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Liu Q, Yuan K, Zhang Q, Du H, Song X, Zhou Y, Qiu B. Breast intervention device for low-field MRI with a customized unilateral coil. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2023; 357:107579. [PMID: 37949007 DOI: 10.1016/j.jmr.2023.107579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/07/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
With the incidence of breast cancer rising to the top among female malignant tumors, magnetic resonance images guided breast biopsy intervention and minimally invasive treatment have developed as a clinically practical research issue. High field studies have shown the diagnostic value of breast MRI, but the examination costs greatly exceed those of competing conventional mammography. In this case, low-field MRI cannot merely provide typical MRI contrast, but also significantly reduce the cost of diagnosis and treatment for breast cancer patients. This work describes a unilateral breast coil and prototype intervention device, which provides a customized solution for low-field MRI-guided breast intervention. Results demonstrate that the low-field MRI breast intervention device facilitates medical intervention procedures. And the designed positioning device can locate the target lesion within 2-3 mm accuracy. Phantom tests with the customized unilateral coil indicate that the open loops perform as well as the 4-channel commercial closed breast coil, presenting a relatively good SNR (signal-to-noise ratio) and uniformity characteristics. MR scanning images of the volunteer breast using the breast intervention coil also show high SNR, which lays a foundation for further implementation of image-guided breast interventional minimally invasive surgery with the low-field MRI system.
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Affiliation(s)
- Qingyun Liu
- Medical Imaging Center, Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Kecheng Yuan
- Medical Imaging Center, Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Qing Zhang
- Medical Imaging Center, Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Huiyu Du
- Medical Imaging Center, Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Xueyan Song
- Medical Imaging Center, Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Yufu Zhou
- Anhui Fuqing Medical Equipment Co., Ltd, Hefei, Anhui 230031, China
| | - Bensheng Qiu
- Medical Imaging Center, Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, Anhui 230026, China.
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2
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Winkelmann MT, Kübler J, Hoffmann R. Magnetic Resonance-guided Procedures: Consensus on Rationale, Techniques, and Outcomes. Tech Vasc Interv Radiol 2023; 26:100914. [PMID: 38071023 DOI: 10.1016/j.tvir.2023.100914] [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
Magnetic resonance (MR) image guidance has demonstrated significant potential in the field of interventional radiology in several applications. This article covers the main points of MR-guided hepatic tumor ablation as a representative of MR-guided procedures. Patient selection and appropriate equipment utilization are essential for successful MR-guided tumor ablation. Intra-procedural planning imaging enables the visualization of the tumor and surrounding anatomical structures in most cases without the application of a contrast agent, ensuring optimal planning of the applicator tract. MRI enables real-time, multiplanar imaging, thus simultaneous observation of the applicator and target tumor is possible during targeting with adaptable slice angulations in case of challenging tumor positions. Typical ablation zone appearance during therapy monitoring with MRI enables safe assessment of the therapy result, resulting in a high primary efficacy rate. Recent advancements in ablation probes have shortened treatment times, while technical strategies address applicator visibility issues. MR-imaging immediately after the procedure is used to rule out complications and to assess technical success. Especially in smaller neoplasms, MRI-guided liver ablation demonstrates positive outcomes in terms of technical success rates, as well as promising survival and recurrence rates. Additionally, percutaneous biopsy under MR guidance offers an alternative to classic guidance modalities, providing high soft tissue contrast and thereby increasing the reliability of lesion detection, particularly in cases involving smaller lesions. Despite these advantages, the use of MR guidance in clinical routine is still limited to few indications and centers, due to by high costs, extended duration, and the need for specialized expertise. In conclusion, MRI-guided interventions could benefit from ongoing advancements in hardware, software, and devices. Such progress has the potential to expand diagnostic and treatment options in the field of interventional radiology.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jens Kübler
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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3
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Özen AC, Russe MF, Lottner T, Reiss S, Littin S, Zaitsev M, Bock M. RF-induced heating of interventional devices at 23.66 MHz. MAGMA (NEW YORK, N.Y.) 2023:10.1007/s10334-023-01099-7. [PMID: 37195365 PMCID: PMC10386938 DOI: 10.1007/s10334-023-01099-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Low-field MRI systems are expected to cause less RF heating in conventional interventional devices due to lower Larmor frequency. We systematically evaluate RF-induced heating of commonly used intravascular devices at the Larmor frequency of a 0.55 T system (23.66 MHz) with a focus on the effect of patient size, target organ, and device position on maximum temperature rise. MATERIALS AND METHODS To assess RF-induced heating, high-resolution measurements of the electric field, temperature, and transfer function were combined. Realistic device trajectories were derived from vascular models to evaluate the variation of the temperature increase as a function of the device trajectory. At a low-field RF test bench, the effects of patient size and positioning, target organ (liver and heart) and body coil type were measured for six commonly used interventional devices (two guidewires, two catheters, an applicator and a biopsy needle). RESULTS Electric field mapping shows that the hotspots are not necessarily localized at the device tip. Of all procedures, the liver catheterizations showed the lowest heating, and a modification of the transmit body coil could further reduce the temperature increase. For common commercial needles no significant heating was measured at the needle tip. Comparable local SAR values were found in the temperature measurements and the TF-based calculations. CONCLUSION At low fields, interventions with shorter insertion lengths such as hepatic catheterizations result in less RF-induced heating than coronary interventions. The maximum temperature increase depends on body coil design.
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Affiliation(s)
- Ali Caglar Özen
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lottner
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Reiss
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Littin
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maxim Zaitsev
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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4
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Karagiannis E, Strouthos I, Leczynski A, Zamboglou N, Ferentinos K. Narrative Review of High-Dose-Rate Interstitial Brachytherapy in Primary or Secondary Liver Tumors. Front Oncol 2022; 12:800920. [PMID: 35299745 PMCID: PMC8920984 DOI: 10.3389/fonc.2022.800920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open
Abstract
The optimal management of intrahepatic malignancies involves a multidisciplinary approach. Although surgical resection has been considered the only curative approach, the use of several minimally invasive ablative techniques has dramatically increased the last two decades, mainly due to the fact that they provide similar oncological results with significantly decreased morbidity. Among these modalities, interstitial liver brachytherapy, probably the most flexible liver ablative method, with excellent clinical data on its safety and effectiveness, is frequently not even mentioned as an option in the current peer reviewed literature and guidelines. Brachytherapy is a type of radiotherapy utilizing radionuclides that are directly inserted into the tumor. Compared to external beam radiation therapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time, with the advantage of a rapid dose fall-off, that allows for sparing of adjacent healthy tissue. For numerous malignancies such as skin, gynecological, breast, prostate, head and neck, bladder, liver and soft-tissue tumors, brachytherapy as a monotherapy or combined with external beam radiation therapy, has become a standard treatment for many decades. This review article aims to describe the high-dose-rate liver brachytherapy technique, its selection criteria, present its advantages and disadvantages, as well as the available clinical data, in order to help physicians to explore and hopefully introduce liver brachytherapy into their clinical routine.
