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Jiang L, Jowkar N, King F, Plishker W, Bhagavatula SK, Levesque VM, Kapur T, Shyn PB. PET/CT Fluoroscopy during PET/CT-Guided Interventions: Initial Experience. J Vasc Interv Radiol 2023; 34:1319-1323. [PMID: 37142215 PMCID: PMC10512656 DOI: 10.1016/j.jvir.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
This study assessed the feasibility and functionality of the use of a high-speed image fusion technology to generate and display positron emission tomography (PET)/computed tomography (CT) fluoroscopic images during PET/CT-guided tumor ablation procedures. Thirteen patients underwent 14 PET/CT-guided ablations for the treatment of 20 tumors. A Food and Drug Administration-cleared multimodal image fusion platform received images pushed from a scanner, followed by near-real-time, nonrigid image registration. The most recent intraprocedural PET dataset was fused to each single-rotation CT fluoroscopy dataset as it arrived, and the fused images were displayed on an in-room monitor. PET/CT fluoroscopic images were generated and displayed in all procedures and enabled more confident targeting in 3 procedures. The mean lag time from CT fluoroscopic image acquisition to the in-room display of the fused PET/CT fluoroscopic image was 21 seconds ± 8. The registration accuracy was visually satisfactory in 13 of 14 procedures. In conclusion, PET/CT fluoroscopy was feasible and may have the potential to facilitate PET/CT-guided procedures.
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Affiliation(s)
- Liwei Jiang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nick Jowkar
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Franklin King
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Sharath K Bhagavatula
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
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2
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Daye D, Hu EY, Glazer DI, Tuncali K, Levesque V, Shyn PB. Periprocedural factors associated with overall patient survival following percutaneous image-guided liver tumor cryoablation. Int J Hyperthermia 2021; 39:34-39. [PMID: 34937523 DOI: 10.1080/02656736.2021.2013552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess the impact of periprocedural factors, including adverse events, on overall patient survival following image-guided liver tumor cryoablation procedures. METHODS In this retrospective single-institution study, 143 patients (73 male, 70 female, ages 29-88) underwent 169 image-guided liver tumor cryoablation procedures between October 1998 and August 2014. Patient, tumor and procedural variables were recorded. The primary outcome was overall survival post-procedure (Kaplan-Meier analysis). Secondary outcomes were the impact of 15 variables on patient survival, which were assessed with multivariate cox regression and log-rank tests. RESULTS Mean tumor diameter was 2.5 ± 1.2 cm. 26 of 143 (18.2%) patients had primary hepatic malignancies; 117 of 143 (81.8%) had liver metastases. Survival analysis revealed survivor functions at 3, 5, 7, 10 and 12 years post-ablation of 0.54, 0.37, 0.30, 0.17 and 0.06, with mean survival time of 40.8 ± 4.9 months. Tumor size ≥4 cm (p = .018), pre-procedural platelet count <100 × 103/μL (p = .023), and prior local radiation therapy (p = .014) were associated with worse overall patient survival. Grade 3 or higher adverse events were not associated with reduced survival (p = .49). CONCLUSIONS All variables associated with overall survival were patient-related and none were associated with the cryoablation procedure. Pre-procedural thrombocytopenia, larger tumor size and history of prior local radiation therapy were independent risk factors for reduced overall survival in patients undergoing hepatic cryoablation. Adverse events related to hepatic cryoablation were not associated with decreased survival.
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Affiliation(s)
- Dania Daye
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA
| | - Emmy Y Hu
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel I Glazer
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Vincent Levesque
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul B Shyn
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Lee EJ, Plishker W, Hata N, Shyn PB, Silverman SG, Bhattacharyya SS, Shekhar R. Rapid Quality Assessment of Nonrigid Image Registration Based on Supervised Learning. J Digit Imaging 2021; 34:1376-1386. [PMID: 34647199 PMCID: PMC8669090 DOI: 10.1007/s10278-021-00523-5] [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: 10/21/2020] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
When preprocedural images are overlaid on intraprocedural images, interventional procedures benefit in that more structures are revealed in intraprocedural imaging. However, image artifacts, respiratory motion, and challenging scenarios could limit the accuracy of multimodality image registration necessary before image overlay. Ensuring the accuracy of registration during interventional procedures is therefore critically important. The goal of this study was to develop a novel framework that has the ability to assess the quality (i.e., accuracy) of nonrigid multimodality image registration accurately in near real time. We constructed a solution using registration quality metrics that can be computed rapidly and combined to form a single binary assessment of image registration quality as either successful or poor. Based on expert-generated quality metrics as ground truth, we used a supervised learning method to train and test this system on existing clinical data. Using the trained quality classifier, the proposed framework identified successful image registration cases with an accuracy of 81.5%. The current implementation produced the classification result in 5.5 s, fast enough for typical interventional radiology procedures. Using supervised learning, we have shown that the described framework could enable a clinician to obtain confirmation or caution of registration results during clinical procedures.
