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Park BK. Assessment of Local Tumor Progression After Image-Guided Thermal Ablation for Renal Cell Carcinoma. Korean J Radiol 2024; 25:33-42. [PMID: 38184767 PMCID: PMC10788605 DOI: 10.3348/kjr.2023.0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 01/08/2024] Open
Abstract
Focal enhancement typically suggests local tumor progression (LTP) after renal cell carcinoma is percutaneously ablated. However, evaluating findings that are false positive or negative of LTP is less familiar to radiologists who have little experience with renal ablation. Various imaging features are encountered during and after thermal ablation. Ablation procedures and previous follow-up imaging should be reviewed before determining if there is LTP. Previous studies have focused on detecting the presence or absence of focal enhancement within the ablation zone. Therefore, various diagnostic pitfalls can be experienced using computed tomography or magnetic resonance imaging examinations. This review aimed to assess how to read images during or after ablation procedures, recognize imaging features of LTP and determine factors that influence LTP.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Mauri G, Monfardini L, Della Vigna P, Montano F, Bonomo G, Buccimazza G, Camisassi N, Rossi D, Maiettini D, Varano GM, Solbiati L, Orsi F. Real-Time US-CT fusion imaging for guidance of thermal ablation in of renal tumors invisible or poorly visible with US: results in 97 cases. Int J Hyperthermia 2021; 38:771-776. [PMID: 33971779 DOI: 10.1080/02656736.2021.1923837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To assess the capability of ultrasound-computed tomography (US-CT) fusion imaging to guide a precise targeting of renal tumors invisible or poorly visible with US. MATERIALS AND METHODS From 2016 renal tumors poorly visible or inconspicuous/invisible at US were treated at our institution with the guidance of US/CT fusion in a room equipped with CT scanner. Feasibility of the procedure, accuracy of targeting, complications, and technique efficacy were evaluated. RESULTS Of 227 patients treated from 2016 to March 2020, 91 patients (65 males and 26 females, mean age 68.5 ± 10.1 years) with 97 renal lesions (mean maximum diameter 21.6 ± 9.4 mm) inconspicuous/invisible (29/97, 29.9%) or poorly visible (68/97, 70.1%) at US underwent treatment under US-CT fusion guidance. US-CT fusion imaging guidance was always technically feasible and enabled correct targeting in 97/97/(100%) of cases. Technical success was achieved in 93/97 lesions (95.9%). Three lesions were retreated during the same ablative session, while 1 was retreated in a subsequent session. Thus, primary efficacy was achieved in one session in 96/97 (98.9%) cases and secondary efficacy in 97/97 (100%) cases. CONCLUSION US-CT image fusion guidance allows for a correct tumor targeting of renal tumors poorly visible or inconspicuous/invisible with US alone, with a high rate of technical success and technique efficacy.
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Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan, Italy
| | | | - Paolo Della Vigna
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Florian Montano
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Post-graduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Guido Bonomo
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giorgio Buccimazza
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Post-graduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Nicola Camisassi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Duccio Rossi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Post-graduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Daniele Maiettini
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Maria Varano
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi Solbiati
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Radiology, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Franco Orsi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Sainani NI, Silverman SG, Tuna IS, Aghayev A, Shyn PB, Tuncali K, Kadiyala V, Tatli S. Incidence and clinical sequelae of portal and hepatic venous thrombosis following percutaneous cryoablation of liver tumors. Abdom Radiol (NY) 2016; 41:970-7. [PMID: 27193794 DOI: 10.1007/s00261-015-0626-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the incidence and sequelae of portal and hepatic venous thrombosis after percutaneous cryoablation of hepatic tumors. METHODS From November 1998 through December 2010, 223 hepatic tumors were cryoablated during 170 ablation procedures in 135 patients. 24-h post-procedure MR images were reviewed retrospectively by two abdominal radiologists in consensus to identify tumor ablations that developed one or more new portal or hepatic venous thromboses in or outside the ablation zone. On follow-up MRI and CT examinations the outcomes of thromboses were classified as resolved, partially recanalized, persistent, or propagated. RESULTS Venous thrombosis developed in association with 54 (24%) of 223 tumor ablations treated during 53 (31%) ablation procedures in 39 (28.8%) patients (15 women, 24 men; age range 40-82 years, mean 59 years). Of these 54 thromboses, 49 (91%) were located in portal vein branches, four (7%) in both portal and hepatic vein branches, and one (2%) in a hepatic vein branch. Thrombosed veins were outside but abutted the ablation zone in 36 (66.7%), and within it in 18 (33.3%). On follow-up imaging (n = 49), thrombi resolved in 29 (59%), partially recanalized in two (4%), persisted in 18 (37%) and propagated from sub-segmental or segmental branches to the left or right portal branches in five (10%). No thrombus propagated to the main portal vein or inferior vena cava. CONCLUSION Portal and hepatic vein branch thromboses are common in small branches following percutaneous cryoablation of hepatic tumors and most resolve spontaneously without sequelae.
