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Albano D, Cintioli R, Messina C, Serpi F, Gitto S, Mascitti L, Vignati G, Glielmo P, Vitali P, Zagra L, Snoj Ž, Sconfienza LM. US-Guided Interventional Procedures for Total Hip Arthroplasty. J Clin Med 2024; 13:3976. [PMID: 38999539 PMCID: PMC11242179 DOI: 10.3390/jcm13133976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
In patients with total hip arthroplasty (THA) with recurrent pain, symptoms may be caused by several conditions involving not just the joint, but also the surrounding soft tissues including tendons, muscles, bursae, and peripheral nerves. US and US-guided interventional procedures are important tools in the diagnostic work-up of patients with painful THA given that it is possible to reach a prompt diagnosis both directly identifying the pathological changes of periprosthetic structures and indirectly evaluating the response and pain relief to local injection of anesthetics under US monitoring. Then, US guidance can be used for the aspiration of fluid from the joint or periarticular collections, or alternatively to follow the biopsy needle to collect samples for culture analysis in the suspicion of prosthetic joint infection. Furthermore, US-guided percutaneous interventions may be used to treat several conditions with well-established minimally invasive procedures that involve injections of corticosteroid, local anesthetics, and platelet-rich plasma or other autologous products. In this review, we will discuss the clinical and technical applications of US-guided percutaneous interventional procedures in painful THA that can be used in routine daily practice for diagnostic and therapeutic purposes.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milan, Italy
| | - Roberto Cintioli
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesca Serpi
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Laura Mascitti
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Giacomo Vignati
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Pierluigi Glielmo
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Paolo Vitali
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Žiga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
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Albano D, Messina C, Gitto S, Fusco S, Sconfienza LM, Bellelli A. US/CT fusion imaging and virtual navigation to guide lumbar intradiscal oxygen-ozone therapy: a pilot study. J Ultrasound 2024; 27:291-296. [PMID: 38102520 PMCID: PMC11178682 DOI: 10.1007/s40477-023-00835-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/02/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE To test the feasibility of US/CT fusion imaging to guide lumbar intradiscal O2/O3 therapy to treat discogenic degenerative low back pain due to lumbar disc herniation (LDH). METHODS We retrospectively included consecutive patients affected by low back pain and/or sciatica due to LDH resistant to conservative therapies, who underwent to lumbar intradiscal O2/O3 injection under CT/US fusion imaging guidance (Fusion Group) and standard CT guidance (Control Group). For each procedure, we collected procedure operative time, room utilization time, number of CT passes, complications, and O2/O3 intradiscal diffusion adequacy. Technical success was defined as the ability to complete the procedure as initially planned to reach the disc. Technical efficacy was based on O2/O3 intradiscal diffusion adequacy, as demonstrated by the last CT scan. RESULTS Six patients (4 males; mean age: 68 ± 15 years) were included in the Fusion group, six (4 males; mean age: 66 ± 12 years) in Control group. No complications were observed in both groups. In Fusion group we found significantly lower room utilization time (30 ± 6 min vs. 46 ± 10 min, p = 0.008), procedure operative time (14 ± 3 min vs. 24 ± 6 min, p = 0.008), and number of CT passes (2 [2,2] vs. 3 [3,3], p = 0.006) than in Control Group, respectively. Technical success and efficacy were 100% in both Groups. CONCLUSION CT/US fusion imaging seems to be a feasible and safe guidance for intradiscal O2/O3 injections, allowing decrease of procedure time and number of CT passes.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, Milan, Italy.