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Affiliation(s)
- Eung-Joo Lee
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD USA
| | - William Plishker
- Institute for Advanced Computer Studies, University of Maryland, College Park, MD USA
| | | | | | | | - Shuvra S. Bhattacharyya
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD USA
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Raj Shekhar
- Institute for Advanced Computer Studies, University of Maryland, College Park, MD USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC USA
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4
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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Liang L, Cool D, Kakani N, Wang G, Ding H, Fenster A. Automatic Radiofrequency Ablation Planning for Liver Tumors With Multiple Constraints Based on Set Covering. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1459-1471. [PMID: 31689185 DOI: 10.1109/tmi.2019.2950947] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Radiofrequency ablation (RFA) is now a widely used minimally invasive treatment method for hepatic tumors. Preoperative planning plays a vital role in RFA therapy. With increasing tumor size, multiple overlapping ablations are needed, which are challenging to optimize while considering clinical constraints. In this paper, we present a new automatic RFA planning method. First, a 2-steps set cover-based model is formulated, which can integrate multiple clinical constraints for optimization of overlapping ablations. To ensure that the planning model can be solved in a reasonable time, a search space reducing strategy is then proposed. We also developed an algorithm for automatic RFA electrode selection, which provides a proper electrode ablation zone for the planning model. The proposed method was evaluated with 20 tumors of varying sizes (0.92 cm3 to 28.4 cm3). Results showed that the proposed method can generate clinical feasible RFA plans with a minimum number of RFA electrodes and ablations, complete tumor coverage and minimized ablation of normal tissue.
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Spahr N, Thoduka S, Abolmaali N, Kikinis R, Schenk A. Multimodal image registration for liver radioembolization planning and patient assessment. Int J Comput Assist Radiol Surg 2018; 14:215-225. [PMID: 30349976 PMCID: PMC6373337 DOI: 10.1007/s11548-018-1877-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022]
Abstract
Purpose Multimodal imaging plays a key role in patient assessment and treatment planning in liver radioembolization. It will reach its full potential for convenient use in combination with deformable image registration methods. A registration framework is proposed for multimodal liver image registration of multi-phase CT, contrast-enhanced late-phase T1, T2, and DWI MRI sequences. Methods A chain of four pair-wise image registrations based on a variational registration framework using normalized gradient fields as distance measure and curvature regularization is introduced. A total of 103 cases of 35 patients was evaluated based on anatomical landmarks and deformation characteristics. Results Good anatomical correspondence and physical plausibility of the deformation fields were attained. The global mean landmark errors vary from 3.20 to 5.36 mm, strongly influenced by low resolved images in z-direction. Moderate volume changes are indicated by mean minimum and maximum Jacobian determinants of 0.44 up to 1.88. No deformation foldings were detected. The mean average divergence of the deformation fields range from 0.08 to 0.16 and the mean harmonic energies vary from 0.08 to 0.58. Conclusion The proposed registration solutions enable the combined use of information from multimodal imaging and provide an excellent basis for patient assessment and primary planning for liver radioembolization.
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Affiliation(s)
- Nadine Spahr
- Fraunhofer Institute for Medical Image Computing, MEVIS, Lübeck, Germany.
| | - Smita Thoduka
- Department of Radiology, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Ron Kikinis
- Fraunhofer Institute for Medical Image Computing, MEVIS, Lübeck, Germany.,Medical Image Computing, University of Bremen, Bremen, Germany.,Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrea Schenk
- Fraunhofer Institute for Medical Image Computing, MEVIS, Lübeck, Germany
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Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes. AJR Am J Roentgenol 2017; 209:1381-1389. [PMID: 28952807 DOI: 10.2214/ajr.16.17582] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this article is to report our intermediate to long-term outcomes with image-guided percutaneous hepatic tumor cryoablation and to evaluate its technical success, technique efficacy, local tumor progression, and adverse event rate. MATERIALS AND METHODS Between 1998 and 2014, 299 hepatic tumors (243 metastases and 56 primary tumors; mean diameter, 2.5 cm; median diameter, 2.2 cm; range, 0.3-7.8 cm) in 186 patients (95 women; mean age, 60.9 years; range, 29-88 years) underwent cryoablation during 236 procedures using CT (n = 126), MRI (n = 100), or PET/CT (n = 10) guidance. Technical success, technique efficacy at 3 months, local tumor progression (mean follow-up, 2.5 years; range, 2 months to 14.6 years), and adverse event rates were calculated. RESULTS The technical success rate was 94.6% (279/295). The technique efficacy rate was 89.5% (231/258) and was greater for tumors smaller than 4 cm (93.4%; 213/228) than for larger tumors (60.0%; 18/30) (p < 0.0001). Local tumor progression occurred in 23.3% (60/258) of tumors and was significantly more common after the treatment of tumors 4 cm or larger (63.3%; 19/30) compared with smaller tumors (18.0%; 41/228) (p < 0.0001). Adverse events followed 33.8% (80/236) of procedures and were grade 3-5 in 10.6% (25/236) of cases. Grade 3 or greater adverse events more commonly followed the treatment of larger tumors (19.5%; 8/41) compared with smaller tumors (8.7%; 17/195) (p = 0.04). CONCLUSION Image-guided percutaneous cryoablation of hepatic tumors is efficacious; however, tumors smaller than 4 cm are more likely to be treated successfully and without an adverse event.