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Affiliation(s)
- Efstratios Karagiannis
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Agnes Leczynski
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
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Weiss J, Winkelmann MT, Gohla G, Kübler J, Clasen S, Nikolaou K, Hoffmann R. MR-guided microwave ablation in hepatic malignancies: clinical experiences from 50 procedures. Int J Hyperthermia 2020; 37:349-355. [PMID: 32286087 DOI: 10.1080/02656736.2020.1750713] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose: To investigate technical success, technique efficacy, safety and outcome of MR-guided microwave ablation (MWA) in hepatic malignancies.Material and methods: In this prospective IRB-approved study, patients scheduled for percutaneous treatment of hepatic malignancies underwent MR-guided MWA in a closed-bore 1.5 T MR system. Technical success was assessed on post-procedural MR control imaging. Technique efficacy was evaluated 4 weeks after the procedure on multi-parametric MRI. Assessment of safety followed the Society of Interventional Radiology grading system. Kaplan-Meier survival estimates were calculated to evaluate overall survival (OS), time to local tumor progression (TLTP), and time to non-target progression (TNTP).Results: Between 2015 and 2019, 47 patients (60.5 ± 12.2 years; 39 male) underwent 50 procedures for 58 hepatic tumors (21 hepatocellular carcinomas; 37 metastases). Mean target tumor size was 16 ± 7mm (range: 6-39 mm). Technical success and technique efficacy were 100% and 98%, respectively. Lesions were treated using 2.6 applicator positions (range: 1-6). Mean energy, ablation duration per tumor, and procedure duration were 43.2 ± 23.5 kJ, 26.7 ± 13.1 min and 211.2 ± 68.7 min, respectively. 10 minor (20%) and 3 major (6%) complications were observed. Median post-interventional hospital admission was 1 day (range: 1-19 days). Median OS was 41.6 (IQR: 26.4-) months. Local recurrence occurred after 4 procedures (8%) with TLTP ranging between 3.1 and 41.9 months. Non-target recurrence was observed in 64% of patients after a median TNTP of 13.8 (IQR 2.3-) months.Conclusion: MR-guided MWA allows for safe and successful treatment of hepatic malignancies with a high technique efficacy however with relatively long procedure durations.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Moritz T Winkelmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Jens Kübler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
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Winkelmann MT, Gohla G, Kübler J, Weiß J, Clasen S, Nikolaou K, Hoffmann R. MR-Guided High-Power Microwave Ablation in Hepatic Malignancies: Initial Results in Clinical Routine. Cardiovasc Intervent Radiol 2020; 43:1631-1638. [PMID: 32699978 PMCID: PMC7591402 DOI: 10.1007/s00270-020-02584-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Evaluation of technique effectiveness, patient safety and ablation parameters of MR-guided microwave ablation in hepatic malignancies using an MR-conditional high-power microwave ablation system. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained. Patients who underwent MR-guided microwave ablation of hepatic malignancies in a 1.5T wide-bore scanner using a perfusion-cooled high-power microwave ablation system with a maximum generator power of 150 W were included. Ablation parameters comprising procedure durations, net ablation duration, applicator positions and ablation zone dimensions were recorded. Adverse events were classified according to the CIRSE classification system. Technique effectiveness was assessed after 1 month. Follow-up was conducted with contrast-enhanced MRI and ranged from 1 to 20 months (mean: 6.1 ± 5.4 months). RESULTS Twenty-one consecutive patients (age: 63.4 ± 10.5 years; 5 female) underwent 22 procedures for 28 tumours (9 hepatocellular carcinomas, 19 metastases) with a mean tumour diameter of 14.6 ± 5.4 mm (range: 6-24 mm). Technique effectiveness was achieved in all lesions. Tumours were treated using 1.7 ± 0.7 applicator positions (range: 1-3). Mean energy and ablation duration per tumour were 75.3 ± 35.4 kJ and 13.3 ± 6.2 min, respectively. Coagulation zone short- and long-axis diameters were 29.1 ± 6.4 mm and 39.9 ± 7.4 mm, respectively. Average procedure duration was 146.4 ± 26.2 min (range: 98-187 min). One minor complication was reported. Five patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed during initial follow-up. CONCLUSION MR-guided high-power microwave ablation provides safe and effective treatment of hepatic malignancies with short ablation times and within acceptable procedure durations.
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Affiliation(s)
- Moritz T Winkelmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jens Kübler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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7
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Song Z, Ye J, Wang Y, Li Y, Wang W. Computed tomography-guided iodine-125 brachytherapy for unresectable hepatocellular carcinoma. J Cancer Res Ther 2020; 15:1553-1560. [PMID: 31939437 DOI: 10.4103/jcrt.jcrt_629_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose This study aimed to retrospectively assess the outcome of interstitial iodine-125 brachytherapy for unresectable hepatocellular carcinoma (HCC). Materials and Methods Between February 2013 and March 2019, 57 patients with 108 unresectable HCC lesions treated with computed tomography (CT)-guided iodine-125 seed brachytherapy were retrospectively analyzed. The primary endpoint was overall survival (OS). The secondary endpoints included local tumor control and progression-free survival (PFS). Potential factors associated with OS were assessed. Results The mean follow-up duration was 24.3 ± 15.6 months (median, 20.5 months; range, 3.9-66.8 months). The median OS time was 23.6 months (95% confidence interval [CI], 18.4-28.8 months). The 1-, 2-, and 3-year actuarial OS rates were 80.0%, 46.1%, and 24.3%, respectively. The median PFS time was 12 months (95% CI, 9.9-14.5 months). The 1- and 2-year actuarial PFS rates were 50% and 20.1%, respectively. Local progression was noted in 11 (11.3%) of 108 lesions with mean local control time of 20.5 ± 8.8 months. The 1- and 2-year local control rates were 96.5% and 88.8%, respectively. Barcelona clinic liver cancer stage and Child-Pugh score were independent risk factors affecting the prognosis (hazard ratio [HR] = 0.330 [95% CI, 0.128-0.853] and HR = 0.303 [95% CI, 0.151-0.610], respectively). Hepatic artery pseudoaneurysm was found in 1 (1.8%) patient with lesion located in the porta hepatis. No other major complications developed during follow-up. Conclusion CT-guided iodine-125 brachytherapy may be an effective and safe alternative with promising survival and increased local control rate in unresectable HCC treatment.
