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Munetomo K, Matsui Y, Tomita K, Uka M, Umakoshi N, Kawabata T, Morimitsu Y, Iguchi T, Hiraki T. Depiction rate of feeding arteries of renal cell carcinoma on four-dimensional computed tomography angiography. Jpn J Radiol 2024; 42:648-655. [PMID: 38388790 PMCID: PMC11139722 DOI: 10.1007/s11604-024-01538-y] [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: 09/30/2023] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To retrospectively evaluate the depiction rate of feeding arteries in biopsy-proven clear cell renal cell carcinoma (CCRCC) on four-dimensional computed tomography angiography (4D-CTA) images. MATERIALS AND METHODS This study included 22 patients with 22 CCRCC and 30 feeding arteries treated with transcatheter renal artery embolization. The depiction rate of the feeding arteries on preprocedural 4D-CTA was evaluated. Images were acquired by 320-row multi-detector computed tomography (CT) 15‒36 s after starting to inject a contrast agent (600 mg/kg iodine) intravenously into patients at 2.1 s intervals (11 phases). Two board-certified radiologists retrospectively assessed the feeder depiction rate in all 11 phases with reference to the procedural images as the gold standard. Discrepancies were resolved by consultation with a third radiologist. RESULTS Among the feeders, 11 (36.7%) were segmental or lobar, and 19 (63.3%) were interlobar or arcuate arteries. The feeder depiction rate was the highest (25 [83.3%] of 30) in the 5th phase (delay, 23.4 s) where the gap in contrast enhancement between the renal artery and cortex was the largest. This was followed by the 6th (23 [76.7%] of 30), 4th (22 [73.3%] of 30]), and 7th (21 [70.0%] of 30) phases. The overall rate of depicting feeding arteries in the 11 phases of 4D-CTA was 28 (93.3%) of 30. CONCLUSIONS The depiction rate of CCRCC feeding arteries including lobar or smaller artery branches by 4D-CTA was favorable. The feeding arteries were optimally visualized during the phase with the largest contrast gap between the renal artery and cortex.
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Affiliation(s)
- Kazuaki Munetomo
- Department of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Yusuke Morimitsu
- Department of Radiological Technology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Garnier M, Curado A, Grancher A, Demeyere M, Verdalle-Cazes M, Burel J, Dacher JN. Fusion imaging for pulmonary artery embolization: impact on fluoroscopy duration and contrast agent exposure. Br J Radiol 2023; 96:20220815. [PMID: 37660369 PMCID: PMC10607406 DOI: 10.1259/bjr.20220815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To assess the impact of fusion imaging guidance on fluoroscopy duration and volume of contrast agent used for pulmonary artery embolization. METHODS Thirty-four consecutive patients who underwent pulmonary artery embolization for pulmonary arterio-venous malformation (n = 28) or hemoptysis (n = 6) were retrospectively included. In the experimental group (n = 15), patients were treated using fusion imaging with 2D/3D registration. In the control group (n = 19), no fusion imaging has been used. Fluoroscopy duration and amount of contrast used were measured and intergroup comparison was performed. RESULTS The average volume of contrast agent used for embolization in the fusion group (118.3 ml) was significantly lower than in the control group (285.3 ml) (p < 0.002). The mean fluoroscopy duration was not significantly different between both groups (19.5 min in the fusion group vs 31.4 min in the control group (p = 0.10)). No significant difference was observed regarding the average X-ray exposure (Air Kerma) (p = 0.68 in the univariate analysis). Technical success rate was 100% for both groups. CONCLUSION Fusion imaging significantly reduces contrast medium volumes needed to perform pulmonary artery embolization. The fluoroscopy duration and the X-ray exposure did not vary significantly. ADVANCES IN KNOWLEDGE CTA-based fusion imaging using 2D-3D registration is a valuable tool for performing pulmonary artery embolization, helpful for planning and guiding catheterization.Compared to the traditional imaging guidance, fusion imaging reduces the volume of contrast agent used.
