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Cao P, Shi D, Li D, Zhu Z, Zhu J, Zhang J, Bai R. Modeling and in vivo experimental validation of 1,064 nm laser interstitial thermal therapy on brain tissue. Front Neurol 2023; 14:1237394. [PMID: 37869141 PMCID: PMC10588634 DOI: 10.3389/fneur.2023.1237394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Laser interstitial thermal therapy (LITT) at 1064 nm is widely used to treat epilepsy and brain tumors; however, no numerical model exists that can predict the ablation region with careful in vivo validation. Methods In this study, we proposed a model with a system of finite element methods simulating heat transfer inside the brain tissue, radiative transfer from the applicator into the brain tissue, and a model for tissue damage. Results To speed up the computation for practical applications, we also validated P1-approximation as an efficient and fast method for calculating radiative transfer by comparing it with Monte Carlo simulation. Finally, we validated the proposed numerical model in vivo on six healthy canines and eight human patients with epilepsy and found strong agreement between the predicted temperature profile and ablation area and the magnetic resonance imaging-measured results. Discussion Our results demonstrate the feasibility and reliability of the model in predicting the ablation area of 1,064 nm LITT, which is important for presurgical planning when using LITT.
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Affiliation(s)
- Peng Cao
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Dingsheng Shi
- Research and Development Department, Hangzhou GenLight MedTech Co., Ltd., Hangzhou, Zhejiang Province, China
| | - Ding Li
- Research and Development Department, Hangzhou GenLight MedTech Co., Ltd., Hangzhou, Zhejiang Province, China
| | - Zhoule Zhu
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Junming Zhu
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Jianmin Zhang
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Ruiliang Bai
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
- Interdisciplinary Institute of Neuroscience and Technology, School of Medicine, Zhejiang University, Hangzhou, China
- MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China
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Lad Y, Jangam A, Carlton H, Abu-Ayyad M, Hadjipanayis C, Ivkov R, Zacharia BE, Attaluri A. Development of a Treatment Planning Framework for Laser Interstitial Thermal Therapy (LITT). Cancers (Basel) 2023; 15:4554. [PMID: 37760524 PMCID: PMC10526178 DOI: 10.3390/cancers15184554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Develop a treatment planning framework for neurosurgeons treating high-grade gliomas with LITT to minimize the learning curve and improve tumor thermal dose coverage. METHODS Deidentified patient images were segmented using the image segmentation software Materialize MIMICS©. Segmented images were imported into the commercial finite element analysis (FEA) software COMSOL Multiphysics© to perform bioheat transfer simulations. The laser probe was modeled as a cylindrical object with radius 0.7 mm and length 100 mm, with a constant beam diameter. A modeled laser probe was placed in the tumor in accordance with patient specific patient magnetic resonance temperature imaging (MRTi) data. The laser energy was modeled as a deposited beam heat source in the FEA software. Penne's bioheat equation was used to model heat transfer in brain tissue. The cerebrospinal fluid (CSF) was modeled as a solid with convectively enhanced conductivity to capture heat sink effects. In this study, thermal damage-dependent blood perfusion was assessed. Pulsed laser heating was modeled based on patient treatment logs. The stationary heat source and pullback heat source techniques were modeled to compare the calculated tissue damage. The developed bioheat transfer model was compared to MRTi data obtained from a laser log during LITT procedures. The application builder module in COMSOL Multiphysics© was utilized to create a Graphical User Interface (GUI) for the treatment planning framework. RESULTS Simulations predicted increased thermal damage (10-15%) in the tumor for the pullback heat source approach compared with the stationary heat source. The model-predicted temperature profiles followed trends similar to those of the MRTi data. Simulations predicted partial tissue ablation in tumors proximal to the CSF ventricle. CONCLUSION A mobile platform-based GUI for bioheat transfer simulation was developed to aid neurosurgeons in conveniently varying the simulation parameters according to a patient-specific treatment plan. The convective effects of the CSF should be modeled with heat sink effects for accurate LITT treatment planning.