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Fusco
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Alberto Bellelli
- Unità Operativa Complessa di Radiologia Diagnostica ed Interventistica, Ospedale Fatebenefratelli San Pietro, Rome, Italy
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Albano D, Bruno F, Agostini A, Angileri SA, Benenati M, Bicchierai G, Cellina M, Chianca V, Cozzi D, Danti G, De Muzio F, Di Meglio L, Gentili F, Giacobbe G, Grazzini G, Grazzini I, Guerriero P, Messina C, Micci G, Palumbo P, Rocco MP, Grassi R, Miele V, Barile A. Dynamic contrast-enhanced (DCE) imaging: state of the art and applications in whole-body imaging. Jpn J Radiol 2021; 40:341-366. [PMID: 34951000 DOI: 10.1007/s11604-021-01223-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022]
Abstract
Dynamic contrast-enhanced (DCE) imaging is a non-invasive technique used for the evaluation of tissue vascularity features through imaging series acquisition after contrast medium administration. Over the years, the study technique and protocols have evolved, seeing a growing application of this method across different imaging modalities for the study of almost all body districts. The main and most consolidated current applications concern MRI imaging for the study of tumors, but an increasing number of studies are evaluating the use of this technique also for inflammatory pathologies and functional studies. Furthermore, the recent advent of artificial intelligence techniques is opening up a vast scenario for the analysis of quantitative information deriving from DCE. The purpose of this article is to provide a comprehensive update on the techniques, protocols, and clinical applications - both established and emerging - of DCE in whole-body imaging.
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Affiliation(s)
- Domenico Albano
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Agostini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Clinical, Special and Dental Sciences, Department of Radiology, University Politecnica delle Marche, University Hospital "Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi", Ancona, Italy
| | - Salvatore Alessio Angileri
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Benenati
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Oncologia ed Ematologia, RadioterapiaRome, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Vito Chianca
- Ospedale Evangelico Betania, Naples, Italy
- Clinica Di Radiologia, Istituto Imaging Della Svizzera Italiana - Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giuliana Giacobbe
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Pasquale Guerriero
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Giuseppe Micci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Abruzzo Health Unit 1, Department of diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, L'Aquila, Italy
| | - Maria Paola Rocco
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Jie T, Guoying F, Gang T, Zhengrong S, Maoping L. Efficacy and Safety of Fusion Imaging in Radiofrequency Ablation of Hepatocellular Carcinoma Compared to Ultrasound: A Meta-Analysis. Front Surg 2021; 8:728098. [PMID: 34938766 PMCID: PMC8685205 DOI: 10.3389/fsurg.2021.728098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Radiofrequency ablation (RFA), generally performed under real-time guidance of ultrasound which is safe and effective, is a common minimally invasive therapy for treating hepatocellular carcinoma. Fusion imaging (FI) is a newly developed imaging method, which integrates CT/MRI accurate imaging and matches the characteristics of real-time ultrasound imaging, thereby providing a new approach to guide tumor ablation therapy. However, the efficacy and safety of FI as opposed to ultrasound in tumor ablation remains unclear. Objective: The present study sought to evaluate the difference in the efficacy and safety between FI and ultrasound in radiofrequency surgery for the treatment of hepatocellular carcinoma through a metaanalysis. Materials and Methods: Searching for studies comparing the efficacy and safety of FI and ultrasound in radiofrequency of hepatocellular carcinoma in PubMed, Embase, and Cochrane Library databases for articles published until April 2021. Random or fixed effect models were used for statistical analysis. Metaanalysis and sensitivity analysis were used on the included studies. Results: A total of six studies met predefined inclusion criteria, and were finally included in the analysis. Sensitivity and subgroup analyses, based on predetermined patient characteristics, allowed minimization of bias. In the RFA of hepatocellular carcinoma, FI decreased 1-year overall survival (OS) when compared with ultrasound. But FI was not significantly different from ultrasound in terms of technical efficiency, 1-, 2-, and 3-year local tumor progression (LTP), complications, as well as 2-year OS. Subgroup analysis, based on tumor mean diameter, showed that FI reduced the rate of 1- and 2-year LTP in patients with tumors of mean diameter ≥15 mm when compared with ultrasound. Moreover, operative complications could be reduced in patients with tumor mean diameter <15 mm using FI, compared with ultrasound. Conclusion: Overall, these results showed that FI may have some effects on improving efficacy and safety of thermal ablation in HCC patients, relative to ultrasound. However, it may be a more effective method for managing large lesions, as well as those that are difficult to ablate. Further large-scale and well-designed randomized controlled trials are needed to validate these findings.
