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Liu LP, Pua R, Rosario-Berrios DN, Sandvold OF, Perkins AE, Cormode DP, Shapira N, Soulen MC, Noël PB. Reproducible spectral CT thermometry with liver-mimicking phantoms for image-guided thermal ablation. Phys Med Biol 2024; 69:045009. [PMID: 38252974 PMCID: PMC10839467 DOI: 10.1088/1361-6560/ad2124] [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: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 01/24/2024]
Abstract
Objectives. Evaluate the reproducibility, temperature tolerance, and radiation dose requirements of spectral CT thermometry in tissue-mimicking phantoms to establish its utility for non-invasive temperature monitoring of thermal ablations.Methods. Three liver mimicking phantoms embedded with temperature sensors were individually scanned with a dual-layer spectral CT at different radiation dose levels during heating (35 °C-80 °C). Physical density maps were reconstructed from spectral results using varying reconstruction parameters. Thermal volumetric expansion was then measured at each temperature sensor every 5 °C in order to establish a correlation between physical density and temperature. Linear regressions were applied based on thermal volumetric expansion for each phantom, and coefficient of variation for fit parameters was calculated to characterize reproducibility of spectral CT thermometry. Additionally, temperature tolerance was determined to evaluate effects of acquisition and reconstruction parameters. The resulting minimum radiation dose to meet the clinical temperature accuracy requirement was determined for each slice thickness with and without additional denoising.Results. Thermal volumetric expansion was robustly replicated in all three phantoms, with a correlation coefficient variation of only 0.43%. Similarly, the coefficient of variation for the slope and intercept were 9.6% and 0.08%, respectively, indicating reproducibility of the spectral CT thermometry. Temperature tolerance ranged from 2 °C to 23 °C, decreasing with increased radiation dose, slice thickness, and iterative reconstruction level. To meet the clinical requirement for temperature tolerance, the minimum required radiation dose ranged from 20, 30, and 57 mGy for slice thickness of 2, 3, and 5 mm, respectively, but was reduced to 2 mGy with additional denoising.Conclusions. Spectral CT thermometry demonstrated reproducibility across three liver-mimicking phantoms and illustrated the clinical requirement for temperature tolerance can be met for different slice thicknesses. The reproducibility and temperature accuracy of spectral CT thermometry enable its clinical application for non-invasive temperature monitoring of thermal ablation.
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Affiliation(s)
- Leening P Liu
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rizza Pua
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Derick N Rosario-Berrios
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Biochemistry and Biophysics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Olivia F Sandvold
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Amy E Perkins
- Philips Healthcare, Orange Village, OH, United States of America
| | - David P Cormode
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Nadav Shapira
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Michael C Soulen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Peter B Noël
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
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Liu LP, Pua R, Rosario-Berrios DN, Sandvold OF, Perkins AE, Cormode DP, Shapira N, Soulen MC, Noël PB. Reproducible spectral CT thermometry with liver-mimicking phantoms for image-guided thermal ablation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.04.23296423. [PMID: 37873236 PMCID: PMC10593007 DOI: 10.1101/2023.10.04.23296423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives Evaluate the reproducibility, temperature sensitivity, and radiation dose requirements of spectral CT thermometry in tissue-mimicking phantoms to establish its utility for non-invasive temperature monitoring of thermal ablations. Materials and Methods Three liver mimicking phantoms embedded with temperature sensors were individually scanned with a dual-layer spectral CT at different radiation dose levels during heating and cooling (35 to 80 °C). Physical density maps were reconstructed from spectral results using a range of reconstruction parameters. Thermal volumetric expansion was then measured at each temperature sensor every 5°C in order to establish a correlation between physical density and temperature. Linear regressions were applied based on thermal volumetric expansion for each phantom, and coefficient of variation for fit parameters was calculated to characterize reproducibility of spectral CT thermometry. Additionally, temperature sensitivity was determined to evaluate the effect of acquisition parameters, reconstruction parameters, and image denoising. The resulting minimum radiation dose to meet the clinical temperature sensitivity requirement was determined for each slice thickness, both with and without additional denoising. Results Thermal volumetric expansion was robustly replicated in all three phantoms, with a correlation coefficient variation of only 0.43%. Similarly, the coefficient of variation for the slope and intercept were 9.6% and 0.08%, respectively, indicating reproducibility of the spectral CT thermometry. Temperature sensitivity ranged from 2 to 23 °C, decreasing with increased radiation dose, slice thickness, and iterative reconstruction level. To meet the clinical requirement for temperature sensitivity, the minimum required radiation dose ranged from 20, 30, and 57 mGy for slice thickness of 2, 3, and 5 mm, respectively, but was reduced to 2 mGy with additional denoising. Conclusions Spectral CT thermometry demonstrated reproducibility across three liver-mimicking phantoms and illustrated the clinical requirement for temperature sensitivity can be met for different slice thicknesses. Moreover, additional denoising enables the use of more clinically relevant radiation doses, facilitating the clinical translation of spectral CT thermometry. The reproducibility and temperature accuracy of spectral CT thermometry enable its clinical application for non-invasive temperature monitoring of thermal ablation.
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Finotti M, D’Amico FE, Romano M, Brizzolari M, Scopelliti M, Zanus G. Colorectal Liver Metastases: A Literature Review of Viable Surgical Options with a Special Focus on Microwave Liver Thermal Ablation and Mini-Invasive Approach. J Pers Med 2022; 13:jpm13010033. [PMID: 36675694 PMCID: PMC9866288 DOI: 10.3390/jpm13010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common tumor worldwide and it is characterized in 20-30% of cases by liver involvement, which strongly affects the long-term patient outcome. There are many available therapies for liver colorectal metastases (CRLMs); the current standard of care is represented by liver resection, and when feasible, associated with systemic chemotherapy. Microwave thermal ablation (MWA) is a viable option in unresectable patients or to achieve treatment with a parenchymal spearing approach. A literature review was performed for studies published between January 2000 and July 2022 through a database search using PUBMED/Medline and the Cochrane Collaboration Library with the following MeSH search terms and keywords: microwave, ablation, liver metastases, colorectal neoplasm, and colon liver rectal metastases. The recurrence rate and overall patients' survival were evaluated, showing that laparoscopic MWA is safe and effective to treat CRLMs when resection is not feasible, or a major hepatectomy in fragile patients is necessary. Considering the low morbidity of this procedure, it is a viable option to treat patients with recurrent diseases in the era of effective chemotherapy and multimodal treatments.