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Affiliation(s)
- Yash Lad
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
| | - Avesh Jangam
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
| | - Hayden Carlton
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Ma’Moun Abu-Ayyad
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
| | - Constantinos Hadjipanayis
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Brad E. Zacharia
- Department of Neurosurgery, Pennsylvania State Health, Hershey, PA 17033, USA
| | - Anilchandra Attaluri
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University Harrisburg, Harrisburg, PA 17057, USA
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Muacevic A, Adler JR, Jimenez MJD, Budnick HC, Raskin J. Thermal Damage Estimate Artifact Following Antecedent Biopsy: A Case Report. Cureus 2022; 14:e31913. [PMID: 36579245 PMCID: PMC9792349 DOI: 10.7759/cureus.31913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
MR-guided laser interstitial therapy (MRgLITT) is becoming more commonly used for minimal access approaches to intracranial lesions of all etiologies. The short-term safety profile of MRgLITT is favorable compared with sweeping incisions and open craniotomies, especially for lesions located in deep, periventricular, and highly eloquent areas. The Visualase software (Medtronic Inc., Minneapolis, MN, USA) has multiple adaptations to assist with this safety margin, including the thermal damage estimate (TDE), which applies predictive mathematical modeling to a two-dimensional (2D) graphical representation. TDE has been shown to highly correlate with actual tissue destruction in a priori MRgLITT cases and to anecdotally be imprecise when MRgLITT is combined with biopsy. We present a case regarding a 17-year-old male patient with intractable focal epilepsy. He underwent stereotactic biopsy and then ablation where it was shown that TDE is ~35% larger in the coronal plane than in the actual ablation zone. Air may have caused this artifact in the biopsy cavity, which affected the proton resonance frequency (PRF) and caused TDE pigment deposition. We believe in the need for a more comprehensive understanding and investigation regarding this TDE artifact. Future prospective studies into MRgLITT should attend carefully in cases where it is combined with biopsy.
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Sebek J, Cappiello G, Rahmani G, Zeinali N, Keating M, Fayemiwo M, Harkin J, McDaid L, Gardiner B, Sheppard D, Senanayake R, Gurnell M, O’Halloran M, Dennedy MC, Prakash P. Image-based computer modeling assessment of microwave ablation for treatment of adrenal tumors. Int J Hyperthermia 2022; 39:1264-1275. [PMID: 36137605 PMCID: PMC9820798 DOI: 10.1080/02656736.2022.2125590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To assess the feasibility of delivering microwave ablation for targeted treatment of aldosterone producing adenomas using image-based computational models. METHODS We curated an anonymized dataset of diagnostic 11C-metomidate PET/CT images of 14 patients with aldosterone producing adenomas (APA). A semi-automated approach was developed to segment the APA, adrenal gland, and adjacent organs within 2 cm of the APA boundary. The segmented volumes were used to implement patient-specific 3D electromagnetic-bioheat transfer models of microwave ablation with a 2.45 GHz directional microwave ablation applicator. Ablation profiles were quantitatively assessed based on the extent of the APA target encompassed by an ablative thermal dose, while limiting thermal damage to the adjacent normal adrenal tissue and sensitive critical structures. RESULTS Across the 14 patients, adrenal tumor volumes ranged between 393 mm3 and 2,395 mm3. On average, 70% of the adrenal tumor volumes received an ablative thermal dose of 240CEM43, while limiting thermal damage to non-target structures, and thermally sparing 83.5-96.4% of normal adrenal gland. Average ablation duration was 293 s (range: 60-600 s). Simulations indicated coverage of the APA with an ablative dose was limited when the axis of the ablation applicator was not well aligned with the major axis of the targeted APA. CONCLUSIONS Image-based computational models demonstrate the potential for delivering microwave ablation to APA targets within the adrenal gland, while limiting thermal damage to surrounding non-target structures.
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Affiliation(s)
- Jan Sebek
- Mike Wiegers Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA
| | - Grazia Cappiello
- Translational Medical Devices Lab, National University of Ireland, Galway, Republic of Ireland
| | - George Rahmani
- Department of Radiology, Galway University Hospitals, Galway, Republic Ireland
| | - Nooshin Zeinali
- Mike Wiegers Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA
| | - Muireann Keating
- School of Medicine, National University of Ireland, Galway, Republic Ireland
| | - Michael Fayemiwo
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Jim Harkin
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Liam McDaid
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Bryan Gardiner
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Declan Sheppard
- Department of Radiology, Galway University Hospitals, Galway, Republic Ireland
| | | | - Mark Gurnell
- Institute of Metabolic Science, University of Cambridge, United Kingdom
| | - Martin O’Halloran
- Translational Medical Devices Lab, National University of Ireland, Galway, Republic of Ireland
| | - M. Conall Dennedy
- School of Medicine, National University of Ireland, Galway, Republic Ireland
| | - Punit Prakash
- Mike Wiegers Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA.,Author to whom correspondence should be addressed: Punit Prakash, 3078 Engineering Hall, 1701D Platt St, Kansas State University, Manhattan, KS 66506, USA.