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Affiliation(s)
- Tao Jie
- Department of General Surgery, Chongqing Medical University, Chongqing, China
| | - Feng Guoying
- Department of General Surgery, Chongqing Medical University, Chongqing, China
| | - Tang Gang
- Department of General Surgery, Chongqing Medical University, Chongqing, China
| | - Shi Zhengrong
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Maoping
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Beleù A, Drudi A, Giaretta A, De Robertis R, Fedrigo I, Martone E, Simone C, Bovo C, D'Onofrio M. Operator Evaluation of Ultrasound Fusion Imaging Usefulness in the Percutaneous Ablation of Hepatic Malignancies: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3159-3169. [PMID: 34392997 DOI: 10.1016/j.ultrasmedbio.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/05/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
The purpose of the work described here was to evaluate the use of ultrasound fusion imaging (US-FI) in percutaneous ablation of hepatic malignancies with respect to its global usefulness, improvement of conspicuity, confidence increment, needle route changes, and time savings. Thirty-four hepatic tumors (28 hepatocellular carcinomas, 6 metastases) were prospectively ablated in 16 consecutive patients (64 ± 11 y, 75% males), first simulating B-mode-only planning and then synchronizing computed tomography/magnetic resonance images with US and proceeding to needle insertion and tumor ablation under US-FI guidance. Surveys were administered to the operators to evaluate their perception of US-FI advantages. First treatment and local recurrence were also compared. US-FI was judged useful in 91% of cases and more useful when the tumor was not conspicuous in B-mode (p < 0.001), in particular for ablation of local recurrences (p = 0.021). Forty-one percent of tumors were undetectable at B-mode evaluation, and 93% of them were completely ablated under US-FI guidance. The confidence of the operator was highly increased by US-FI in 68% of cases. In 71% of cases, the radiologist saved time using US-FI, especially in treatment of local recurrences (p = 0.024). In conclusion, US-FI significantly increases the detection of target tumors, improves the confidence of the operator and is a time-saving method, especially in the treatment of local recurrences.
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Affiliation(s)
- Alessandro Beleù
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy.
| | - Alessandro Drudi
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Alvise Giaretta
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | | | - Ilaria Fedrigo
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Enrico Martone
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Conci Simone
- Department of Surgery, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Chiara Bovo
- Health Director, Azienda Ospedaliera Universitaria Integrata, Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
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A Multicenter Randomized Controlled Prospective Study to Assess Efficacy of Laparoscopic Electrochemotherapy in the Treatment of Locally Advanced Pancreatic Cancer. J Clin Med 2021; 10:jcm10174011. [PMID: 34501459 PMCID: PMC8432461 DOI: 10.3390/jcm10174011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Eighty percent of patients with pancreatic adenocarcinoma present a locally advanced or metastatic disease at diagnosis and are not eligible for surgery if not with palliative intent. In cases of locally advanced disease (LAPC), the combination of chemo and radiotherapy is the only therapeutic option and correlates with a median survival of 15 months (10 months without treatment), with partial remission of disease in 50% of cases. The feasibility and safety of Electrochemotherapy (ECT) have been demonstrated in the treatment of deep tumors. Aim: The aim of the study is to evaluate the efficacy of electrochemotherapy (ECT) followed by conventional systemic treatment compared to the only conventional systemic treatment in LAPC in terms of objective response and overall survival. Patients and Methods: This study is a phase IIb prospective multicenter randomized controlled trial with two arms. The study will include 90 patients: 45 in the control group and 45 in the experimental group. Patients with LAPC in the control arm will receive conventional chemotherapy (FOLFOXIRI). Patients with LAPC in the experimental arm will be subjected to Electrochemotherapy and subsequently to FOLFOXIRI. The objective response at 30, 90, and 180 days from treatment will be based on the computed tomography (CT), magnetic resonance (MR), and positron emission tomography/CT response (PET/CT). The objective long-term treatment response will be evaluated with the modified response evaluation criteria in solid tumors (m-RECIST) criteria, which will take into account the difference in vascularization, determined by the images obtained by CT and MR of the tumor treated before and after ECT. Conclusions: Not resectable liver metastasis, pancreatic tumors, and locally advanced renal carcinomas can be treated with laparoscopic electrodes. ECT could represent an effective therapeutic option for patients not eligible for surgery susceptible to be managed only with palliative therapies.