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Affiliation(s)
- Michele Finotti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
- Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical, Dallas, TX 75204, USA
- Correspondence:
| | | | - Maurizio Romano
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
| | - Marco Brizzolari
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
| | - Michele Scopelliti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
| | - Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
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Du ZS, Wang YS, Xie JM, Li T, Shi ZY, Lu QA, Zhang Y, Zhao Z, Bi N, Song ZB, Zhu TB. Feasibility of microwave ablation of the vertebral growth plate for spine growth regulation: a preliminary study. Int J Hyperthermia 2021; 38:1233-1241. [PMID: 34396870 DOI: 10.1080/02656736.2021.1964619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To explore the feasibility of microwave ablation (MWA) of the vertebral growth plate as a minimally invasive treatment for early-onset scoliosis. MATERIALS AND METHODS One side of the L1-L3 vertebral growth plates were ablated using different MWA powers. Ablation safety and size were examined. Subsequently, L1-L3 vertebral growth plates were ablated on one side for 40 s at 20 W. At 2, 4, and 6 weeks after the ablation, growth changes of the spine were observed. RESULTS No piglets died during and after ablation, and all had modified Tarlov Grade 5. The safe MWA time (time for safely ablating the vertebral growth plate) was 17.0 ± 1.5 s at 50 W, 23.0 ± 2.3 s at 40 W, 31.0 ± 3.1 s at 30 W, 47.0 ± 3.7 s at 20 W, 70.0 ± 4.2 s at 15 W, and 158.0 ± 5.0 s at 10 W. With power <15 W, the vertebral growth plate could not be effectively ablated within the safe ablation time. Within the safe ablation times, the MWA size on hematoxylin and eosin slices on a transverse diameter was between 7 and 10 mm; and that on longitudinal diameter was mainly determined by the ablation needle length. Moreover, the growth plate and annulus fibrosus on the ablated side grew poorly over time, the vertebral body showed significant wedge-shaped changes, and the spine showed significant unbalanced growth. CONCLUSION MWA of the vertebral growth plate can be performed safely when accompanied with appropriate thermometry, and could be a new minimally invasive strategy in regulating spine growth.
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Affiliation(s)
- Zhi-Shan Du
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ying-Song Wang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jing-Ming Xie
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tao Li
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Yue Shi
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Qiu-An Lu
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ying Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ni Bi
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Bo Song
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting-Biao Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Mukund A, Ramalingam R, Anandpara KM, Patidar Y, Vijayaraghavan R, Sarin SK. Efficacy and safety of percutaneous microwave ablation for hepatocellular carcinomas <4 cm in difficult location. Br J Radiol 2020; 93:20191025. [PMID: 32970472 PMCID: PMC7716003 DOI: 10.1259/bjr.20191025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Tumor location is a critical factor for determining technical success and local recurrence following percutaneous ablation of hepatocellular carcinomas (HCC). The purpose of this retrospective study was to evaluate the safety and outcome measures of percutaneous microwave ablation (pMWA) for HCCs <4 cm in difficult locations. METHODS Retrospective review included 81 patients who underwent pMWA for HCCs <4 cm. Fourty-three patients (30 males and 13 females; mean age, 61 years) with 53 HCCs located near the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, large vessel and exophytic location were included under difficult location group. Thirty-eight patients (29 males and nine females; mean age, 60 years) with 48 HCCs in other locations were included under control group. Baseline demographics were recorded. Technical efficacy, local tumor progression (LTP), and complication rates were evaluated. RESULTS Mean follow-up period was 3.4 months (range 1-7). There was no major complication in both the groups; two patients had a mild perihepatic hemorrhage in the difficult location group which was managed conservatively. There was no difference between the groups in the overall technical efficacy rate (84.9% vs 91.7%, p = 0.294), LTP rate (4.4% vs 2.2%. p = 0.57) or complication rate (4.6% vs 0%, p = 0.177). CONCLUSION Our data suggest that there is no significant difference in technical efficacy, LTP or complication rates for MWA in both difficult and normal locations. ADVANCES IN KNOWLEDGE With proper patient selection, pre-procedural planning and appropriate technique, pMWA is feasible, safe, and effective for small HCCs in difficult location with an acceptable range of complications.
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Affiliation(s)
- Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ravindran Ramalingam
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karan Manoj Anandpara
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajan Vijayaraghavan
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Huang Q, Li J, Zeng Q, Tan L, Zheng R, He X, Li K. Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery. BMC Cancer 2020; 20:763. [PMID: 32795279 PMCID: PMC7427902 DOI: 10.1186/s12885-020-07261-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background To evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery. Methods Thirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS). Results The use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 16 months. The 1-, 2-, and 3-year LTP rates were 2.9, 5.7 and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1, 86.8 and 69.5%. Conclusion In patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.
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Affiliation(s)
- Qiannan Huang
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Jianguo Li
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Qingjing Zeng
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Lei Tan
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Rongqin Zheng
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Xuqi He
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China.
| | - Kai Li
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China.
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Soliman AF, Abouelkhair MM, Hasab Allah MS, El-Kady NM, Ezzat WM, Gabr HA, Elsayed EH, Saleh AI, Kamel A. Efficacy and Safety of Microwave Ablation (MWA) for Hepatocellular Carcinoma (HCC) in Difficult Anatomical Sites in Egyptian Patients with Liver Cirrhosis. Asian Pac J Cancer Prev 2019; 20:295-301. [PMID: 30678453 PMCID: PMC6485570 DOI: 10.31557/apjcp.2019.20.1.295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and aim: Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) has
become a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder,
pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwave
ablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treating
patients with HCC in difficult anatomical sites in comparison to those in conventional sites. Patients and methods:
Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mm
from the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with
50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailed
protocol. Results: Most of the patients were males, with a mean age of 57.8 years. In the study group, two patients
had lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablation
rates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were
100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. One
patient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomatic
pleural effusion were reported after ablation without statistically significant difference between the groups or among
subgroups. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.