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Affiliation(s)
- Zhaomin Song
- Department of Oncology, The Third Hospital of Qinhuangdao City, Qinhuangdao City, Hebei Province, China
| | - Jiacheng Ye
- Department of Interventional Medicine, Nanping First Hospital Affiliated to Fujian Medical University, Nanping City, Fujian Province, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
| | - Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
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8
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Winkelmann MT, Archid R, Gohla G, Hefferman G, Kübler J, Weiss J, Clasen S, Nikolaou K, Nadalin S, Hoffmann R. MRI-guided percutaneous thermoablation in combination with hepatic resection as parenchyma-sparing approach in patients with primary and secondary hepatic malignancies: single center long-term experience. Cancer Imaging 2020; 20:37. [PMID: 32460898 PMCID: PMC7251813 DOI: 10.1186/s40644-020-00316-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Combination therapy using hepatic resection (HR) and intra-operative thermal ablation is a treatment approach for patients with technically unresectable liver malignancies. The aim of this study was to investigate safety, survival and local recurrence rates for patients with technically unresectable liver tumors undergoing HR and separate percutaneous MR-guided thermoablation procedure as an alternative approach. METHODS Data from all patients with primary or secondary hepatic malignancies treated at a single institution between 2004 and 2018 with combined HR and MR-guided percutaneous thermoablation was collected and retrospectively analyzed. Complications, procedure related information and patient characteristics were collected from institutional records. Overall survival and disease-free survival were estimated using the Kaplan-Meier method. RESULTS A total of 31 patients (age: 62.8 ± 9.1 years; 10 female) with hepatocellular carcinoma (HCC; n = 7) or hepatic metastases (n = 24) were treated for 98 hepatic tumors. Fifty-six tumors (mean diameter 28.7 ± 23.0 mm) were resected. Forty-two tumors (15.1 ± 7.6 mm) were treated with MR-guided percutaneous ablation with a technical success rate of 100%. Local recurrence at the ablation site occurred in 7 cases (22.6%); none of these was an isolated local recurrence. Six of 17 patients (35.3%) treated for colorectal liver metastases developed local recurrence. Five patients developed recurrence at the resection site (16.1%). Non-local hepatic recurrence was observed in 18 cases (58.1%) and extrahepatic recurrence in 11 cases (35.5%) during follow-up (43.1 ± 26.4 months). Ten patients (32.3%) developed complications after HR requiring pharmacological or interventional treatment. No complication requiring therapy was observed after ablation. Median survival time was 44.0 ± 7.5 months with 1-,3-, 5-year overall survival rates of 93.5, 68.7 and 31.9%, respectively. The 1-, 3- and 5-year disease-free survival rates were 38.7, 19.4 and 9.7%, respectively. CONCLUSION The combination of HR and MR-guided thermoablation is a safe and effective approach in the treatment of technically unresectable hepatic tumors and can achieve long-term survival.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Rami Archid
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tübingen, Germany
| | - Georg Gohla
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Gerald Hefferman
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jens Kübler
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Jakob Weiss
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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Fischbach F, Hass P, Schindele D, Genseke P, Geisendorf L, Stehning C, Schostak M, Brunner T, Pech M, Fischbach K. MRI targeted single fraction HDR Brachytherapy for localized Prostate Carcinoma: a feasibility study of focal radiation therapy (ProFocAL). Eur Radiol 2019; 30:2072-2081. [PMID: 31828412 DOI: 10.1007/s00330-019-06505-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to establish the setup and workflow for delivering focal MRI-guided high-dose-rate (HDR) brachytherapy for prostate cancer (PCA) and to assess patient comfort and safety aspects of MRI-guided single-fraction HDR. METHODS Patients with histologically proven focal low- to intermediate-risk PCA with a single PIRADS 4/5 lesion were treated with percutaneous interstitial HDR brachytherapy in a single fraction with a minimum dose for the gross tumor volume of 20 Gy while sparing the organ at risk (OAR). Using a 3T-MRI, brachytherapy catheters were placed transgluteal in freehand technique. No antibiotic therapy or general analgesics were administered. Patient data, procedure time, patient discomfort, and complications were recorded. Quarterly PSA controls, biannual follow-up imaging, and annual re-biopsy were planned. RESULTS So far, 9 patients were successfully treated and followed for 6 months. Mean intervention time was 34 min. Using the VAS scale, the pain reported for the intervention ranged from 2 to 3. Short-term follow-up showed no acute genitourinary or gastrointestinal toxicity so far. None of the patients displayed signs of infection. PSA levels in all patients decreased significantly. On follow up no residual PCA was detected treated region so far. PSA levels in all patients decreased significantly. On follow-up, no residual PCA was detected so far. CONCLUSIONS MR-guided single-fraction focal HDR brachytherapy for localized PCA is feasible as well as safe for the individual patient. Catheters can be placed accurately and maximum therapeutic dose distribution can be restricted to the tumor. Countersigning the minimally invasive character of the procedure, no general anesthesia or antibiosis is necessary. KEY POINTS • MR-guided focal HDR brachytherapy allows an accurate placement of catheters with maximum therapeutic dose distribution restricted to the tumor. • No major anesthesia or antibiosis is necessary emphasizing the minimal invasive character of the procedure. • Patients with low- and intermediate-risk prostate carcinoma in particular may benefit to halt disease progression whereas treatment-related morbidity is reduced compared with radical therapy.
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Affiliation(s)
- Frank Fischbach
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Peter Hass
- Department of Radiotherapy, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Daniel Schindele
- Department of Urology, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Philipp Genseke
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Lisa Geisendorf
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
| | | | - Martin Schostak
- Department of Urology, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Thomas Brunner
- Department of Radiotherapy, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
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Collettini F, Jonczyk M, Meddeb A, Wieners G, Geisel D, Schnapauff D, Gebauer B. Feasibility and Safety of CT-Guided High-Dose-Rate Brachytherapy Combined with Transarterial Chemoembolization Using Irinotecan-Loaded Microspheres for the Treatment of Large, Unresectable Colorectal Liver Metastases. J Vasc Interv Radiol 2019; 31:315-322. [PMID: 31537409 DOI: 10.1016/j.jvir.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/05/2019] [Accepted: 05/11/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate feasibility and safety of combined irinotecan chemoembolization and CT-guided high-dose-rate brachytherapy (HDRBT) in patients with unresectable colorectal liver metastases > 3 cm in diameter. MATERIALS AND METHODS This prospective study included 23 patients (age, 70 y ± 11.3; 16 men) with 47 liver metastases (size, 62 mm ± 18.7). Catheter-related adverse events were reported per Society of Interventional Radiology classification, and treatment toxicities were reported per Common Terminology Criteria for Adverse Events. Liver-related blood values were analyzed by Wilcoxon test, with P < .05 as significant. Time to local tumor progression, progression-free survival (PFS), and overall survival (OS) were estimated by Kaplan-Meier method. RESULTS No catheter-related major or minor complications were recorded. Significant differences vs baseline levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT; both P < .001), γ-glutamyltransferase (GGT; P = .013), and hemoglobin (P = .014) were recorded. After therapy, 11 of 23 patients (47.8%) presented with new grade I/II toxicities (bilirubin, n = 3 [13%]; AST, n = 16 [70%]; ALT, n = 18 [78%]; ALP, n = 12 [52%] and hemoglobin, n = 15 [65%]). Moreover, grade III/IV toxicities developed in 10 (43.5%; 1 grade IV): AST, n = 6 (26%), grade III, n = 5; grade IV, n = 1; ALT, n = 3 (13%); GGT, n = 7 (30%); and hemoglobin, n = 1 (4%). However, all new toxicities resolved within 3 months after therapy without additional treatment. Median local tumor control, PFS, and OS were 6, 4, and 8 months, respectively. CONCLUSIONS Combined irinotecan chemoembolization and CT-guided HDRBT is safe and shows a low incidence of toxicities, which were self-resolving.