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Sebek J, Taeprasartsit P, Wibowo H, Beard WL, Bortel R, Prakash P. Microwave ablation of lung tumors: A probabilistic approach for simulation-based treatment planning. Med Phys 2021; 48:3991-4003. [PMID: 33964020 DOI: 10.1002/mp.14923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Microwave ablation (MWA) is a clinically established modality for treatment of lung tumors. A challenge with existing application of MWA, however, is local tumor progression, potentially due to failure to establish an adequate treatment margin. This study presents a robust simulation-based treatment planning methodology to assist operators in comparatively assessing thermal profiles and likelihood of achieving a specified minimum margin as a function of candidate applied energy parameters. METHODS We employed a biophysical simulation-based probabilistic treatment planning methodology to evaluate the likelihood of achieving a specified minimum margin for candidate treatment parameters (i.e., applied power and ablation duration for a given applicator position within a tumor). A set of simulations with varying tissue properties was evaluated for each considered combination of power and ablation duration, and for four different scenarios of contrast in tissue biophysical properties between tumor and normal lung. A treatment planning graph was then assembled, where distributions of achieved minimum ablation zone margins and collateral damage volumes can be assessed for candidate applied power and treatment duration combinations. For each chosen power and time combination, the operator can also visualize the histogram of ablation zone boundaries overlaid on the tumor and target volumes. We assembled treatment planning graphs for generic 1, 2, and 2.5 cm diameter spherically shaped tumors and also illustrated the impact of tissue heterogeneity on delivered treatment plans and resulting ablation histograms. Finally, we illustrated the treatment planning methodology on two example patient-specific cases of tumors with irregular shapes. RESULTS The assembled treatment planning graphs indicate that 30 W, 6 min ablations achieve a 5-mm minimum margin across all simulated cases for 1-cm diameter spherical tumors, and 70 W, 10 min ablations achieve a 3-mm minimum margin across 90% of simulations for a 2.5-cm diameter spherical tumor. Different scenarios of tissue heterogeneity between tumor and lung tissue revealed 2 min overall difference in ablation duration, in order to reliably achieve a 4-mm minimum margin or larger each time for 2-cm diameter spherical tumor. CONCLUSIONS An approach for simulation-based treatment planning for microwave ablation of lung tumors is illustrated to account for the impact of specific geometry of the treatment site, tissue property uncertainty, and heterogeneity between the tumor and normal lung.
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Affiliation(s)
- Jan Sebek
- Department of Electrical and Computer Engineering, Kansas State University Manhattan, KS, 66506, USA.,Department of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | - Pinyo Taeprasartsit
- PhenoMapper, LLC, San Jose, CA, 95112, USA.,Department of Computing, Faculty of Science, Silpakorn University, Thailand
| | | | - Warren L Beard
- Department of Clinical Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Radoslav Bortel
- Department of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University Manhattan, KS, 66506, USA
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Predictive modeling of brain tumor laser ablation dynamics. J Neurooncol 2019; 144:193-203. [PMID: 31240526 DOI: 10.1007/s11060-019-03220-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/16/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laser interstitial thermal therapy (LITT) is a novel MR thermometry-guided thermoablative tool revolutionizing the clinical management of brain tumors. A limitation of LITT is our inability to estimate a priori how tissues will respond to thermal energy, which hinders treatment planning and delivery. The aim of this study was to determine whether brain tumor LITT ablation dynamics may be predicted by features of the preoperative MRI and the relevance of these data, if any, to the recurrence of metastases after LITT. METHODS Intraoperative thermal damage estimate (TDE) map pixels representative of irreversible damage were retrospectively quantified relative to ablation onset for 101 LITT procedures. Raw TDE pixel counts and TDE pixel counts modelled with first order dynamics were related to eleven independent variables derived from the preoperative MRI, demographics, laser settings, and tumor pathology. Stepwise regression analysis generated predictive models of LITT dynamics, and leave-one-out cross validation evaluated the accuracy of these models at predicting TDE pixel counts solely from the independent variables. Using a deformable atlas, TDE maps were co-registered to the immediate post-ablation MRI, allowing comparison of predicted and actual ablation sizes. RESULTS Brain tumor TDE pixel counts modelled with first order dynamics, but not raw pixel counts, are correlated with the independent variables. Independent variables showing strong relations to the TDE pixel measures include T1 gadolinium and T2 signal, perfusion, and laser power. Associations with tissue histopathology are minimal. Leave-one-out analysis demonstrates that predictive models using these independent variables account for 77% of the variance observed in TDE pixel counts. Analysis of metastases treated revealed a trend towards the over-estimation of LITT effects by TDE maps during rapid ablations, which was associated with tumor recurrence. CONCLUSIONS Features of the preoperative MRI are predictive of LITT ablation dynamics and could eventually be used to improve the clinical efficacy with which LITT is delivered to brain tumors.