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Affiliation(s)
- Nisha I Sainani
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Ibrahim S Tuna
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Ayaz Aghayev
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Kemal Tuncali
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Vivek Kadiyala
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Servet Tatli
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Chehab MA, Brinjikji W, Copelan A, Venkatesan AM. Navigational Tools for Interventional Radiology and Interventional Oncology Applications. Semin Intervent Radiol 2015; 32:416-27. [PMID: 26622105 DOI: 10.1055/s-0035-1564705] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The interventional radiologist is increasingly called upon to successfully access challenging biopsy and ablation targets, which may be difficult based on poor visualization, small size, or the proximity of vulnerable regional anatomy. Complex therapeutic procedures, including tumor ablation and transarterial oncologic therapies, can be associated with procedural risk, significant procedure time, and measurable radiation time. Navigation tools, including electromagnetic, optical, laser, and robotic guidance systems, as well as image fusion platforms, have the potential to facilitate these complex interventions with the potential to improve lesion targeting, reduce procedure time, and radiation dose, and thus potentially improve patient outcomes. This review will provide an overview of currently available navigational tools and their application to interventional radiology and oncology. A summary of the pertinent literature on the use of these tools to improve safety and efficacy of interventional procedures compared with conventional techniques will be presented.
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Affiliation(s)
- Monzer A Chehab
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | - Alexander Copelan
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
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Levesque VM, Shyn PB, Tuncali K, Tatli S, Nawfel RD, Olubiyi O, Silverman SG. Radiation dose during CT-guided percutaneous cryoablation of renal tumors: Effect of a dose reduction protocol. Eur J Radiol 2015. [DOI: 10.1016/j.ejrad.2015.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Wang Q, Li J, An S, Chen Y, Jiang C, Wang X. Magnetic resonance-guided regional gene delivery strategy using a tumor stroma-permeable nanocarrier for pancreatic cancer. Int J Nanomedicine 2015; 10:4479-90. [PMID: 26203245 PMCID: PMC4508066 DOI: 10.2147/ijn.s84930] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gene therapy is a very promising technology for treatment of pancreatic ductal adenocarcinoma (PDAC). However, its application has been limited by the abundant stromal response in the tumor microenvironment. The aim of this study was to prepare a dendrimer-based gene-free loading vector with high permeability in the tumor stroma and explore an imaging-guided local gene delivery strategy for PDAC to promote the efficiency of targeted gene delivery. METHODS The experimental protocol was approved by the animal ethics committee of Zhongshan Hospital, Fudan University. Third-generation dendrigraft poly-L-lysines was selected as the nanocarrier scaffold, which was modified by cell-penetrating peptides and gadolinium (Gd) chelates. DNA plasmids were loaded with these nanocarriers via electrostatic interaction. The cellular uptake and loaded gene expression were examined in MIA PaCa-2 cell lines in vitro. Permeability of the nanoparticles in the tumor stroma and transfected gene distribution in vivo were studied using a magnetic resonance imaging-guided delivery strategy in an orthotopic nude mouse model of PDAC. RESULTS The nanocarriers were synthesized with a dendrigraft poly-L-lysine to polyethylene glycol to DTPA ratio of 1:3.4:8.3 and a mean diameter of 110.9±7.7 nm. The luciferases were strictly expressed in the tumor, and the luminescence intensity in mice treated by Gd-DPT/plasmid luciferase (1.04×10(4)±9.75×10(2) p/s/cm(2)/sr) was significantly (P<0.05) higher than in those treated with Gd-DTPA (9.56×10(2)±6.15×10 p/s/cm(2)/sr) and Gd-DP (5.75×10(3)± 7.45×10(2) p/s/cm(2)/sr). Permeability of the nanoparticles modified by cell-penetrating peptides was superior to that of the unmodified counterpart, demonstrating the improved capability of nanoparticles for diffusion in tumor stroma on magnetic resonance imaging. CONCLUSION This study demonstrated that an image-guided gene delivery system with a stroma-permeable gene vector could be a potential clinically translatable gene therapy strategy for PDAC.