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Affiliation(s)
- Federico Collettini
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Martin Jonczyk
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Aymen Meddeb
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Gero Wieners
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dirk Schnapauff
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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Bala MM, Riemsma RP, Wolff R, Pedziwiatr M, Mitus JW, Storman D, Swierz MJ, Kleijnen J. Cryotherapy for liver metastases. Cochrane Database Syst Rev 2019; 7:CD009058. [PMID: 31291464 PMCID: PMC6620095 DOI: 10.1002/14651858.cd009058.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The liver is affected by two of the most common groups of malignant tumours: primary liver tumours and liver metastases from colorectal carcinoma. Liver metastases are significantly more common than primary liver cancer and long-term survival rates reported for patients after radical surgical treatment is approximately 50%. However, R0 resection (resection for cure) is not feasible in the majority of patients. Cryotherapy is performed with the use of an image-guided cryoprobe which delivers liquid nitrogen or argon gas to the tumour tissue. The subsequent process of freezing is associated with formation of ice crystals, which directly damage exposed tissue, including cancer cells. OBJECTIVES To assess the beneficial and harmful effects of cryotherapy compared with no intervention, other ablation methods, or systemic treatments in people with liver metastases. SEARCH METHODS We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, and six other databases up to June 2018. SELECTION CRITERIA Randomised clinical trials assessing beneficial and harmful effects of cryotherapy and its comparators for liver metastases, irrespective of the location of the primary tumour. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We extracted information on participant characteristics, interventions, study outcomes, and data on the outcomes important for our review, as well as information on the design and methodology of the trials. Two review authors independently assessed risk of bias in each study. One review author performed data extraction and a second review author checked entries. MAIN RESULTS We found no randomised clinical trials comparing cryotherapy versus no intervention or versus systemic treatments; however, we identified one randomised clinical trial comparing cryotherapy with conventional surgery. The trial was conducted in Ukraine. The trial included 123 participants with solitary, or multiple unilobar or bilobar liver metastases; 63 participants received cryotherapy and 60 received conventional surgery. There were 36 women and 87 men. The primary sites for the metastases were colon and rectum (66.6%), stomach (7.3%), breast (6.5%), skin (4.9%), ovaries (4.1%), uterus (3.3%), kidney (3.3%), intestines (1.6%), pancreas (1.6%), and unknown (0.8%). The trial was not reported sufficiently enough to assess the risk of bias of the randomisation process, allocation concealment, or presence of blinding. It was also not possible to assess incomplete outcome data and selective outcome reporting bias. The certainty of evidence was low because of risk of bias and imprecision.The participants were followed for up to 10 years (minimum five months). The trial reported that the mortality at 10 years was 81% (51/63) in the cryotherapy group and 92% (55/60) in the conventional surgery group. The calculated by us relative risk (RR) with 95% Confidence Interval (CI) was: RR 0.88, 95% CI 0.77 to 1.02. We judged the evidence as low-certainty evidence. Regarding adverse events and complications, separately and in total, our calculation showed no evidence of a difference in recurrence of the malignancy in the liver: 86% (54/63) of the participants in the cryotherapy group and 95% (57/60) of the participants in the conventional surgery group developed a new malignancy (RR 0.90, 95% CI 0.80 to 1.01; low-certainty evidence). The frequency of reported complications was similar between the cryotherapy group and the conventional surgery group, except for postoperative pain. Both insignificant and pronounced pain were reported to be more common in the cryotherapy group while intense pain was reported to be more common in the conventional surgery group. However, the authors did not report whether there was any evidence of a difference. There were no intervention-related mortality or bile leakages.We identified no evidence for health-related quality of life, cancer mortality, or time to progression of liver metastases. The study reported tumour response in terms of the carcinoembryonic antigen level in 69% of participants, and reported results in the form of a graph for 30% of participants. The carcinoembryonic antigen level was lower in the cryotherapy group, and decreased to normal values faster in comparison with the control group (P < 0.05). FUNDING the trial did not provide information on funding. AUTHORS' CONCLUSIONS The evidence for the effectiveness of cryotherapy versus conventional surgery in people with liver metastases is of low certainty. We are uncertain about our estimate and cannot determine whether cryotherapy compared with conventional surgery is beneficial or harmful. We found no evidence for the benefits or harms of cryotherapy compared with no intervention, or versus systemic treatments.
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Affiliation(s)
- Malgorzata M Bala
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine; Department of Hygiene and Dietetics; Systematic Reviews UnitKopernika 7KrakowPoland31‐034
| | - Robert P Riemsma
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Robert Wolff
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Michal Pedziwiatr
- Jagiellonian University Medical College2nd Department of General SurgeryKopernika Street 21KrakówMalopolskaPoland31‐501
| | - Jerzy W Mitus
- Centre of Oncology, Maria Skłodowska – Curie Memorial Institute, Krakow Branch. Department of Anatomy, Jagiellonian University Medical College Krakow, PolandDepartment of Surgical Oncologyul. Garncarska 11KrakowPoland31‐115
| | - Dawid Storman
- University HospitalDepartment of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Department of Adult PsychiatryKrakowPoland
| | - Mateusz J Swierz
- Jagiellonian University Medical CollegeDepartment of Hygiene and Dietetics, Systematic Reviews UnitKrakowPoland
| | - Jos Kleijnen
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
- School for Public Health and Primary Care (CAPHRI), Maastricht UniversityMaastrichtNetherlands6200 MD
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Winkelmann MT, Clasen S, Pereira PL, Hoffmann R. Local treatment of oligometastatic disease: current role. Br J Radiol 2019; 92:20180835. [PMID: 31124700 DOI: 10.1259/bjr.20180835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The presence of distant metastases has long been a predictor of poor outcome in solid cancer. However, in an oncologic situation called oligometastatic disease (OMD), multiple studies have revealed a survival benefit with aggressive treatment of these metastases. Besides surgery and radiation therapy, local thermal therapies have developed into a treatment option for OMD. Most studies concerning local therapy of OMD are available for colorectal cancer, which is therefore the focus of this article. Furthermore, this review gives a basic overview of the most popular ablation techniques for treatment of OMD.