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Affiliation(s)
- Ahmad F Soliman
- Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Ultrasound-guided percutaneous microwave ablation assisted by three-dimensional visualization operative treatment planning system and percutaneous transhepatic cholangial drainage with intraductal chilled saline perfusion for larger hepatic hilum hepatocellular (D ≥ 3 cm): preliminary results. Oncotarget 2017; 8:79742-79749. [PMID: 29108354 PMCID: PMC5668087 DOI: 10.18632/oncotarget.19275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 06/02/2017] [Indexed: 01/05/2023] Open
Abstract
To assess the clinical efficiency of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional (3D) visualization operative treatment planning system and percutaneous transhepatic cholangial drainage with intraductal chilled saline perfusion (PTCD-ICSP) for larger hepatic hilum hepatocellular carcinoma (HH-HCC) (D ≥ 3 cm). The combination therapy was performed in 14 patients from Sep 2011 to May 2017. The major outcomes for assessment were biliary duct complications, local tumor recurrence, distant recurrence and overall survival rates. Median follow-up period was 26 months. The series of 3D visualization operative treatment planning, PTCD-ICSP and US-PMWA were successfully performed and complete ablation was achieved in all cases. The mean session for one tumor was 1.0 ± 0.4. The mean ablation time for per tumor was 1805 ± 567s. The saline volume used for the PTCD-ICSP was 250-450 ml per session. The 1-, 2-, and 3-year local tumor recurrence rates were 7.1%, 14.3%, and 35.7%, the 1-, 2-, and 3-year distant recurrence rates were 0%, 14.3%, and 28.6%, and 1-, 2-, and 3-year overall survival rates were 100%, 92.9%, and 71.4%, respectively. No severe complications related to ablation occurred. Conclusions US-PMWA assisted by 3D visualization operative treatment planning system and PTCD-ICSP appears to be a safe, effective and innovative technique for management for larger HH-HCCs, which improved the prognosis.
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CT-guided microwave ablation through the lungs for treating liver tumors near the diaphragm. Oncotarget 2017; 8:79270-79278. [PMID: 29108305 PMCID: PMC5668038 DOI: 10.18632/oncotarget.17422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/20/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose To explore the short-term efficacy and safety of CT-guided microwave ablation (MWA) for treating liver tumors near the diaphragm. Results The complete response (CR) rate for CT-guided MWA through the lung was 94.7% (124/131). The incomplete response (ICR) rate was 5.3% (7/131), of which 6 patients with ICRs achieved CRs after MWA. The CR rate for Group I was higher than Group II (99.0% vs. 80.0%, P=0.001). The mean follow-up time was 11.2 ±7.50 months. The total local recurrence (LR) rate was 15.3% (20/131). The complication rate was 26.5%, and no severe complications were recorded. All complications were controllable and treatable. The incidence of diaphragmatic thickening during the MWA was 18.8% (P>0.05); the incidence of exudative changes inside the lungs was 6.8% (P>0.05). Conclusions CT-guided MWA can detect changes in liver tissue, in the diaphragm and nearby lung tissues during the ablation process. It's safe and effective to treat tumors close to the diaphragm by CT-guided MWA through the lung. Methods CT-guided MWA was used on 131 tumors that were close to the diaphragm (distance between tumor and diaphragm ≤ 5 mm) in 117 patients with liver cancer. The tumors were divided into a < 3.0 cm group (Group I, n= 101) and a ≥ 3.0 cm group (Group II, n= 30) based on tumor diameters. The complications within 2 weeks following treatment were counted, and the safety and short-term efficacy of MWA were analyzed.
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Zhang LL, Xia GM, Liu YJ, Dou R, Eisenbrey J, Liu JB, Wang XW, Qian LX. Effect of a poloxamer 407-based thermosensitive gel on minimization of thermal injury to diaphragm during microwave ablation of the liver. World J Gastroenterol 2017; 23:2141-2148. [PMID: 28405141 PMCID: PMC5374125 DOI: 10.3748/wjg.v23.i12.2141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/21/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the insulating effect of a poloxamer 407 (P407)-based gel during microwave ablation of liver adjacent to the diaphragm.
METHODS We prepared serial dilutions of P407, and 22.5% (w/w) concentration was identified as suitable for ablation procedures. Subsequently, microwave ablations were performed on the livers of 24 rabbits (gel, saline, control groups, n = 8 in each). The P407 solution and 0.9% normal saline were injected into the potential space between the diaphragm and liver in experimental groups. No barriers were applied to the controls. After microwave ablations, the frequency, size and degree of thermal injury were compared histologically among the three groups. Subsequently, another 8 rabbits were injected with the P407 solution and microwave ablation was performed. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN) and creatinine (Cr) in serum were tested at 1 d before microwave ablation and 3 and 7 d after operation.
RESULTS In vivo ablation thermal injury to the adjacent diaphragm was evaluated in the control, saline and 22.5% P407 gel groups (P = 0.001-0.040). However, there was no significant difference in the volume of ablation zone among the three groups (P > 0.05). Moreover, there were no statistical differences among the preoperative and postoperative gel groups according to the levels of
ALT, AST, BUN and Cr in serum (all P > 0.05).
CONCLUSION Twenty-two point five percent P407 gel could be a more effective choice during microwave ablation of hepatic tumors adjacent to the diaphragm. Further studies for clinical translation are warranted.
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A clinical study of thermal monitoring techniques of ultrasound-guided microwave ablation for hepatocellular carcinoma in high-risk locations. Sci Rep 2017; 7:41246. [PMID: 28112263 PMCID: PMC5255547 DOI: 10.1038/srep41246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022] Open
Abstract
To confirm the safety and effectiveness of the minimally invasive thermal monitor technique on percutaneous ultrasound-guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) in high-risk locations, a total of 189 patients with 226 HCC nodules in high-risk locations were treated with MWA. The real-time temperature of the tissue between the lesion margin and the vital structures was monitored by inserting a 21G thermal monitoring needle. The major indexes of technical success, technique effectiveness, local tumour progression and complications were observed during the follow-up period. Technical success was acquired in all patients. Technique effectiveness was achieved with one session in 119 lesions based on contrast-enhanced ultrasound (CEUS) 3-5 days after treatment. An additional 95 lesions achieved technique effectiveness at the second session. Within the follow-up period of 6-58 months (median 38 months), the 1-, 2-, 3-, and 4-year local tumour progression rate was 11.1%, 18.1%, 19.1%, and 19.9%, respectively. There were no major complications in all the patients except for the common side effects. These results indicate that the thermal monitor technique can be applied to prevent major complications in vulnerable structures and allow percutaneous MWA to achieve satisfactory technique effectiveness in the treatment of HCC in high-risk locations.