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Affiliation(s)
- Qingbing Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, People’s Republic of China
| | - Jianfeng Li
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, People’s Republic of China
| | - Sai An
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, People’s Republic of China
| | - Yi Chen
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Chen Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education, Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai, People’s Republic of China
| | - Xiaolin Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, People’s Republic of China
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Ultrasonography-guided radiofrequency ablation of malignant musculoskeletal soft-tissue tumors using the "moving-shot" technique at a single-institution experience. Ultrasound Q 2015; 30:295-300. [PMID: 25415868 DOI: 10.1097/ruq.0000000000000062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present study describes the use of the "moving-shot" technique for successful radiofrequency ablation (RFA) of malignant musculoskeletal soft-tissue tumors. Ultrasonography-guided RFA was performed in 6 malignant soft-tissue tumors in 5 patients. Short-term follow-up after RFA (8-27 weeks) showed that complete necrosis was achieved in all lesions, and 5 lesions (83%) decreased in size. Discomfort caused by the tumors decreased subjectively in all patients after ablation. Our results indicate that ultrasonography-guided RFA using the moving-shot technique can be an effective treatment option for locoregional control of malignant soft-tissue tumors. Long-term follow-up studies with a larger number of patients are necessary.
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Overduin CG, Bomers JGR, Jenniskens SFM, Hoes MF, ten Haken B, de Lange F, Fütterer JJ, Scheenen TWJ. T1-weighted MR image contrast around a cryoablation iceball: A phantom study and initial comparison within vivofindings. Med Phys 2014; 41:112301. [DOI: 10.1118/1.4896824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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De Filippo M, Bozzetti F, Martora R, Zagaria R, Ferretti S, Macarini L, Brunese L, Rotondo A, Rossi C. Radiofrequency thermal ablation of renal tumors. Radiol Med 2014; 119:499-511. [PMID: 25024061 DOI: 10.1007/s11547-014-0412-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/30/2014] [Indexed: 01/08/2023]
Abstract
Percutaneous radiofrequency ablation (PRFA) of renal malignancies is currently a therapeutic option for patients who are not able to undergo surgery. Some authors consider PRFA as the therapeutic standard in the treatment of renal neoplasms in non-operable patients due to comorbid conditions and in patients with mild-moderate renal failure, to preserve residual renal functionality. The use of PRFA has become more and more widespread due to a rise in the incidental detection of renal cell carcinomas with the ever-increasing use of Imaging for the study of abdominal diseases. Clinical studies indicate that RF ablation is an effective therapy with a low level of risk of complications, which provides good results in selected patients over short and medium term periods of time, however up to now few long-term studies have been carried out which can confirm the effectiveness of PRFA.
