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Delgado JF, Owen JW, Pritchard WF, Varble NA, Lopez-Silva TL, Mikhail AS, Arrichiello A, Ray T, Morhard R, Borde T, Saccenti L, Xu S, Rivera J, Schneider JP, Karanian JW, Wood BJ. Ultrasound and x-ray imageable poloxamer-based hydrogel for loco-regional therapy delivery in the liver. Sci Rep 2024; 14:20455. [PMID: 39227382 PMCID: PMC11372101 DOI: 10.1038/s41598-024-70992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 08/22/2024] [Indexed: 09/05/2024] Open
Abstract
Intratumoral injections have the potential for enhanced cancer treatment efficacy while reducing costs and systemic exposure. However, intratumoral drug injections can result in substantial off-target leakage and are invisible under standard imaging modalities like ultrasound (US) and x-ray. A thermosensitive poloxamer-based gel for drug delivery was developed that is visible using x-ray imaging (computed tomography (CT), cone beam CT, fluoroscopy), as well as using US by means of integrating perfluorobutane-filled microbubbles (MBs). MBs content was optimized using tissue mimicking phantoms and ex vivo bovine livers. Gel formulations less than 1% MBs provided gel depositions that were clearly identifiable on US and distinguishable from tissue background and with minimal acoustic artifacts. The cross-sectional areas of gel depositions obtained with US and CT imaging were similar in studies using ex vivo bovine liver and postmortem in situ swine liver. The gel formulation enhanced multimodal image-guided navigation, enabling fusion of ultrasound and x-ray/CT imaging, which may enhance targeting, definition of spatial delivery, and overlap of tumor and gel. Although speculative, such a paradigm for intratumoral drug delivery might streamline clinical workflows, reduce radiation exposure by reliance on US, and boost the precision and accuracy of drug delivery targeting during procedures. Imageable gels may also provide enhanced temporal and spatial control of intratumoral conformal drug delivery.
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Affiliation(s)
- Jose F Delgado
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
- Fischell Department of Bioengineering, University of Maryland, College Park. Maryland, USA.
| | - Joshua W Owen
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
| | - Nicole A Varble
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- Philips Healthcare, Cambridge, MA, USA
| | - Tania L Lopez-Silva
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Andrew S Mikhail
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Antonio Arrichiello
- Department of Diagnostic and Interventional Radiology, UOS of Interventional Radiology, Ospedale Maggiore Di Lodi, Largo Donatori del Sangue, Lodi, Italy
| | - Trisha Ray
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Robert Morhard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Tabea Borde
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Laetitia Saccenti
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Jocelyne Rivera
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- Institute of Biomedical Engineering, St. Catherine's College, University of Oxford, Oxford, UK
| | - Joel P Schneider
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - John W Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
- Fischell Department of Bioengineering, University of Maryland, College Park. Maryland, USA.
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Hooshangnejad H, China D, Huang Y, Zbijewski W, Uneri A, McNutt T, Lee J, Ding K. XIOSIS: An X-Ray-Based Intra-Operative Image-Guided Platform for Oncology Smart Material Delivery. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:3176-3187. [PMID: 38602853 PMCID: PMC11418373 DOI: 10.1109/tmi.2024.3387830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Image-guided interventional oncology procedures can greatly enhance the outcome of cancer treatment. As an enhancing procedure, oncology smart material delivery can increase cancer therapy's quality, effectiveness, and safety. However, the effectiveness of enhancing procedures highly depends on the accuracy of smart material placement procedures. Inaccurate placement of smart materials can lead to adverse side effects and health hazards. Image guidance can considerably improve the safety and robustness of smart material delivery. In this study, we developed a novel generative deep-learning platform that highly prioritizes clinical practicality and provides the most informative intra-operative feedback for image-guided smart material delivery. XIOSIS generates a patient-specific 3D volumetric computed tomography (CT) from three intraoperative radiographs (X-ray images) acquired by a mobile C-arm during the operation. As the first of its kind, XIOSIS (i) synthesizes the CT from small field-of-view radiographs;(ii) reconstructs the intra-operative spacer distribution; (iii) is robust; and (iv) is equipped with a novel soft-contrast cost function. To demonstrate the effectiveness of XIOSIS in providing intra-operative image guidance, we applied XIOSIS to the duodenal hydrogel spacer placement procedure. We evaluated XIOSIS performance in an image-guided virtual spacer placement and actual spacer placement in two cadaver specimens. XIOSIS showed a clinically acceptable performance, reconstructed the 3D intra-operative hydrogel spacer distribution with an average structural similarity of 0.88 and Dice coefficient of 0.63 and with less than 1 cm difference in spacer location relative to the spinal cord.
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Lin J, Liu H, Liang S, Luo L, Guan S, Wu S, Liu Y, Xu S, Yan R, Xu E. Microwave ablation for colorectal liver metastases with ultrasound fusion imaging assistance: a stratified analysis study based on tumor size and location. Abdom Radiol (NY) 2024:10.1007/s00261-024-04508-0. [PMID: 39090260 DOI: 10.1007/s00261-024-04508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/20/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To investigate the efficacy of ultrasound fusion imaging-assisted microwave ablation (MWA) for patients with colorectal liver metastases (CRLM) based on stratified analysis of tumor size and location. METHODS Patients with CRLM who underwent ultrasound fusion imaging-assisted MWA in our hospital between February 2020 and February 2023 were enrolled into this retrospective study. Ultrasound fusion imaging was used for detection, guidance, monitoring and immediate evaluation throughout the MWA procedures. Technical success, technique efficacy, local tumor progression (LTP), intrahepatic progression and overall survival (OS) were recorded and analyzed. The subgroup analysis of intrahepatic progression of MWA for CRLM was performed according to tumor size and location. RESULTS A total of 51 patients with 122 nodules were enrolled. Both technical success and technique efficacy were acquired in all nodules. In a median follow-up period of 19 months, 2.5% of the nodules (3/122) were observed LTP. The 1-year and 2-year cumulative intrahepatic progression rates were 38.7% and 52.1% respectively. Patients were divided into subgroups according to tumor size (≥ 30 mm, n = 13; < 30 mm, n = 38) and tumor location (perivascular, n = 20; non-perivascular, n = 31 and subcapsular, n = 36; non-subcapsular, n = 15). The cumulative intrahepatic progression rates were similar between the subgroups regarding tumor size and perivascular location, while significantly higher in the subcapsular group than in the non-subcapsular group (p = 0.021). CONCLUSION Ultrasound fusion imaging-assisted MWA exhibited satisfactory local efficacy for CRLM, especially for non-subcapsular tumors.
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Affiliation(s)
- Jia Lin
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Huahui Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Shuang Liang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Liping Luo
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Sainan Guan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Shanshan Wu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Ying Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Shuxian Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China
| | - Ronghua Yan
- Department of Radiology, Peking University Shenzhen Hospital, NO.1120 Lianhua Road, Shenzhen, 518000, Guangdong Province, China.
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-Sen University, NO.3025 Shennan Middle Road, Shenzhen, 518000, Guangdong Province, China.
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Paccini M, Paschina G, De Beni S, Stefanov A, Kolev V, Patanè G. US & MR/CT Image Fusion with Markerless Skin Registration: A Proof of Concept. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01176-w. [PMID: 39020154 DOI: 10.1007/s10278-024-01176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/18/2024] [Accepted: 05/31/2024] [Indexed: 07/19/2024]
Abstract
This paper presents an innovative automatic fusion imaging system that combines 3D CT/MR images with real-time ultrasound acquisition. The system eliminates the need for external physical markers and complex training, making image fusion feasible for physicians with different experience levels. The integrated system involves a portable 3D camera for patient-specific surface acquisition, an electromagnetic tracking system, and US components. The fusion algorithm comprises two main parts: skin segmentation and rigid co-registration, both integrated into the US machine. The co-registration aligns the surface extracted from CT/MR images with the 3D surface acquired by the camera, facilitating rapid and effective fusion. Experimental tests in different settings, validate the system's accuracy, computational efficiency, noise robustness, and operator independence.
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Affiliation(s)
| | | | | | | | - Velizar Kolev
- MedCom GmbH, Dolivostr., 11, Darmstadt, 64293, Germany
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Wang F, Zhang Q, Yan K, Jing X, Chen Y, Kong W, Zhao Q, Zhu Z, Dong Y, Wang W. 3D-CEUS/MRI-CEUS fusion imaging vs 2D-CEUS after locoregional therapies for hepatocellular carcinoma: a multicenter prospective study of therapeutic response evaluation. Eur Radiol 2024:10.1007/s00330-024-10915-0. [PMID: 38992106 DOI: 10.1007/s00330-024-10915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To compare the diagnostic accuracy of 3D contrast-enhanced ultrasound (CEUS)/MRI-CEUS fusion imaging with 2D-CEUS in assessing the response of hepatocellular carcinoma (HCC) to locoregional therapies in a multicenter prospective study. MATERIALS AND METHODS A consecutive series of patients with HCC scheduled for locoregional treatment were enrolled between April 2021 and March 2023. Patients were randomly divided into 3D-CEUS/MRI-CEUS fusion imaging group (3D/fusion group) or 2D-CEUS group (2D group). CEUS was performed 1 week before and 4-6 weeks after locoregional treatment. Contrast-enhanced MRI (CE-MRI) 4-6 weeks after treatment was set as the reference standard. CEUS images were evaluated for the presence or absence of viable tumors. Diagnostic performance criteria, including sensitivity, specificity, accuracy, and area under the curve (AUC), were determined for each modality. RESULTS A total of 140 patients were included, 70 patients in the 2D group (mean age, 60.2 ± 10.4 years) and 70 patients in the 3D/fusion group (mean age, 59.8 ± 10.6 years). The sensitivity of the 3D/fusion group was 100.0% (95% CI: 75.9, 100.0), higher than that of the 2D group (55.6%, 95% CI: 22.7, 84.7; p = 0.019). The specificity of the 3D/fusion group was 96.3% (95% CI: 86.2, 99.4), which was comparable to that of the 2D group (98.4%, 95% CI: 90.0, 99.9; p = 0.915). The AUC of the 3D/fusion group was 0.98 (95% CI: 0.95, 1.00), higher than that of the 2D group (0.77, 95% CI: 0.56, 0.98; p = 0.020). CONCLUSION 3D-CEUS/MRI-CEUS fusion imaging exhibits superior diagnostic accuracy in evaluating the treatment response to locoregional therapies for HCC. CLINICAL RELEVANCE STATEMENT 3D-CEUS/MRI-CEUS fusion imaging can be applied for post-treatment assessment of residual tumors in HCC undergoing locoregional treatment, offering potential benefits in terms of accurate diagnosis and clinical management. KEY POINTS Evaluating for HCC recurrence following locoregional therapy is important. 3D-CEUS/MRI-CEUS fusion imaging achieved a higher sensitivity than 2D-CEUS in assessing residual tumors after locoregional therapies. 3D-CEUS/MRI-CEUS fusion imaging can help clinicians intervene early in residual HCC lesions after locoregional treatment.
