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Minami Y, Minami T, Ueshima K, Yagyu Y, Tsurusaki M, Okada T, Hori M, Kudo M, Murakami T. Three-Dimensional Radiological Assessment of Ablative Margins in Hepatocellular Carcinoma: Pilot Study of Overlay Fused CT/MRI Imaging with Automatic Registration. Cancers (Basel) 2021; 13:cancers13061460. [PMID: 33806751 PMCID: PMC8004695 DOI: 10.3390/cancers13061460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We investigate the feasibility of image fusion application for ablative margin assessment in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and possible causes for a wrong initial evaluation of technical success through a side-by-side comparison. METHODS A total of 467 patients with 1100 HCCs who underwent RFA were reviewed retrospectively. Seventeen patients developed local tumor progressions (LTPs) (median size, 1.0 cm) despite initial judgments of successful ablation referring to contrast-enhanced images obtained in the 24 h after ablation. The ablative margins were reevaluated radiologically by overlaying fused images pre- and post-ablation. RESULTS The initial categorizations of the 17 LTPs had been grade A (absolutely curative) (n = 5) and grade B (relatively curative) (n = 12); however, the reevaluation altered the response categories to eight grade C (margin-zero ablation) and nine grade D (existence of residual HCC). LTP occurred in eight patients re-graded as C within 4 to 30.3 months (median, 14.3) and in nine patients re-graded as D within 2.4 to 6.7 months (median, 4.2) (p = 0.006). Periablational hyperemia enhancements concealed all nine HCCs reevaluated as grade D. CONCLUSION Side-by-side comparisons carry a risk of misleading diagnoses for LTP of HCC. Overlay fused imaging technology can be used to evaluate HCC ablative margin with high accuracy.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
- Correspondence: ; Tel.: +81-72-366-0221 (ext. 3149); Fax: +81-72-367-2880
| | - Tomohiro Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Masakatsu Tsurusaki
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Hori
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
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Miyata A, Arita J, Kawaguchi Y, Hasegawa K, Kokudo N. Simulation and navigation liver surgery: an update after 2,000 virtual hepatectomies. Glob Health Med 2020; 2:298-305. [PMID: 33330824 PMCID: PMC7731191 DOI: 10.35772/ghm.2020.01045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 04/24/2023]
Abstract
The advent of preoperative 3-dimensional (3D) simulation software has made a variety of unprecedented surgical simulations possible. Since 2004, we have performed more than 2,000 preoperative simulations in the University of Tokyo Hospital, and they have enabled us to obtain a great deal of information, such as the detailed shape of liver segments, the precise volume of each segment, and the volume of hepatic venous drainage areas. As a result, we have been able to perform more aggressive and complicated surgery safely. The next step is to create a navigation system that will accurately reproduce the preoperative plan. Real-time virtual sonography (RVS) is a navigation system that provides fusion images of ultrasonography and reconstructed computed tomography images or magnetic resonance images. The RVS system facilitates the surgeon's understanding of interpretation of ultrasound images and the detection of tumors that are difficult to find by ultrasound alone. In the near future, surgical navigation systems may evolve to the point where they will be able to inform surgeons intraoperatively in real time about not only intrahepatic structures, such as vessels and tumors, but also the portal territory, hepatic vein drainage areas, and resection lines that have been planned preoperatively.