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Gruber-Rouh T, Marko C, Thalhammer A, Nour-Eldin NE, Langenbach M, Beeres M, Naguib NN, Zangos S, Vogl TJ. Current strategies in interventional oncology of colorectal liver metastases. Br J Radiol 2016; 89:20151060. [PMID: 27164030 DOI: 10.1259/bjr.20151060] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The adequate treatment of non-resectable liver metastases from colorectal cancer which are resistant to systemic chemotherapy currently provides a great challenge. The aim is to identify and review key strategies in the treatment of colorectal liver metastases. A search for current literature on the topic of interventional strategies for colorectal metastases was performed in Medline in order to achieve this goal. Studies before 2005 and with <20 patients treated for colorectal metastases were excluded. Transarterial chemoembolization (TACE), transarterial embolization and selective internal radiation therapy (SIRT) were identified as examples of regional strategies for colorectal liver metastases, utilizing the unique blood supply of the liver. Radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation were selected as examples for currently available ablative techniques. Median survival in the key studies reviewed ranged from 7.7 to 28.6 for TACE, 8.3-12.6 for SIRT, 8.2-53.2 for RFA and 29-43 months for MWA. After review of the literature, it can be concluded that interventional oncologic therapies are a safe and effective method for treating colorectal liver metastases. The use of new chemotherapeutic agents for local therapy and new ablation technologies and techniques may increase patient survival and allows a neoadjuvant therapy setting. In addition, a combination of local therapies may be used to increase effectiveness in the future, which is subject to further research.
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Affiliation(s)
- Tatjana Gruber-Rouh
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Marko
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Axel Thalhammer
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Nour-Eldin Nour-Eldin
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.,2 Department of Radiology, Faculty of Medicine (Kasr Al-Ainy), Cairo University, Alexandria, Egypt
| | - Marcel Langenbach
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Martin Beeres
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Nagy N Naguib
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.,3 Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Stephan Zangos
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- 1 Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
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Liu SR, Liang P, Yu XL, Cheng ZG, Han ZY, Yu J. Percutaneous microwave ablation for liver tumours adjacent to the marginal angle. Int J Hyperthermia 2015; 30:306-11. [PMID: 25144820 DOI: 10.3109/02656736.2014.938702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This study was designed to describe the technical essentials of microwave ablation (MWA) for tumours adjacent to the liver marginal angle (LMA) and to determine the feasibility, safety and efficacy of this approach. MATERIALS AND METHODS A total of 22 patients with primary or metastatic liver tumours adjacent to the LMA were enrolled. There were 19 small tumours (≤3 cm) and three larger tumours (>3 cm) with maximum diameters ranging from 0.7-2.7 cm (mean 1.7 ± 0.6 cm) and 4.7-6.6 cm (mean 5.4 ± 1.0 cm), respectively. For small tumours the entire acute angle was segmentally blocked utilising MWA. For larger tumours, the feeding arteries were initially blocked with ethanol before conformal ablation. Artificial ascites, real-time monitoring, small ethanol doses, colour Doppler flow imaging or contrast enhanced ultrasound guidance was used as an additional technique to assist with ablation. Contrast imaging was performed to evaluate the ablative efficacy. Treatment responses, local tumour progression (LTP) and complications were recorded. RESULTS All patients achieved a complete response. LTP was identified in two cases (9.1%) during the 4.5 month median follow-up period (range 2-29 months). A total of five additional sessions were performed, and secondary effectiveness was achieved in patients with LTP. No major complications were observed. CONCLUSIONS Percutaneous MWA is a new promising technique for tumours adjacent to the LMA, especially in cases with small tumours. Technical improvements to this procedure are expected to improve the results for large tumours abutting the LMA.
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Affiliation(s)
- Shi-rong Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital , Beijing , China
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Zhi-yu H, Ping L, Xiao-ling Y, Zhi-gang C, Fang-yi L, Jie Y. Ultrasound-guided percutaneous microwave ablation of sporadic renal angiomyolipoma: preliminary results. Acta Radiol 2015; 56:56-62. [PMID: 24526757 DOI: 10.1177/0284185113519357] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Microwave ablation (MWA) has been developed as one of the most commonly used local oncologic treatments. However, there is still a dearth of studies concerning MWA in the treatment of renal angiomyolipomas (AML). PURPOSE To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous MWA when treating AML. MATERIAL AND METHODS Nineteen lesions with pathologically confirmed AML in 14 patients (5 men, 9 women; mean age, 49.2 ± 14 years) were treated with US-guided percutaneous MWA with one or two cooled-shaft needle antennae. A power output of 45 W or 50 W for 300-1140 s was emitted to achieve complete tumor necrosis. Contrast-enhanced ultrasound (CEUS) was performed to observe the treatment efficacy 3 days later. Patients were followed up with CEUS, computed tomography (CT), and/or magnetic resonance imaging (MRI) after 1, 3, and 6 months, and long-term ablation efficacy was evaluated every 6 months thereafter. RESULTS Among the 19 renal lesions, 17 achieved complete ablation as monitored by US after one session of MWA, and two patients required a second session of MWA. Postoperative evaluation with CEUS showed that complete ablation was obtained in 15 lesions; however, in four lesions, complete ablation could not be attained. During the follow-up period of 6-36 months (median, 10 months), a fistula to the descending colon was found in one patient and local infection around the ablation zone was found in another. Neither injury to the renal pelvis nor damage to renal function was observed. None of the patients exhibited hematuria or abnormalities in routine urine tests during the hospitalization period or during follow-up. Minor complications, such as subcapsular bleeding, mild to moderate pain, and fever were eliminated after appropriate treatment. CONCLUSION MWA is an effective and minimally invasive technique for the management of AML that can preserve renal function with acceptable complication rates.