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Affiliation(s)
- Feihang Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang Jing
- Department of Ultrasonography, Tianjin Third Central Hospital, Tianjin, China
| | - Yaqing Chen
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wentao Kong
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiyu Zhao
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zheng Zhu
- Department of Ultrasound, The First People's Hospital of Taicang, Suzhou, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.
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Delgado JF, Pritchard WF, Varble N, Lopez-Silva TL, Arrichiello A, Mikhail AS, Morhard R, Ray T, Havakuk MM, Nguyen A, Borde T, Owen JW, Schneider JP, Karanian JW, Wood BJ. X-ray imageable, drug-loaded hydrogel that forms at body temperature for image-guided, needle-based locoregional drug delivery. Sci Rep 2024; 14:13352. [PMID: 38858467 PMCID: PMC11164888 DOI: 10.1038/s41598-024-64189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/06/2024] [Indexed: 06/12/2024] Open
Abstract
Liver cancer ranks as the fifth leading cause of cancer-related death globally. Direct intratumoral injections of anti-cancer therapeutics may improve therapeutic efficacy and mitigate adverse effects compared to intravenous injections. Some challenges of intratumoral injections are that the liquid drug formulation may not remain localized and have unpredictable volumetric distribution. Thus, drug delivery varies widely, highly-dependent upon technique. An X-ray imageable poloxamer 407 (POL)-based drug delivery gel was developed and characterized, enabling real-time feedback. Utilizing three needle devices, POL or a control iodinated contrast solution were injected into an ex vivo bovine liver. The 3D distribution was assessed with cone beam computed tomography (CBCT). The 3D distribution of POL gels demonstrated localized spherical morphologies regardless of the injection rate. In addition, the gel 3D conformal distribution could be intentionally altered, depending on the injection technique. When doxorubicin (DOX) was loaded into the POL and injected, DOX distribution on optical imaging matched iodine distribution on CBCT suggesting spatial alignment of DOX and iodine localization in tissue. The controllability and localized deposition of this formulation may ultimately reduce the dependence on operator technique, reduce systemic side effects, and facilitate reproducibility across treatments, through more predictable standardized delivery.
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Affiliation(s)
- Jose F Delgado
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA.
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.
| | - William F Pritchard
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Nicole Varble
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
- Philips Healthcare, Cambridge, MA, USA
| | - Tania L Lopez-Silva
- Chemical Biology Laboratory, National Cancer Institute, National Institutes of Health, Center for Cancer Research, Frederick, MD, USA
| | - Antonio Arrichiello
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
- UOS of Interventional Radiology, Department of Diagnostic and Interventional Radiology, Ospedale Maggiore di Lodi, Largo Donatori del Sangue, Lodi, Italy
| | - Andrew S Mikhail
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Robert Morhard
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Trisha Ray
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Michal M Havakuk
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
- Interventional Radiology Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Alex Nguyen
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
- Computer Science Department, Stanford University, Stanford, CA, USA
| | - Tabea Borde
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Joshua W Owen
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Joel P Schneider
- Chemical Biology Laboratory, National Cancer Institute, National Institutes of Health, Center for Cancer Research, Frederick, MD, USA
| | - John W Karanian
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
| | - Bradford J Wood
- National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, Bethesda, MD, USA
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
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Wei X, Hu H, Qi L, Zhong L, Liao Y, Pu J. Preoperative simulation results and intraoperative image fusion guidance for transjugular intrahepatic portosystemic shunt placement: a feasibility study of nineteen patients. Diagn Interv Radiol 2024; 30:107-116. [PMID: 36994668 PMCID: PMC10916528 DOI: 10.4274/dir.2022.221652] [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] [Received: 06/10/2022] [Accepted: 12/29/2022] [Indexed: 03/31/2023]
Abstract
PURPOSE The purpose is to evaluate the feasibility and efficacy of preoperative simulation results and intraoperative image fusion guidance during transjugular intrahepatic portosystemic shunt (TIPS) creation. METHODS Nineteen patients were enrolled in the present study. The three-dimensional (3D) structures of the bone, liver, portal vein, inferior vena cava, and hepatic vein in the contrast-enhanced computed tomography (CT) scanning area were reconstructed in the Mimics software. The virtual Rosch-Uchida liver access set and the VIATORR stent model were established in the 3D Max software. The puncture path from the hepatic vein to the portal vein and the release position of the stent were simulated in the Mimics and 3D Max software, respectively. The simulation results were exported to Photoshop software, and the 3D reconstructed top of the liver diaphragm was used as the registration point to fuse with the liver diaphragmatic surface of the intraoperative fluoroscopy image. The selected portal vein system fusion image was overlaid on the reference display screen to provide image guidance during the operation. As a control, the last 19 consecutive cases of portal vein puncture under the guidance of conventional fluoroscopy were analyzed retrospectively, including the number of puncture attempts, puncture time, total procedure time, total fluoroscopy time, and total exposure dose (dose area product). RESULTS The average time of preoperative simulation was about 61.26 ± 6.98 minutes. The average time of intraoperative image fusion was 6.05 ± 1.13 minutes. The median number of puncture attempts was not significantly different between the study group (n = 3) and the control group (n = 3; P = 0.175). The mean puncture time in the study group (17.74 ± 12.78 min) was significantly lower than that in the control group (58.32 ± 47.11 min; P = 0.002). The mean total fluoroscopy time was not significantly different between the study group (26.63 ± 12.84 min) and the control group (40.00 ± 23.44 min; P = 0.083). The mean total procedure time was significantly lower in the study group (79.74 ± 37.39 min) compared with the control group (121.70 ± 62.24 min; P = 0.019). The dose area product of the study group (220.60 ± 128.4 Gy. cm2) was not significantly different from that of the control group (228.5 ± 137.3 Gy. cm2; P = 0.773). There were no image guidance-related complications. CONCLUSION The use of preoperative simulation results and intraoperative image fusion to guide a portal vein puncture is feasible, safe, and effective when creating a TIPS. The method is cheap and may improve portal vein puncture, which may be valuable for hospitals lacking intravascular ultrasound and digital subtraction angiography (DSA) equipment equipped with a CT-angiography function.
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Affiliation(s)
- Xin Wei
- Department of Interventional Radiology, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Hong Hu
- Department of Interventional Radiology, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Lin Qi
- School of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Liming Zhong
- Department of Interventional Radiology, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Yunguo Liao
- Department of Interventional Radiology, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
| | - Jiaqi Pu
- Department of Interventional Radiology, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China
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Zeng Q, Xie S, He X, Guo Y, Wu Y, He N, Zhang L, Yu X, Zheng R, Li K. FI-CEUS: a solution to improve the diagnostic accuracy in MRI LI-RADS-indeterminate (LR-3/4) FLLs at risk for HCC. Front Oncol 2024; 13:1225116. [PMID: 38298440 PMCID: PMC10828013 DOI: 10.3389/fonc.2023.1225116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/28/2023] [Indexed: 02/02/2024] Open
Abstract
Objective To evaluate the diagnostic accuracy of fusion imaging contrast-enhanced ultrasound (FI-CEUS) of magnetic resonance imaging (MRI) LI-RADS-indeterminate (LR-3/4) and conventional ultrasound undetected focal liver lesions (FLLs) in patients at risk for hepatocellular carcinoma (HCC). Methods Between February 2020 and July 2021, 71 FLLs in 63 patients were registered for diagnostic performance evaluation respectively for ultrasound-guided thermal ablation evaluation in this retrospective study. Diagnostic performance regarding FLLs was compared between FI-CEUS and contrast-enhanced MRI (CE-MRI). Results For diagnostic performance evaluation, among 71 lesions in 63 patients, the diagnostic efficacy of FI-CEUS with LI-RADS was significantly higher than that of CE-MRI (P < 0.05) in both overall and hierarchical comparison (except for the group with lesion diameter ≥2 cm). For malignant lesions, the proportion of arterial phase hyperenhancement (APHE) and washout on FI-CEUS was higher than that on CE-MRI (P < 0.05). Conclusion FI-CEUS has a high value in the precise qualitative diagnosis of small FLLs (<2 cm) of MRI LI-RADS-indeterminate diagnosis (LR-3/4) that are undetected by conventional ultrasound in patients at risk for HCC and can be a good supplementary CE-MRI diagnostic method for thermal ablation evaluation.
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Affiliation(s)
- Qingjing Zeng
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sidong Xie
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuqi He
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuefei Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuxuan Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Na He
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University-Yuedong Hospital, Meizhou, China
| | - Lanxia Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuan Yu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Choi K, Kim SH, Kim S. Self-supervised denoising of projection data for low-dose cone-beam CT. Med Phys 2023; 50:6319-6333. [PMID: 37079443 DOI: 10.1002/mp.16421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Convolutional neural networks (CNNs) have shown promising results in image denoising tasks. While most existing CNN-based methods depend on supervised learning by directly mapping noisy inputs to clean targets, high-quality references are often unavailable for interventional radiology such as cone-beam computed tomography (CBCT). PURPOSE In this paper, we propose a novel self-supervised learning method that reduces noise in projections acquired by ordinary CBCT scans. METHODS With a network that partially blinds input, we are able to train the denoising model by mapping the partially blinded projections to the original projections. Additionally, we incorporate noise-to-noise learning into the self-supervised learning by mapping the adjacent projections to the original projections. With standard image reconstruction methods such as FDK-type algorithms, we can reconstruct high-quality CBCT images from the projections denoised by our projection-domain denoising method. RESULTS In the head phantom study, we measure peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) values of the proposed method along with the other denoising methods and uncorrected low-dose CBCT data for a quantitative comparison both in projection and image domains. The PSNR and SSIM values of our self-supervised denoising approach are 27.08 and 0.839, whereas those of uncorrected CBCT images are 15.68 and 0.103, respectively. In the retrospective study, we assess the quality of interventional patient CBCT images to evaluate the projection-domain and image-domain denoising methods. Both qualitative and quantitative results indicate that our approach can effectively produce high-quality CBCT images with low-dose projections in the absence of duplicate clean or noisy references. CONCLUSIONS Our self-supervised learning strategy is capable of restoring anatomical information while efficiently removing noise in CBCT projection data.
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Affiliation(s)
- Kihwan Choi
- Bionics Research Center, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Seung Hyoung Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungwon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
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10
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Chehab M, Kouri BE, Miller MJ, Venkatesan AM. Image Fusion Technology in Interventional Radiology. Tech Vasc Interv Radiol 2023; 26:100915. [PMID: 38071026 DOI: 10.1016/j.tvir.2023.100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Image fusion technology aims to improve patient outcomes for image-guided interventions by leveraging the strengths of multimodality imaging datasets. This most commonly involves the overlay or co-display of advanced cross-sectional imaging permitting freedom of device placement via conventional image guidance such as ultrasound, fluoroscopy, and computed tomography. This can allow the interventionalist to target and treat lesions that would otherwise be difficult or impossible to visualize and access using conventional imaging guidance. Furthermore, the use of image fusion can allow for procedures traditionally performed with cross-sectional imaging to be performed under ultrasound or fluoroscopy, by importing the data from preacquired cross-sectional imaging into the interventional procedure. This manuscript provides an overview of image fusion technologies used for interventional radiology (IR) guidance, with an emphasis on technical considerations.