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Granata V, Grassi R, Fusco R, Belli A, Cutolo C, Pradella S, Grazzini G, La Porta M, Brunese MC, De Muzio F, Ottaiano A, Avallone A, Izzo F, Petrillo A. Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma. Infect Agent Cancer 2021; 16:53. [PMID: 34281580 PMCID: PMC8287696 DOI: 10.1186/s13027-021-00393-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
This article provides an overview of diagnostic evaluation and ablation treatment assessment in Hepatocellular Carcinoma (HCC). Only studies, in the English language from January 2010 to January 202, evaluating the diagnostic tools and assessment of ablative therapies in HCC patients were included. We found 173 clinical studies that satisfied the inclusion criteria.HCC may be noninvasively diagnosed by imaging findings. Multiphase contrast-enhanced imaging is necessary to assess HCC. Intravenous extracellular contrast agents are used for CT, while the agents used for MRI may be extracellular or hepatobiliary. Both gadoxetate disodium and gadobenate dimeglumine may be used in hepatobiliary phase imaging. For treatment-naive patients undergoing CT, unenhanced imaging is optional; however, it is required in the post treatment setting for CT and all MRI studies. Late arterial phase is strongly preferred over early arterial phase. The choice of modality (CT, US/CEUS or MRI) and MRI contrast agent (extracelllar or hepatobiliary) depends on patient, institutional, and regional factors. MRI allows to link morfological and functional data in the HCC evaluation. Also, Radiomics is an emerging field in the assessment of HCC patients.Postablation imaging is necessary to assess the treatment results, to monitor evolution of the ablated tissue over time, and to evaluate for complications. Post- thermal treatments, imaging should be performed at regularly scheduled intervals to assess treatment response and to evaluate for new lesions and potential complications.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Roberta Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
- Italian Society of Medical and Interventional Radiology SIRM, SIRM Foundation, Milan, Italy
| | | | - Andrea Belli
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Silvia Pradella
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Grazzini
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Alessandro Ottaiano
- Abdominal Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonio Avallone
- Abdominal Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
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Granata V, Fusco R, Salati S, Petrillo A, Di Bernardo E, Grassi R, Palaia R, Danti G, La Porta M, Cadossi M, Gašljević G, Sersa G, Izzo F. A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115592. [PMID: 34073865 PMCID: PMC8197272 DOI: 10.3390/ijerph18115592] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Imaging methods and the most appropriate criteria to be used for detecting and evaluating response to oncological treatments depend on the pathology and anatomical site to be treated and on the treatment to be performed. This document provides a general overview of the main imaging and histopathological findings of electroporation-based treatments (Electrochemotherapy-ECT and Irreversible electroporation-IRE) compared to thermal approach, such as radiofrequency ablation (RFA), in deep-seated cancers with a particular attention to pancreatic and liver cancer. METHODS Numerous electronic datasets were examined: PubMed, Scopus, Web of Science and Google Scholar. The research covered the years from January 1990 to April 2021. All titles and abstracts were analyzed. The inclusion criteria were the following: studies that report imaging or histopathological findings after ablative thermal and not thermal loco-regional treatments (ECT, IRE, RFA) in deep-seated cancers including pancreatic and liver cancer and articles published in the English language. Exclusion criteria were unavailability of full text and congress abstracts or posters and different topic respect to inclusion criteria. RESULTS 558 potentially relevant references through electronic searches were identified. A total of 38 articles met the inclusion criteria: 20 studies report imaging findings after RFA or ECT or IRE in pancreatic and liver cancer; 17 studies report histopathological findings after RFA or ECT or IRE; 1 study reports both imaging and histopathological findings after RFA or ECT or IRE. CONCLUSIONS Imaging features are related to the type of therapy administrated, to the timing of re-assessment post therapy and to the imaging technique being used to observe the effects. Histological findings after both ECT and IRE show that the treated area becomes necrotic and encapsulated in fibrous tissue, suggesting that the size of the treated lesion cannot be measured as an endpoint to detect response. Moreover, histology frequently reported signs of apoptosis and reduced vital tissue, implying that imaging criteria, which take into account the viability and not the size of the lesion, are more appropriate to evaluate response to treatment.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (V.G.); (A.P.)