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Jermakowicz WJ, Cajigas I, Dan L, Guerra S, Sur S, D’Haese PF, Kanner AM, Jagid JR. Ablation dynamics during laser interstitial thermal therapy for mesiotemporal epilepsy. PLoS One 2018; 13:e0199190. [PMID: 29979717 PMCID: PMC6034782 DOI: 10.1371/journal.pone.0199190] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/02/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction The recent emergence of laser interstitial thermal therapy (LITT) as a frontline surgical tool in the management of brain tumors and epilepsy is a result of advances in MRI thermal imaging. A limitation to further improving LITT is the diversity of brain tissue thermoablative properties, which hinders our ability to predict LITT treatment-related effects. Utilizing the mesiotemporal lobe as a consistent anatomic model system, the goal of this study was to use intraoperative thermal damage estimate (TDE) maps to study short- and long-term effects of LITT and to identify preoperative variables that could be helpful in predicting tissue responses to thermal energy. Methods For 30 patients with mesiotemporal epilepsy treated with LITT at a single institution, intraoperative TDE maps and pre-, intra- and post-operative MRIs were co-registered in a common reference space using a deformable atlas. The spatial overlap of TDE maps with manually-traced immediate (post-ablation) and delayed (6-month) ablation zones was measured using the dice similarity coefficient (DSC). Then, motivated by simple heat-transfer models, ablation dynamics were quantified at amygdala and hippocampal head from TDE pixel time series fit by first order linear dynamics, permitting analysis of the thermal time constant (τ). The relationships of these measures to 16 independent variables derived from patient demographics, mesiotemporal anatomy, preoperative imaging characteristics and the surgical procedure were examined. Results TDE maps closely overlapped immediate ablation borders but were significantly larger than the ablation cavities seen on delayed imaging, particularly at the amygdala and hippocampal head. The TDEs more accurately predicted delayed LITT effects in patients with smaller perihippocampal CSF spaces. Analyses of ablation dynamics from intraoperative TDE videos showed variable patterns of lesion progression after laser activation. Ablations tended to be slower for targets with increased preoperative T2 MRI signal and in close proximity to large, surrounding CSF spaces. In addition, greater laser energy was required to ablate mesial versus lateral mesiotemporal structures, an effect associated with laser trajectory and target contrast-enhanced T1 MRI signal. Conclusions Patient-specific variations in mesiotemporal anatomy and pathology may influence the thermal coagulation of these tissues. We speculate that by incorporating demographic and imaging data into predictive models we may eventually enhance the accuracy and precision with which LITT is delivered, improving outcomes and accelerating adoption of this novel tool.