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Affiliation(s)
- Monzer Chehab
- Radiology Department, Interventional Radiology, Beaumont Hospital, Dearborn, MI
| | - Brian E Kouri
- Atrium Health Wake Forest Baptist Hospital, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael J Miller
- Atrium Health Wake Forest Baptist Hospital, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Aradhana M Venkatesan
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
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11
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Li L, Chen J, Huang Y, Wu C, Ye D, Wu W, Zhou X, Qin P, Jia T, Lin Y, Su Z. Precise localization of microvascular invasion in hepatocellular carcinoma based on three-dimensional histology-MR image fusion: an ex vivo experimental study. Quant Imaging Med Surg 2023; 13:5887-5901. [PMID: 37711836 PMCID: PMC10498258 DOI: 10.21037/qims-23-220] [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] [Received: 02/23/2023] [Accepted: 06/19/2023] [Indexed: 09/16/2023]
Abstract
Background Microvascular invasion (MVI) is an independent risk factor for postoperative recurrence of hepatocellular carcinoma (HCC). However, MVI cannot be detected by conventional imaging. To localize MVI precisely on magnetic resonance (MR) images, we evaluated the feasibility and accuracy of 3-dimensional (3D) histology-MR image fusion of the liver. Methods Animal models of VX2 liver tumors were established in 10 New Zealand white rabbits under ultrasonographic guidance. The whole liver lobe containing the VX2 tumor was extracted and divided into 4 specimens, for a total of 40 specimens. MR images were obtained with a T2-weighted sequence for each specimen, and then histological images were obtained by intermittent, serial pathological sections. 3D histology-MR image fusion was performed via landmark registration in 3D Slicer software. We calculated the success rate and registration errors of image fusion, and then we located the MVI on MR images. Regarding influencing factors, we evaluated the uniformity of tissue thickness after sampling and the uniformity of tissue shrinkage after dehydration. Results The VX2 liver tumor model was successfully established in the 10 rabbits. The incidence of MVI was 80% (8/10). 3D histology-MR image fusion was successfully performed in the 39 specimens, and the success rate was 97.5% (39/40). The average registration error was 0.44±0.15 mm. MVI was detected in 20 of the 39 successfully registered specimens, resulting in a total of 166 MVI lesions. The specific location of all MVI lesions was accurately identified on MR images using 3D histology-MR image fusion. All MVI lesions showed as slightly hyperintense on the high-resolution MR T2-weighted images. The results of the influencing factor assessment showed that the tissue thickness was uniform after sampling (P=0.38), but the rates of the tissue shrinkage was inconsistent after dehydration (P<0.001). Conclusions 3D histology-MR image fusion of the isolated liver tumor model is feasible and accurate and allows for the successful identification of the specific location of MVI on MR images.
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Affiliation(s)
- Liujun Li
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Department of Ultrasound, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Jiaxin Chen
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yongquan Huang
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chaoqun Wu
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Dalin Ye
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Wenhao Wu
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xuan Zhou
- Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Peixin Qin
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Taoyu Jia
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yuhong Lin
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhongzhen Su
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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12
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Sorensen AM, Zlevor AM, Kisting MA, Couillard AB, Ziemlewicz TJ, Toia GV, Hinshaw JL, Woods M, Stratchko LM, Pickhardt PJ, Foltz ML, Peppler WW, Lee FT, Knavel Koepsel EM. CT Navigation for Percutaneous Needle Placement: How I Do It. Tech Vasc Interv Radiol 2023; 26:100911. [PMID: 38071032 DOI: 10.1016/j.tvir.2023.100911] [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: 12/18/2023]
Abstract
CT navigation (CTN) has recently been developed to combine many of the advantages of conventional CT and CT-fluoroscopic guidance for needle placement. CTN systems display real-time needle position superimposed on a CT dataset. This is accomplished by placing electromagnetic (EM) or optical transmitters/sensors on the patient and needle, combined with fiducials placed within the scan field to superimpose a known needle location onto a CT dataset. Advantages of CTN include real-time needle tracking using a contemporaneous CT dataset with the patient in the treatment position, reduced radiation to the physician, facilitation of procedures outside the gantry plane, fewer helical scans during needle placement, and needle guidance based on diagnostic-quality CT datasets. Limitations include the display of a virtual (vs actual) needle position, which can be inaccurate if the needle bends, the fiducial moves, or patient movement occurs between scans, and limitations in anatomical regions with a high degree of motion such as the lung bases. This review summarizes recently introduced CTN technologies in comparison to historical methods of CT needle guidance. A "How I do it" section follows, which describes how CT navigation has been integrated into the study center for both routine and challenging procedures, and includes step-by-step explanations, technical tips, and pitfalls.
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Affiliation(s)
- Anna M Sorensen
- Departments of Radiology, University of Wisconsin, Madison, WI
| | - Annie M Zlevor
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | | | - Giuseppe V Toia
- Departments of Radiology, University of Wisconsin, Madison, WI; Medical Physics, University of Wisconsin, Madison, WI
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI
| | - Michael Woods
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | - Marcia L Foltz
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | - Fred T Lee
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI; Biomedical Engineering, University of Wisconsin, Madison, WI
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Zlevor AM, Kisting MA, Couillard AB, Rossebo AE, Szczykutowicz TP, Mao L, White JK, Hartung MP, Gettle LM, Hinshaw JL, Pickhardt PJ, Ziemlewicz TJ, Foltz ML, Lee FT. Percutaneous CT-Guided Abdominal and Pelvic Biopsies: Comparison of an Electromagnetic Navigation System and CT Fluoroscopy. J Vasc Interv Radiol 2023; 34:910-918. [PMID: 36736821 DOI: 10.1016/j.jvir.2023.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis. MATERIALS AND METHODS A retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d'Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm). RESULTS The population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°. CONCLUSIONS Percutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.
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Affiliation(s)
- Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy P Szczykutowicz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - James K White
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael P Hartung
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Marcia L Foltz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin.
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Cloud-based fusion imaging improves operative metrics during fenestrated endovascular aneurysm repair. J Vasc Surg 2023; 77:366-373. [PMID: 36181994 DOI: 10.1016/j.jvs.2022.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Endovascular treatment of complex aortic pathology has been associated with increases in procedural-related metrics, including the operative time and radiation exposure. Three-dimensional fusion imaging technology has decreased the radiation dose and iodinated contrast use during endovascular aneurysm repair. The aim of the present study was to report our institutional experience with the use of a cloud-based fusion imaging platform during fenestrated endovascular aneurysm repair (FEVAR). METHODS A retrospective review of a prospectively maintained aortic database was performed to identify all patients who had undergone FEVAR with commercially available devices (Zenith Fenestrated; Cook Medical Inc, Bloomington, IN) between 2013 and 2020 and all endovascular aneurysm repairs performed using Cydar EV Intelligent Maps (Cydar Medical, Cambridge, UK). The Cydar EV cohort was reviewed further to select all FEVARs performed with overlay map guidance. The patient demographic, clinical, and procedure metrics were analyzed, with a comparative analysis of FEVAR performed without and with the Cydar EV imaging platform. Patients were excluded from comparative analysis if the data were incomplete in the dataset or they had a documented history of prior open or endovascular abdominal aortic aneurysm repair. RESULTS During the 7-year study period, 191 FEVARs had been performed. The Cydar EV imaging platform was implemented in 2018 and used in 124 complex endovascular aneurysm repairs, including 69 consecutive FEVARs. A complete dataset was available for 137 FEVARs. With exclusion to select for de novo FEVAR, a comparative analysis was performed of 53 FEVAR without and 63 with Cydar EV imaging guidance. The cohorts were similar in patient demographics, medical comorbidities, and aortic aneurysm characteristics. No significant difference was noted between the two groups for major adverse postoperative events, length of stay, or length of intensive care unit stay. The use of Cydar EV resulted in nonsignificant decreases in the mean fluoroscopy time (69.3 ± 28 minutes vs 66.2 ± 33 minutes; P = .598) and operative time (204.4 ± 64 minutes vs 186 ± 105 minutes; P = .278). A statistically significant decrease was found in the iodinated contrast volume (105 ± 44 mL vs 83 ± 32 mL; P = .005), patient radiation exposure using the dose area product (1,049,841 mGy/cm2 vs 630,990 mGy/cm2; P < .001) and cumulative air kerma levels (4518 mGy vs 3084 mGy; P = .02) for patients undergoing FEVAR with Cydar EV guidance. CONCLUSIONS At our aortic center, we have observed a trend toward shorter operative times and significant reductions in both iodinated contrast use and radiation exposure during FEVAR using the Cydar EV intelligent maps. Intelligent map guidance improved the efficiency of complex endovascular aneurysm repair, providing a safer intervention for both patient and practitioner.