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Affiliation(s)
- Massimo De Filippo
- Section of Diagnostic Imaging, Department of Surgical Sciences, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy,
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Imaging-Guided Percutaneous Cryotherapy of Bone and Soft-Tissue Tumors: What Is the Impact on the Muscles Around the Ablation Site? AJR Am J Roentgenol 2014; 202:1361-5. [DOI: 10.2214/ajr.13.11430] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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12
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Castro A, Jenkins LC, Salas N, Lorber G, Leveillee RJ. Ablative therapies for small renal tumours. Nat Rev Urol 2013; 10:284-91. [DOI: 10.1038/nrurol.2013.68] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Kagadis GC, Katsanos K, Karnabatidis D, Loudos G, Nikiforidis GC, Hendee WR. Emerging technologies for image guidance and device navigation in interventional radiology. Med Phys 2012; 39:5768-81. [PMID: 22957641 DOI: 10.1118/1.4747343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent developments in image-guidance and device navigation, along with emerging robotic technologies, are rapidly transforming the landscape of interventional radiology (IR). Future state-of-the-art IR procedures may include real-time three-dimensional imaging that is capable of visualizing the target organ, interventional tools, and surrounding anatomy with high spatial and temporal resolution. Remote device actuation is becoming a reality with the introduction of novel magnetic-field enabled instruments and remote robotic steering systems. Robots offer several degrees of freedom and unprecedented accuracy, stability, and dexterity during device navigation, propulsion, and actuation. Optimization of tracking and navigation of interventional tools inside the human body will be critical in converting IR suites into the minimally invasive operating theaters of the future with increased safety and unsurpassed therapeutic efficacy. In the not too distant future, individual image guidance modalities and device tracking methods could merge into autonomous, multimodality, multiparametric platforms that offer real-time data of anatomy, morphology, function, and metabolism along with on-the-fly computational modeling and remote robotic actuation. The authors provide a concise overview of the latest developments in image guidance and device navigation, while critically envisioning what the future might hold for 2020 IR procedures.
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Affiliation(s)
- George C Kagadis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece.
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Abstract
Medical imaging in interventional oncology is used differently than in diagnostic radiology and prioritizes different imaging features. Whereas diagnostic imaging prioritizes the highest-quality imaging, interventional imaging prioritizes real-time imaging with lower radiation dose in addition to high-quality imaging. In general, medical imaging plays five key roles in image-guided therapy, and interventional oncology, in particular. These roles are (a) preprocedure planning, (b) intraprocedural targeting, (c) intraprocedural monitoring, (d) intraprocedural control, and (e) postprocedure assessment. Although many of these roles are still relatively basic in interventional oncology, as research and development in medical imaging focuses on interventional needs, it is likely that the role of medical imaging in intervention will become even more integral and more widely applied. In this review, the current status of medical imaging for intervention in oncology will be described and directions for future development will be examined.
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Affiliation(s)
- Stephen B Solomon
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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Elhawary H, Oguro S, Tuncali K, Morrison PR, Tatli S, Shyn PB, Silverman SG, Hata N. Multimodality non-rigid image registration for planning, targeting and monitoring during CT-guided percutaneous liver tumor cryoablation. Acad Radiol 2010; 17:1334-44. [PMID: 20817574 DOI: 10.1016/j.acra.2010.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 06/06/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to develop non-rigid image registration between preprocedure contrast-enhanced magnetic resonance (MR) images and intraprocedure unenhanced computed tomographic (CT) images, to enhance tumor visualization and localization during CT imaging-guided liver tumor cryoablation procedures. MATERIALS AND METHODS A non-rigid registration technique was evaluated with different preprocessing steps and algorithm parameters and compared to a standard rigid registration approach. The Dice similarity coefficient, target registration error, 95th-percentile Hausdorff distance, and total registration time (minutes) were compared using a two-sided Student's t test. The entire registration method was then applied during five CT imaging-guided liver cryoablation cases with the intraprocedural CT data transmitted directly from the CT scanner, with both accuracy and registration time evaluated. RESULTS Selected optimal parameters for registration were a section thickness of 5 mm, cropping the field of view to 66% of its original size, manual segmentation of the liver, B-spline control grid of 5 × 5 × 5, and spatial sampling of 50,000 pixels. A mean 95th-percentile Hausdorff distance of 3.3 mm (a 2.5 times improvement compared to rigid registration, P < .05), a mean Dice similarity coefficient of 0.97 (a 13% increase), and a mean target registration error of 4.1 mm (a 2.7 times reduction) were measured. During the cryoablation procedure, registration between the preprocedure MR and the planning intraprocedure CT imaging took a mean time of 10.6 minutes, MR to targeting CT image took 4 minutes, and MR to monitoring CT imaging took 4.3 minutes. Mean registration accuracy was <3.4 mm. CONCLUSIONS Non-rigid registration allowed improved visualization of the tumor during interventional planning, targeting, and evaluation of tumor coverage by the ice ball. Future work is focused on reducing segmentation time to make the method more clinically acceptable.