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Affiliation(s)
| | - Adelya Curado
- Department of Radiology, CHU de Rouen, Rouen, France
| | - Adrien Grancher
- Department of Hepatogastroenterology, Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Rouen, France
| | | | | | - Julien Burel
- Department of Radiology, CHU de Rouen, Rouen, France
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Catheter navigation support for liver radioembolization guidance: feasibility of structure-driven intensity-based registration. Int J Comput Assist Radiol Surg 2020; 15:1881-1894. [PMID: 32870445 DOI: 10.1007/s11548-020-02250-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The fusion of pre/intraoperative images may improve catheter manipulation during radioembolization (RE) interventions by adding relevant information. The objective of this work is to propose and evaluate the performance of a RE guidance strategy relying on structure-driven intensity-based registration between preoperative CTA and intraoperative X-ray images. METHODS The navigation strategy is decomposed into three image fusion steps, supporting the catheter navigation from the femoral artery till reaching the injection site (IS). During the pretreatment assessment intervention, the aorta and the origins of its side branches are projected on the intraoperative 2D fluoroscopy following a 3D/2D bone-based registration process, to assist the celiac trunk access. Subsequently, a similar approach consisting in projecting the hepatic vasculature on intraoperative DSA through 3D/2D vessel-based registration is performed to assist the IS location. Lastly, the selected IS is reproduced during the treatment intervention by employing 2D/2D image-based registration between pretreatment and treatment fluoroscopic images. RESULTS The three fusion steps were independently evaluated on subsets of 20, 19 and 5 patient cases, respectively. Best results were obtained with gradient difference as similarity measure and with a delimited preoperative vascular structure for vessel-based registration. The approach resulted in qualitatively appropriate anatomical correspondences when projecting the preoperative structures on intraoperative images. With the best configuration, the registration steps showed accuracy and feasibility in aligning data, with global mean landmarks errors of 1.59 mm, 2.32 mm and 2.17 mm, respectively, a computation time that never exceeded 5 s, 25 s and 11 s, respectively, and a user interaction limited to manual initialization of the 3D/2D registration. CONCLUSION An image fusion-based approach has been specifically proposed for RE procedures guidance. The catheter manipulation strategy based on the fusion of pre- and intraoperative images has the potential to support different steps of the RE clinical workflow and to guide the overall procedure.
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Combining Direct 3D Volume Rendering and Magnetic Particle Imaging to Advance Radiation-Free Real-Time 3D Guidance of Vascular Interventions. Cardiovasc Intervent Radiol 2019; 43:322-330. [PMID: 31529176 DOI: 10.1007/s00270-019-02340-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Magnetic particle imaging (MPI) is a novel tomographic radiation-free imaging technique that combines high spatial resolution and real-time capabilities, making it a promising tool to guide vascular interventions. Immediate availability of 3D image data is a major advantage over the presently used digital subtraction angiography (DSA), but new methods for real-time image analysis and visualization are also required to take full advantage of the MPI properties. This laboratory study illustrates respective techniques by means of three different patient-specific 3D vascular flow models. MATERIAL AND METHODS The selected models corresponded to typical anatomical intervention sites. Routine patient cases and image data were selected, relevant vascular territories segmented, 3D models generated and then 3D-printed. Printed models were used to perform case-specific MPI imaging. The resulting MPI images, direct volume rendering (DVR)-based fast 3D visualization options, and their suitability to advance vascular interventions were evaluated and compared to conventional DSA. RESULTS The experiments illustrated the feasibility and potential to enhance image interpretation during interventions by using MPI real-time volumetric imaging and problem-tailored DVR-based fast (approximately 30 frames/s) 3D visualization options. These options included automated viewpoint selection and cutaway views. The image enhancement potential is especially relevant for complex geometries (e.g., in the presence of superposed vessels). CONCLUSION The unique features of the as-yet preclinical imaging modality MPI render it promising for guidance of vascular interventions. Advanced fast DVR could help to fulfill this promise by intuitive visualization of the 3D intervention scene in real time.