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Affiliation(s)
- Akinori Miyata
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
- Address correspondence to:Kiyoshi Hasegawa, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail:
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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Miyata A, Arita J, Shirata C, Abe S, Akamatsu N, Kaneko J, Kokudo N, Hasegawa K. Quantitative Assessment of the Accuracy of Real-Time Virtual Sonography for Liver Surgery. Surg Innov 2019; 27:60-67. [PMID: 31516065 DOI: 10.1177/1553350619875301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Real-time virtual sonography (RVS) is a navigation system for liver surgery. In this study, the degree of misalignment of intraoperative RVS images with computed tomographic (CT) images was measured. Methods. Between December 2014 and July 2015, intraoperative RVS was performed in a total of 33 patients undergoing liver surgery. Reconstructed CT images, rendered like intraoperative ultrasonographic (IOUS) images, were adjusted with the IOUS images and visualized side by side. The degree of misalignment between the reconstructed CT images and IOUS images was measured at anterior section, posterior section, and left liver in each patient. Furthermore, the time required for the adjustment was measured as the "adjustment time." Results. The degree of misalignment between the images could potentially be measured for a total of 96 points in the 33 patients. Of these, the actual measurement could not be conducted for 35 points due to poor visualization of the intrahepatic vasculature (n = 20) or to a large misalignment that hampered continuation of further adjustment (n = 15). The median degree of misalignment was 9.8 mm (range = 2.4-37.6 mm) in the right anterior section, 9.8 mm (range = 2.7-71.5 mm) in the right posterior section, and 9.5 mm (range = 0.9-37.6 mm) in the left liver. The median adjustment time was 105 seconds (range = 51-245 seconds). Conclusions. Although some misalignment occurred, it might be acceptable for selected situations. Further investigation is needed to reduce the frequency of adjustment failure.
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Affiliation(s)
- Akinori Miyata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chikara Shirata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Abe
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Management consensus guideline for hepatocellular carcinoma: 2016 updated by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2017; 117:381-403. [PMID: 29074347 DOI: 10.1016/j.jfma.2017.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. METHODS The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. RESULTS The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. CONCLUSION With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality.
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Kitai S, Kudo M, Nishida N, Izumi N, Sakamoto M, Matsuyama Y, Ichida T, Nakashima O, Matsui O, Ku Y, Kokudo N, Makuuchi M. Survival Benefit of Locoregional Treatment for Hepatocellular Carcinoma with Advanced Liver Cirrhosis. Liver Cancer 2016; 5:175-89. [PMID: 27493893 PMCID: PMC4960362 DOI: 10.1159/000367765] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) with decompensated liver cirrhosis (LC) is a life-threatening condition, which is amenable to liver transplantation (LT) as the standard first-line treatment. However, the application of LT can be limited due to a shortage of donor livers. This study aimed to clarify the effect of non-surgical therapy on the survival of patients with HCC and decompensated LC. METHODS Of the 58,886 patients with HCC registered in the nationwide survey of the Liver Cancer Study Group of Japan (January 2000-December 2005), we included 1,344 patients with primary HCC and Child-Pugh (C-P) grade C for analysis in this retrospective study. Among the patients analyzed, 108 underwent LT, 273 were treated by local ablation therapy (LAT), 370 were treated by transarterial chemoembolization (TACE), and 593 received best supportive care (BSC). The effect of LT, LAT, and TACE on overall survival (OS) was analyzed using multivariate and propensity score analyses. RESULTS Patient characteristics did not differ significantly between each treatment group and the BSC group, after propensity score matching. LAT (hazard ratio [HR]) =0.568; 95% confidence interval [CI], 0.40-0.80) and TACE (HR=0.691; 95% CI, 0.50-0.96) were identified as significant contributors to OS if the C-P score was less than 11 and tumor conditions met the Milan criteria. CONCLUSIONS For patients with HCC within the Milan criteria and with a C-P score of 10 or 11, locoregional treatment can be used as a salvage treatment if LT is not feasible.