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Affiliation(s)
- Walter J. Jermakowicz
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Iahn Cajigas
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Lia Dan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Santiago Guerra
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Samir Sur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Pierre-Francois D’Haese
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Andres M. Kanner
- Epilepsy Division, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Jonathan R. Jagid
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
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Liu C, Wang L, He X, Xu Y, Lu D, Li P, Lv R, Feng Y, Liu M, Li C. 1.0T MR-guided percutaneous coaxial cutting needle biopsy in pancreatic lesion diagnosis. J Magn Reson Imaging 2018; 48:382-388. [PMID: 29319916 DOI: 10.1002/jmri.25952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/21/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pancreatic carcinoma is a common cause of cancer deaths worldwide. Biopsy is often required for the initial diagnosis of pancreatic masses. Biopsy can be performed endoscopically or percutaneously with computed tomography (CT) and ultrasound (US) guidance. MRI offers many inherent advantages over CT and US. PURPOSE/HYPOTHESIS To prospectively evaluate the feasibility, accuracy, and safety of MRI-guided percutaneous coaxial cutting needle biopsy of pancreatic lesions using an open 1.0T high-field MR scanner. STUDY TYPE Prospective. POPULATION Thirty-one patients with 31 pancreatic lesions underwent MR-guided percutaneous coaxial cutting needle biopsy. FIELD STRENGTH/SEQUENCE 1.0T T2 WI-TSE PDW-aTSE T1 WI-TFE. ASSESSMENT Final diagnosis was confirmed by surgery and clinical follow-up for at least 12 months. The accuracy, sensitivity, and specificity were calculated. Complications were recorded. STATISTICAL TESTS There was no statistical analysis in this study. RESULTS The procedure was technically successful and final biopsy samples were adequate for histopathological examination in all patients. Biopsy pathology revealed malignant pancreatic tumor in 25 patients (25/31, 80.6%), and benign pancreatic lesions were present in six patients (6/31, 19.4%). The final diagnosis was pancreatic malignancy in 27 patients and benign disease in four patients, which was confirmed by surgery and clinical follow-up. Two biopsy results were false-negative. The diagnostic accuracy in biopsies was 93.5% (29 of 31). The sensitivity to detect a malignant disease was 92.6% (25 of 27), and the specificity was 100%. All patients tolerated the procedure well; minor peripancreatic hemorrhage was found in two patients after the procedure, and none had major complications either during or after the procedure. DATA CONCLUSION MRI-guided percutaneous biopsy of pancreatic lesions using an open 1.0T high-field scanner has high diagnostic accuracy, which is feasible and safe for use in clinical practice. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2018;48:382-388.
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Affiliation(s)
- Chao Liu
- Department of Minimally Invasive Tumor, Tai'an Central Hospital, Tai'an, Shandong, P.R. China
| | - Ligang Wang
- Department of Interventional Therapy, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, P.R. China
| | - Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Dong Lu
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Peipei Li
- Department of Oncology, Liaocheng Tumor Hospital, Liaocheng, Shandong, P.R. China
| | - Rongbin Lv
- Department of Nuclear Medicine, Tai'an Central Hospital, Tai'an, Shandong, P.R. China
| | - Yong Feng
- Department of Minimally Invasive Tumor, Tai'an Central Hospital, Tai'an, Shandong, P.R. China
| | - Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
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Tatsui CE, Nascimento CNG, Suki D, Amini B, Li J, Ghia AJ, Thomas JG, Stafford RJ, Rhines LD, Cata JP, Kumar AJ, Rao G. Image guidance based on MRI for spinal interstitial laser thermotherapy: technical aspects and accuracy. J Neurosurg Spine 2017; 26:605-612. [DOI: 10.3171/2016.9.spine16475] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVEImage guidance for spinal procedures is based on 3D-fluoroscopy or CT, which provide poor visualization of soft tissues, including the spinal cord. To overcome this limitation, the authors developed a method to register intraoperative MRI (iMRI) of the spine into a neuronavigation system, allowing excellent visualization of the spinal cord. This novel technique improved the accuracy in the deployment of laser interstitial thermal therapy probes for the treatment of metastatic spinal cord compression.METHODSPatients were positioned prone on the MRI table under general anesthesia. Fiducial markers were applied on the skin of the back, and a plastic cradle was used to support the MRI coil. T2-weighted MRI sequences of the region of interest were exported to a standard navigation system. A reference array was sutured to the skin, and surface matching of the fiducial markers was performed. A navigated Jamshidi needle was advanced until contact was made with the dorsal elements; its position was confirmed with intraoperative fluoroscopy prior to advancement into a target in the epidural space. A screenshot of its final position was saved, and then