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Ierardi AM, Carnevale A, Stellato E, De Lorenzis E, Uccelli L, Dionigi G, Giganti M, Montanari E, Carrafiello G. Cone Beam Computed Tomography Image Fusion with Cross Sectional Images for Percutaneous Renal Tumor Ablation: Preliminary Data. Technol Cancer Res Treat 2023; 22:15330338231154994. [PMID: 36991549 PMCID: PMC10064458 DOI: 10.1177/15330338231154994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/12/2018] [Accepted: 01/18/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE Percutaneous ablative treatments in the kidney are now standard options for local cancer therapy. Multimodality image guidance, combining two 3D image sets, may improve procedural images and interventional strategies. We aimed to assess the value of intra-procedural cone beam computed tomography (CBCT) with magnetic resonance (MR) or CT imaging fusion technique in the guidance of percutaneous microwave ablation (MWA) of renal neoplasms. MATERIALS AND METHODS Fifteen patients (eight males, seven females, median age 65 years, median lesion size 20 mm) underwent percutaneous MWA for 15 renal tumors. All the procedures were performed in a dedicated angiography room setting; CBCT ablation planning capabilities included multimodality image fusion. Preoperative contrast-enhanced CT was available in 12 patients, whereas magnetic resonance imaging in the remaining. All patients were considered inoperable due to comorbidities, advanced age, and/or refusal to undergo surgery. Exclusion criteria were: tumors visible at unenhanced CBCT, metastatic disease, and uncorrected coagulopathy. Technical success and technical effectiveness were calculated. Procedural time, complications and recurrences were registered. RESULTS MWA under CBCT-guidance with fusion technique was technically successful in 14 out of 15 cases (93%). The median procedural time was 45 min. No procedure-related complications were reported. No enhancing tissue was visualized in the area of ablation at 1-month follow-up. All 15 cases were recurrence-free at last follow-up assessment (median follow-up of 12 months); no cancer-specific deaths were registered. CONCLUSION CBCT-CT/MR image fusion is technically feasible and safe in achieving correct targeting and complete ablation of renal lesions. This approach bears the potential to overcome most of the limitations of unenhanced CBCT guidance alone; larger series are needed to validate this technique.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aldo Carnevale
- Radiology Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Elvira Stellato
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Licia Uccelli
- Radiology Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianlorenzo Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Melchiore Giganti
- Radiology Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
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16
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Lau CY, Adan MA, Earhart J, Seamon C, Nguyen T, Savramis A, Adams L, Zipparo ME, Madeen E, Huik K, Grossman Z, Chimukangara B, Wulan WN, Millo C, Nath A, Smith BR, Ortega-Villa AM, Proschan M, Wood BJ, Hammoud DA, Maldarelli F. Imaging and biopsy of HIV-infected individuals undergoing analytic treatment interruption. Front Med (Lausanne) 2022; 9:979756. [PMID: 36072945 PMCID: PMC9441850 DOI: 10.3389/fmed.2022.979756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background HIV persistence during antiretroviral therapy (ART) is the principal obstacle to cure. Lymphoid tissue is a compartment for HIV, but mechanisms of persistence during ART and viral rebound when ART is interrupted are inadequately understood. Metabolic activity in lymphoid tissue of patients on long-term ART is relatively low, and increases when ART is stopped. Increases in metabolic activity can be detected by 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and may represent sites of HIV replication or immune activation in response to HIV replication. Methods FDG-PET imaging will be used to identify areas of high and low metabolic uptake in lymphoid tissue of individuals undergoing long-term ART. Baseline tissue samples will be collected. Participants will then be randomized 1:1 to continue or interrupt ART via analytic treatment interruption (ATI). Image-guided biopsy will be repeated 10 days after ATI initiation. After ART restart criteria are met, image-guided biopsy will be repeated once viral suppression is re-achieved. Participants who continued ART will have a second FDG-PET and biopsies 12–16 weeks after the first. Genetic characteristics of HIV populations in areas of high and low FDG uptake will be assesed. Optional assessments of non-lymphoid anatomic compartments may be performed to evaluate HIV populations in distinct anatomic compartments. Anticipated results We anticipate that PET standardized uptake values (SUV) will correlate with HIV viral RNA in biopsies of those regions and that lymph nodes with high SUV will have more viral RNA than those with low SUV within a patient. Individuals who undergo ATI are expected to have diverse viral populations upon viral rebound in lymphoid tissue. HIV populations in tissues may initially be phylogenetically diverse after ATI, with emergence of dominant viral species (clone) over time in plasma. Dominant viral species may represent the same HIV population seen before ATI. Discussion This study will allow us to explore utility of PET for identification of HIV infected cells and determine whether high FDG uptake respresents areas of HIV replication, immune activation or both. We will also characterize HIV infected cell populations in different anatomic locations. The protocol will represent a platform to investigate persistence and agents that may target HIV populations. Study protocol registration Identifier: NCT05419024.
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Affiliation(s)
- Chuen-Yen Lau
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
- *Correspondence: Chuen-Yen Lau
| | - Matthew A. Adan
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Jessica Earhart
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Cassie Seamon
- Critical Care Medicine Department, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Thuy Nguyen
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
| | - Ariana Savramis
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Lindsey Adams
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
| | - Mary-Elizabeth Zipparo
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
| | - Erin Madeen
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
| | - Kristi Huik
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
| | - Zehava Grossman
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
| | - Benjamin Chimukangara
- Critical Care Medicine Department, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Wahyu Nawang Wulan
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
| | - Corina Millo
- PET Department, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Avindra Nath
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Bryan R. Smith
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ana M. Ortega-Villa
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Michael Proschan
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Bradford J. Wood
- Interventional Radiology, Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Dima A. Hammoud
- Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Frank Maldarelli
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Frederick, MD, United States
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Lawrence EM, Lubner MG, Pickhardt PJ, Hartung MP. Ultrasound-guided biopsy of challenging abdominopelvic targets. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2567-2583. [PMID: 34322727 DOI: 10.1007/s00261-021-03223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/18/2023]
Abstract
Percutaneous ultrasound-guided biopsies have become the standard of practice for tissue diagnosis in the abdomen and pelvis for many sites including liver, kidney, abdominal wall, and peripheral nodal stations. Additional targets may appear difficult or impossible to safely biopsy by ultrasound due to interposed bowel loops/vasculature, deep positioning, association with the bowel, or concern for poor visibility; however, by optimizing technique, it is often possible to safely and efficiently use real-time ultrasound guidance for sampling targets that normally would be considered only appropriate for CT guided or surgical/endoscopic biopsy.
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Affiliation(s)
- Edward M Lawrence
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael P Hartung
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA.
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Meine TC, Hinrichs JB, Werncke T, Afat S, Biggemann L, Bucher A, Büttner M, Christner S, Dethlefsen E, Engel H, Gerwing M, Getzin T, Gräger S, Gresser E, Grunz JP, Harder F, Heidenreich J, Hitpaß L, Jakobi K, Janisch M, Kocher N, Kopp M, Lennartz S, Martin O, Moher Alsady T, Pamminger M, Pedersoli F, Piechotta PL, Platz Batista da Silva N, Raudner M, Roehrich S, Schindler P, Schwarze V, Seppelt D, Sieren MM, Spurny M, Starekova J, Storz C, Wiesmüller M, Zopfs D, Ringe KI, Meyer BC, Wacker FK. Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology. ROFO-FORTSCHR RONTG 2021; 194:272-280. [PMID: 34794186 DOI: 10.1055/a-1586-2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT). METHODS In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT's level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded. Each RiT performed two punctures. The first puncture was performed with a transaxial or single angulated needle path and the second with a single or double angulated needle path. Puncture deviation and puncture duration were compared between the procedures and were correlated with the self-assessments. RESULTS RiTs in both the CT guidance and CACT guidance groups did not differ with respect to radiologic experience (p = 1), angiographic experience (p = 0.415), and number of ultrasound-guided puncture procedures (p = 0.483), CT-guided puncture procedures (p = 0.934), and CACT-guided puncture procedures (p = 0.466). The puncture duration was significantly longer with CT guidance (without navigation tool) than with CACT guidance with navigation software (p < 0.001). There was no significant difference in the puncture duration between the first and second puncture using CT guidance (p = 0.719). However, in the case of CACT, the second puncture was significantly faster (p = 0.006). Puncture deviations were not different between CT-guided and CACT-guided puncture (p = 0.337) and between the first and second puncture of CT-guided and CACT-guided puncture (CT: p = 0.130; CACT: p = 0.391). The self-assessment of manual skills did not correlate with puncture deviation (p = 0.059) and puncture duration (p = 0.158). The self-assessed spatial skills correlated positively with puncture deviation (p = 0.011) but not with puncture duration (p = 0.541). CONCLUSION The RiTs achieved a puncture deviation that was clinically adequate with respect to their level of training and did not differ between CT-guided and CACT-guided puncture. The puncture duration was shorter when using CACT. CACT guidance with navigation software support has a potentially steeper learning curve. Spatial skills might accelerate the learning of image-guided puncture. KEY POINTS · The CT-guided and CACT-guided puncture experience of the RiTs selected as part of the program "Researchers for the Future" of the German Roentgen Society was adequate with respect to the level of training.. · Despite the lower collective experience of the RiTs with CACT-guided puncture with navigation software assistance, the learning curve regarding CACT-guided puncture may be faster compared to the CT-guided puncture technique.. · If the needle path is complex, CACT guidance with navigation software assistance might have an advantage over CT guidance.. CITATION FORMAT · Meine TC, Hinrichs JB, Werncke T et al. Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1586-2733.
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Affiliation(s)
- Timo C Meine
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Thomas Werncke
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Saif Afat
- Institute for Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Lorenz Biggemann
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Bucher
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Martina Büttner
- Clinic for Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Sara Christner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ebba Dethlefsen
- Clinic for Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Hannes Engel
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Mirjam Gerwing
- Clinic for Radiology, University Hospital Münster, Germany
| | - Tobias Getzin
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Stephanie Gräger
- Institute for Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Germany
| | - Eva Gresser
- Department of Radiology, Ludwig Maximilians University Munich, München, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Felix Harder
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, München, Germany
| | - Julius Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Lea Hitpaß
- Clinic for Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Kristina Jakobi
- Institute for Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | | | - Nadja Kocher
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Markus Kopp
- Institute of Radiology, University Hospitals Erlangen Department of Radiology, Erlangen, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Ole Martin
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Tawfik Moher Alsady
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Matthias Pamminger
- Department of Radiology, Medical University Innsbruck Department of Radiology, Innsbruck, Austria
| | - Frederico Pedersoli
- Clinic for Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Paula Louise Piechotta
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | | | - Marcus Raudner
- University Clinic of Radiology and Nuclear Medicine, General Hospital of the City of Vienna-Hospital of the Medical University of Vienna, Wien, Austria
| | - Sebastian Roehrich
- University Clinic of Radiology and Nuclear Medicine, General Hospital of the City of Vienna-Hospital of the Medical University of Vienna, Wien, Austria
| | | | - Vincent Schwarze
- Department of Radiology, Ludwig Maximilians University Munich, München, Germany
| | - Danilo Seppelt
- Department for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, Germany
| | - Malte M Sieren
- Clinic for Radiology und Nuclear Medicine, University Medical Center Schleswig-Holstein Lübeck Campus, Lübeck, Germany
| | - Manuela Spurny
- Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf Center of Diagnostic, Hamburg, Germany
| | - Corinna Storz
- Neuroradiology, University Hospital Freiburg, Germany
| | - Marco Wiesmüller
- Institute of Radiology, University Hospitals Erlangen Department of Radiology, Erlangen, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Kristina Imeen Ringe
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Barzakova E, Senthilvel N, Bruners P, Keil S, Lurje G, Zimmermann M, Kuhl CK, Isfort P. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome. ROFO-FORTSCHR RONTG 2021; 194:515-520. [PMID: 34794185 DOI: 10.1055/a-1669-9342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Small hepatic malignancies scheduled for CT-guided percutaneous ablation may have been identified in the hepatobiliary phase of liver MRI or in a specific phase of multi-phase CT but may be occult on unenhanced CT used to guide the ablation. We investigated whether the detectability of the target lesion would impact the efficacy of CT-guided hepatic tumor ablations. MATERIALS AND METHODS We included 69 patients with 99 malignant liver lesions (25 primary, 44 metastases) who underwent IRE (n = 35), RFA (n = 41), or MWA (n = 23) between 01/2015 and 06/2018. All procedures were performed under CT guidance. Lesions not detectable on CT (NDL) were targeted through identification of anatomical landmarks on preinterventional contrast-enhanced CT or MRI. Rates of incomplete ablation, size of ablation zone, local tumor recurrence, intrahepatic progression-free survival (ihPFS), and adverse event rates were compared for detectable lesions (DL) vs. NDL. RESULTS 40 lesions were NDL, and 59 lesions were DL on unenhanced CT. The mean follow-up was 16.2 months (14.8 for DL and 18.2 for NDL). The mean diameter of NDL and DL was similar (12.9 mm vs. 14.9 mm). The mean ablation zone size was similar (37.1 mm vs. 38.8 mm). Incomplete ablation did not differ between NDL vs. DL (5.0 % [2/40; 0.6-16.9 %] vs. 3.4 % [2/59; 0.4-11.7 %]), nor did local tumor recurrence (15.4 % [6/39; 5.7 %-30.5 %] vs. 16.9 % [10/59; 8.4-29.0 %]), or median ihPFS (15.5 months vs. 14.3 months). CONCLUSION Target lesion detectability on interventional CT does not have a significant impact on outcome after percutaneous liver ablation when anatomical landmarks are used to guide needle placement. KEY POINTS · Liver tumors can be successfully ablated even if they are not detectable on the navigational CT scan.. · Anatomical landmarks should be used and compared to preinterventional imaging.. CITATION FORMAT · Barzakova E, Senthilvel N, Bruners P et al. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome . Fortschr Röntgenstr 2021; DOI: 10.1055/a-1669-9342.