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Affiliation(s)
- Han Zhi-yu
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, PR China
| | - Liang Ping
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, PR China
| | - Yu Xiao-ling
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, PR China
| | - Cheng Zhi-gang
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, PR China
| | - Liu Fang-yi
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, PR China
| | - Yu Jie
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, PR China
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Li X, Han Z, Cheng Z, Yu J, Liu S, Yu X, Liang P. Preoperative neutrophil-to-lymphocyte ratio is a predictor of recurrence following thermal ablation for recurrent hepatocellular carcinoma: a retrospective analysis. PLoS One 2014; 9:e110546. [PMID: 25330319 PMCID: PMC4203800 DOI: 10.1371/journal.pone.0110546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/15/2014] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of this study is to determine the predictive value of preoperative blood neutrophil-to-lymphocyte ratio (NLR) for recurrence in recurrent hepatocellular carcinoma (RHCC) patients following thermal ablation. MATERIAL AND METHODS This retrospective study enrolled 506 RHCC patients who underwent thermal ablation from April 2006 to April 2014. The clinicopathological parameters including NLR were evaluated to identify predictors of recurrence rate after thermal ablation. A Cox multiple regression analysis was performed to determine the parameters that predicted recurrence in RHCC patients. The best cutoff value of NLR was determined with time-dependent receiver operating characteristic (ROC) curve analysis. The recurrence-free survival (RFS) rate was determined in patients with high and low NLR. RESULTS The multivariate Cox proportional hazard model analysis showed that NLR was a prognostic factor in recurrence-free survival. NLR ≥ 2.14 was evaluated (AUROC = 0.824; P<0.001), and 183 of 506 patients (36.2%) had a NLR of more than 2.14. During the follow-up period (12-96 months), the 1-, and 3- year recurrence rates were 20.7% and 31.6% in low NLR group, respectively. These recurrence rates were significantly less than those in the high NLR group (57.9% and 82.5%, respectively) (P<0.001). A recurrence-free survival analyses demonstrated that the RFS in the low NLR group (67.2%) was significantly higher than that in the high NLR group (13.1%) (P<0.001). CONCLUSION Our results show that preoperative NLR is a predictor for re-recurrence after thermal ablation in RHCC patients. Additionally, patients with NLR <2.14 have a lower recurrence rate, which may improve the clinical management of RHCC patients.
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Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Shirong Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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Wu W, Xue Y, Wang D, Xue J, Zhai W, Liang P. A simulator for percutaneous hepatic microwave thermal ablation under ultrasound guidance. Int J Hyperthermia 2014; 30:429-37. [PMID: 25296705 DOI: 10.3109/02656736.2014.957738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The purpose of this study was to provide a simulation therapy environment for microwave thermal ablation (MWA) under the guidance of ultrasound, and to present an inexpensive and portable simulator built on real patient-based pre-operative computed tomography (CT) data. We established an experimental simulation system for teaching MWA and present the results of a preliminary evaluation of the simulator's realism and utility for training. The system comprises physical elements of an electromagnetic tracking device and an abdominal phantom, and software elements providing three-dimensional (3D) image processing tools, real-time navigation functions and objective evaluation function module. Details of the novel aspects of this system are presented, including a portable electromagnetic tracking device, adoption of real patient-based pre-operative CT data of liver, operation simulation of MWA, and recording and playback of the operation simulation. Patients with liver cancer were selected for evaluation of the clinical application value of the experimental simulation system. A total of 50 consultant interventional radiologists and 20 specialist registrars in radiology rated the simulator's hardware reality and overall ergonomics. Results show that the simulator system we describe can be used as a training tool for MWA. It enables training with real patient cases prior to surgery, and it can provide a realistic simulation of the actual procedure.
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Affiliation(s)
- Wenbo Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital , Beijing
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17
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Li X, Han Z, Cheng Z, Yu J, Yu X, Liang P. Prognostic value of preoperative absolute lymphocyte count in recurrent hepatocellular carcinoma following thermal ablation: a retrospective analysis. Onco Targets Ther 2014; 7:1829-35. [PMID: 25336974 PMCID: PMC4199816 DOI: 10.2147/ott.s69227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose To investigate the prognostic value of preoperative absolute lymphocyte count (ALC) in recurrent hepatocellular carcinoma (RHCC) following thermal ablation. Materials and methods We retrospectively analyzed the relationship between preoperative ALC and the clinicopathologic factors and long-term prognosis in 423 RHCC patients who underwent curative thermal ablation. Correlation analysis, receiver operating characteristic (ROC) calculation, Kaplan–Meier curves, and multivariate regression were used for statistical analysis. Results The median time to recurrence was 12 months for RHCC patients after thermal ablation. On multivariate Cox regression analysis, preoperative ALC was an independent risk factor for cancer recurrence, along with tumor differentiation and α-fetoprotein level. ALC ≥1.64×109/L defined by ROC calculation was associated with prolonged survival (area under the curve 0.741, P<0.001). Patients with ALC ≥1.64×109/L showed a mean survival of 20.2 months versus 11.6 months for patients with ALC <1.64×109/L (P<0.001). Patients were stratified into high and low groups according to ALC status. After excluding the basic parameters between groups, the 1- and 3-year recurrence rates in the high group were 20.9% and 29.5%, respectively, which were significantly lower than those of the low group (58.4% and 71.9%, respectively; P<0.001). The recurrence-free survival rates in the two groups analyzed by Kaplan–Meier curves were significantly different (P<0.001). Conclusion Preoperative ALC is a powerful prognostic factor for RHCC recurrence after thermal ablation, which suggests that maintaining a high ALC in RHCC patients might improve cancer outcomes.