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Eisner BH, Kurtz MP, Harisinghani MG. Evolving role of magnetic resonance imaging in renal cancer imaging. J Endourol 2010; 24:707-11. [PMID: 20433369 DOI: 10.1089/end.2009.0507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
MRI is an imaging modality that is used in the evaluation and treatment of renal cancer. Although less frequently used than CT, MRI is useful in several aspects of renal cancer evaluation and may have some advantages. MRI has shown promising results for renal cancer staging (especially determination of vascular invasion by tumor), in differentiating malignant from benign complex cystic renal lesions, and in the treatment and follow-up of minimally invasive ablative therapies for renal cancer. In addition, new research shows promise for novel applications of MRI. Herein we review the evolving of MRI in renal cancer imaging.
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Affiliation(s)
- Brian H Eisner
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Rioja J, Tzortzis V, Mamoulakis C, Laguna M. Crioterapia de tumores renales: estado actual y desarrollos contemporáneos. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kawamoto S, Solomon SB, Bluemke DA, Fishman EK. Computed tomography and magnetic resonance imaging appearance of renal neoplasms after radiofrequency ablation and cryoablation. Semin Ultrasound CT MR 2009; 30:67-77. [PMID: 19358438 DOI: 10.1053/j.sult.2008.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thermal ablation procedures including radiofrequency ablation and cryoablation have been increasingly used for treatment for small renal cell carcinoma. Currently, computed tomography and magnetic resonance imaging are usually used to assess residual or recurrent disease after thermal ablation of renal tumor. After thermal ablation, the zone of ablation is usually seen as an area of hypoattenuation on computed tomography and is generally hypointense at T2-weighted magnetic resonance imaging and iso- to hyperintense at T1-weighted imaging relative to renal parenchyma. The ablation zone frequently involutes over time. Residual tumor after thermal ablation is most common at the margin of the ablation zone and often seen as nodular or crescent-shaped areas of contrast enhancement. Accurate assessment of ablated tumors at postprocedural imaging is essential for evaluating the adequacy of treatment and guiding further management. Complications are uncommon and usually minor but should be detected on postprocedural imaging studies.
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Affiliation(s)
- Satomi Kawamoto
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Hui GC, Tuncali K, Tatli S, Morrison PR, Silverman SG. Comparison of Percutaneous and Surgical Approaches to Renal Tumor Ablation: Metaanalysis of Effectiveness and Complication Rates. J Vasc Interv Radiol 2008; 19:1311-20. [PMID: 18725094 DOI: 10.1016/j.jvir.2008.05.014] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Revised: 05/07/2008] [Accepted: 05/15/2008] [Indexed: 12/25/2022] Open
Affiliation(s)
- Gladwin C Hui
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Morrison PR, Silverman SG, Tuncali K, Tatli S. MRI-guided cryotherapy. J Magn Reson Imaging 2008; 27:410-20. [DOI: 10.1002/jmri.21260] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Kos S, Huegli R, Bongartz GM, Jacob AL, Bilecen D. MR-guided endovascular interventions: a comprehensive review on techniques and applications. Eur Radiol 2007; 18:645-57. [PMID: 18071710 DOI: 10.1007/s00330-007-0818-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 10/01/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
The magnetic resonance (MR) guidance of endovascular interventions is probably one of the greatest challenges of clinical MR research. MR angiography is not only an imaging tool for the vasculature but can also simultaneously depict high tissue contrast, including the differentiation of the vascular wall and perivascular tissues, as well as vascular function. Several hurdles had to be overcome to allow MR guidance for endovascular interventions. MR hardware and sequence design had to be developed to achieve acceptable patient access and to allow real-time or near real-time imaging. The development of interventional devices, both applicable and safe for MR imaging (MRI), was also mandatory. The subject of this review is to summarize the latest developments in real-time MRI hardware, MRI, visualization tools, interventional devices, endovascular tracking techniques, actual applications and safety issues.