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Affiliation(s)
- Emona Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Niveditha Senthilvel
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
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Li Q, Li JF, Mao XR. Application of artificial intelligence in liver diseases: From diagnosis to treatment. Artif Intell Gastroenterol 2021; 2:133-140. [DOI: 10.35712/aig.v2.i5.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Infectious or noninfectious liver disease has inexorably risen as one of the leading causes of global death and disease burden. There were an estimated 2.14 million liver-related deaths in 2017, representing an 11.4% increase since 2012. Traditional diagnosis and treatment methods have various dilemmas in different causes of liver disease. As a hot research topic in recent years, the application of artificial intelligence (AI) in different fields has attracted extensive attention, and new technologies have brought more ideas for the diagnosis and treatment of some liver diseases. Machine learning (ML) is the core of AI and the basic way to make a computer intelligent. ML technology has many potential uses in hepatology, ranging from exploring new noninvasive means to predict or diagnose different liver diseases to automated image analysis. The application of ML in liver diseases can help clinical staff to diagnose and treat different liver diseases quickly, accurately and scientifically, which is of importance for reducing the incidence and mortality of liver diseases, reducing medical errors, and promoting the development of medicine. This paper reviews the application and prospects of AI in liver diseases, and aims to improve clinicians’ awareness of the importance of AI in the diagnosis and treatment of liver diseases.
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Affiliation(s)
- Qiong Li
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jun-Feng Li
- Department of Infectious Diseases & Institute of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao-Rong Mao
- Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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21
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de Ruiter QMB, Xu S, Li M, Pritchard WF, Starost MF, Filie A, Mikhail AS, Mauda-Havakuk M, Esparza-Trujillo JA, Bakhutashvili I, Heidari P, Mahmood U, Karanian JW, Wood BJ. Electromagnetic Tracking and Optical Molecular Imaging Guidance for Liver Biopsy and Point-of-Care Tissue Assessment in Phantom and Woodchuck Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2021; 44:1439-1447. [PMID: 34021380 PMCID: PMC8384721 DOI: 10.1007/s00270-021-02853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate an integrated liver biopsy platform that combined CT image fusion, electromagnetic (EM) tracking, and optical molecular imaging (OMI) of indocyanine green (ICG) to target hepatocellular carcinoma (HCC) lesions and a point-of-care (POC) OMI to assess biopsy cores, all based on tumor retention of ICG compared to normal liver, in phantom and animal model. MATERIAL A custom CT image fusion and EM-tracked guidance platform was modified to integrate the measurement of ICG fluorescence intensity signals in targeted liver tissue with an OMI stylet or a POC OMI system. Accuracy was evaluated in phantom and a woodchuck with HCC, 1 day after administration of ICG. Fresh biopsy cores and paraffin-embedded formalin-fixed liver tissue blocks were evaluated with the OMI stylet or POC system to identify ICG fluorescence signal and ICG peak intensity. RESULTS The mean distance between the initial guided needle delivery location and the peak ICG signal was 5.0 ± 4.7 mm in the phantom. There was complete agreement between the reviewers of the POC-acquired ICG images, cytology, and histopathology in differentiating HCC-positive from HCC-negative biopsy cores. The peak ICG fluorescence intensity signal in the ex vivo liver blocks was 39 ± 12 and 281 ± 150 for HCC negative and HCC positive, respectively. CONCLUSION Biopsy guidance with fused CT imaging, EM tracking, and ICG tracking with an OMI stylet to detect HCC is feasible. Immediate assessment of ICG uptake in biopsy cores with the POC OMI system is feasible and correlates with the presence of HCC in the tissue.
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Affiliation(s)
- Quirina M B de Ruiter
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ming Li
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Matthew F Starost
- Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Armando Filie
- Laboratory of Pathology, Center for Cancer Research, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Andrew S Mikhail
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Michal Mauda-Havakuk
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Juan A Esparza-Trujillo
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Pedram Heidari
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Umar Mahmood
- Center for Cancer research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - John W Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
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22
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Sieren MM, Schareck C, Kaschwich M, Horn M, Matysiak F, Stahlberg E, Wegner F, Oechtering TH, Barkhausen J, Goltz J. Accuracy of registration techniques and vascular imaging modalities in fusion imaging for aortic endovascular interventions: a phantom study. CVIR Endovasc 2021; 4:51. [PMID: 34125287 PMCID: PMC8200901 DOI: 10.1186/s42155-021-00234-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background This study aimed to assess the error of different registration techniques and imaging modalities for fusion imaging of the aorta in a standardized setting using a anthropomorphic body phantom. Materials and methods A phantom with the 3D printed vasculature of a patient suffering from an infrarenal aortic aneurysm was constructed. Pulsatile flow was generated via an external pump. CTA/MRA of the phantom was performed, and a virtual 3D vascular model was computed. Subsequently, fusion imaging was performed employing 3D-3D and 2D-3D registration techniques. Accuracy of the registration was evaluated from 7 right/left anterior oblique c-arm angulations using the agreement of centerlines and landmarks between the phantom vessels and the virtual 3D virtual vascular model. Differences between imaging modalities were assessed in a head-to-head comparison based on centerline deviation. Statistics included the comparison of means ± standard deviations, student’s t-test, Bland-Altman analysis, and intraclass correlation coefficient for intra- and inter-reader analysis. Results 3D-3D registration was superior to 2D-3D registration, with the highest mean centerline deviation being 1.67 ± 0.24 mm compared to 4.47 ± 0.92 mm. The highest absolute deviation was 3.25 mm for 3D-3D and 6.25 mm for 2D-3D registration. Differences for all angulations between registration techniques reached statistical significance. A decrease in registration accuracy was observed for c-arm angulations beyond 30° right anterior oblique/left anterior oblique. All landmarks (100%) were correctly positioned using 3D-3D registration compared to 81% using 2D-3D registration. Differences in accuracy between CT and MRI were acceptably small. Intra- and inter-reader reliability was excellent. Conclusion In the realm of registration techniques, the 3D-3D method proved more accurate than did the 2D-3D method. Based on our data, the use of 2D-3D registration for interventions with high registration quality requirements (e.g., fenestrated aortic repair procedures) cannot be fully recommended. Regarding imaging modalities, CTA and MRA can be used equivalently.
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Affiliation(s)
- M M Sieren
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - C Schareck
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - M Kaschwich
- Department for Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - M Horn
- Department for Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - F Matysiak
- Department for Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - E Stahlberg
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - F Wegner
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - T H Oechtering
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - J Barkhausen
- Department for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - J Goltz
- Department for Radiology and Neuroradiology, Sana Hospital, Lübeck, Germany
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Ergonomics in Interventional Radiology: Awareness Is Mandatory. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050500. [PMID: 34069174 PMCID: PMC8157181 DOI: 10.3390/medicina57050500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.
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Li ADR, Liu Y, Plott J, Chen L, Montgomery JS, Shih A. Multi-Bevel Needle Design Enabling Accurate Insertion in Biopsy for Cancer Diagnosis. IEEE Trans Biomed Eng 2021; 68:1477-1486. [PMID: 33507862 PMCID: PMC8104469 DOI: 10.1109/tbme.2021.3054922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To obtain definitive cancer diagnosis for suspicious lesions, accurate needle deployment and adequate tissue sampling in needle biopsy are essential. However, the single-bevel needles in current biopsy devices often induce deflection during insertion, potentially causing lesion missampling/undersampling and cancer misdiagnosis. This study aims to reveal the biopsy needle design criteria enabling both low deflection and adequate tissue sampling. METHODS A novel model capable of predicting needle deflection and tissue deformation was first established to understand needle-tissue interaction with different needle tip geometries. Experiments of needle deflection and ex-vivo tissue biopsy were conducted for model validation. RESULTS The developed model showed a reasonably good prediction on the correlation of needle tip type vs. the resultant needle deflection and tissue sampling length. A new multi-bevel needle with the tissue separation point below the needle groove face has demonstrated to be an effective design with an 87% reduction in deflection magnitude and equivalently long tissue sampling length compared to the current single-bevel needle. CONCLUSION This study has revealed two critical design criteria for biopsy needles: 1) multiple bevel faces at the needle tip can generate forces to balance bending moments during insertion to enable a low needle deflection and 2) the tissue separation point should be below the needle groove face to ensure long tissue sampling length. SIGNIFICANCE The developed methodologies and findings in this study serve as proof-of-concept and can be utilized to investigate various biopsy procedures to improve cancer diagnostic accuracy as well as other procedures requiring accurate needle insertion.
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Xu E, Li K, Long Y, Luo L, Zeng Q, Tan L, He X, Huang Q, Wu Y, Zheng R. Intra-Procedural CT/MR-Ultrasound Fusion Imaging Helps to Improve Outcomes of Thermal Ablation for Hepatocellular Carcinoma: Results in 502 Nodules. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:e9-e19. [PMID: 31671457 DOI: 10.1055/a-1021-1616] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim was to assess the value of intra-procedural CT/MR-ultrasound (CT/MR-US) fusion imaging in the management of thermal ablation for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study was approved by the institutional review board. From May 2010 to October 2016, 543 HCC nodules in 440 patients (387 men and 53 women; age range: 25-84 years) that met the Milan Criteria were treated by percutaneous thermal ablation using intra-procedural CT/MR-US fusion imaging. The HCC nodules were divided into subgroups and compared (≤ 3 cm and > 3 cm, or high-risk and low-risk location, or inconspicuous and conspicuous, respectively). Technique efficacy and major complication were calculated. Cumulative local tumor progression (LTP), tumor-free and overall survival rates were estimated with the Kaplan-Meier method. RESULTS CT/MR-US fusion imaging was successfully registered in 419 patients with 502 nodules. The technique efficacy rate of thermal ablation was 99.4 %. The major complication rate was 1.9 %. The cumulative LTP rates were 3.2 %, 5.6 % and 7.2 % at 1, 3, and 5 years, respectively. There were no significant differences for the comparisons of cumulative LTP rates between different subgroups (P = 0.541, 0.314, 0.329). The cumulative tumor-free survival rates were 74.8 %, 54.0 % and 37.5 % at 1, 3, and 5 years, respectively. The cumulative overall survival rates were 97.8 %, 87.1 % and 81.7 % at 1, 3, and 5 years, respectively. CONCLUSION Intra-procedural CT/MR-ultrasound fusion imaging is a useful technique for percutaneous liver thermal ablation. It could help to achieve satisfying survival outcomes for HCC patients who meet the Milan Criteria.