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Affiliation(s)
- Moritz T Winkelmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
| | - Stephan Clasen
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
| | - Philippe L Pereira
- 2 Department of Radiology, SLK-Hospital Heilbronn GmbH, Am Gesundbrunnen, Heilbronn, Germany
| | - Rüdiger Hoffmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
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Radioablation by Image-Guided (HDR) Brachytherapy and Transarterial Chemoembolization in Hepatocellular Carcinoma: A Randomized Phase II Trial. Cardiovasc Intervent Radiol 2018; 42:239-249. [DOI: 10.1007/s00270-018-2127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022]
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Beld E, Seevinck PR, Schuurman J, Viergever MA, Lagendijk JJ, Moerland MA. Development and Testing of a Magnetic Resonance (MR) Conditional Afterloader for Source Tracking in Magnetic Resonance Imaging-Guided High-Dose-Rate (HDR) Brachytherapy. Int J Radiat Oncol Biol Phys 2018; 102:960-968. [DOI: 10.1016/j.ijrobp.2018.04.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 01/18/2023]
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Weiss J, Hoffmann R, Rempp H, Keβler DE, Pereira PL, Nikolaou K, Clasen S. Feasibility, efficacy, and safety of percutaneous MR-guided ablation of small (≤12 mm) hepatic malignancies. J Magn Reson Imaging 2018; 49:374-381. [PMID: 30221797 DOI: 10.1002/jmri.26252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Percutaneous tumor ablation is commonly performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor may be challenging. MRI guidance provides more reliable visualization of target tumors and allows for real-time imaging and multiplanar capabilities, making it the modality of choice, in particular if lesions are small. PURPOSE To investigate the feasibility, technical success, and safety of percutaneous MR-guided ablation (RFA n = 27 / MWA n = 16) of small (≤12 mm) hepatic malignancies. STUDY TYPE Retrospective case study. POPULATION In all, 45 patients (age: 61.1 ± 11.8) with hepatic malignancies and a lesion diameter of ≤12 mm scheduled for percutaneous MR-guided tumor ablation based on a tumor board decision were included. FIELD STRENGTH A 1.5T MR system was used for planning, targeting, and monitoring. ASSESSMENT Feasibility assessment included the detection of the target tumor, tumor delineation during MR-fluoroscopy guided targeting, and the number of attempts needed for precise applicator placement. Technical success was defined as successful performance of the procedure including a safety margin of 5 mm. Safety evaluation was based on procedure-related complications. STATISTICAL TEST Frequency. RESULTS Tumor ablation (mean diameter 9.0 ± 2.1 mm) was successfully completed in 43/45 patients. Planning imaging was conducted without a contrast agent in 79% (n = 37). In 64% (n = 30), the target tumors were visible with MR-fluoroscopy. In six patients (13%), planning imaging revealed new, unexpected small lesions, which were either treated in the same session (n = 4) or changed therapy management (n = 2) due to diffuse tumor progress. Postprocedural imaging revealed a technical success of 100% (43/43), with no major complications. During follow-up, no local tumor progression was observed (mean follow-up 24.7 ± 14.0 months) although 28% (12) patients developed new hepatic lesions distant to the ablation zone. No major complications were observed. DATA CONCLUSION MR-guided ablation is a feasible approach for an effective and safe treatment of small hepatic malignancies. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2019;49:374-381.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Hansjoerg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - David-Emanuel Keβler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Rak M, König T, Tönnies KD, Walke M, Ricke J, Wybranski C. Joint deformable liver registration and bias field correction for MR-guided HDR brachytherapy. Int J Comput Assist Radiol Surg 2017; 12:2169-2180. [DOI: 10.1007/s11548-017-1633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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Wybranski C, Pech M, Lux A, Ricke J, Fischbach F, Fischbach K. Hybrid Approach for Biliary Interventions Employing MRI-Guided Bile Duct Puncture with Near-Real-Time Imaging. Cardiovasc Intervent Radiol 2017; 40:884-893. [PMID: 28160096 DOI: 10.1007/s00270-017-1591-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the feasibility of a hybrid approach employing MRI-guided bile duct (BD) puncture for subsequent fluoroscopy-guided biliary interventions in patients with non-dilated (≤3 mm) or dilated BD (≥3 mm) but unfavorable conditions for ultrasonography (US)-guided BD puncture. METHODS A total of 23 hybrid interventions were performed in 21 patients. Visualization of BD and puncture needles (PN) in the interventional MR images was rated on a 5-point Likert scale by two radiologists. Technical success, planning time, BD puncture time and positioning adjustments of the PN as well as technical success of the biliary intervention and complication rate were recorded. RESULTS Visualization even of third-order non-dilated BD and PN was rated excellent by both radiologists with good to excellent interrater agreement. MRI-guided BD puncture was successful in all cases. Planning and BD puncture times were 1:36 ± 2.13 (0:16-11:07) min. and 3:58 ± 2:35 (1:11-9:32) min. Positioning adjustments of the PN was necessary in two patients. Repeated capsular puncture was not necessary in any case. All biliary interventions were completed successfully without major complications. CONCLUSION A hybrid approach which employs MRI-guided BD puncture for subsequent fluoroscopy-guided biliary intervention is feasible in clinical routine and yields high technical success in patients with non-dilated BD and/or unfavorable conditions for US-guided puncture. Excellent visualization of BD and PN in near-real-time interventional MRI allows successful cannulation of the BD.
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Affiliation(s)
- Christian Wybranski
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
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Alternate update of shifted extended keyholes (AUSEK): A new accelerating strategy for interventional MRI. Magn Reson Imaging 2016; 36:112-120. [PMID: 27989902 DOI: 10.1016/j.mri.2016.10.031] [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: 07/27/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022]
Abstract
Real-time or near-real-time acquisition plays a key role in providing immediate image guidance for interventional magnetic resonance imaging (iMRI). However, the requirement of accurate needle tip localization has made several accelerating techniques, like Keyhole imaging or sliding window reconstruction, difficult to be applied to iMRI. The purpose of this work was to further explore the possible ways of applying view sharing techniques to iMRI. Inspired by Keyhole imaging, we present an easy-to-implement accelerating strategy called "Alternate update of shifted extended keyholes (AUSEK)". In this method, the keyhole views are not only extended but also shifted towards either high-frequency edge to form two divisions in k-space. The divisions which are mirrored to each other along the center are alternately updated following a reference scan. By using simulations and experiments, we demonstrate that AUSEK could effectively preserve the spatial resolution of the image, especially of the needle, at a temporal acceleration rate of about 2.5. AUSEK was implemented online in an open-configuration low-field MR imaging system.
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Henken KR, Seevinck PR, Dankelman J, van den Dobbelsteen JJ. Manually controlled steerable needle for MRI-guided percutaneous interventions. Med Biol Eng Comput 2016; 55:235-244. [PMID: 27108292 PMCID: PMC5272900 DOI: 10.1007/s11517-016-1490-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 03/18/2016] [Indexed: 12/03/2022]
Abstract
This study aims to develop and evaluate a manually controlled steerable needle that is compatible with and visible on MRI to facilitate full intra-procedural control and accurate navigation in percutaneous interventions. The steerable needle has a working channel that provides a lumen to a cutting stylet or a therapeutic instrument. A steering mechanism based on cable-operated compliant elements is integrated in the working channel. The needle can be steered by adjusting the orientation of the needle tip through manipulation of the handle. The steering mechanism is evaluated by recording needle deflection at constant steering angles. A steering angle of 20.3° results in a deflection of 9.1–13.3 mm in gelatin and 4.6–18.9 mm in porcine liver tissue at an insertion depth of 60 mm. Additionally, the possibility to control the needle path under MRI guidance is evaluated in a gelatin phantom. The needle can be steered to targets at different locations while starting from the same initial position and orientation under MRI guidance with generally available sequences. The steerable needle offers flexibility to the physician in control and choice of the needle path when navigating the needle toward the target position, which allows for optimization of individual treatment and may increase target accuracy.
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Affiliation(s)
- Kirsten R Henken
- TUDelft, Biomechanical Engineering, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - Peter R Seevinck
- Imaging Division, Image Sciences Institute, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jenny Dankelman
- TUDelft, Biomechanical Engineering, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Abstract
The use of magnetic resonance imaging (MRI) in radiotherapy (RT) planning is rapidly expanding. We review the wide range of image contrast mechanisms available to MRI and the way they are exploited for RT planning. However a number of challenges are also considered: the requirements that MR images are acquired in the RT treatment position, that they are geometrically accurate, that effects of patient motion during the scan are minimized, that tissue markers are clearly demonstrated, that an estimate of electron density can be obtained. These issues are discussed in detail, prior to the consideration of a number of specific clinical applications. This is followed by a brief discussion on the development of real-time MRI-guided RT.