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Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
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18
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Vogl TJ, Farshid P, Naguib NNN, Darvishi A, Bazrafshan B, Mbalisike E, Burkhard T, Zangos S. Thermal ablation of liver metastases from colorectal cancer: radiofrequency, microwave and laser ablation therapies. Radiol Med 2014; 119:451-61. [PMID: 24894923 DOI: 10.1007/s11547-014-0415-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/26/2014] [Indexed: 12/14/2022]
Abstract
Surgery is currently considered the treatment of choice for patients with colorectal cancer liver metastases (CRLM) when resectable. The majority of these patients can also benefit from systemic chemotherapy. Recently, local or regional therapies such as thermal ablations have been used with acceptable outcomes. We searched the medical literature to identify studies and reviews relevant to radiofrequency (RF) ablation, microwave (MW) ablation and laser-induced thermotherapy (LITT) in terms of local progression, survival indexes and major complications in patients with CRLM. Reviewed literature showed a local progression rate between 2.8 and 29.7 % of RF-ablated liver lesions at 12-49 months follow-up, 2.7-12.5 % of MW ablated lesions at 5-19 months follow-up and 5.2 % of lesions treated with LITT at 6-month follow-up. Major complications were observed in 4-33 % of patients treated with RF ablation, 0-19 % of patients treated with MW ablation and 0.1-3.5 % of lesions treated with LITT. Although not significantly different, the mean of 1-, 3- and 5-year survival rates for RF-, MW- and laser ablated lesions was (92.6, 44.7, 31.1 %), (79, 38.6, 21 %) and (94.2, 61.5, 29.2 %), respectively. The median survival in these methods was 33.2, 29.5 and 33.7 months, respectively. Thermal ablation may be an appropriate alternative in patients with CRLM who have inoperable liver lesions or have operable lesions as an adjunct to resection. However, further competitive evaluation should clarify the efficacy and priority of these therapies in patients with colorectal cancer liver metastases.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany,
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19
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North DA, Groeschl RT, Sindram D, Martinie JB, Iannitti DA, Bloomston M, Schmidt C, Rilling WS, Gamblin TC, Martin RCG. Microwave ablation for hepatic malignancies: a call for standard reporting and outcomes. Am J Surg 2014; 208:284-94. [PMID: 24970652 DOI: 10.1016/j.amjsurg.2014.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/05/2014] [Accepted: 02/24/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Clinical standards of reporting microwave ablation outcomes have not been defined with regard to ablation success, 90-day morbidity, local recurrence after ablation, and nonablation hepatic recurrence. We propose recommendations for microwave ablation reporting and quality standards. METHODS Literature review of clinical studies focusing on microwave ablation of primary and metastatic hepatic tumors was reported. RESULTS Ablation success remains the highest quality reporting standard with variations in nomenclature, but with a universal agreement of complete destruction of the target lesion within 1 month after initial microwave ablation. Local recurrence after ablation remains highly variable, with reports as low as 2.2% to as high as 22%; standards lack a common, clearly defined distance from the initial target ablated lesion and the requirement that the target lesion be defined as an ablation success before it can be called a recurrence. Nonablation hepatic recurrence, nonhepatic recurrence, and 90-day morbidity and mortality remain limited in the current literature. CONCLUSIONS Standardization of hepatic microwave ablation reporting standards are proposed. Current reporting standards in microwave ablation of hepatic malignancies are suboptimal and lack standardization for comparison across institutions.
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Affiliation(s)
- Durham A North
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Ryan T Groeschl
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David Sindram
- Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - John B Martinie
- Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - David A Iannitti
- Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Mark Bloomston
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | - Carl Schmidt
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | - William S Rilling
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Robert C G Martin
- Department of Surgery, University of Louisville, Louisville, KY, USA.
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Zhang M, Liang P, Cheng ZG, Yu XL, Han ZY, Yu J. Efficacy and safety of artificial ascites in assisting percutaneous microwave ablation of hepatic tumours adjacent to the gastrointestinal tract. Int J Hyperthermia 2014; 30:134-41. [DOI: 10.3109/02656736.2014.891765] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Huang S, Yu J, Liang P, Yu X, Cheng Z, Han Z, Li Q. Percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: a long-term follow-up. Eur J Radiol 2013; 83:552-8. [PMID: 24418287 DOI: 10.1016/j.ejrad.2013.12.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/05/2013] [Accepted: 12/12/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE To retrospectively evaluate the effectiveness and safety of ultrasound (US)-guided percutaneous microwave ablation (MWA) in the treatment of hepatocellular carcinoma (HCC) adjacent to large vessels. MATERIALS AND METHODS From February 2006 to February 2013, 452 patients with 605 HCC nodules were treated with US-guided percutaneous MWA. Into large vessels group (Group L), 139 patients with 163 lesions (diameter, 1.0-7.0 cm; mean, 2.5±1.1 cm) located less than 5mm away from large vessels were enrolled. And 313 patients with 442 lesions (diameter, 1.0-8.0 cm; mean, 2.5±1.2 cm) located more than 5mm away from hepatic surface, large vessels, gallbladder and gastrointestinal tract were included in control group (Group C). During the ablation, the temperature of marginal ablation tissues was monitored and controlled. RESULTS The median follow-up time was 24.5 months (range 2.1-87.7 months) in Group L, and 25.7 months (range 1.6-93.9 months) in Group C. Technical effectiveness was achieved in 157 of 163 (96.3%) tumors in Group L and 429 of 442 (97.1%) tumors in Group C, respectively (p>0.05). The 1-, 3- and 5-year local tumor progression rates and the 1-, 3- and 5-year accumulative survival rates in the two groups have no significantly statistical differences. In addition, no immediate or periprocedural major complications, no delayed complication of vessels or bile ducts injury were found in both of the two groups. CONCLUSIONS With strict temperature monitoring, US-guided percutaneous MWA is an efficient and safe technology in treating hepatocellular carcinoma adjacent to large vessels.
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Affiliation(s)
- Shijia Huang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Qinying Li
- No. 135, Shengli East Road, Huanglong District, Puyang City, Henan Province 475000, China.
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Liu F, Liang P, Yu X, Lu T, Cheng Z, Lei C, Han Z. A three-dimensional visualisation preoperative treatment planning system in microwave ablation for liver cancer: A preliminary clinical application. Int J Hyperthermia 2013; 29:671-7. [DOI: 10.3109/02656736.2013.834383] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Liang P, Yu J, Lu MD, Dong BW, Yu XL, Zhou XD, Hu B, Xie MX, Cheng W, He W, Jia JW, Lu GR. Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy. World J Gastroenterol 2013; 19:5430-8. [PMID: 24023485 PMCID: PMC3761095 DOI: 10.3748/wjg.v19.i33.5430] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
Primary liver cancer and liver metastases are among the most frequent malignancies worldwide, with an increasing number of new cases and deaths every year. Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy. This synopsis outlines the first clinical practice guidelines for ultrasound-guided percutaneous microwave ablation therapy for hepatic malignancy, which was created by a joint task force of the Society of Chinese Interventional Ultrasound. The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment, as well as proposing the criteria for the treatment candidates.