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Affiliation(s)
- Erjiao Xu
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Li
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yinglin Long
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liping Luo
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lei Tan
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuqi He
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiannan Huang
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuxuan Wu
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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Tinelli G, Bonnet M, Hertault A, Sica S, Di Tanna GL, Bianchini A, Fabre D, Sobocinski J, Haulon S. Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair. J Endovasc Ther 2021; 28:415-424. [PMID: 33660577 DOI: 10.1177/1526602821996725] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. MATERIALS AND METHODS Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. RESULTS A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. CONCLUSION Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.
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Affiliation(s)
- Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | | | - Adrien Hertault
- Vascular and Endovascular Surgery Department, Valenciennes General Hospital, Valenciennes, France
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Aurélia Bianchini
- Vascular and Endovascular Surgery Department, Valenciennes General Hospital, Valenciennes, France
| | - Dominique Fabre
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris Saclay, France
| | | | - Stéphan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris Saclay, France
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Radu C, Fisher P, Mitrea D, Birlescu I, Marita T, Vancea F, Florian V, Tefas C, Badea R, Ștefănescu H, Nedevschi S, Pisla D, Hajjar NA. Integration of Real-Time Image Fusion in the Robotic-Assisted Treatment of Hepatocellular Carcinoma. BIOLOGY 2020; 9:biology9110397. [PMID: 33198415 PMCID: PMC7697343 DOI: 10.3390/biology9110397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/23/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Simple Summary Hepatocellular carcinoma is one of the leading causes of cancer-related deaths worldwide. An image fusion system is developed for the robotic-assisted treatment of hepatocellular carcinoma, which is not only capable of imaging data interpretation and reconstruction, but also automatic tumor detection. The optimization and integration of the image fusion system within a novel robotic system has the potential to demonstrate the feasibility of the robotic-assisted targeted treatment of hepatocellular carcinoma by showing benefits such as precision, patients safety and procedure ergonomics. Abstract Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide, with its mortality rate correlated with the tumor staging; i.e., early detection and treatment are important factors for the survival rate of patients. This paper presents the development of a novel visualization and detection system for HCC, which is a composing module of a robotic system for the targeted treatment of HCC. The system has two modules, one for the tumor visualization that uses image fusion (IF) between computerized tomography (CT) obtained preoperatively and real-time ultrasound (US), and the second module for HCC automatic detection from CT images. Convolutional neural networks (CNN) are used for the tumor segmentation which were trained using 152 contrast-enhanced CT images. Probabilistic maps are shown as well as 3D representation of HCC within the liver tissue. The development of the visualization and detection system represents a milestone in testing the feasibility of a novel robotic system in the targeted treatment of HCC. Further optimizations are planned for the tumor visualization and detection system with the aim of introducing more relevant functions and increase its accuracy.
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Affiliation(s)
- Corina Radu
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Petra Fisher
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
| | - Delia Mitrea
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Iosif Birlescu
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
- Correspondence: (I.B.); (D.P.)
| | - Tiberiu Marita
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Flaviu Vancea
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Vlad Florian
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Cristian Tefas
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Radu Badea
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Horia Ștefănescu
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
| | - Sergiu Nedevschi
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Doina Pisla
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
- Correspondence: (I.B.); (D.P.)
| | - Nadim Al Hajjar
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
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Sheth RA, Baerlocher MO, Connolly BL, Dariushnia SR, Shyn PB, Vatsky S, Tam AL, Gupta S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. J Vasc Interv Radiol 2020; 31:1840-1848. [DOI: 10.1016/j.jvir.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
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Long Y, Xu E, Zeng Q, Ju J, Huang Q, Liang P, Zheng R, Li K. Intra-procedural real-time ultrasound fusion imaging improves the therapeutic effect and safety of liver tumor ablation in difficult cases. Am J Cancer Res 2020; 10:2174-2184. [PMID: 32775009 PMCID: PMC7407341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/27/2020] [Indexed: 06/11/2023] Open
Abstract
In certain difficult cases involving tumors unclear in B-mode ultrasound or tumors in a high-risk location, image-guided liver tumor thermal ablation was previously contraindicated. The aim of this retrospective study was to investigate the value of intra-procedural ultrasound fusion imaging in improving the therapeutic effect and safety of liver tumor ablation in difficult cases. A total of 502 patients (441 males and 61 females, aged 52 ± 11 years) with 805 liver tumors (16 ± 6 mm; range, 4-29 mm) who underwent thermal ablation with intra-procedural fusion imaging from October 2010 to June 2018 in our hospital were enrolled. Fusion imaging was employed for targeting, puncture guidance and immediate evaluation of the therapeutic response. Contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) was performed one month after ablation and every 3~6 months in the follow-up period. 511 and 294 liver tumors were in classified in the difficult case group and the non-difficult case group, respectively. The technical efficacy rate was 99.4% (800/805), and no difference was found between the two groups (P=0.658). No significant difference in the local tumor progression rate was found between the difficult case group (1 year: 3.2%; 3 years: 7.6%; 5 years: 7.6%) and non-difficult case group (1 year: 2.1%; 3 years: 5.5%; 5 years: 11.6%) (P=0.874). The major complication rate was 1.8% (11/608). Injury to adjacent organs occurred in only 1 patient who sustained a bile duct injury. We conclude that intra-procedural fusion imaging can improve the therapeutic efficacy and safety of thermal ablation in difficult cases and may expand the indications for thermal ablation.
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Affiliation(s)
- Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Erjiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
- Department of Medical Ultrasonic, The Eighth Affiliated Hospital of Sun Yat-sen UniversityChina
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Jinxiu Ju
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Qiannan Huang
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General HospitalBeijing, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
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Endovascular Infrarenal Aortic Aneurysm Repair Performed in a Hybrid Operating Room Versus Conventional Operating Room Using a C-Arm. Ann Vasc Surg 2020; 69:366-372. [PMID: 32504790 DOI: 10.1016/j.avsg.2020.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To compare contrast usage and radiation exposure during endovascular aneurysm repair (EVAR) using mobile C-arm imaging in a conventional operating room (OR) or fixed angiographic equipment in a hybrid OR (HR). METHODS A retrospective unicenter study from May 2016 to August 2019. All consecutive patients undergoing standard EVAR were included. Patients were divided into 2 groups. Group OR included EVARs performed in a conventional OR with a mobile C-arm (May 2016 to April 2018) and group HR included EVARs performed with a fixed angiographic equipment in an HR (May 2018 to August 2019). Data collected included patient demographics, aneurysm diameter, neck length, radiation dose: median dose-area product (DAP), fluoroscopy time, total operative time, contrast use, and 30-day clinical outcomes. RESULTS A total of 77 patients were included in the study (42 patients in group OR and 35 patients in group HR). There was no difference in age, body mass index (BMI), mean aneurysm, and neck length between groups. Patients in the group HR received less contrast volume (108.6 mL [±41.5] vs. 162.5 mL [±52.6]; P < 0.001), but higher radiation dose (154 Gy cm2 [±102.9] vs. 61.5 Gy cm2 [±42.4]; P < 0.001). There were no differences in fluoroscopy time (20.4 min [±8.5] vs. 23.2 min [±12.4]; P = 0.274) and total operative time (106.4 [±22.3] vs. 109.4 [±25.8]; P = 0.798). No difference was found in terms of 30-day complication rates or operative mortality between groups. DAP was positively correlated with BMI in the group OR (Spearman's rank correlation coefficient rs, 0.580; P < 0.001), but no correlation could be seen in the group HR (rs, 0.408; P = 0.028). CONCLUSIONS Routine EVAR performed in a hybrid fixed-imaging suite may be associated with less contrast usage, but higher radiation exposure in our center. The significantly higher radiation exposure when the mobile C-arm is replaced by an HR should not be underestimated.
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Piccinelli M. Multimodality image fusion, moving forward. J Nucl Cardiol 2020; 27:973-975. [PMID: 30693427 PMCID: PMC6661216 DOI: 10.1007/s12350-019-01607-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
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Citone M, Fanelli F, Falcone G, Mondaini F, Cozzi D, Miele V. A closer look to the new frontier of artificial intelligence in the percutaneous treatment of primary lesions of the liver. Med Oncol 2020; 37:55. [PMID: 32424627 DOI: 10.1007/s12032-020-01380-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
The purpose of thermal ablation is induction of tumor death by means of localized hyperthermia resulting in irreversible cellular damage. Ablative therapies are well-recognized treatment modalities for HCC lesions and are considered standard of care for HCC nodules < 3 cm in diameter in patients not suitable for surgery. Effective lesion treatment rely on complete target volume ablation. Technical limitations are represented by large (> 3 cm) or multicentric nodules as well as complex nodule location and poor lesion conspicuity. Artificial Intelligence (AI) is a general term referred to computational algorithms that can analyze data and perform complex tasks otherwise prerogative of Human Intelligence. AI has a variety of application in percutaneous ablation procedures such as Navigational software, Fusion Imaging, and robot-assisted ablation tools. Those instruments represent relative innovations in the field of Interventional Oncology and promising strategies to overcome actual limitations of ablative therapy in order to increase feasibility and technical results. This work aims to review the principal application of Artificial Intelligence in the percutaneous ablation of primary lesions of the liver with special focus on how AI can impact in the treatment of HCC especially on potential advantages on the drawbacks of the conventional technique.
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Affiliation(s)
- M Citone
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - F Fanelli
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - G Falcone
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - F Mondaini
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - D Cozzi
- Emergency Radiology Department, Careggi University Hospital, L.go G.A. Brambilla, 3, 50134, Florence, Italy
| | - V Miele
- Emergency Radiology Department, Careggi University Hospital, L.go G.A. Brambilla, 3, 50134, Florence, Italy.
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34
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Fang X, Xu S, Wood BJ, Yan P. Deep learning-based liver segmentation for fusion-guided intervention. Int J Comput Assist Radiol Surg 2020; 15:963-972. [PMID: 32314228 DOI: 10.1007/s11548-020-02147-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/30/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Tumors often have different imaging properties, and there is no single imaging modality that can visualize all tumors. In CT-guided needle placement procedures, image fusion (e.g. with MRI, PET, or contrast CT) is often used as image guidance when the tumor is not directly visible in CT. In order to achieve image fusion, interventional CT image needs to be registered to an imaging modality, in which the tumor is visible. However, multi-modality image registration is a very challenging problem. In this work, we develop a deep learning-based liver segmentation algorithm and use the segmented surfaces to assist image fusion with the applications in guided needle placement procedures for diagnosing and treating liver tumors. METHODS The developed segmentation method integrates multi-scale input and multi-scale output features in one single network for context information abstraction. The automatic segmentation results are used to register an interventional CT with a diagnostic image. The registration helps visualize the target and guide the interventional operation. RESULTS The segmentation results demonstrated that the developed segmentation method is highly accurate with Dice of 96.1% on 70 CT scans provided by LiTS challenge. The segmentation algorithm is then applied to a set of images acquired for liver tumor intervention for surface-based image fusion. The effectiveness of the proposed methods is demonstrated through a number of clinical cases. CONCLUSION Our study shows that deep learning-based image segmentation can obtain useful results to help image fusion for interventional guidance. Such a technique may lead to a number of other potential applications.