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Affiliation(s)
- Satoshi Kitai
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | | | - Osamu Nakashima
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yonson Ku
- hDepartment of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masatoshi Makuuchi
- Department of Surgery, Japanese Red Cross Medical Center, Tokyo, Japan,*Masatoshi Kudo, MD, PhD, Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511 (Japan), Tel. +81 723 66 0221 (ext: 3149), E-Mail
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Hu Z, Zhu J, Liu F, Wang N, Xue Q. Feasibility of US-CT image fusion to identify the sources of abnormal vascularization in posterior sacroiliac joints of ankylosing spondylitis patients. Sci Rep 2015; 5:18356. [PMID: 26669847 PMCID: PMC4680934 DOI: 10.1038/srep18356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/17/2015] [Indexed: 12/12/2022] Open
Abstract
Ultrasound (US) can be used to evaluate the inflammatory activity of the sacroiliac joints (SIJs) in ankylosing spondylitis (AS) patients, but to precisely locate the abnormal vascularization observed on color Doppler US (CDUS) was difficult. To address this issue, we performed US and computed tomography (CT) fusion imaging of SIJs with 84 inpatients and 30 controls, and then assessed the sources of abnormal vascularization in the posterior SIJs of AS patients based on the fused images. Several possible factors impacting the fusion process were considered including the lesion classes of SIJ, the skinfold thickness of the sacral region and the cross-sectional levels of the first, second and third posterior sacral foramina. Our data showed high image fusion success rates at the 3 levels in the AS group (97.0%, 87.5% and 79.8%, respectively) and the control group (96.7%, 86.7%, and 86.7%, respectively).The skinfold thickness was identified as the main factor affecting the success rates. The successfully fused images revealed significant differences in the distribution of abnormal vascularization between 3 levels, as detected via CDUS (P = 0.011), which suggested that inflammation occurred in distinct tissues at different levels of the SIJ (intraligamentous inflammation in Regions 1 and 2; intracapsular inflammation in Region 3).
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Affiliation(s)
- Zhenlong Hu
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China.,Shanghai Institute of Ultrasound in Medicine, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Jiaan Zhu
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China.,Department of Ultrasound, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, People's Republic of China
| | - Fang Liu
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China.,Shanghai Institute of Ultrasound in Medicine, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Niansong Wang
- Department of Rheumatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Qin Xue
- Department of Rheumatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China
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Lee CH, Chen WT, Lin CC, Teng W, Lin SM, Chiu CT. Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations. Kaohsiung J Med Sci 2015; 31:413-9. [DOI: 10.1016/j.kjms.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 01/06/2023] Open
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Ogawa C, Minami Y, Morioka Y, Noda A, Arasawa S, Izuta M, Kubo A, Matsunaka T, Tamaki N, Shibatouge M, Kudo M. Virtual sonography for novice sonographers: usefulness of SYNAPSE VINCENT® with pre-check imaging of tumor location. Oncology 2014; 87 Suppl 1:50-4. [PMID: 25427733 DOI: 10.1159/000368145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the usefulness of a virtual ultrasound (US) imaging device as a tool to assist novice sonographers. MATERIALS AND METHODS A prospective blinded pilot study was conducted involving patients with liver lesions. Two sonographers and 2 medical doctors with less than 5 years of experience performed US examinations. The time needed to detect liver lesions on US and the success rate for detecting liver lesions with and without using the virtual US imaging device SYNAPSE VINCENT® (Fujifilm Medical Co., Tokyo, Japan) before US examination were evaluated. RESULTS Thirty-two patients with the following 42 liver lesions were included: liver cyst (n = 24), hemangioma (n = 8), hepatocellular carcinoma (n = 6), and liver metastasis (n = 4). The maximal diameter of these lesions ranged from 0.3 to 1.5 cm (mean ± SD, 0.8 ± 0.4). The average time for detecting liver lesions on US was 47.8 s (range, 7-113) with VINCENT and 112.9 s (range, 14-313) without VINCENT before US examination. There were significant differences in the duration of US examination with and without VINCENT (p = 0.0002, Student's t test). The rates for accurately detecting liver lesions were 100 and 76.2% (16/21) in US beginners with and without VINCENT, respectively. Significantly higher detection rates were found in the US beginners who used VINCENT compared to those who did not use VINCENT (p = 0.047, Fisher's exact test). CONCLUSION Before US examination, a reference with VINCENT could contribute to the successful detection of liver lesions and could be time-saving for US beginners.