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Fusion Imaging Reduces Radiation and Contrast Medium Exposure During Endovascular Revascularization of Iliac Steno-Occlusive Disease. Cardiovasc Intervent Radiol 2019; 42:1635-1643. [PMID: 31187227 DOI: 10.1007/s00270-019-02250-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To evaluate feasibility, safety and efficacy of fusion imaging in order to guide endovascular revascularization of iliac steno-occlusive disease. MATERIALS AND METHODS Retrospectively, we identified twenty-six patients (20 male, mean age 63 ± 8y; Rutherford II-V) who underwent revascularization of a chronic total occlusion (n = 6; 23%) or severe stenosis (n = 20; 77%) of the common and/or external iliac artery. Median lesion length was 33 mm (IQR 20-60). In one group of patients (NEW; n = 11), fusion imaging with 2-D/3-D registration was used to guide revascularization. No baseline digital subtraction angiography (DSA) had been acquired in these patients. In another group of patients (OLD; n = 15), no fusion imaging had been utilized and at least one DSA run had been performed to guide the procedure. In both groups, final DSA of the treated lesions was performed. Number of DSA runs, radiation and contrast medium exposure, technical success (residual stenosis < 30%) and complications were analyzed. RESULTS Median DSA runs needed in OLD for guidance were n = 2 (IQR 2-3) and in NEW n = 0 (IQR 0-0; p = 0.001). Compared to OLD, median dose area product (DAP) was reduced by 17,118 mGy*cm2 (IQR 10,407-23,614; p = 0.016) if fusion imaging guidance had been used (NEW). Based on the median DAP of the final angiogram in NEW, median DAP reduction was 6007 mGy*cm2 (IQR 5012-16,105; p = 0.1). Median total contrast medium volume injected in NEW was 45 ml (IQR 30-90) and in OLD 120 ml (IQR 100-140; p = 0.001). Technical success was 100% for both groups. In 1/27 patients (3.7%) a minor complication (embolism) occurred. CONCLUSION Fusion imaging proved to be feasible as well as safe and significantly reduces radiation and contrast medium exposure during endovascular revascularization of iliac steno-occlusive disease.
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Goudeketting SR, Heinen SGH, de Haan MW, Sailer AM, van den Heuvel DAF, van Strijen MJ, de Vries JPPM. Fluoroscopy with MRA fusion image guidance in endovascular iliac artery interventions: study protocol for a randomized controlled trial (3DMR-Iliac-roadmapping study). Trials 2018; 19:603. [PMID: 30382900 PMCID: PMC6211411 DOI: 10.1186/s13063-018-2981-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 10/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Endovascular iliac artery interventions rely on the use of two-dimensional digital subtraction angiographies with an iodinated contrast agent and ionizing radiation. The amount of iodinated contrast agent should be limited because of its potentially nephrotoxic effects. Three-dimensional (3D) image fusion requires registration of a preprocedural magnetic resonance angiogram (MRA) or computed tomography (CT) angiogram to a perprocedurally acquired cone-beam CT or two fluoroscopic orthogonal projections. After registration, the 3D angiography images can be overlaid on the fluoroscopy screen and will follow table and C-arm movements. This study will assess the added value of the 3D image fusion technique in iliac artery interventions regarding the amount of the iodinated contrast agent administered. METHODS/DESIGN The study cohort will comprise 106 patients (> 18 years) with symptomatic common and/or external iliac artery stenoses or occlusions and a recent (< 6 months) diagnostic MRA from the pelvis through the lower extremities, for which an endovascular intervention is indicated. Patients will be randomized into the control or study group (i.e. treatment without or with 3D image fusion guidance). The primary endpoint is the amount of administered iodinated contrast agent (mL). Secondary outcomes are technical success of the procedure, defined as < 30% residual stenosis over the treated lesion, fluoroscopy time, and radiation dose as dose area product (mGycm2). Patient participation in the study will be completed after hospital discharge. DISCUSSION This study is a randomized controlled multicenter trial to provide evidence on the effect of the 3D image fusion technique on the amount of administered iodinated contrast during endovascular common and/or external iliac artery interventions. TRIAL REGISTRATION Nederlands Trial Register, NTR5008 . Registered on 16 December 2014.