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Affiliation(s)
- Xi Fang
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Pingkun Yan
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA.
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Huang Q, Zeng Q, Long Y, Tan L, Zheng R, Xu E, Li K. Fusion imaging techniques and contrast-enhanced ultrasound for thermal ablation of hepatocellular carcinoma - A prospective randomized controlled trial. Int J Hyperthermia 2020; 36:1207-1215. [PMID: 31813295 DOI: 10.1080/02656736.2019.1687945] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives: This randomized controlled trial (RCT) aims to compare the clinical application values of contrast-enhanced ultrasound (CEUS), computed tomography/magnetic resonance-CEUS (CT/MR-CEUS), and three-dimensional ultrasound-CEUS (3DUS-CEUS) Fusion imaging (FI) techniques in the assistance of thermal ablation for hepatocellular carcinoma (HCC).Methods: A RCT was conducted on 374 patients with 456 HCCs between January 2016 and September 2017. CEUS, CT/MR-CEUS, and 3DUS-CEUS FI techniques were randomly used to assist HCC ablation. All lesions were ablated according to a previously determined plan, and FI groups required a 5-mm ablative margin. The primary endpoints were technical efficacy of thermal ablation and local tumor progression (LTP).Results: According to randomization, 153 (18.8 ± 8.0 cm), 153 (18.3 ± 6.6 cm) and 150 (19.1 ± 6.9 cm) HCCs were assigned to CT/MR-CEUS, 3DUS-CEUS and CEUS groups respectively. Technical efficacy rates (99.3% vs. 100% vs. 100%) were achieved in the three groups, showing no statistical differences (p = 1.000). The median follow-up time was 24 (1-37) months. LTP rates at 1 and 2 years were 3.4%, 12.2% for CT/MR-CEUS FI, 4.8%, 9.0% for 3DUS-CEUS FI, and 8.6%, 19.9% for CEUS, respectively (p = .105). The results of subgroup analysis for LTP were statistically significant when patients with albumin-bilirubin (ALBI) grade 2 and 3 (p = .000), and tumor located at risky positions (p = .042). In addition, the p value in group of multiple tumors was close to .05 (p = .052).Conclusions: All the three techniques are feasible for intraoperative HCC thermal ablation. Compared with CEUS, FI techniques are more suitable in patients with ALBI grade 2 and 3, multiple tumors, and in tumors at risky locations.
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Affiliation(s)
- Qiannan Huang
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Lei Tan
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Erjiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
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Yang R, Lu H, Wang Y, Peng X, Mao C, Yi Z, Guo Y, Guo C. CT-MRI Image Fusion-Based Computer-Assisted Navigation Management of Communicative Tumors Involved the Infratemporal-Middle Cranial Fossa. J Neurol Surg B Skull Base 2020; 82:e321-e329. [PMID: 34306956 DOI: 10.1055/s-0040-1701603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/24/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for preoperative assessment of the three-dimensional (3D) spatial position relationships of tumor, vital vessels, brain tissue, and craniomaxillofacial bones precisely. The value of CT-MRI-based image fusion was explored for the preoperative assessment, virtual planning, and navigation surgery application during the treatment of communicative tumors involved the infratemporal fossa (ITF) and middle cranial fossa. Methods Eight patients with infratemporal-middle cranial fossa communicative tumors (ICFCTs) were enrolled in this retrospective study. Plain CT, contrast CT, and MRI image data were imported into a workstation for image fusion, which were used for 3D image reconstruction, virtual surgical planning, and intraoperative navigation sequentially. Therapeutic effect was evaluated through the clinical data analysis of ICFCT patients after CT-MRI image fusion-based navigation-guided biopsy or surgery. Results High-quality CT-MRI image fusion and 3D reconstruction were obtained in all eight cases. Image fusion combined with 3D image reconstruction enhanced the preoperative assessment of ICFCT, and improved the surgical performance via virtual planning. Definite pathological diagnosis was obtained in all four navigation-guided core needle biopsies. Complete removal of the tumor was achieved with one exception among the seven navigation-guided operations. Postoperative cerebrospinal fluid leakage occurred in one patient with recurrent meningioma. Conclusion CT-MRI image fusion combined with computer-assisted navigation management, optimized the accuracy, safety, and surgical results for core needle biopsy and surgery of ICFCTs.
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Affiliation(s)
- Rong Yang
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Han Lu
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Yang Wang
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Xin Peng
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Chi Mao
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Zhiqiang Yi
- Department of Neurosurgery, Peking University First Hospital, Beijing, P.R. China
| | - Yuxing Guo
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Chuanbin Guo
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
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New horizon of fusion imaging using echocardiography: its progress in the diagnosis and treatment of cardiovascular disease. J Echocardiogr 2019; 18:9-15. [DOI: 10.1007/s12574-019-00455-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022]
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Tacher V, Blain M, Hérin E, Vitellius M, Chiaradia M, Oubaya N, Derbel H, Kobeiter H. CBCT-Based Image Guidance for Percutaneous Access: Electromagnetic Navigation Versus 3D Image Fusion with Fluoroscopy Versus Combination of Both Technologies-A Phantom Study. Cardiovasc Intervent Radiol 2019; 43:495-504. [PMID: 31650244 DOI: 10.1007/s00270-019-02356-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE We set out to compare three types of three-dimensional CBCT-based imaging guidance modalities in a phantom study: image fusion with fluoroscopy (IF), electromagnetic navigation (EMN) and the association of both technologies (CEMNIF). MATERIALS AND METHODS Four targets with a median diameter of 11 mm [first quartile (Q1): 10; third quartile (Q3): 12] with acute angle access (z-axis < 45°) and four targets of 10 mm [8-15] with large angle access (z-axis > 45°) were defined on an abdominal phantom (CIRS, Meditest, Tabuteau, France). Acute angle access targets were punctured using IF, EMN or CEMNIF and large angle access targets with EMN by four operators with various experiences. Efficacy (target reached), accuracy (distance between needle tip and target center), procedure time, radiation exposure and reproducibility were explored and compared. RESULTS All targets were reached (100% efficacy) by all operators. For targets with acute angle access, procedure times (EMN: 265 s [236-360], IF: 292 s [260-345], CEMNIF: 320 s [240-333]) and accuracy (EMN: 3 mm [2-5], IF: 2 mm [1-3], CEMNIF: 3 mm [2-4]) were similar. Radiation exposure (EMN: 0; IF: 708 mGy.cm2 [599-1128]; CEMNIF: 51 mGy.cm2 [15-150]; p < 0.001) was significantly higher with IF than with CEMNIF and EMN. For targets with large angle access, procedure times (EMN: 345 s [259-457], CEMNIF: 425 s [340-473]; p = 0.01) and radiation exposure (EMN: 0, CEMIF: 159 mGy.cm2 [39-316]; p < 0.001) were significantly lower with EMN but with lower accuracy (EMN: 4 mm [4-6] and CEMNIF: 4 mm [3, 4]; p = 0.01). The operator's experience did not impact the tested parameters regardless of the technique. CONCLUSION In this phantom study, EMN was not limited to acute angle targets. Efficacy and accuracy of puncture for acute angle access targets with EMN, IF or CEMNIF were similar. CEMNIF is more accurate for large angle access targets at the cost of a slightly higher procedure time and radiation exposure.
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Affiliation(s)
- Vania Tacher
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. .,Université Paris-Est Créteil (UPEC), 94010, Créteil, France. .,Unité INSERM U955 #18, IMRB, Créteil, France.
| | - Maxime Blain
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Edouard Hérin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France
| | - Manuel Vitellius
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Mélanie Chiaradia
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Nadia Oubaya
- Service de santé publique, APHP Hôpital Henri Mondor, Créteil, France.,UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Paris-Est University, 94000, Créteil, France
| | - Haytham Derbel
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France.,Unité INSERM U955 #18, IMRB, Créteil, France
| | - Hicham Kobeiter
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.,Université Paris-Est Créteil (UPEC), 94010, Créteil, France
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Liu M, Anderson RC, Lan X, Conti PS, Chen K. Recent advances in the development of nanoparticles for multimodality imaging and therapy of cancer. Med Res Rev 2019; 40:909-930. [PMID: 31650619 DOI: 10.1002/med.21642] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/27/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
This review explores recent work directed toward the development of nanoparticles (NPs) for multimodality cancer imaging and targeted cancer therapy. In the growing era of precision medicine, theranostics, or the combined use of targeted molecular probes in diagnosing and treating diseases is playing a particularly powerful role. There is a growing interest, particularly over the past few decades, in the use of NPs as theranostic tools due to their excellent performance in receptor target specificity and reduction in off-target effects when used as therapeutic agents. This review discusses recent advances, as well as the advantages and challenges of the application of NPs in cancer imaging and therapy.
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Affiliation(s)
- Mei Liu
- Department of Radiology, Molecular Imaging Center, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Redmond-Craig Anderson
- Department of Radiology, Molecular Imaging Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peter S Conti
- Department of Radiology, Molecular Imaging Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kai Chen
- Department of Radiology, Molecular Imaging Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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Ridouani F, Srimathveeravalli G. Percutaneous image-guided ablation: From techniques to treatments. Presse Med 2019; 48:e219-e231. [PMID: 31447333 DOI: 10.1016/j.lpm.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Image-guided ablation is performed by percutaneously introducing ablation probes to deliver energy into a tumor to destroy it in a controlled and localized fashion. Ablation modalities can be broadly classified as thermal or non-thermal based on the mechanism of tumor destruction and are performed using different types of image guidance for planning, delivering and follow-up of the treatment. Ablation is performed in a minimally invasive fashion, providing greater residual organ preservation with minimal morbidity to the patient. Image-guided ablation is being used in the clinic for the treatment of primary and metastatic tumors, and this article reviews state of the art for the treatment of malignancies in the liver, lung, kidney and musculoskeletal tissue.
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Affiliation(s)
- Fourat Ridouani
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, USA
| | - Govindarajan Srimathveeravalli
- University of Massachusetts, Institute for Applied Life Sciences, Department of Mechanical and Industrial Engineering, Amherst, USA.
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Simultaneous reconstruction of multiple stiff wires from a single X-ray projection for endovascular aortic repair. Int J Comput Assist Radiol Surg 2019; 14:1891-1899. [PMID: 31440962 DOI: 10.1007/s11548-019-02052-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Endovascular repair of aortic aneurysms (EVAR) can be supported by fusing pre- and intraoperative data to allow for improved navigation and to reduce the amount of contrast agent needed during the intervention. However, stiff wires and delivery devices can deform the vasculature severely, which reduces the accuracy of the fusion. Knowledge about the 3D position of the inserted instruments can help to transfer these deformations to the preoperative information. METHOD We propose a method to simultaneously reconstruct the stiff wires in both iliac arteries based on only a single monoplane acquisition, thereby avoiding interference with the clinical workflow. In the available X-ray projection, the 2D course of the wire is extracted. Then, a virtual second view of each wire orthogonal to the real projection is estimated using the preoperative vessel anatomy from a computed tomography angiography as prior information. Based on the real and virtual 2D wire courses, the wires can then be reconstructed in 3D using epipolar geometry. RESULTS We achieve a mean modified Hausdorff distance of 4.2 mm between the estimated 3D position and the true wire course for the contralateral side and 4.5 mm for the ipsilateral side. CONCLUSION The accuracy and speed of the proposed method allow for use in an intraoperative setting of deformation correction for EVAR.