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Affiliation(s)
- Maria A Schmidt
- Cancer Research UK Cancer Imaging Centre, Royal Marsden Hospital and the Institute of Cancer Research, Downs Road, Sutton, Surrey, SM2 5PT, UK
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Targeting Accuracy, Procedure Times and User Experience of 240 Experimental MRI Biopsies Guided by a Clinical Add-On Navigation System. PLoS One 2015. [PMID: 26222443 PMCID: PMC4519044 DOI: 10.1371/journal.pone.0134370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES MRI is of great clinical utility for the guidance of special diagnostic and therapeutic interventions. The majority of such procedures are performed iteratively ("in-and-out") in standard, closed-bore MRI systems with control imaging inside the bore and needle adjustments outside the bore. The fundamental limitations of such an approach have led to the development of various assistance techniques, from simple guidance tools to advanced navigation systems. The purpose of this work was to thoroughly assess the targeting accuracy, workflow and usability of a clinical add-on navigation solution on 240 simulated biopsies by different medical operators. METHODS Navigation relied on a virtual 3D MRI scene with real-time overlay of the optically tracked biopsy needle. Smart reference markers on a freely adjustable arm ensured proper registration. Twenty-four operators - attending (AR) and resident radiologists (RR) as well as medical students (MS) - performed well-controlled biopsies of 10 embedded model targets (mean diameter: 8.5 mm, insertion depths: 17-76 mm). Targeting accuracy, procedure times and 13 Likert scores on system performance were determined (strong agreement: 5.0). RESULTS Differences in diagnostic success rates (AR: 93%, RR: 88%, MS: 81%) were not significant. In contrast, between-group differences in biopsy times (AR: 4:15, RR: 4:40, MS: 5:06 min:sec) differed significantly (p<0.01). Mean overall rating was 4.2. The average operator would use the system again (4.8) and stated that the outcome justifies the extra effort (4.4). Lowest agreement was reported for the robustness against external perturbations (2.8). CONCLUSIONS The described combination of optical tracking technology with an automatic MRI registration appears to be sufficiently accurate for instrument guidance in a standard (closed-bore) MRI environment. High targeting accuracy and usability was demonstrated on a relatively large number of procedures and operators. Between groups with different expertise there were significant differences in experimental procedure times but not in the number of successful biopsies.
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Liu M, Sequeiros RB, Xu Y, He X, Zhu T, Li L, Lü Y, Huang J, Li C. MRI-guided percutaneous transpedicular biopsy of thoracic and lumbar spine using a 0.23t scanner with optical instrument tracking. J Magn Reson Imaging 2015; 42:1740-6. [PMID: 25946392 DOI: 10.1002/jmri.24924] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/06/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ming Liu
- Department of Interventional MRI; Shandong Medical Imaging Research Institute, Shandong University; Jinan Shandong P.R. China
| | | | - Yujun Xu
- Department of Interventional MRI; Shandong Medical Imaging Research Institute, Shandong University; Jinan Shandong P.R. China
| | - Xiangmeng He
- Department of Interventional MRI; Shandong Medical Imaging Research Institute, Shandong University; Jinan Shandong P.R. China
| | - Tongyin Zhu
- Department of hepatobiliary and pancreatic surgery; First Affiliated Hospital of Zhejiang University; Hangzhou Zhejiang P.R. China
| | - Lei Li
- Department of Interventional Radiology; Qingdao Central Hospital; Qingdao Shandong P.R. China
| | - Yubo Lü
- Department of Interventional MRI; Shandong Medical Imaging Research Institute, Shandong University; Jinan Shandong P.R. China
| | - Jie Huang
- Department of Interventional MRI; Shandong Medical Imaging Research Institute, Shandong University; Jinan Shandong P.R. China
| | - Chengli Li
- Department of Interventional MRI; Shandong Medical Imaging Research Institute, Shandong University; Jinan Shandong P.R. China
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Wybranski C, Eberhardt B, Fischbach K, Fischbach F, Walke M, Hass P, Röhl FW, Kosiek O, Kaiser M, Pech M, Lüdemann L, Ricke J. Accuracy of applicator tip reconstruction in MRI-guided interstitial 192Ir-high-dose-rate brachytherapy of liver tumors. Radiother Oncol 2015; 115:72-7. [PMID: 25779722 DOI: 10.1016/j.radonc.2015.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 11/26/2022]
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CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma. Strahlenther Onkol 2014; 191:405-12. [DOI: 10.1007/s00066-014-0781-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/30/2014] [Indexed: 12/12/2022]
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Fischbach F, Fischbach K, Ricke J. [Percutaneous interventions in an open MR system: technical background and clinical indications]. Radiologe 2013; 53:993-1000. [PMID: 24170286 DOI: 10.1007/s00117-012-2462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The latest and therefore more efficient open magnetic resonance (MR) scanners with a field strength of 1 T allow freehand fluoroscopic interventions with excellent image quality. Specifically designed interactive software simplifies examination planning and performance. Guidance in two imaging planes allows fast and accurate device positioning and interventional procedures during free breathing. The diagnostic and therapeutic spectrum includes a wide variety of interstitial percutaneous interventions. The most important are periradicular therapy (PRT), intra-abdominal drainage and nephrostoma placement, biopsies, especially in the breasts and liver and focal ablation therapy of malignant hepatic or renal lesions. As the approach is fast and robotic devices are not needed the method is increasingly being carried out in the clinical routine. A drawback of MR-guided interventions is the limitation in verbal communication during image acquisition. Furthermore, the portfolio of MR compatible instruments needs to be extended.
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Affiliation(s)
- F Fischbach
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland,
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Computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of metastases adjacent to the liver hilum. Eur J Radiol 2013; 82:e509-14. [PMID: 23791521 DOI: 10.1016/j.ejrad.2013.04.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 03/30/2013] [Accepted: 04/09/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate technical feasibility and clinical outcome of computed tomography-guided high-dose-rate-brachytherapy (CT-HDRBT) ablation of metastases adjacent to the liver hilum. MATERIALS AND METHODS Between November 2007 and May 2012, 32 consecutive patients with 34 metastases adjacent to the liver hilum (common bile duct or hepatic bifurcation ≤5 mm distance) were treated with CT-HDRBT. Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. MRI follow-up was performed 6 weeks and every 3 months post intervention. The primary endpoint was local tumor control (LTC); secondary endpoints included time to progression (TTP) and overall survival (OS). RESULTS Patients were available for MRI evaluation for a mean follow-up time of 18.75 months (range: 3-56 months). Mean tumor diameter was 4.3 cm (range: 1.3-10.7 cm). One major complication was observed. Four (11.8%) local recurrences were observed after a local tumor control of 5, 8, 9 and 10 months, respectively. Twenty-two patients (68.75%) experienced a systemic tumor progression during the follow up period. Mean TTP was 12.9 months (range: 2-56 months). Nine patients died during the follow-up period. Median OS was 20.24 months. CONCLUSION Minimally invasive CT-HDRBT is a safe and effective option also for unresectable liver metastases adjacent to the liver hilum that would have been untreatable by thermal ablation.