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Qu P, Yu X, Liang P, Cheng Z, Han Z, Liu F, Yu J. Contrast-enhanced ultrasound in the characterization of hepatocellular carcinomas treated by ablation: comparison with contrast-enhanced magnetic resonance imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1571-1579. [PMID: 23830098 DOI: 10.1016/j.ultrasmedbio.2013.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/26/2013] [Accepted: 03/27/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate the clinical utility of low-mechanical-index contrast-enhanced ultrasound (CEUS) in assessing the response to percutaneous microwave ablation in patients with hepatocellular carcinoma by comparing the results with those of contrast-enhanced magnetic resonance imaging (CEMRI). Between August 2005 and July 2011, 182 patients with 231 lesions treated by microwave ablation were included in the study. One month after microwave ablation, CEUS and CEMRI were performed to evaluate therapeutic responses. The difference in diagnostic accuracy between the two methods was analyzed to evaluate the value of contrast-enhanced ultrasound after microwave ablation. The final diagnosis was based on computed tomography and MRI typical findings of therapeutic response of hepatocellular carcinoma, proven serum tumor marker levels and additional follow-up. The sensitivity of CEUS and CEMRI in evaluating the therapeutic effect of hepatocellular carcinoma was 86.5% and 84.6%; the specificity, 98.3% and 98.9%; and the accuracy, 95.7% and 95.7%.There was no significant statistical disparity between CEUS and CEMRI (p > 0.05).The sensitivity, specificity and accuracy were 98.1, 97.2 and 97.8% when CEUS was used in combination with CEMRI to evaluate the therapeutic response of hepatocellular carcinoma to microwave ablation. CEUS examination was proven to be a tolerable and easy modality for assessment of the therapeutic effect of microwave ablation and can provide results comparable to those obtained with CEMRI. Combining the results of these two examinations may reduce false-positive and false-negative diagnoses.
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Affiliation(s)
- Peng Qu
- Department of Intentional Ultrasound, Chinese Liberation Army General Hospital, Beijing, China
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Qi C, Yu XL, Liang P, Cheng ZG, Liu FY, Han ZY, Yu J. Ultrasound-guided microwave ablation for abdominal wall metastatic tumors: a preliminary study. World J Gastroenterol 2012; 18:3008-14. [PMID: 22736926 PMCID: PMC3380330 DOI: 10.3748/wjg.v18.i23.3008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/28/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the feasibility, safety and efficacy of ultrasound-guided microwave (MW) ablation for abdominal wall metastatic tumors. METHODS From August 2007 to December 2010, a total of 11 patients with 23 abdominal wall nodules (diameter 2.59 cm ± 1.11 cm, range 1.3 cm to 5.0 cm) were treated with MW ablation. One antenna was inserted into the center of tumors less than 1.7 cm, and multiple antennae were inserted simultaneously into tumors 1.7 cm or larger. A 21 gauge thermocouple was inserted near important organs which required protection (such as bowel or gallbladder) for real-time temperature monitoring during MW ablation. Treatment outcome was observed by contrast-enhanced ultrasound and magnetic resonance imaging (MRI) [or computed tomography (CT)] during follow-up. RESULTS MW ablation was well tolerated by all patients. Six patients with 11 nodules had 1 thermocouple inserted near important organs for real-time temperature monitoring and the maximum temperature was 56 °C. Major complications included mild pain (54.5%), post-ablation fever (100%) and abdominal wall edema (25%). All 23 tumors (100%) in this group were completely ablated, and no residual tumor or local recurrence was observed at a median follow-up of 13 mo (range 1 to 32 mo). The ablation zone was well defined on contrast-enhanced imaging (contrast-enhanced CT, MRI and/or contrast-enhanced ultrasound) and gradually shrank with time. CONCLUSION Ultrasound-guided MW ablation may be a feasible, safe and effective treatment for abdominal wall metastatic tumors in selected patients.
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Pathak S, Jones R, Tang JMF, Parmar C, Fenwick S, Malik H, Poston G. Ablative therapies for colorectal liver metastases: a systematic review. Colorectal Dis 2011; 13:e252-65. [PMID: 21689362 DOI: 10.1111/j.1463-1318.2011.02695.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The standard treatment for colorectal liver metastases (CRLM) is surgical resection. Only 20-30% of patients are deemed suitable for surgery. Recently, much attention has focused on ablative therapies either to treat unresectable CRLM or to extend the margins of resectability. This review aims to assess the long-term outcome and complication rates of various ablative therapies used in the management of CRLM. METHOD A literature search was performed of electronic databases including Medline, Cochrane Collaboration Library and the National Library of Medicine's ClinicalTrials.gov. Inclusion criteria were ablation for CRLM with minimum 1 year follow-up and >10 patients, published between January 1994 and January 2010. RESULTS In all, 226 potentially relevant studies were identified, of which 75 met the inclusion criteria. Cryotherapy (26 studies) had local recurrence rates of 12-39%, with mean 1-, 3- and 5-year survival rates of 84%, 37% and 17%. The major complication rate ranged from 7% to 66%. Microwave ablation (13 studies) had a local recurrence rate of 5-13%, with a mean 1-, 3- and 5-year survival of 73%, 30% and 16%, and a major complication rate ranging from 3% to 16%. Radiofrequency ablation (36 studies) had a local recurrence rate of 10-31%, with a mean 1-, 3- and 5-year survival of 85%, 36% and 24%, with major complication rate ranging from 0% to 33%. CONCLUSION Ablative therapies offer significantly improved survival compared with palliative chemotherapy alone with 5-year survival rates of 17-24%. Complication rates amongst commonly used techniques are low.
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Affiliation(s)
- S Pathak
- Department of Hepatobiliary Surgery, Aintree University NHS Foundation Trust, Liverpool, UK.
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Liu F, Yu X, Liang P, Cheng Z, Han Z, Dong B. Contrast-enhanced ultrasound-guided microwave ablation for hepatocellular carcinoma inconspicuous on conventional ultrasound. Int J Hyperthermia 2011; 27:555-62. [PMID: 21797695 DOI: 10.3109/02656736.2011.564262] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate the efficiency and feasibility of contrast-enhanced ultrasound (CEUS)-guided microwave ablation for hepatocellular carcinoma inconspicuous on conventional US. MATERIALS AND METHODS From March 2006 to February 2010, 107 patients (93 male, 14 female; mean age 58.9±11.0 years) with 107 hepatocellular carcinoma (HCC) nodules (mean maximum diameter 19.5±8.5 mm) inconspicuous on conventional US underwent microwave (MW) ablation under CEUS guidance in this study. US contrast agent was SonoVue (Bracco, Milan, Italy), a second-generation contrast agent. CEUS was performed first, and then MW ablation was carried out by means of CEUS guidance under unconscious intravenous anaesthesia if the tumours were displayed on CEUS. RESULTS 105 tumours were successfully visualised on CEUS by using 1-2 times contrast agent injection and MW ablation was performed under CEUS guidance. The technical success rate was 98.13% (105/107). The number of antenna insertions for each tumour was 1.89±0.92, and the mean session of MW ablation for each tumour was 1.08±0.28. The mean duration of energy application for each tumour was 7.05±4.03 min. The follow-up time was 12-54 months (median 18 months). The technique effectiveness rate was 99.05% (104/105). The local tumour progression rate was 1.9% (2/105). There were no severe complications in any patients. CONCLUSION CEUS-guided MW ablation is an efficient and feasible treatment method for patients with hepatocellular carcinoma inconspicuous on conventional US.