the Jamshidi needle was exchanged for an MRI-compatible access cannula. MRI of the exact axial plane of each access cannula was obtained and compared with the corresponding screenshot saved during positioning. The discrepancy in millimeters between the trajectories was measured to evaluate accuracy of the image guidanceRESULTSThirteen individuals underwent implantation of 47 laser probes. The median absolute value of the discrepancy between the location predicted by the navigation system and the actual position of the access cannulas was 0.7 mm (range 0–3.2 mm). No injury or adverse event occurred during the procedures.CONCLUSIONSThis study demonstrates the feasibility of image guidance based on MRI to perform laser interstitial thermotherapy of spinal metastasis. The authors' method permits excellent visualization of the spinal cord, improving safety and workflow during laser ablations in the epidural space. The results can be extrapolated to other indications, including biopsies or drainage of fluid collections near the spinal cord.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Juan P. Cata
- 6Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston; and
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Vijayan RC, Thompson RC, Chambless LB, Morone PJ, He L, Clements LW, Griesenauer RH, Kang H, Miga MI. Android application for determining surgical variables in brain-tumor resection procedures. J Med Imaging (Bellingham) 2017; 4:015003. [PMID: 28331887 DOI: 10.1117/1.jmi.4.1.015003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/13/2017] [Indexed: 11/14/2022] Open
Abstract
The fidelity of image-guided neurosurgical procedures is often compromised due to the mechanical deformations that occur during surgery. In recent work, a framework was developed to predict the extent of this brain shift in brain-tumor resection procedures. The approach uses preoperatively determined surgical variables to predict brain shift and then subsequently corrects the patient's preoperative image volume to more closely match the intraoperative state of the patient's brain. However, a clinical workflow difficulty with the execution of this framework is the preoperative acquisition of surgical variables. To simplify and expedite this process, an Android, Java-based application was developed for tablets to provide neurosurgeons with the ability to manipulate three-dimensional models of the patient's neuroanatomy and determine an expected head orientation, craniotomy size and location, and trajectory to be taken into the tumor. These variables can then be exported for use as inputs to the biomechanical model associated with the correction framework. A multisurgeon, multicase mock trial was conducted to compare the accuracy of the virtual plan to that of a mock physical surgery. It was concluded that the Android application was an accurate, efficient, and timely method for planning surgical variables.
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Affiliation(s)
- Rohan C Vijayan
- Vanderbilt University , Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Reid C Thompson
- Vanderbilt University Medical Center , Department of Neurological Surgery, Nashville, Tennessee, United States
| | - Lola B Chambless
- Vanderbilt University Medical Center , Department of Neurological Surgery, Nashville, Tennessee, United States
| | - Peter J Morone
- Vanderbilt University Medical Center , Department of Neurological Surgery, Nashville, Tennessee, United States
| | - Le He
- Vanderbilt University Medical Center , Department of Neurological Surgery, Nashville, Tennessee, United States
| | - Logan W Clements
- Vanderbilt University , Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Rebekah H Griesenauer
- Vanderbilt University , Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Hakmook Kang
- Vanderbilt University Medical Center , Department of Biostatistics, Nashville, Tennessee, United States
| | - Michael I Miga
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States; Vanderbilt University Medical Center, Department of Neurological Surgery, Nashville, Tennessee, United States; Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
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Lopresto V, Pinto R, Farina L, Cavagnaro M. Treatment planning in microwave thermal ablation: clinical gaps and recent research advances. Int J Hyperthermia 2016; 33:83-100. [PMID: 27431328 DOI: 10.1080/02656736.2016.1214883] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Microwave thermal ablation (MTA) is a minimally invasive therapeutic technique aimed at destroying pathologic tissues through a very high temperature increase induced by the absorption of an electromagnetic field at microwave (MW) frequencies. Open problems, which are delaying MTA applications in clinical practice, are mainly linked to the extremely high temperatures, up to 120 °C, reached by the tissue close to the antenna applicator, as well as to the ability of foreseeing and controlling the shape and dimension of the thermally ablated area. Recent research was devoted to the characterisation of dielectric, thermal and physical properties of tissue looking at their changes with the increasing temperature, looking for possible developments of reliable, automatic and personalised treatment planning. In this paper, a review of the recently obtained results as well as new unpublished data will be presented and discussed.