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Percutaneous Abscess Drainage Using Near Real-Time MR Guidance in an Open 1.0-T MR Scanner. Invest Radiol 2013; 48:477-84. [DOI: 10.1097/rli.0b013e318284383f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Magnetic Resonance–Guided Freehand Radiofrequency Ablation of Malignant Liver Lesions. Invest Radiol 2013; 48:422-8. [DOI: 10.1097/rli.0b013e3182803dae] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nonrigid 3D medical image registration and fusion based on deformable models. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:902470. [PMID: 23690883 PMCID: PMC3652073 DOI: 10.1155/2013/902470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/26/2013] [Indexed: 11/17/2022]
Abstract
For coregistration of medical images, rigid methods often fail to
provide enough freedom, while reliable elastic methods are
available clinically for special applications only. The number of
degrees of freedom of elastic models must be reduced for use in
the clinical setting to archive a reliable result. We propose a novel geometry-based method of nonrigid 3D
medical image registration and fusion. The proposed method uses a 3D surface-based deformable model as
guidance. In our twofold approach, the deformable mesh from one
of the images is first applied to the boundary of the object to be
registered. Thereafter, the non-rigid volume deformation vector
field needed for registration and fusion inside of the region of
interest (ROI) described by the active surface is inferred from
the displacement of the surface mesh points. The method was validated using clinical images of a quasirigid
organ (kidney) and of an elastic organ (liver). The
reduction in standard deviation of the image intensity difference
between reference image and model was used as a measure of
performance. Landmarks placed at vessel bifurcations in the liver
were used as a gold standard for evaluating registration results
for the elastic liver. Our registration method was compared with
affine registration using mutual information applied to the
quasi-rigid kidney. The new method achieved 15.11% better quality with a
high confidence level of 99% for rigid registration. However,
when applied to the quasi-elastic liver, the method has
an averaged landmark dislocation of 4.32 mm. In contrast, affine
registration of extracted livers yields a significantly (P = 0.000001) smaller dislocation of 3.26 mm. In conclusion, our
validation shows that the novel approach is applicable in cases
where internal deformation is not crucial, but it has limitations in
cases where internal displacement must also be taken into account.
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Collettini F, Schippers AC, Schnapauff D, Denecke T, Hamm B, Riess H, Wust P, Gebauer B. Percutaneous ablation of lymph node metastases using CT-guided high-dose-rate brachytherapy. Br J Radiol 2013; 86:20130088. [PMID: 23659925 DOI: 10.1259/bjr.20130088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the technical feasibility, safety and clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) for achieving local tumour control (LTC) in isolated lymph node metastases. METHODS From January 2008 to December 2011, 10 patients (six males and four females) with isolated nodal metastases were treated with CT-HDRBT. Five lymph node metastases were para-aortic, three were at the liver hilum, one at the coeliac trunk and one was a left iliac nodal metastasis. The mean lesion diameter was 36.5 mm (range 12.0-67.0 mm). Patients were followed up by either contrast-enhanced CT or MRI 6 weeks and then every 3 months after the end of treatment. The primary end point was LTC. Secondary end points included primary technical effectiveness rate, adverse events and progression-free survival. RESULTS The first follow-up examination after 6 weeks revealed complete coverage of all nodal metastases treated. There was no peri-interventional mortality or major complications. The mean follow-up period was 13.2 months (range 4-20 months). 2 out of 10 patients (20%) showed local tumour progression 9 and 10 months after ablation. 5 out of 10 patients (50%) showed systemic tumour progression. The mean progression-free interval was 9.2 months (range 2-20 months). CONCLUSION CT-HDRBT is a safe and effective technique for minimally invasive ablation of nodal metastases. ADVANCES IN KNOWLEDGE CT-HDRBT of lymph node metastases is feasible and safe. CT-HDRBT might be a viable therapeutic alternative to obtain LTC in selected patients with isolated lymph node metastases.
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Affiliation(s)
- F Collettini
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Rothgang E, Gilson WD, Wacker F, Hornegger J, Lorenz CH, Weiss CR. Rapid freehand MR-guided percutaneous needle interventions: An image-based approach to improve workflow and feasibility. J Magn Reson Imaging 2013; 37:1202-12. [DOI: 10.1002/jmri.23894] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 09/17/2012] [Indexed: 11/11/2022] Open
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Collettini F, Golenia M, Schnapauff D, Poellinger A, Denecke T, Wust P, Riess H, Hamm B, Gebauer B. Percutaneous computed tomography-guided high-dose-rate brachytherapy ablation of breast cancer liver metastases: initial experience with 80 lesions. J Vasc Interv Radiol 2012; 23:618-26. [PMID: 22525020 DOI: 10.1016/j.jvir.2012.01.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To analyze initial experience with computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of breast cancer liver metastases (BCLM). MATERIALS AND METHODS Between January 2008 and December 2010, 37 consecutive women with 80 liver metastases were treated with CT-HDRBT in 56 sessions. Mean age was 58.6 years (range, 34-83 y). Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. The mean radiation dose was 18.57 Gy (standard deviation 2.27). Tumor response was evaluated by gadoxetic acid-enhanced liver magnetic resonance (MR) imaging performed before treatment, 6 weeks after treatment, and every 3 months thereafter. RESULTS Two patients were lost to follow-up; the remaining 35 patients were available for MR imaging evaluation for a mean follow-up time of 11.6 months (range 3-32 mo). Mean tumor diameter was 25.5 mm (range 8-74 mm). Two (2.6%) local recurrences were observed after local tumor control for 10 months and 12 months. Both local progressions were successfully retreated. Distant tumor progression (new metastases or enlargement of nontreated metastases) occurred during the follow-up period in 11 (31.4%) patients. Seven (20%) patients died during the follow-up period. Overall survival ranged from 3-39 months (median 18 months). CONCLUSIONS CT-HDRBT is a safe and effective ablative therapy, providing a high rate of local tumor control in patients with BCLM.
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Affiliation(s)
- Federico Collettini
- Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Abstract
Limitations of thermal liver cancer ablation have led to the development of percutaneous, catheter-based brachytherapy for the treatment of liver malignancies. Computed tomography (CT)-guided brachytherapy has been used to treat primary and metastatic liver cancers, including very large tumors >10 cm. Cooling effects by adjacent blood vessels are not a concern in brachytherapy, and the method may be used safely in tumors unsuitable for thermal ablation that are close to the liver hilum due to the relatively high radiation tolerance of bile duct. CT scanning is used for dosimetry planning after catheter implantation and also to guide the catheter placement itself. Major complications, including postinterventional bleeding, are rare despite frequent application of this technique in a salvage situation. Patients with liver cirrhosis have an increased risk for complications. Prospective trials of CT-guided brachytherapy have been performed with promising survival rates for liver metastases and hepatocellular carcinoma, respectively. In this article, the radiobiological and technical properties of CT-guided brachytherapy, appropriate patients for treatment, and prospective trials that have been published to date are reviewed.
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Affiliation(s)
- Jens Ricke
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany.