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Affiliation(s)
- Chikara Ogawa
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan
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Minami T, Minami Y, Chishina H, Arizumi T, Takita M, Kitai S, Yada N, Inoue T, Hagiwara S, Ueshima K, Nishida N, Kudo M. Combination guidance of contrast-enhanced US and fusion imaging in radiofrequency ablation for hepatocellular carcinoma with poor conspicuity on contrast-enhanced US/fusion imaging. Oncology 2014; 87 Suppl 1:55-62. [PMID: 25427734 DOI: 10.1159/000368146] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of the combination guidance of contrast-enhanced US (CEUS) and fusion imaging in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) with poor conspicuity on B-mode US and CEUS/fusion imaging. MATERIALS AND METHODS We conducted a retrospective cohort study, which included 356 patients with 556 HCCs that were inconspicuous on B-mode US. A total of 192 patients with 344 HCCs, 123 patients with 155 HCCs, and 37 patients with 57 HCCs underwent RFA under CEUS guidance, fusion imaging guidance, and the combination of CEUS and fusion imaging guidance. RESULTS The average number of treatment sessions was 1.1 (range: 1-2) in the CEUS guidance group, 1.1 (range: 1-2) in the fusion imaging guidance group, and 1.1 (range: 1-3) in the combination of CEUS and fusion imaging guidance group. Treatment analysis did not reveal significantly more RFA treatment sessions in the combination guidance group than in the other groups (p = 0.97, Student's t test). During the follow-up period (1.1-85.3 months, mean ± SD, 43.2 ± 59.5), the 3-year local tumor progression rates were 4.9, 7.2, and 5.9% in the CEUS guidance group, the fusion imaging guidance group, and the combination guidance group, respectively (p = 0.84, log-rank test). CONCLUSION In spite of selection bias, session frequency and local tumor progression were not different under the combination guidance with CEUS and fusion imaging in RFA. The combination of fusion imaging and CEUS guidance in RFA therapy is an effective treatment for HCC with poor conspicuity on B-mode US and CEUS/fusion imaging.
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Affiliation(s)
- Tomohiro Minami
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan
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Minami Y, Kudo M. Ultrasound fusion imaging of hepatocellular carcinoma: a review of current evidence. Dig Dis 2014; 32:690-5. [PMID: 25376285 DOI: 10.1159/000368001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
With advances in technology, imaging techniques that entail fusion of sonography and CT or MRI have been introduced in clinical practice. Ultrasound fusion imaging provides CT or MRI cross-sectional multiplanar images that correspond to the sonographic images, and fusion imaging of B-mode sonography and CT or MRI can be displayed simultaneously and in real time according to the angle of the transducer. Ultrasound fusion imaging helps us understand the three-dimensional relationship between the liver vasculature and tumors, and can detect small liver tumors with poor conspicuity. This fusion imaging is attracting the attention of operators who perform radiofrequency ablation (RFA) for the treatment of hepatic malignancies because this real-time, multimodality comparison can increase monitoring and targeting confidence during the procedure. When RFA with fusion imaging was performed on small hepatocellular carcinomas (HCCs) with poor conspicuity, it was reported that the rates of technical success and local tumor progression were 94.4-100% and 0-8.3%. However, there have been no studies comparing fusion imaging guidance and contrast-enhanced sonography, CT or MRI guidance in ablation. Fusion imaging-guided RFA has proved to be effective for HCCs that are poorly defined on not only conventional B-mode sonography but also contrast-enhanced sonography. In addition, fusion imaging could be useful to assess the treatment response of RFA because of three-dimensional information. Here, we give an overview of the current status of ultrasound fusion imaging for clinical application in the liver.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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Kono M, Inoue T, Kudo M, Chishina H, Arizumi T, Takita M, Kitai S, Yada N, Hagiwara S, Minami Y, Ueshima K, Nishida N, Murakami T. Radiofrequency ablation for hepatocellular carcinoma measuring 2 cm or smaller: results and risk factors for local recurrence. Dig Dis 2014; 32:670-7. [PMID: 25376283 DOI: 10.1159/000367999] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the risk factors for local recurrence with radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) measuring ≤2 cm. METHODS This study involved 234 patients with 274 HCCs measuring ≤2 cm who had undergone RFA as the initial treatment. The mean tumor diameter was 1.478 cm. The median follow-up period was 829 days. We evaluated the post-RFA cumulative local recurrence rate and analyzed the risk factors contributing to clinical outcomes. RESULTS Cumulative local recurrence rates were 9, 19 and 19% at 1, 2 and 3 years, respectively. Among the 145 cases with a complete safety margin (SM) after RFA, only 4 developed local tumor recurrence and the cumulative rates of local tumor recurrence at 1, 2 and 3 years were 2, 3 and 3%, respectively. Among the 129 cases with incomplete SM, local tumor recurrence developed in 34 and the cumulative rates of local tumor progression at 1, 2 and 3 years were 14, 36 and 36%, respectively. In multivariate analysis, significant risk factors were tumor location (liver surface), irregular gross type and SM <5 mm. CONCLUSION Even with HCC measuring ≤2 cm, location and gross type of tumor should be carefully evaluated before RFA is performed.