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Affiliation(s)
- Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
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Yu MA, Liang P, Yu XL, Cheng ZG, Han ZY, Liu FY, Yu J. Liver abscess as a complication of microwave ablation for liver metastatic cholangiocarcinoma after bilioenteric anastomosis. Int J Hyperthermia 2011; 27:503-9. [DOI: 10.3109/02656736.2011.555876] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yu MA, Liang P, Yu XL, Cheng ZG, Han ZY, Liu FY, Yu J. Sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma. Eur J Radiol 2011; 80:548-52. [PMID: 21300500 DOI: 10.1016/j.ejrad.2011.01.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 01/05/2011] [Accepted: 01/05/2011] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma. MATERIALS AND METHODS From May 2006 to March 2010, 15 patients (11 men, 4 women; mean age, 57.4 years) with 24 histologically proven intrahepatic primary cholangiocarcinoma lesions (mean tumor size, 3.2±1.9 cm; range, 1.3-9.9 cm) were treated with microwave ablation. RESULTS Thirty-eight sessions were performed for 24 nodules in 15 patients. The follow-up period was 4-31 months (mean, 12.8±8.0 months). The ablation success rate, the technique effectiveness rate, and the local tumor progression rate were 91.7% (22/24), 87.5% (21/24), and 25% (6/24) respectively according to the results of follow-up. The cumulative overall 6, 12, 24 month survival rates were 78.8%, 60.0%, and 60.0%, respectively. Major complication occurred including liver abscess in two patients (13.3%) and needle seeding in one patient (6.7%). Both complications were cured satisfied with antibiotic treatment combined to catheter drainage for abscess and resection for needle seeding. The minor complications and side effects were experienced by most patients which subsided with supportive treatment. CONCLUSION Microwave ablation can be used as a safe and effective technique to treat intrahepatic primary cholangiocarcinoma.
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Affiliation(s)
- Ming-An Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
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Jones C, Badger S, Ellis G. The role of microwave ablation in the management of hepatic colorectal metastases. Surgeon 2011; 9:33-7. [DOI: 10.1016/j.surge.2010.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/16/2010] [Accepted: 07/20/2010] [Indexed: 12/22/2022]
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Qiu-Jie S, Zhi-Yu H, Xiao-Xia N, Wen-Yuan S, Yuan-Yuan S, Liu H, Xin L, Ping L. Feasible temperature of percutaneous microwave ablation of dog liver abutting the bowel. Int J Hyperthermia 2011; 27:124-31. [PMID: 21204623 DOI: 10.3109/02656736.2010.508763] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This study used a dog model to determine the optimal temperature of percutaneous microwave ablation that causes complete necrosis of liver but not the adjacent bowel, supporting the use of this method to specifically and effectively treat liver tumour abutting the bowel. MATERIALS AND METHODS Ultrasound-guided percutaneous microwave ablation of liver abutting the bowel was performed on healthy adult dogs. Temperature of the ablation margin was monitored and controlled through inserted thermal monitoring needles. Dogs were divided into three groups and received microwave ablation at 75-95°C, 65-75°C, or 55-65°C. Imaging and histological examination were used to evaluate the damage of the bowel adjacent to the ablated liver. RESULTS Within one hour of treatment, the bowel adjacent to the ablated liver was seriously burned in the group receiving 75-95°C microwave ablation. Inflammation and congestion were found in the submucosa of the bowel in the group receiving 65-75°C microwave ablation. Minor inflammation was found in the mucosa of the bowel in the group receiving 55-65°C microwave ablation. Moreover, in the group receiving 55-65°C microwave ablation, ablated liver areas were covered with omenta, and histological examination revealed inflammatory reaction of the omenta 28 days after ablation. CONCLUSIONS Microwave ablation at 55-65°C for 6 min is preferred for ablation of liver tissue abutting the bowel in dogs. These findings may provide some valuable reference for percutaneous microwave ablation of human liver tumour adjacent to the bowel.
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Affiliation(s)
- Shao Qiu-Jie
- Department of Interventional Ultrasound, General Hospital of PLA, Beijing
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Liu FY, Yu XL, Liang P, Wang Y, Zhou P, Yu J. Comparison of percutaneous 915 MHz microwave ablation and 2450 MHz microwave ablation in large hepatocellular carcinoma. Int J Hyperthermia 2010; 26:448-55. [PMID: 20433313 DOI: 10.3109/02656731003717574] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare the effectiveness of ultrasound (US)-guided percutaneous 915 MHz microwave (MW) ablation with the 2450 MHz MW ablation for large hepatocellular carcinoma (HCC) (>4 cm in diameter). MATERIALS AND METHODS Patients with HCC >4 cm in diameter who underwent US-guided percutaneous MW ablation with curative intention between March 2007 and December 2008 (39) were randomly divided into two groups, 915 MHz MW group and 2450 MHz MW group. We compared the results of ablation between the two groups. RESULTS Fewer antenna insertions for each tumour were required in the 915 MHz MW group (3.69 +/- 0.6) than in the 2450 MHz MW group (4.71 +/- 1.61) (p = 0.01). According to the follow-up contrast-enhanced imagings, technique effectiveness rate was 85.7% (18/21) and 73.7% (14/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). The rate of local tumour progression (LTP) was 14.3% (3/21) and 26.3% (5/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). There were no deaths and no thrombosis of major vessels in any patient. CONCLUSIONS Compared with 2450 MHz MW ablation, our initial experience showed that percutaneous 915 MHz MW ablation with cooled-shaft antennae was safe and could achieve a high technique effectiveness rate with fewer insertion numbers in the treatment of large HCC. Therefore, percutaneous 915 MHz MW ablation may provide a new method for the treatment of large HCC.
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Affiliation(s)
- Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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