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Affiliation(s)
- Seline R. Goudeketting
- Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Stefan G. H. Heinen
- Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anna M. Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | | | | | - Jean-Paul P. M. de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Quero G, Lapergola A, Soler L, Shahbaz M, Hostettler A, Collins T, Marescaux J, Mutter D, Diana M, Pessaux P. Virtual and Augmented Reality in Oncologic Liver Surgery. Surg Oncol Clin N Am 2018; 28:31-44. [PMID: 30414680 DOI: 10.1016/j.soc.2018.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Virtual reality (VR) and augmented reality (AR) in complex surgery are evolving technologies enabling improved preoperative planning and intraoperative navigation. The basis of these technologies is a computer-based generation of a patient-specific 3-dimensional model from Digital Imaging and Communications in Medicine (DICOM) data. This article provides a state-of-the- art overview on the clinical use of this technology with a specific focus on hepatic surgery. Although VR and AR are still in an evolving stage with only some clinical application today, these technologies have the potential to become a key factor in improving preoperative and intraoperative decision making.
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Affiliation(s)
- Giuseppe Quero
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Alfonso Lapergola
- IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Luc Soler
- IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Muhammad Shahbaz
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Alexandre Hostettler
- IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Toby Collins
- IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l'Hôpital, Strasbourg 67091, France; IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Didier Mutter
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l'Hôpital, Strasbourg 67091, France; IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l'Hôpital, Strasbourg 67091, France; Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg 67091, France
| | - Patrick Pessaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l'Hôpital, Strasbourg 67091, France; IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l'Hôpital, Strasbourg 67091, France; Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg 67091, France.
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Morita S, Yamazaki H, Endo K, Suzaki S, Mitsuhashi A, Shiohara T, Yatabe M, Ichihara A, Sakai S. Image Fusion Guidance with Pre-procedural CT with Real-Time Fluoroscopy for Adrenal Venous Sampling. Cardiovasc Intervent Radiol 2018. [DOI: 10.1007/s00270-018-1930-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Goudeketting SR, Heinen SGH, Ünlü Ç, van den Heuvel DAF, de Vries JPPM, van Strijen MJ, Sailer AM. Pros and Cons of 3D Image Fusion in Endovascular Aortic Repair: A Systematic Review and Meta-analysis. J Endovasc Ther 2017; 24:595-603. [DOI: 10.1177/1526602817708196] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
| | - Stefan G. H. Heinen
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Hospital, Alkmaar, the Netherlands
| | | | | | - Marco J. van Strijen
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Anna M. Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
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Fu J, Song J, Zhao Y, Wang F, Shao G. Triple-phase 99mTc-3P-RGD 2 imaging of peripheral primitive neuroectodermal tumor in the hip muscle group with bone metastasis. Mol Clin Oncol 2016; 6:197-200. [PMID: 28357093 DOI: 10.3892/mco.2016.1119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/12/2016] [Indexed: 12/17/2022] Open
Abstract
Peripheral primitive neuroectodermal tumors (pPNETs) are a group of aggressive neoplasms that are most commonly encountered in pediatric patients and may be located in the abdomen, pelvis, thoracopulmonary region and, rarely, in the head and neck region. pPNETs in adults are extremely rare. The present study reports a case of pPNET located in the hip muscles with bone metastasis. The patient was a 44-year-old woman who complained of progressive pain and swelling with a mass near the left hip. Computed tomography (CT) and enhanced CT revealed a soft tissue mass lesion in the hip muscle group measuring 4.3×4.3×4.4 cm. The lesion was ill-defined, heterogeneous, exhibiting mild post-contrast enhancement. There was a large number of bent neovessels and several branches from the left internal iliac artery and deep femoral artery on enhanced CT scan. Triple-phase dynamic imaging with integrin αvβ3-targeted 99mTc-3P-RGD2 as the radiotracer revealed increased blood perfusion and radiotracer aggregation in the large, ill-defined, heterogeneous, hypodense mass and adjacent bone. The patient was suspected of having pPNET with bone metastasis, which was confirmed by histological examination of a sample obtained by needle aspiration. Due to the high blood perfusion of primary pPNETs and high RGD uptake by the primary and metastatic lesions, chemoembolization and anti-angiogenic therapy were considered to be the optimal therapeutic choice. This also suggested that 177Lu-labeled RGD has great potential for the targeted treatment of pPNETs with multiple metastases.