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Affiliation(s)
- Masashi Kono
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan
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Franz AM, Haidegger T, Birkfellner W, Cleary K, Peters TM, Maier-Hein L. Electromagnetic tracking in medicine--a review of technology, validation, and applications. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1702-1725. [PMID: 24816547 DOI: 10.1109/tmi.2014.2321777] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without line-of-sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.
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Sofuni A, Itoi T, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Tanaka R, Umeda J, Tonozuka R, Honjo M, Mukai S, Moriyasu F. Real-time virtual sonography visualization and its clinical application in biliopancreatic disease. World J Gastroenterol 2013; 19:7419-7425. [PMID: 24259973 PMCID: PMC3831224 DOI: 10.3748/wjg.v19.i42.7419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/14/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the usefulness of real-time virtual sonography (RVS) in biliary and pancreatic diseases.
METHODS: This study included 15 patients with biliary and pancreatic diseases. RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography (CT) image, using pre-scanned CT volume data. The ultrasound used was EUB-8500 with a convex probe EUP-C514. The RVS images were evaluated based on 3 levels, namely, excellent, good and poor, by the displacement in position.
RESULTS: By combining the objectivity of CT with free scanning using RVS, it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures. The resulting evaluation levels of the RVS images were 12 excellent (pancreatic cancer, bile duct cancer, cholecystolithiasis and cholangiocellular carcinoma) and 3 good (pancreatic cancer and gallbladder cancer). Compared with conventional B-mode ultrasonography and CT, RVS images achieved a rate of 80% superior visualization and 20% better visualization.
CONCLUSION: RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.
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Salomon LJ, Bernard JP, Millischer AE, Sonigo P, Brunelle F, Boddaert N, Ville Y. MRI and ultrasound fusion imaging for prenatal diagnosis. Am J Obstet Gynecol 2013; 209:148.e1-9. [PMID: 23685001 DOI: 10.1016/j.ajog.2013.05.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/14/2013] [Accepted: 05/14/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE A combination of magnetic resonance imaging (MRI) images with real time high-resolution ultrasound known as fusion imaging may improve prenatal examination. This study was undertaken to evaluate the feasibility of using fusion of MRI and ultrasound (US) in prenatal imaging. STUDY DESIGN This study was conducted in a tertiary referral center. All patients referred for prenatal MRI were offered to undergo fusion of MRI and US examination. All cases underwent 1.5 Tesla MRI protocol including at least 3 T2-weighted planes. The Digital Imaging and Communications in Medicine volume dataset was then loaded into the US system for manual registration of the live US image and fusion imaging examination. RESULTS Over the study period, 24 patients underwent fusion imaging at a median gestational age of 31 (range, 24-35) weeks. Data registration, matching and then volume navigation was feasible in all cases. Fusion imaging allowed superimposing MRI and US images therefore providing with real time imaging capabilities and high tissue contrast. It also allowed adding a real time Doppler signal on MRI images. Significant fetal movement required repeat-registration in 15 (60%) cases. The average duration of the overall additional scan with fusion imaging was 10 ± 5 minutes. CONCLUSION The combination of fetal real time MRI and US image fusion and navigation is feasible. Multimodality fusion imaging may enable easier and more extensive prenatal diagnosis.