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Affiliation(s)
- V Lopresto
- a Division of Health Protection Technologies , Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA) , Rome , Italy
| | - R Pinto
- a Division of Health Protection Technologies , Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA) , Rome , Italy
| | - L Farina
- b Department of Information Engineering, Electronics and Telecommunications , Sapienza University of Rome , Rome , Italy
| | - M Cavagnaro
- b Department of Information Engineering, Electronics and Telecommunications , Sapienza University of Rome , Rome , Italy
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Liu M, Huang J, Xu Y, He X, Li L, Lü Y, Liu Q, Sequeiros RB, Li C. MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open high-field MRI scanner with respiratory gating. Eur Radiol 2016; 27:1459-1466. [PMID: 27516355 DOI: 10.1007/s00330-016-4518-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/27/2016] [Accepted: 07/19/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To prospectively evaluate the feasibility, safety and accuracy of MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open MR scanner with respiratory gating. METHODS Sixty-five patients with 65 solitary pulmonary lesions underwent MR-guided percutaneous coaxial cutting needle biopsy using a 1.0-T open MR scanner with respiratory gating. Lesions were divided into two groups according to maximum lesion diameters: ≤2.0 cm (n = 31) and >2.0 cm (n = 34). The final diagnosis was established in surgery and subsequent histology. Diagnostic accuracy, sensitivity and specificity were compared between the groups using Fisher's exact test. RESULTS Accuracy, sensitivity and specificity of MRI-guided percutaneous pulmonary biopsy in diagnosing malignancy were 96.9 %, 96.4 % and 100 %, respectively. Accuracy, sensitivity and specificity were 96.8 %, 96.3 % and 100 % for lesions 2.0 cm or smaller and 97.1 %, 96.4 % and 100 %, respectively, for lesions larger than 2.0 cm. There was no significant difference between the two groups (P > 0.05). Biopsy-induced complications encountered were pneumothorax in 12.3 % (8/65) and haemoptysis in 4.6 % (3/65). There were no serious complications. CONCLUSIONS MRI-guided percutaneous biopsy using a 1.0-T open MR scanner with respiratory gating is an accurate and safe diagnostic technique in evaluation of pulmonary lesions. KEY POINTS • MRI-guided percutaneous lung biopsy using a 1.0-T open MR scanner is feasibility. • 96.9 % differentiation accuracy of malignant and benign lung lesions is possible. • No serious complications occurred in MRI-guided lung biopsy.
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Affiliation(s)
- Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Jie Huang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Lei Li
- Department of Interventional Radiology, Qingdao Central Hospital, Qingdao, Shandong, People's Republic of China
| | - Yubo Lü
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Qiang Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | | | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China.
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Deshazer G, Prakash P, Merck D, Haemmerich D. Experimental measurement of microwave ablation heating pattern and comparison to computer simulations. Int J Hyperthermia 2016; 33:74-82. [PMID: 27431040 DOI: 10.1080/02656736.2016.1206630] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION For computational models of microwave ablation (MWA), knowledge of the antenna design is necessary, but the proprietary design of clinical applicators is often unknown. We characterised the specific absorption rate (SAR) during MWA experimentally and compared to a multi-physics simulation. METHODS An infrared (IR) camera was used to measure SAR during MWA within a split ex vivo liver model. Perseon Medical's short-tip (ST) or long-tip (LT) MWA antenna were placed on top of a tissue sample (n = 6), and microwave power (15 W) was applied for 6 min, while intermittently interrupting power. Tissue surface temperature was recorded via IR camera (3.3 fps, 320 × 240 resolution). SAR was calculated intermittently based on temperature slope before and after power interruption. Temperature and SAR data were compared to simulation results. RESULTS Experimentally measured SAR changed considerably once tissue temperatures exceeded 100 °C, contrary to simulation results. The ablation zone diameters were 1.28 cm and 1.30 ± 0.03 cm (transverse), and 2.10 cm and 2.66 ± -0.22 cm (axial), for simulation and experiment, respectively. The average difference in temperature between the simulation and experiment were 5.6 °C (ST) and 6.2 °C (LT). Dice coefficients for 1000 W/kg SAR iso-contour were 0.74 ± 0.01 (ST) and 0.77 (± 0.03) (LT), suggesting good agreement of SAR contours. CONCLUSION We experimentally demonstrated changes in SAR during MWA ablation, which were not present in simulation, suggesting inaccuracies in dielectric properties. The measured SAR may be used in simplified computer simulations to predict tissue temperature when the antenna geometry is unknown.