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Affiliation(s)
- Sebastian Kos
- Institute of Radiology, Division of Interventional Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Permpongkosol S, Link RE, Kavoussi LR, Solomon SB. Temperature Measurements of the Low-Attenuation Radiographic Ice Ball During CT-Guided Renal Cryoablation. Cardiovasc Intervent Radiol 2007; 31:116-21. [DOI: 10.1007/s00270-007-9220-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 05/06/2007] [Accepted: 05/14/2007] [Indexed: 12/01/2022]
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Tatli S, Morrison PR, Tuncali K, Silverman SG. Interventional MRI for Oncologic Applications. Tech Vasc Interv Radiol 2007; 10:159-70. [DOI: 10.1053/j.tvir.2007.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Li JJ, Xu GL, Gu MF, Luo GY, Rong Z, Wu PH, Xia JC. Complications of high intensity focused ultrasound in patients with recurrent and metastatic abdominal tumors. World J Gastroenterol 2007; 13:2747-51. [PMID: 17569147 PMCID: PMC4147127 DOI: 10.3748/wjg.v13.i19.2747] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the local and systemic complications of high intensity focused ultrasound (HIFU) for patients with recurrent and metastatic abdominal tumors.
METHODS: From Aug 2001 to Aug 2004, 17 patients with recurrent and metastatic abdominal tumors were enrolled in this study. Real-time sonography was taken, and vital signs, liver and kidney function, skin burns, local reactions, and systemic effects were observed and recored before, during, and after HIFU. CT and MRI were also taken before and after HIFU.
RESULTS: All 17 patients had skin burns and pain in the treatment region; the next common complication was neurapraxia of the stomach and intestines to variable degrees. The other local and systemic complications were relatively rare. Severe complications were present in two patients; one developed a superior mesenteric artery infarction resulting in necrosis of the entire small intestines, and the other one suffered from a perforation in terminal ileum due to HIFU treatment.
CONCLUSION: Although HIFU is a one of noninvasive treatments for the recurrent and metastatic abdominal tumors, there are still some common and severe complications which need serious consideration.
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Affiliation(s)
- Jian-Jun Li
- Department of HIFU, Cancer Center, Sun Yat-sen University, National Key Laboratory of Oncology, 651, Dongfengdong Road, Guangzhou 510060, Guangdong Province, China.
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Kawamoto S, Permpongkosol S, Bluemke DA, Fishman EK, Solomon SB. Sequential changes after radiofrequency ablation and cryoablation of renal neoplasms: role of CT and MR imaging. Radiographics 2007; 27:343-55. [PMID: 17374857 DOI: 10.1148/rg.272065119] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiofrequency (RF) ablation and cryoablation are increasingly being used as minimally invasive treatments for renal malignancies. Accurate assessment of ablated tumors at postprocedural imaging is essential for evaluating the adequacy of treatment and guiding further management. Renal tumors treated with RF ablation or cryoablation appear as low-attenuation regions at computed tomography (CT) and, relative to renal parenchyma, are generally hypointense at T2-weighted magnetic resonance (MR) imaging and iso- to hyperintense at T1-weighted imaging. The use of intravenous contrast material is essential for the evaluation of possible residual or recurrent tumor. At follow-up CT or MR imaging, successfully treated renal tumors appear as focal masses that demonstrate no evidence of contrast enhancement and that frequently decrease in size over time, whereas residual or recurrent tumor can be detected as abnormal foci of contrast enhancement. Follow-up surveillance imaging is warranted because long-term results for renal tumor ablation are not known, and evaluation for residual, recurrent, or metachronous tumor is essential.