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Affiliation(s)
- Jingjing Fu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 21006, P.R. China
| | - Jinhua Song
- Department of Intervention, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 21006, P.R. China
| | - Youcai Zhao
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 21006, P.R. China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 21006, P.R. China
| | - Guoqiang Shao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 21006, P.R. China
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Rouabah K, Varoquaux A, Caporossi J, Louis G, Jacquier A, Bartoli J, Moulin G, Vidal V. Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt placement. Diagn Interv Imaging 2016; 97:1095-1102. [DOI: 10.1016/j.diii.2016.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 04/13/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
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Ohta K, Shimohira M, Murai T, Nishimura J, Iwata H, Ogino H, Hashizume T, Shibamoto Y. Percutaneous fiducial marker placement prior to stereotactic body radiotherapy for malignant liver tumors: an initial experience. JOURNAL OF RADIATION RESEARCH 2016; 57:174-7. [PMID: 26826200 PMCID: PMC4795956 DOI: 10.1093/jrr/rrv099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/30/2015] [Indexed: 05/03/2023]
Abstract
The aim of this study was to describe our initial experience with a gold flexible linear fiducial marker and to evaluate the safety and technical and clinical efficacy of stereotactic body radiotherapy using this marker for malignant liver tumors. Between July 2012 and February 2015, 18 patients underwent percutaneous fiducial marker placement before stereotactic body radiotherapy for malignant liver tumors. We evaluated the technical and clinical success rates of the procedure and the associated complications. Technical success was defined as successful placement of the fiducial marker at the target site, and clinical success was defined as the completion of stereotactic body radiotherapy without the marker dropping out of position. All 18 fiducial markers were placed successfully, so the technical success rate was 100% (18/18). All 18 patients were able to undergo stereotactic body radiotherapy without marker migration. Thus, the clinical success rate was 100% (18/18). Slight pneumothorax occurred as a minor complication in one case. No major complications such as coil migration or bleeding were observed. The examined percutaneous fiducial marker was safely placed in the liver and appeared to be useful for stereotactic body radiotherapy for malignant liver tumors.
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Affiliation(s)
- Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan Department of Radiation Oncology, Yokohama CyberKnife Center
| | | | - Hiromitsu Iwata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center
| | - Hiroyuki Ogino
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center
| | - Takuya Hashizume
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
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van den Berg JC. Update on New Tools for Three-dimensional Navigation in Endovascular Procedures. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:279-85. [PMID: 26798746 DOI: 10.12945/j.aorta.2014.14-054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/08/2014] [Indexed: 11/18/2022]
Abstract
Three-dimensional (3D) guidance for endovascular procedures has developed over the last decade from 3D rotational angiography to the use of dynamic 3D roadmap techniques. The latest development is image merging. This technique combines real-time feedback of fluoroscopy with optimal soft-tissue contrast of previously performed computed tomography (CT) or magnetic resonance angiography. Merging of CT angiography and cone-beam CT/fluoroscopic images is feasible, and preliminary results look promising. Merging will allow us to further reduce radiation exposure, contrast dose, and procedural time, and its main use and benefit will be in complex endovascular interventions.