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Tomonari A, Tsuji K, Yamazaki H, Aoki H, Kang JH, Kodama Y, Sakurai Y, Maguchi H. Feasibility of fused imaging for the evaluation of radiofrequency ablative margin for hepatocellular carcinoma. Hepatol Res 2013. [PMID: 23198863 DOI: 10.1111/hepr.12022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the feasibility of fusion of conventional imaging modalities to facilitate assessment of ablative margin of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). METHODS Two hundred and thirty-nine liver lesions in 109 patients underwent percutaneous RFA under ultrasound for HCC from January 2008 to December 2010. Within these patients, 13 lesions in 12 patients who developed local tumor progression in the follow-up period of at least 8 months were retrospectively reviewed. Imaging obtained before and after RFA was used for creating fused images on a workstation. Ablative margins were assessed using only axial images, and with fused images. RESULTS The ablative margin was assessed as sufficient in all 13 lesions using side-by-side axial images; however, all lesions were assessed as insufficient with fused imaging evaluation. The reason for the discrepancy of the assessment results were differences in the respiratory dislocation of the liver in the pre- and post-RFA images in eight lesions (61.5%), and rotational displacement of the liver and the torso in five (38.5%). The site of local tumor recurrence relative to the HCC lesion was craniocaudal in 12 lesions, dorsoventral in seven and lateral in seven. In all lesions, the site of local tumor recurrence was congruent with the area of the thinnest ablative margin. CONCLUSION Assessment of ablative margin with fused imaging revealed insufficiency of ablation previously evaluated as sufficient with conventional axial imaging. Fused imaging evaluation has proved to be an accurate and useful tool for the assessment of RFA margins.
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Affiliation(s)
- Akiko Tomonari
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
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Abstract
OBJECTIVE The aim of our article is to give an overview of the current and future possibilities of real-time image fusion involving ultrasound. We present a review of the existing English-language peer-reviewed literature assessing this technique, which covers technical solutions (for ultrasound and endoscopic ultrasound), image fusion in several anatomic regions, and electromagnetic needle tracking. CONCLUSION The recent progress of real-time ultrasound in image fusion may provide several new possibilities, including diagnosis, treatment, and follow-up of oncologic patients.
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Abstract
Hepatocellular carcinoma (HCC) is the second commonest cancer in Taiwan. The national surveillance program can detect HCC in its early stages, and various curative modalities (including surgical resection, orthotopic liver transplantation, and local ablation) are employed for the treatment of small HCC. Local ablation therapies are currently advocated for early-stage HCC that is unresectable because of co-morbidities, the need to preserve liver function, or refusal of resection. Among the various local ablation therapies, the most commonly used modalities include percutaneous ethanol injection and radiofrequency ablation (RFA); percutaneous acetic acid injection and microwave ablation are used less often. RFA is more commonly employed than other local ablative modalities in Taiwan because the technique is highly effective, minimally invasive, and requires fewer sessions. RFA is therefore advocated in Taiwan as the first-line curative therapy for unresectable HCC or even for resectable HCC. However, current RFA procedures are less effective against tumors that are in high-risk or difficult-to-ablate locations, are poorly visualized on ultrasonography (US), or are large. Recent advancements in RFA in Taiwan can resolve these issues by the creation of artificial ascites or pleural effusion, application of real-time virtual US assistance, use of combination therapy before RFA, or use of switching RF controllers with multiple electrodes. This review article provides updates on the clinical outcomes and advances in local ablative modalities (mostly RFA) for HCC in Taiwan.