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Collettini F, Schnapauff D, Poellinger A, Denecke T, Schott E, Berg T, Wust P, Hamm B, Gebauer B. Hepatocellular carcinoma: computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of large (5-7 cm) and very large (>7 cm) tumours. Eur Radiol 2011; 22:1101-9. [PMID: 22173693 DOI: 10.1007/s00330-011-2352-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/23/2011] [Accepted: 11/10/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Evaluate the clinical outcome of CT-guided high-dose-rate-brachytherapy (CT-HDRBT) of hepatocellular carcinoma (HCC) larger than 5 cm in diameter with the goal of local tumour control (LTC). METHODS Thirty-five patients with 35 unresectable HCCs ranging in size from 5 to 12 cm (mean: 7.1 cm) were treated with CT-HDRBT. Tumours were classified into two groups according to diameter: "large lesions" (5-7 cm) and "very large lesions" (>7 cm). Tumour response was evaluated by Gd-EOB-DTPA-enhanced liver magnetic resonance imaging (MRI) performed before, 6 weeks after, and then every 3 months after treatment. Endpoints included local tumour control (LTC), progression-free survival (PFS) and overall survival (OS). RESULTS Nineteen tumours were classified as "large" and 16 as "very large". Complete tumour enclosure was achieved in all patients after the first CT-HDRBT session. Five patients were lost to follow-up. At a mean follow-up of 12.8 months, two patients had local progression (6.7%), one in each group. Nine patients (30%) experienced distant progression, five (26.3%) in the "large" and four (25%) in the "very large" group. No patients died during the follow-up period. No major complications were recorded. CONCLUSIONS CT-HDRBT is a promising therapy for HCCs that exceed indications for thermal ablation. KEY POINTS • Computed Tomography guided high-dose-rate brachytherapy offers new therapeutic options for hepatocellular carcinoma • CT-HDRBT can be safely practised in HCCs exceeding 5 cm in diameter • CT-HDRBT offers high rate of local control where thermal ablation is impossible • CT-HDRBT could be a valid alternative to TACE for intermediate stage HCC.
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Affiliation(s)
- Federico Collettini
- Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Onishi H, Kim T, Imai Y, Hori M, Nagano H, Nakaya Y, Tsuboyama T, Nakamoto A, Tatsumi M, Kumano S, Okada M, Takamura M, Wakasa K, Tomiyama N, Murakami T. Hypervascular hepatocellular carcinomas: detection with gadoxetate disodium-enhanced MR imaging and multiphasic multidetector CT. Eur Radiol 2011; 22:845-54. [PMID: 22057248 DOI: 10.1007/s00330-011-2316-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/29/2011] [Accepted: 10/15/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To retrospectively compare the accuracy of detection of hypervascular hepatocellular carcinoma (HCC) by multiphasic multidetector CT and by gadoxetate disodium-enhanced MR imaging. METHODS After ethical approval, we analysed a total of 73 hypervascular HCC lesions from 31 patients suspected of having HCC, who underwent both gadoxetate disodium-enhanced MR imaging and multiphasic multidetector CT. Five blinded observers independently reviewed CT images, as well as dynamic MR images alone and combined with hepatobiliary phase MR images. Diagnostic accuracy (Az values), sensitivities and positive predictive values were compared by using the Scheffe post hoc test. RESULTS The mean Az value for dynamic and hepatobiliary phase MR combined (0.81) or dynamic MR images alone (0.78) was significantly higher than that for CT images (0.67, P < 0.001, 0.005, respectively). The mean sensitivity of the combined MR images (0.67) was significantly higher than that of dynamic MR alone (0.52, P < 0.05) or CT images (0.44, P < 0.05). The mean positive predictive values were 0.96, 0.95 and 0.94, for CT, dynamic MR alone and combined MR images, respectively. CONCLUSIONS Compared with multiphasic multidetector CT, gadoxetate disodium-enhanced MR imaging combining dynamic and hepatobiliary phase images results in significantly improved sensitivity and diagnostic accuracy for detection of hypervascular HCC. KEY POINTS Gadoxetate disodium is a new liver-specific MR imaging contrast agent. Gadoxetate disodium-enhanced MRI helps the assessment of patients with liver disease. It showed high diagnostic accuracy for the detection of hepatocellular carcinoma.
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Affiliation(s)
- Hiromitsu Onishi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Lü Y, Liu M, Li C, Wu L, Fritz J. MRI-guided biopsy and aspiration in the head and neck: evaluation of 77 patients. Eur Radiol 2011; 22:404-10. [PMID: 21987213 DOI: 10.1007/s00330-011-2270-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/27/2011] [Accepted: 08/30/2011] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of MRI-guided percutaneous biopsy procedures of head and neck lesions using 0.23T open MRI with optical tracking. METHODS A retrospective analysis of 77 patients (51 male, 26 female; mean age, 43 years; range, 11-88 years) who underwent MRI-guided percutaneous biopsy of a head and neck lesion was performed. Mean lesion diameter was 3 cm (range, 1-7.8 cm). Rapid gradient echo sequences were used for image guidance. 23/77 lesions were biopsied after intravenous gadolinium. Tissue sampling techniques included needle aspiration (n = 19) and core needle biopsy (n = 58). Outcome variables included technical success, diagnostic accuracy, procedure time and complications. RESULTS In all patients, a sufficient amount of tissue for pathological analysis was obtained. Pathological analysis diagnosed 41 malignant lesions and 36 benign lesions. In 42 cases, surgical correlation was available. In 35 cases, the final diagnosis was confirmed by imaging and clinical follow-up. MR-guided biopsy had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 93.2%, 100%, 100%, 91.7%, and 96%, respectively. Procedure time was 29 min (range, 15-47 min). No major complications occurred. CONCLUSIONS MRI-guided biopsy of head and neck lesions has a high diagnostic performance and is safe in clinical practice. KEY POINTS • MRI-guided biopsy helps clinicians to assess patients with head&neck masses. • Differention of malignant and benign lesions is possible with 96% accuracy. • The safety profile of MRI-guided biopsy of head&neck lesions is favorable. • MRI guidance enables accurate biopsy without the use of ionizing radiation.
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Affiliation(s)
- Yubo Lü
- Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Road, Jinan, China
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Fischbach F, Thormann M, Seidensticker M, Kropf S, Pech M, Ricke J. Assessment of fast dynamic imaging and the use of Gd-EOB-DTPA for MR-guided liver interventions. J Magn Reson Imaging 2011; 34:874-9. [DOI: 10.1002/jmri.22691] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 05/23/2011] [Indexed: 11/09/2022] Open
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Streitparth F, Hartwig T, Schnackenburg B, Strube P, Putzier M, Chopra S, De Bucourt M, Hamm B, Teichgräber U. MR-guided discography using an open 1 Tesla MRI system. Eur Radiol 2010; 21:1043-9. [DOI: 10.1007/s00330-010-2011-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 10/02/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
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Evaluation of MR imaging guided steroid injection of the sacroiliac joints for the treatment of children with refractory enthesitis-related arthritis. Eur Radiol 2010; 21:1050-7. [DOI: 10.1007/s00330-010-1994-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/03/2010] [Accepted: 10/11/2010] [Indexed: 11/25/2022]
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Will K, Krug J, Jungnickel K, Fischbach F, Ricke J, Rose G, Omar A. MR-compatible RF ablation system for online treatment monitoring using MR thermometry. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:1601-1604. [PMID: 21096130 DOI: 10.1109/iembs.2010.5626664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
RF ablation (RFA) is used for thermal ablation of tumors in which the RF electrode is placed in the tissue under image-guidance. Because of the good tumor visibility and the lack of ionizing radiation, MR-guided RFA is the method of choice. Additionally, with the help of MR thermometry the RF ablation can be monitored during the intervention. Unfortunately, the imaging of an MR scanner is highly sensitive to interferences caused by external electrical signals. In this paper the high-power RF ablation signal of a commercially available medical therapy device is made MR-compatible. A design of a low-pass filter with high-power compatibility is presented. The filter performance is demonstrated by means of simulations and measurements.
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Affiliation(s)
- Karl Will
- Department of Signal Processing and Communications, Otto-von-Guericke-University of Magdeburg, Universitaetsplatz 2, 39106, Germany.
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