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Wermelink B, Willigendael EM, Smit C, Beuk RJ, Brusse-Keizer M, Meerwaldt R, Geelkerken RH. Radiation exposure in an endovascular aortic aneurysm repair program after introduction of a hybrid operating theater. J Vasc Surg 2019; 70:1927-1934.e2. [PMID: 31327609 DOI: 10.1016/j.jvs.2019.01.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/31/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND A hybrid operating theater (HOT) enables optimal image quality, improved ergonomics, and excellent sterility for complex endovascular and hybrid procedures. We hypothesize that the commissioning of a new HOT involves a learning curve. It is unclear how steep the learning curve of these advanced HOTs is. The main purpose of this research was to evaluate radiation exposure parameters in a new HOT for a team of vascular surgeons experienced with infrarenal endovascular aneurysm repair (EVAR) procedures in a conventional operating room with a mobile C-arm. In addition, a comparison of the dose-area product (DAP) achieved in this study and in the literature was made. METHODS Before commissioning of the HOT, four vascular surgeons completed a comprehensive HOT training program. From the commissioning of the HOT, clinical and procedural data for all consecutive acute and elective patients treated with EVAR were retrospectively collected for a period of 18 months (January 2016-June 2017). A literature review was conducted of the dose-area product in EVAR procedures performed with a dedicated fixed system or mobile C-arm to analyze how this study performed compared with the literature. RESULTS In the 18-month study period, 77 patients were treated with EVAR (59 electively and 18 acutely), from whom the data were obtained. There was no significant change in radiation exposure parameters over time. From the commissioning of the HOT, EVAR procedures were performed with radiation exposure parameters similar to those of studies found in experienced vascular centers using fixed systems. CONCLUSIONS Concerning radiation exposure parameters, the commissioning of a new HOT was not accompanied by a learning curve. Radiation exposure parameters achieved in this study were similar to those of studies from experienced and dedicated vascular centers.
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Affiliation(s)
- Bryan Wermelink
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, the Netherlands; TechMed Centre, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
| | - Edith M Willigendael
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - Casper Smit
- Medical Technology, Medical Spectrum Twente, Enschede, the Netherlands
| | - Roland J Beuk
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | | | - Robbert Meerwaldt
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, the Netherlands; TechMed Centre, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
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Calandri M, Ruggeri V, Carucci P, Mirabella S, Veltri A, Fonio P, Gazzera C. Thermal ablation with fusion imaging guidance of hepatocellular carcinoma without conspicuity on conventional or contrast-enhanced US: surrounding anatomical landmarks matter. Radiol Med 2019; 124:1043-1048. [PMID: 31270723 DOI: 10.1007/s11547-019-01057-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/18/2019] [Indexed: 12/15/2022]
Abstract
AIM Evaluating clinical and technical factors affecting thermal ablation of B-Mode/CEUS inconspicuous HCC nodules, relying only on fusion imaging (FI) performed under conscious sedation and using previously acquired CT or MR. MATERIALS AND METHODS Among 367 HCC nodules treated in the study period, data of 37 B-mode/CEUS undetectable HCC nodules treated with FI-guided ablation were extracted from our prospectively collected institutional database. Analyzed variables included patients' sex, age, cirrhosis etiology, Child-Pugh status, size of the lesion, liver segment, subcapsular or central liver site, type of imaging used for fusion (MR/CT), and the presence of surrounding anatomical landmarks (SAL) < 3 cm from the index lesion. RESULTS The primary efficacy was 59.4% (22/37 nodules); nine lesions (24.3%) were partially ablated (PA), six lesions (16.7%) were mistargeted (MA). Eight nodules were retreated with a CA obtained in all cases (100% CA, secondary efficacy in 30/37-81.1%). LTP was observed in 2/30 cases (6.7%). Two minor complications were registered (Clavien-Dindo, Grade1, CIRSE Classification Grade 2). SAL were related to a better ablation outcome (37.5% vs 84.6% p = 0.01). No differences were observed between CA group and PA-MA group in terms of lesion size (15.4 mm vs 14.9 mm p = 0.63), liver segment (p = 0.58), subcapsular or central liver site (8/22 36% vs 4/15 26.7% p = 0.84), and imaging (MR vs CT, p = 0.72). CONCLUSION Even in the presence of potentially critical conditions (completely B-Mode/CEUS inconspicuous nodules, spontaneous breathing, and previously acquired CT or MRI), FI-only guidance is safe and allows having good primary, secondary efficacy and LTP rates. The outcome of the procedure is heavily affected by the presence of SAL.
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Affiliation(s)
- Marco Calandri
- Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy.
| | - Valeria Ruggeri
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
| | - Patrizia Carucci
- Gastro-Hepatology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Stefano Mirabella
- Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Veltri
- Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
| | - Carlo Gazzera
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
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Degrauwe N, Hocquelet A, Digklia A, Schaefer N, Denys A, Duran R. Theranostics in Interventional Oncology: Versatile Carriers for Diagnosis and Targeted Image-Guided Minimally Invasive Procedures. Front Pharmacol 2019; 10:450. [PMID: 31143114 PMCID: PMC6521126 DOI: 10.3389/fphar.2019.00450] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
We are continuously progressing in our understanding of cancer and other diseases and learned how they can be heterogeneous among patients. Therefore, there is an increasing need for accurate characterization of diseases at the molecular level. In parallel, medical imaging and image-guided therapies are rapidly developing fields with new interventions and procedures entering constantly in clinical practice. Theranostics, a relatively new branch of medicine, refers to procedures combining diagnosis and treatment, often based on patient and disease-specific features or molecular markers. Interventional oncology which is at the convergence point of diagnosis and treatment employs several methods related to theranostics to provide minimally invasive procedures tailored to the patient characteristics. The aim is to develop more personalized procedures able to identify cancer cells, selectively reach and treat them, and to assess drug delivery and uptake in real-time in order to perform adjustments in the treatment being delivered based on obtained procedure feedback and ultimately predict response. Here, we review several interventional oncology procedures referring to the field of theranostics, and describe innovative methods that are under development as well as future directions in the field.
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Affiliation(s)
- Nils Degrauwe
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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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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Kobe A, Zadory M, Hamie QM, Froehlich JM, Klarhöfer M, Elsässer T, Pfammatter T, Guggenberger R. Development of an anthropomorphic spine phantom suitable for fusion of MR neurography with interventional flat-panel CT. Eur J Radiol 2019; 112:153-160. [PMID: 30777205 DOI: 10.1016/j.ejrad.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/12/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To design a spine phantom suitable for fusion of MR neurography (MRN) with interventional flat panel computed tomography (FPCT) images from tissue-equivalent agarose gels and artificial nerves in MRI, including material with equal attenuation to bone in computed tomography (CT). METHODS T1-/T2-relaxation times of target tissue were determined in vivo (n = 5) using MR mapping-techniques. Serial dilution of castor oil lipogels was performed ex vivo in order to define correct composition for tissue-equivalent relaxation times. Similarly, serial dilution series of calcium carbonate (CaCO3) and barium sulphate (BaSO4) in synthetic resin were used to adjust radiodensity of selected vertebral bodies (L1-L5) and sacrum in CT. Nerve tissue was simulated with agarose-impregnated polyethylene fibers. Spine phantom was assembled using respective components in anthropomorphic geometry. A fat-saturated, T2-weighted 3D SPACE STIR sequence was acquired for MRN and subsequently fused with an on-site FPCT scan of the phantom. RESULTS In vivo T1-/T2-values for fat tissue were found to be at 394 ± 16 ms and 161 ± 16 ms, corresponding to a castor oil concentration of 50%. Analogously, bone marrow-equivalent values were measured at 822 ± 21 ms and 67 ± 6 ms, simulated with 40% castor oil. Cortical bone-like radiodensity of 1'115 ± 80 HU was achieved for artificial bone with 30% CaCO3 and 1.5% BaSO4. Simulated nerves were successfully depicted in MRN and fused with FPCT, combining optimal contrasts for nerves and bones on-site. CONCLUSIONS The customized phantom showed analogous tissue contrasts to in vivo conditions in both MRN and FPCT, facilitating simulations of fusion-image guided spine interventions.
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Affiliation(s)
- Adrian Kobe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Qeumars M Hamie
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
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Cornelis FH, Korenbaum C, Ben Ammar M, Tavolaro S, Nouri-Neuville M, Lotz JP. Multimodal image-guided electrochemotherapy of unresectable liver metastasis from renal cell cancer. Diagn Interv Imaging 2019; 100:309-311. [PMID: 30691970 DOI: 10.1016/j.diii.2019.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/10/2019] [Indexed: 12/20/2022]
Affiliation(s)
- F H Cornelis
- Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France.
| | - C Korenbaum
- Department of Medical Oncology and Cellular Therapy, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France
| | - M Ben Ammar
- Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France
| | - S Tavolaro
- Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France
| | - M Nouri-Neuville
- Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France
| | - J P Lotz
- Department of Medical Oncology and Cellular Therapy, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France
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Performance of a feature-based algorithm for 3D-3D registration of CT angiography to cone-beam CT for endovascular repair of complex abdominal aortic aneurysms. BMC Med Imaging 2018; 18:42. [PMID: 30409129 PMCID: PMC6225564 DOI: 10.1186/s12880-018-0285-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A crucial step in image fusion for intraoperative guidance during endovascular procedures is the registration of preoperative computed tomography angiography (CTA) with intraoperative Cone Beam CT (CBCT). Automatic tools for image registration facilitate the 3D image guidance workflow. However their performance is not always satisfactory. The aim of this study is to assess the accuracy of a new fully automatic, feature-based algorithm for 3D3D registration of CTA to CBCT. METHODS The feature-based algorithm was tested on clinical image datasets from 14 patients undergoing complex endovascular aortic repair. Deviations in Euclidian distances between vascular as well as bony landmarks were measured and compared to an intensity-based, normalized mutual information algorithm. RESULTS The results for the feature-based algorithm showed that the median 3D registration error between the anatomical landmarks of CBCT and CT images was less than 3 mm. The feature-based algorithm showed significantly better accuracy compared to the intensity-based algorithm (p < 0.001). CONCLUSION A feature-based algorithm for 3D image registration is presented.
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50
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Potential benefit of a simultaneous, side-by-side display of contrast MDCT and echocardiography over routine sequential imaging for assessment of adult congenital heart disease: A preliminary study. J Cardiol 2018; 72:395-402. [DOI: 10.1016/j.jjcc.2018.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 01/04/2023]
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