| | - Roberta Fusco
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
- Correspondence:
| | - Simona Salati
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (V.G.); (A.P.)
| | - Elio Di Bernardo
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Roberta Grassi
- Radiology Division, Università Degli Studi Della Campania Luigi Vanvitelli, I-80143 Naples, Italy;
- Italian Society of Medical and Interventional Radiology SIRM, SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (R.P.); (F.I.)
| | - Ginevra Danti
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, I-50139 Florence, Italy;
| | | | - Matteo Cadossi
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Gorana Gašljević
- Department of Pathology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia;
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia;
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (R.P.); (F.I.)
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9
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Abbreviated MRI Protocol for the Assessment of Ablated Area in HCC Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073598. [PMID: 33808466 PMCID: PMC8037601 DOI: 10.3390/ijerph18073598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 02/07/2023]
Abstract
Background: Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of hepatocellular carcinoma (HCC) following loco regional therapy. The aim of this study was to compare sensitivity of standard MRI protocol versus abbreviated protocol (only T1-Weigthed fat suppressed (FS) sequences pre- and post-contrast phase) in the detection of ablated area according to LI-RADS Treatment Response (LR-TR) categories. Methods: From January 2015 to June 2020, we selected 64 patients with HCC, who underwent Radiofrequency ablation (RFA) or Microwave ablation (MWA) treatment. According to inclusion criteria, 136 pathologically proven treated HCC (median 2, range 1–3 per patient; mean size 20.0 mm; range 15–30 mm) in 58 patients (26 women, 32 men; median age, 74 years; range, 62–83 years) comprised our study population. For each ablated area, abbreviated protocol, and standard Magnetic Resonance Imaging (MRI) studies were independently and blindly assessed in random order within and between three expert radiologists. Each radiologist assessed the ablated area by using the following categories: “LR-TR Non-viable” = 1; “LR-TR Equivocal” = 2 and “LR-TR Viable” = 0. Results: According to the concordance between MRI and Contrast enhancement ultrasound (CEUS) among 136 treated HCCs, 115 lesions were assessed as non-viable or totally ablate and 21 as viable or partially ablate. The accuracy for standard MRI protocol and abbreviated MRI protocol for predicting pathologic tumor viability of a consensus reading was 98.6% (sensitivity = 100%; specificity = 98.3%; positive predictive value = 91.3% and negative predictive value = 100%). No differences were found in sensitivity or specificity between standard MRI LR-TR viable and abbreviated MRI LR-TR viable categories (p value > 0.05 at McNemar test). Conclusion: The abbreviated dynamic protocol showed similar diagnostic accuracy to conventional MRI study in the assessment of treated HCCs, with a reduction of the acquisition study time of 30% respect to conventional MRI.
