013-0717-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/03/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study was designed to determine the effectiveness of a percutaneously inserted coil as a landmark before radiofrequency ablation (RFA) of poorly visible liver tumors on unenhanced computed tomography and ultrasound. METHODS This was a single-center, retrospective study of 46 consecutive patients treated from January 2008 to June 2012 with RFA under CT guidance for 57 poorly visible liver tumors after percutaneous coil insertion. Effectiveness was evaluated by the rate of local tumor progression (LTP), and the risk factors of LTP were evaluated by multiple univariate analysis. RESULTS After a mean follow-up of 15.9 months, the overall rate of LTP was 22.8 % (13/57). An increase in the distance between the coil and the center of the tumor was a predictive factor of LTP (p = 0.005) and resulted in an increase in time to place the RFA probe. LTP was significantly reduced in case of coil placed within the tumor (10 vs. 43.5 %, p = 0.009). CONCLUSIONS The effectiveness of the "coil-assisted" RFA for poorly visible liver tumors is improved by centering the coil in the tumor in order to facilitate the placement of the RFA probe and equal to the results of RFA under direct image guidance.
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Affiliation(s)
- Geoffroy Farouil
- Department of Interventional Radiology, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France,
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Rajesh S, Mukund A, Arora A, Jain D, Sarin SK. Contrast-enhanced US-guided Radiofrequency Ablation of Hepatocellular Carcinoma. J Vasc Interv Radiol 2013; 24:1235-40. [DOI: 10.1016/j.jvir.2013.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 04/02/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022] Open
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Advanced ultrasonography technologies to assess the effects of radiofrequency ablation on hepatocellular carcinoma. Radiol Oncol 2013; 47:224-9. [PMID: 24133386 PMCID: PMC3794877 DOI: 10.2478/raon-2013-0033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/24/2013] [Indexed: 01/08/2023] Open
Abstract
Background Radiofrequency ablation (RFA) is a curative therapy for hepatocellular carcinoma (HCC). In RFA, ultrasonography (US) is most commonly used to guide tumor puncture, while its effects are assessed using dynamic computed tomography or magnetic resonance. The differences in modalities used for RFA and assessment of its effects complicate RFA. We developed a method for assessing the effects of RFA on HCC by combining contrast-enhanced (CE) US and real-time virtual sonography with three-dimensional US data. Patients and methods Before RFA, we performed a sweep scan of the target HCC nodule and the surrounding hepatic parenchyma to generate three-dimensional US data. After RFA, we synchronized multi-planar reconstruction images derived from stored three-dimensional US data with real-time US images on the same US monitor and performed CEUS and real-time virtual sonography. Using a marking function, we drew a sphere marker along the target HCC nodule contour on pre-treatment US- multi-planar reconstruction images so that the automatically synchronized sphere marker represented the original HCC nodule contour on post-treatment real-time CEUS images. Ablation was considered sufficient when an avascular area with a margin of several millimeters in all directions surrounded the sphere marker on CEUS. Results This method was feasible and useful for assessing therapeutic effects in 13 consecutive patients with HCC who underwent RFA. In 2 patients who underwent multiple sessions of RFA, HCC-nodule portions requiring additional RFA were easily identified on US images. Conclusions This method using advanced US technologies will facilitate assessment of the effects of RFA on HCC.
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Abstract
OBJECTIVE The aim of our article is to give an overview of the current and future possibilities of real-time image fusion involving ultrasound. We present a review of the existing English-language peer-reviewed literature assessing this technique, which covers technical solutions (for ultrasound and endoscopic ultrasound), image fusion in several anatomic regions, and electromagnetic needle tracking. CONCLUSION The recent progress of real-time ultrasound in image fusion may provide several new possibilities, including diagnosis, treatment, and follow-up of oncologic patients.
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Appelbaum L, Solbiati L, Sosna J, Nissenbaum Y, Greenbaum N, Goldberg SN. Evaluation of an electromagnetic image-fusion navigation system for biopsy of small lesions: assessment of accuracy in an in vivo swine model. Acad Radiol 2013; 20:209-17. [PMID: 23395242 DOI: 10.1016/j.acra.2012.09.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the accuracy of a novel combined electromagnetic (EM) navigation/image fusion system for biopsy of small lesions. MATERIALS AND METHODS Using ultrasound (US) guidance, metallic (2 × 1 mm) targets were imbedded in the paraspinal muscle (n = 28), kidney (n = 18), and liver (n = 4) of four 55- to 65-kg pigs. Baseline helical computed tomography (CT) imaging (Brilliance; Philips) identified these biopsy targets and six and nine cutaneous fiducial markers. CT data were imported into a MyLab Twice system (Esaote, Genoa, Italy) for CT/US image fusion. After verification of successful image fusion, baseline registration error and respiratory motion error were assessed by documenting deviation of the US and CT position of the targets in real time. Biopsy targeting was subsequently performed under conditions of normal respiratory using 15-cm 16G eTrax needles (Civco). To mimic the conditions of poor US visualization, only reconstructed CT information was displayed during biopsy. Accuracy of targeting was measured by repeat CT scanning as the distance of the needle tip to the target center. Targeting accuracy of free-hand vs. guided technique, and electromagnetic (EM) sensor positioning (ie, on the hub or within the needle stylus tip) were evaluated. RESULTS In muscle, needle registration error was 0.9 ± 1.2 mm and respiratory motion error 4.0 ± 1.0 mm. Target accuracy was 4.0 ± 3.2 mm when an EM sensor was imbedded in the needle tip. Yet, with the EM sensor back on the needle hub, greater targeting accuracy was achieved using an US guide (3.2 ± 1.6 mm) vs. freehand (5.7 ± 3.2 mm, P = .04). For kidney, registration error was 1.8 ± 1.7 mm and respiratory motion error 4.9 ± 1.0 mm. For the deeper kidney targets, target accuracy was 4.4 ± 3.2 mm with a tip EM sensor, which was an improvement over the hub EM sensor positioning (9.3 ± 4.6 mm; P < .01). An additional source of fusion error was noted for liver. Beyond 17 ± 1 mm of respiratory motion, targets were observed to move >3 cm with US transducer/needle compression resulting in 14 ± 1.4 mm targeting accuracy. CONCLUSIONS A combined image-fusion/EM tracking platform can provide a high degree of needle placement accuracy (<5 mm) when targeting small lesions. Results fall within accuracy of respiratory error; with best results obtained by incorporating an EM sensor into the tip of the biopsy system.