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Affiliation(s)
- Garron Deshazer
- a Department of Diagnostic Imaging , Rhode Island Hospital , Providence , Rhode Island , USA
| | - Punit Prakash
- b Department of Electrical and Computer Engineering , Kansas State University , Manhattan , Kansas , USA
| | - Derek Merck
- a Department of Diagnostic Imaging , Rhode Island Hospital , Providence , Rhode Island , USA
| | - Dieter Haemmerich
- c Department of Pediatrics , Medical University of South Carolina , Charleston , South Carolina , USA
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Sebek J, Albin N, Bortel R, Natarajan B, Prakash P. Sensitivity of microwave ablation models to tissue biophysical properties: A first step toward probabilistic modeling and treatment planning. Med Phys 2016; 43:2649. [DOI: 10.1118/1.4947482] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Zhan Q, Chen X. Boolean Combinations of Implicit Functions for Model Clipping in Computer-Assisted Surgical Planning. PLoS One 2016; 11:e0145987. [PMID: 26751685 PMCID: PMC4709173 DOI: 10.1371/journal.pone.0145987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
This paper proposes an interactive method of model clipping for computer-assisted surgical planning. The model is separated by a data filter that is defined by the implicit function of the clipping path. Being interactive to surgeons, the clipping path that is composed of the plane widgets can be manually repositioned along the desirable presurgical path, which means that surgeons can produce any accurate shape of the clipped model. The implicit function is acquired through a recursive algorithm based on the Boolean combinations (including Boolean union and Boolean intersection) of a series of plane widgets' implicit functions. The algorithm is evaluated as highly efficient because the best time performance of the algorithm is linear, which applies to most of the cases in the computer-assisted surgical planning. Based on the above stated algorithm, a user-friendly module named SmartModelClip is developed on the basis of Slicer platform and VTK. A number of arbitrary clipping paths have been tested. Experimental results of presurgical planning for three types of Le Fort fractures and for tumor removal demonstrate the high reliability and efficiency of our recursive algorithm and robustness of the module.
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Affiliation(s)
- Qiqin Zhan
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojun Chen
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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Fahrenholtz SJ, Moon TY, Franco M, Medina D, Danish S, Gowda A, Shetty A, Maier F, Hazle JD, Stafford RJ, Warburton T, Fuentes D. A model evaluation study for treatment planning of laser-induced thermal therapy. Int J Hyperthermia 2015; 31:705-14. [PMID: 26368014 DOI: 10.3109/02656736.2015.1055831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A cross-validation analysis evaluating computer model prediction accuracy for a priori planning magnetic resonance-guided laser-induced thermal therapy (MRgLITT) procedures in treating focal diseased brain tissue is presented. Two mathematical models are considered. (1) A spectral element discretisation of the transient Pennes bioheat transfer equation is implemented to predict the laser-induced heating in perfused tissue. (2) A closed-form algorithm for predicting the steady-state heat transfer from a linear superposition of analytic point source heating functions is also considered. Prediction accuracy is retrospectively evaluated via leave-one-out cross-validation (LOOCV). Modelling predictions are quantitatively evaluated in terms of a Dice similarity coefficient (DSC) between the simulated thermal dose and thermal dose information contained within N = 22 MR thermometry datasets. During LOOCV analysis, the transient model's DSC mean and median are 0.7323 and 0.8001 respectively, with 15 of 22 DSC values exceeding the success criterion of DSC ≥ 0.7. The steady-state model's DSC mean and median are 0.6431 and 0.6770 respectively, with 10 of 22 passing. A one-sample, one-sided Wilcoxon signed-rank test indicates that the transient finite element method model achieves the prediction success criteria, DSC ≥ 0.7, at a statistically significant level.
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Affiliation(s)
- Samuel J Fahrenholtz
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
| | - Tim Y Moon
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - Michael Franco
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - David Medina
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - Shabbar Danish
- d Department of Neurosurgery , Robert Wood Johnson Hospital , New Brunswick, New Jersey , USA , and
| | | | | | - Florian Maier
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA
| | - John D Hazle
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
| | - Roger J Stafford
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
| | - Tim Warburton
- c Department of Computational and Applied Mathematics , Rice University , Houston , Texas , USA
| | - David Fuentes
- a Department of Imaging Physics , M.D. Anderson Cancer Center, University of Texas , Houston , Texas , USA .,b Graduate School of Biomedical Sciences, University of Texas , Houston , Texas , USA
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