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10
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Jing X, Zhou Y, Ding J, Wang Y, Qin Z, Wang Y, Zhou H. The Learning Curve for Thermal Ablation of Liver Cancers: 4,363-Session Experience for a Single Central in 18 Years. Front Oncol 2020; 10:540239. [PMID: 33194601 PMCID: PMC7606932 DOI: 10.3389/fonc.2020.540239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022] Open
Abstract
This study aimed to explore the special efforts required to achieve proficiency in performing thermal ablation of liver cancers, including tumors in difficult locations, and clarify the effects of handing-down teaching on the corresponding process. Major complications of patients receiving percutaneous thermal ablation of liver cancer were analyzed. Polynomial fitting was used to describe the connection between major complication rates and special experience. Learning curve of major complications was plotted both for the whole group and for each operator, respectively. Tumors in difficult locations were further studied. A total of 4,363 thermal ablation sessions were included in this study. 143 of 4,363 patients had major complications, corresponding to an incidence rate of 3.27%. 806 thermal ablation sessions were performed for tumors in difficult locations. The major complication rate of these sessions is 6.33%. According to the trend of the learning curve of the 4363 patients, the experience of the whole group can be classified into five stages, that is, the high-risk, relatively stable, unstable, proficient and stable periods. A learning curve for an individual operator can be classified into the high-risk, proficient and stable periods. The major complication rates for the chronologically first, second and third operator of the group are 3.23, 3.35, and 3.31%, respectively. The special experience needed to bypass the first stage corresponds to 410, 510, and 440 sessions, the second stage, 1850, 850, and 870 sessions, by the three operators, respectively. The major complication rates for the tumors in difficult locations for the first, second and third operator were 7.04, 5.53, and 5.98%, respectively. For the tumors in difficult locations, the special experience needed to bypass the first stage corresponds to 150, 130, and 140 sessions, the second stage, 290, 175, and 185 sessions, by the three operators, respectively. In conclusion, the learning process of an operator percutaneous thermal ablation for liver cancer can be classified into three stages. The major complication rate for tumors in difficult locations were higher than that for all tumors. Handing-down teaching can make an operator arrive at the third stage earlier but not the second stage.
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Affiliation(s)
- Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Yijun Wang
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China.,Department of Hepatobiliary Surgery, Tianjin Third Central Hospital, Tianjin, China
| | - Zhengyi Qin
- Department of Ultrasound, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
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11
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Citone M, Fanelli F, Falcone G, Mondaini F, Cozzi D, Miele V. A closer look to the new frontier of artificial intelligence in the percutaneous treatment of primary lesions of the liver. Med Oncol 2020; 37:55. [PMID: 32424627 DOI: 10.1007/s12032-020-01380-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
The purpose of thermal ablation is induction of tumor death by means of localized hyperthermia resulting in irreversible cellular damage. Ablative therapies are well-recognized treatment modalities for HCC lesions and are considered standard of care for HCC nodules < 3 cm in diameter in patients not suitable for surgery. Effective lesion treatment rely on complete target volume ablation. Technical limitations are represented by large (> 3 cm) or multicentric nodules as well as complex nodule location and poor lesion conspicuity. Artificial Intelligence (AI) is a general term referred to computational algorithms that can analyze data and perform complex tasks otherwise prerogative of Human Intelligence. AI has a variety of application in percutaneous ablation procedures such as Navigational software, Fusion Imaging, and robot-assisted ablation tools. Those instruments represent relative innovations in the field of Interventional Oncology and promising strategies to overcome actual limitations of ablative therapy in order to increase feasibility and technical results. This work aims to review the principal application of Artificial Intelligence in the percutaneous ablation of primary lesions of the liver with special focus on how AI can impact in the treatment of HCC especially on potential advantages on the drawbacks of the conventional technique.
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Affiliation(s)
- M Citone
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - F Fanelli
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - G Falcone
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - F Mondaini
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - D Cozzi
- Emergency Radiology Department, Careggi University Hospital, L.go G.A. Brambilla, 3, 50134, Florence, Italy
| | - V Miele
- Emergency Radiology Department, Careggi University Hospital, L.go G.A. Brambilla, 3, 50134, Florence, Italy.
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