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Affiliation(s)
- Satomi Kawamoto
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, JHOC 3235A, Baltimore, MD 21287, USA.
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Archip N, Tatli S, Morrison P, Jolesz F, Warfield SK, Silverman S. Non-rigid registration of pre-procedural MR images with intra-procedural unenhanced CT images for improved targeting of tumors during liver radiofrequency ablations. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2007; 10:969-977. [PMID: 18044662 DOI: 10.1007/978-3-540-75759-7_117] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In the United States, unenhanced CT is currently the most common imaging modality used to guide percutaneous biopsy and tumor ablation. The majority of liver tumors such as hepatocellular carcinomas are visible on contrast-enhanced CT or MRI obtained prior to the procedure. Yet, these tumors may not be visible or may have poor margin conspicuity on unenhanced CT images acquired during the procedure. Non-rigid registration has been used to align images accurately, even in the presence of organ motion. However, to date, it has not been used clinically for radiofrequency ablation (RFA), since it requires significant computational infrastructure and often these methods are not sufficient robust. We have already introduced a novel finite element based method (FEM) that is demonstrated to achieve good accuracy and robustness for the problem of brain shift in neurosurgery. In this current study, we adapt it to fuse pre-procedural MRI with intra-procedural CT of liver. We also compare its performance with conventional rigid registration and two non-rigid registration methods: b-spline and demons on 13 retrospective datasets from patients that underwent RFA at our institution. FEM non-rigid registration technique was significantly better than rigid (p < 10-5), non-rigid b-spline (p < 10-4) and demons (p < 10-4) registration techniques. The results of our study indicate that this novel technology may be used to optimize placement of RF applicator during CT-guided ablations.
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Kim YK, Kim CS, Lee JM, Chung GH, Chon SB. Efficacy and safety of radiofrequency ablation of hepatocellular carcinoma in the hepatic dome with the CT-guided extrathoracic transhepatic approach. Eur J Radiol 2006; 60:100-7. [PMID: 16781835 DOI: 10.1016/j.ejrad.2006.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Revised: 04/11/2006] [Accepted: 05/02/2006] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to determine the efficacy and safety of radiofrequency (RF) ablation for the treatment of hepatocellular carcinoma (HCC) in the hepatic dome with CT-guided extrathoracic transhepatic approach. MATERIALS AND METHODS Fifteen patients with 15 HCCs (size range: 0.8-4 cm, mean size: 1.8 cm) in the hepatic dome were treated by RF ablation using cooled-tip electrodes and with CT-guided extrathoracic transhepatic approach. Therapeutic response of the tumor to RF ablation and procedure-related complications including hepatic injury, hemoperitoneum, and thermal injury of diaphragm were evaluated. RESULTS The average number of needle punctures to ensure the correct needle position in the targeted tumor was 3.7 (range: 1-6 punctures). The average ablation time was 14.7 min (range: 8-25 min). Complete necrosis without marginal recurrence after at least 13-month follow-up was attained in 13 tumors (86.7%). There were no major complications related to the procedures. Six patients had shoulder pain that lasted three days to two weeks after the procedures and their symptoms were resolved with conservative treatment. CONCLUSIONS RF ablation using CT-guided extrathoracic transhepatic approach is an effective and safe technique for the treatment of HCC in the hepatic dome.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School, Keum Am Dong, JeonJu, South Korea.
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Carrino JA, Jolesz FA. MRI-Guided interventions. Acad Radiol 2005; 12:1063-4. [PMID: 16099692 DOI: 10.1016/j.acra.2005.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 06/09/2005] [Accepted: 06/09/2005] [Indexed: 11/18/2022]
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