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Affiliation(s)
- Liat Appelbaum
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120.
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Abstract
The main methods of treatment for hepatocellular carcinoma (HCC) in Japan are hepatic resection, radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE). Meticulous follow up is then undertaken to check for recurrence, which is treated using repeated RFA or TACE. Hepatic arterial infusion chemotherapy has been introduced as treatment for advanced HCC, and the molecular-targeted drug sorafenib is also now available. Rigorous medical care using these treatment methods and early diagnosis mean that the prognosis for HCC in Japan is the best in the world. This paper reviews the treatment strategies for HCC in Japan.
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Affiliation(s)
- Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University, Kanazawa, Ishikawa, Japan
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Makino Y, Imai Y, Ohama H, Igura T, Kogita S, Sawai Y, Fukuda K, Takamura M, Ohashi H, Murakami T. Ultrasonography Fusion Imaging System Increases the Chance of Radiofrequency Ablation for Hepatocellular Carcinoma with Poor Conspicuity on Conventional Ultrasonography. Oncology 2013; 84 Suppl 1:44-50. [DOI: 10.1159/000345889] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Makino Y, Imai Y, Igura T, Ohama H, Kogita S, Sawai Y, Fukuda K, Ohashi H, Murakami T. Usefulness of the multimodality fusion imaging for the diagnosis and treatment of hepatocellular carcinoma. Dig Dis 2012; 30:580-7. [PMID: 23258098 DOI: 10.1159/000343070] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A multimodality fusion imaging system has been introduced for the clinical practice of diagnosis and treatment of hepatocellular carcinoma (HCC), especially for loco-regional treatment. An ultrasonography (US) fusion imaging system can provide a side-by-side display of real-time US images and any cross-sectional images of multiplanar reconstruction of CT or MRI that synchronize real-time US. The US fusion imaging system enables us to perform radiofrequency ablation (RFA) for HCCs difficult to detect on conventional US safely. Besides, we can evaluate the treatment effects of RFA easily at the bedside by combining the contrast-enhanced US and the US fusion imaging system. Fusion images of pre- and post-RFA CT have been utilized for the assessment of the treatment effects of RFA. Although the treatment effects of RFA have been conventionally evaluated, comparing pre- and post-RFA CT side-by-side, the evaluation tends to be inaccurate. On CT fusion images, the tumor and the ablation zone are overlaid and we can grasp the positional relation easily, leading to quantitative and more accurate evaluation. The multimodality fusion imaging system has become quite an important tool for loco-regional treatment of HCC because of its usefulness for both the guidance during the RFA procedure and the evaluation of its treatment effects.
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Affiliation(s)
- Yuki Makino
- Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18 Johnan, Ikeda, Osaka, Japan
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Liu J, Zhan W, Zhou M, Zhang X, Hu Y, Zhu Y. The feasibility study of US-MRI virtual navigation in the shoulder. Clin Imaging 2012; 36:803-9. [PMID: 23041159 DOI: 10.1016/j.clinimag.2011.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 10/07/2011] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of ultrasound sonography (US)-magnetic resonance imaging (MRI) virtual navigation in the shoulder. METHODS We selected 10 healthy volunteers and 10 patients with supraspinatus tendinitis to fuse in the shoulder with a Virtual Navigator System. We selected five internal marks as follows: (1) ① acromion, ② the point of junction between the supraspinatus muscle and the tendon, ③ the point of the middle in the surface of the head of humerus in the plane of ②, ④ the point of attachment of the supraspinatus tendon in the great tuberosity of humerus, and ⑤ the point of the middle in the surface of the head of humerus in the plane of ④. To make three, four, and five marks in different combinations in the process of image fusion successively, it should be based on these points. The observed targets included coincidence, stability, and accuracy in the sonography and magnetic resonance images by two radiologists. RESULTS The supraspinatus tendon of the 10 volunteers and the lesions of 10 patients with supraspinatus tendinitis could be fused between the sonography image and the magnetic resonance image. The effect of the combination of ②+③+④+⑤ in the group with four-point internal marks was most satisfactory (P<.05). CONCLUSION The process of the combination of ②+③+④+⑤ in the group with four-point internal marks is considered the best method, and the application of US-MRI virtual navigation is regarded feasible in the shoulder.
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Affiliation(s)
- Jun Liu
- Ruijin Hospital, Shanghai Jiaotong, University School of Medicine, Shanghai 200025, China.
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Fukuda H, Ito R, Ohto M, Sakamoto A, Otsuka M, Togawa A, Miyazaki M, Yamagata H. US-CT 3D dual imaging by mutual display of the same sections for depicting minor changes in hepatocellular carcinoma. Eur J Radiol 2012; 81:2014-9. [DOI: 10.1016/j.ejrad.2011.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/17/2011] [Accepted: 05/19/2011] [Indexed: 10/18/2022]
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