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Reid MW, Hannemann NP, York GE, Ritter JL, Kini JA, Lewis JD, Sherman PM, Velez CS, Drennon AM, Bolzenius JD, Tate DF. Comparing Two Processing Pipelines to Measure Subcortical and Cortical Volumes in Patients with and without Mild Traumatic Brain Injury. J Neuroimaging 2017; 27:365-371. [DOI: 10.1111/jon.12431] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/13/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Matthew W. Reid
- Defense and Veterans Brain Injury Center San Antonio Military Medical Center San Antonio TX
| | | | - Gerald E. York
- Alaska Radiology Associates TBI Imaging and Research Anchorage AK
| | - John L. Ritter
- Defense and Veterans Brain Injury Center San Antonio Military Medical Center San Antonio TX
| | | | - Jeffrey D. Lewis
- Department of Neurology Uniformed Services University of the Health Sciences School of Medicine Bethesda MD
| | - Paul M. Sherman
- Department of Aeromedical Research, 711th Human Performance Wing U.S. Air Force School of Aerospace Medicine Dayton OH
- Department of Radiology 59th Medical Wing, Wilford Hall ASC San Antonio TX
| | - Carmen S. Velez
- Missouri Institute of Mental Health University of Missouri‐St Louis Berkeley MO
| | - Ann Marie Drennon
- Defense and Veterans Brain Injury Center San Antonio Military Medical Center San Antonio TX
| | - Jacob D. Bolzenius
- Missouri Institute of Mental Health University of Missouri‐St Louis Berkeley MO
| | - David F. Tate
- Missouri Institute of Mental Health University of Missouri‐St Louis Berkeley MO
- Department of Physical Medicine and Rehabilitation (Adjunct) Baylor College of Medicine Houston TX
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Tani S, Tatli S, Hata N, Garcia-Rojas X, Olubiyi OI, Silverman SG, Tokuda J. Three-dimensional quantitative assessment of ablation margins based on registration of pre- and post-procedural MRI and distance map. Int J Comput Assist Radiol Surg 2016; 11:1133-42. [PMID: 27038962 DOI: 10.1007/s11548-016-1398-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/19/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Contrast-enhanced MR images are widely used to confirm the adequacy of ablation margin after liver ablation for early prediction of local recurrence. However, quantitative assessment of the ablation margin by comparing pre- and post-procedural images remains challenging. We developed and tested a novel method for three-dimensional quantitative assessment of ablation margin based on non-rigid image registration and 3D distance map. METHODS Our method was tested with pre- and post-procedural MR images acquired in 21 patients who underwent image-guided percutaneous liver ablation. The two images were co-registered using non-rigid intensity-based registration. After the tumor and ablation volumes were segmented, target volume coverage, percent of tumor coverage, and Dice similarity coefficient were calculated as metrics representing overall adequacy of ablation. In addition, 3D distance map around the tumor was computed and superimposed on the ablation volume to identify the area with insufficient margins. For patients with local recurrences, the follow-up images were registered to the post-procedural image. Three-dimensional minimum distance between the recurrence and the areas with insufficient margins was quantified. RESULTS The percent tumor coverage for all nonrecurrent cases was 100 %. Five cases had tumor recurrences, and the 3D distance map revealed insufficient tumor coverage or a 0-mm margin. It also showed that two recurrences were remote to the insufficient margin. CONCLUSIONS Non-rigid registration and 3D distance map allow us to quantitatively evaluate the adequacy of the ablation margin after percutaneous liver ablation. The method may be useful to predict local recurrences immediately following ablation procedure.
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Affiliation(s)
- Soichiro Tani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Surgery, Biomedical Innovation Center, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan.
| | - Servet Tatli
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Olutayo I Olubiyi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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