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Affiliation(s)
- Shi-Ming Lin
- *Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, College of Medicine, Chang Gung Memorial Hospital and Chang Gung University 5 Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan 333 (ROC), Tel.+886 3 3281200 Ext. 8107, E-Mail ;
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Lin SM. Ultrasonography-Guided Radiofrequency Ablation in Hepatocellular Carcinoma: Current Status and Future Perspectives. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Appelbaum L, Solbiati L, Sosna J, Nissenbaum Y, Greenbaum N, Goldberg SN. Evaluation of an electromagnetic image-fusion navigation system for biopsy of small lesions: assessment of accuracy in an in vivo swine model. Acad Radiol 2013; 20:209-17. [PMID: 23395242 DOI: 10.1016/j.acra.2012.09.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the accuracy of a novel combined electromagnetic (EM) navigation/image fusion system for biopsy of small lesions. MATERIALS AND METHODS Using ultrasound (US) guidance, metallic (2 × 1 mm) targets were imbedded in the paraspinal muscle (n = 28), kidney (n = 18), and liver (n = 4) of four 55- to 65-kg pigs. Baseline helical computed tomography (CT) imaging (Brilliance; Philips) identified these biopsy targets and six and nine cutaneous fiducial markers. CT data were imported into a MyLab Twice system (Esaote, Genoa, Italy) for CT/US image fusion. After verification of successful image fusion, baseline registration error and respiratory motion error were assessed by documenting deviation of the US and CT position of the targets in real time. Biopsy targeting was subsequently performed under conditions of normal respiratory using 15-cm 16G eTrax needles (Civco). To mimic the conditions of poor US visualization, only reconstructed CT information was displayed during biopsy. Accuracy of targeting was measured by repeat CT scanning as the distance of the needle tip to the target center. Targeting accuracy of free-hand vs. guided technique, and electromagnetic (EM) sensor positioning (ie, on the hub or within the needle stylus tip) were evaluated. RESULTS In muscle, needle registration error was 0.9 ± 1.2 mm and respiratory motion error 4.0 ± 1.0 mm. Target accuracy was 4.0 ± 3.2 mm when an EM sensor was imbedded in the needle tip. Yet, with the EM sensor back on the needle hub, greater targeting accuracy was achieved using an US guide (3.2 ± 1.6 mm) vs. freehand (5.7 ± 3.2 mm, P = .04). For kidney, registration error was 1.8 ± 1.7 mm and respiratory motion error 4.9 ± 1.0 mm. For the deeper kidney targets, target accuracy was 4.4 ± 3.2 mm with a tip EM sensor, which was an improvement over the hub EM sensor positioning (9.3 ± 4.6 mm; P < .01). An additional source of fusion error was noted for liver. Beyond 17 ± 1 mm of respiratory motion, targets were observed to move >3 cm with US transducer/needle compression resulting in 14 ± 1.4 mm targeting accuracy. CONCLUSIONS A combined image-fusion/EM tracking platform can provide a high degree of needle placement accuracy (<5 mm) when targeting small lesions. Results fall within accuracy of respiratory error; with best results obtained by incorporating an EM sensor into the tip of the biopsy system.
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Affiliation(s)
- Liat Appelbaum
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120.
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Makino Y, Imai Y, Igura T, Ohama H, Kogita S, Sawai Y, Fukuda K, Ohashi H, Murakami T. Usefulness of the multimodality fusion imaging for the diagnosis and treatment of hepatocellular carcinoma. Dig Dis 2012; 30:580-7. [PMID: 23258098 DOI: 10.1159/000343070] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A multimodality fusion imaging system has been introduced for the clinical practice of diagnosis and treatment of hepatocellular carcinoma (HCC), especially for loco-regional treatment. An ultrasonography (US) fusion imaging system can provide a side-by-side display of real-time US images and any cross-sectional images of multiplanar reconstruction of CT or MRI that synchronize real-time US. The US fusion imaging system enables us to perform radiofrequency ablation (RFA) for HCCs difficult to detect on conventional US safely. Besides, we can evaluate the treatment effects of RFA easily at the bedside by combining the contrast-enhanced US and the US fusion imaging system. Fusion images of pre- and post-RFA CT have been utilized for the assessment of the treatment effects of RFA. Although the treatment effects of RFA have been conventionally evaluated, comparing pre- and post-RFA CT side-by-side, the evaluation tends to be inaccurate. On CT fusion images, the tumor and the ablation zone are overlaid and we can grasp the positional relation easily, leading to quantitative and more accurate evaluation. The multimodality fusion imaging system has become quite an important tool for loco-regional treatment of HCC because of its usefulness for both the guidance during the RFA procedure and the evaluation of its treatment effects.
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Affiliation(s)
- Yuki Makino
- Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18 Johnan, Ikeda, Osaka, Japan
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