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Affiliation(s)
- Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Sede Civico, Lugano, Switzerland
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Sailer AM, de Haan MW, de Graaf R, van Zwam WH, Schurink GWH, Nelemans PJ, Wildberger JE, Das M. Fusion guidance in endovascular peripheral artery interventions: a feasibility study. Cardiovasc Intervent Radiol 2014; 38:314-21. [PMID: 25073947 DOI: 10.1007/s00270-014-0951-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was designed to evaluate the feasibility of endovascular guidance by means of live fluoroscopy fusion with magnetic resonance angiography (MRA) and computed tomography angiography (CTA). METHODS Fusion guidance was evaluated in 20 endovascular peripheral artery interventions in 17 patients. Fifteen patients had received preinterventional diagnostic MRA and two patients had undergone CTA. Time for fluoroscopy with MRA/CTA coregistration was recorded. Feasibility of fusion guidance was evaluated according to the following criteria: for every procedure the executing interventional radiologists recorded whether 3D road-mapping provided added value (yes vs. no) and whether PTA and/or stenting could be performed relying on the fusion road-map without need for diagnostic contrast-enhanced angiogram series (CEAS) (yes vs. no). Precision of the fusion road-map was evaluated by recording maximum differences between the position of the vasculature on the virtual CTA/MRA images and conventional angiography. RESULTS Average time needed for image coregistration was 5 ± 2 min. Three-dimensional road-map added value was experienced in 15 procedures in 12 patients. In half of the patients (8/17), intervention was performed relying on the fusion road-map only, without diagnostic CEAS. In two patients, MRA roadmap showed a false-positive lesion. Excluding three patients with inordinate movements, mean difference in position of vasculature on angiography and MRA/CTA road-map was 1.86 ± 0.95 mm, implying that approximately 95 % of differences were between 0 and 3.72 mm (2 ± 1.96 standard deviation). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for peripheral artery interventions is feasible. By reducing the number of CEAS, this technology may contribute to enhance procedural safety.
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Affiliation(s)
- Anna M Sailer
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands,
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Gupta A, Grünhagen T. Live MR angiographic roadmapping for uterine artery embolization: a feasibility study. J Vasc Interv Radiol 2013; 24:1690-7. [PMID: 23993741 DOI: 10.1016/j.jvir.2013.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/04/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To assess the feasibility of live magnetic resonance (MR) angiography roadmapping guidance for uterine artery (UA) embolization (UAE) for fibroid tumors. MATERIALS AND METHODS Twenty patients underwent UAE with live MR angiographic roadmapping. The pre-acquired MR angiography scan was coregistered with the live intraprocedural fluoroscopy stream to create a visual roadmap to direct the microcatheter during UAE. Patient radiation dose, as measured by dose-area product (DAP), procedure time, contrast medium volume, and fluoroscopy time, was recorded. For the first 10 patients, an additional parameter of contrast medium volume needed to catheterize each UA was recorded. RESULTS In all 20 patients (40 UAs), the MR angiography overlay on live fluoroscopy was accurate and allowed for successful catheterization of the UA, resulting in a technical success rate of 100%. In the subset of the initial 20 UAs (ie, the first 10 patients) in which this data point was recorded, 17 (85%) were successfully catheterized with no iodinated contrast medium at all, by purely relying on the MR angiography roadmap. Mean procedure time was 45 minutes (range, 30-99 min), mean contrast agent dose was 75 mL (range, 46-199 mL), and mean DAP was 155 Gy · cm(2) (range, 37-501 Gy · cm(2)). CONCLUSIONS Live MR angiographic roadmapping is feasible and accurate for catheter guidance during UAE.
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Affiliation(s)
- Atul Gupta
- Department of Interventional Radiology, Paoli Hospital, 255 W. Lancaster Ave., Paoli, PA 19301.
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