Ultrasound fusion imaging

Advanced multiparametric MRI and FDG-PET/CT in multinodular and vacuolating neuronal tumor: A pathologically confirmed case

Multinodular and vacuolating neuronal tumor (MVNT) is a relatively new disease concept proposed in 2013 and was classified as a separate tumor type in 2021 by the World Health Organization (WHO) classification. MVNT can cause seizures but is a benign disease, with no cases of enlargement or postoperative recurrence reported. Recent reports described advanced MRI features in MVNT cases, but the diagnosis of MVNT is usually based on characteristic MRI findings of clusters of nodules. Here, we report advanced multiparametric MRI and FDG-PET/CT findings in a case of MVNT with epileptiform symptoms that was pathologically confirmed by surgery.

Usefulness of ultrasound fusion technology for hepatocellular carcinoma localisation, pre- and post-thermal ablation

INTRODUCTION

Percutaneous thermal ablation of inconspicuous lesions can be challenging. Fusion ultrasound (FUS) allows the use of previously performed diagnostic imaging like computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET-CT) to localise hepatocellular carcinoma (HCC) for treatment. This paper illustrates FUS case studies of pre-, intra- and post-ablation imaging of inconspicuous HCC, supplemented by use of contrast-enhanced ultrasound (CEUS).

METHOD

Four prospective cases during September 2014 to October 2018, with HCC amenable to ablation, which were poorly identified on ultrasound, underwent FUS. FUS pre-screening was scheduled within three months of the previous CT or MRI, and between one to four weeks prior to the scheduled ablation date. Post-ablation imaging with FUS was performed between four to six weeks to coincide with their routine follow-up CT or MRI.

FINDINGS

There were potential benefits observed in the cases with combined techniques of FUS and CEUS for limiting circumstances such as heat sink effect, multiple lesions targeting, inconspicuous lesion detection and pre-ablation technical feasibility assessment.

DISCUSSION

The combined use of FUS and CEUS improves tumour visibility, increases operator imaging confidence and reduces heat sink effect during percutaneous thermal ablation.

CONCLUSION

FUS imaging is helpful in targeting poor conspicuity lesions that cannot be detected on grey-scale ultrasound. It facilitates in ensuring optimal treatment of hepatic lesions for improvement of patient prognosis and follow-up imaging.

Novel Magnetic Elastic Phase-Change Nanodroplets as Dual Mode Contrast Agent for Ultrasound and Magnetic Resonance Imaging

Recently, dual-mode imaging systems merging magnetic resonance imaging (MRI) and ultrasound (US) have been developed. Designing a dual-mode contrast agent is complex due to different mechanisms of enhancement. Herein, we describe novel phase change nanodroplets (PCNDs) with perfluoropentane encapsulated in a pre-polyglycerol sebacate (pre-PGS) shell loaded with polyethylene glycol (PEG)-coated iron oxide nanoparticles as having a dual-mode contrast agent effect. Iron oxide nanoparticles were prepared via the chemical co-precipitation method and PCNDs were prepared via the solvent displacement technique. PCNDs showed excellent enhancement in the in vitro US much more than Sonovue^® microbubbles. Furthermore, they caused a susceptibility effect resulting in a reduction of signal intensity on MRI. An increase in the concentration of nanoparticles caused an increase in the MR contrast effect but a reduction in US intensity. The concentration of nanoparticles in a shell of PCNDs was optimized to obtain a dual-mode contrast effect. Biocompatibility, hemocompatibility, and immunogenicity assays showed that PCNDs were safe and non-immunogenic. Another finding was the dual-mode potential of unloaded PCNDs as T1 MR and US contrast agents. Results suggest the excellent potential of these PCNDs for use as dual-mode contrast agents for both MRI and US.

Electromagnetic tracking-based ultrasound/computed tomography fusion imaging in dogs: preliminary application to ocular and periocular regions

In ultrasound/computed tomography (CT) fusion images, ultrasound allows visualization of the target in real time. CT provides a navigation for ultrasound scanning and improves the overview in areas of limited visualization with ultrasound. This study was performed to investigate the feasibility of ultrasound/CT fusion based on an electromagnetic tracking technique using external fiducial markers for canine ocular and periocular regions. In 7 Beagle dogs, contrast-enhanced CT images of the head were obtained with placing external fiducial markers over the frontal region and both sides of the forepaws of the dog. Ultrasonography was performed under a magnetic field by installing a position sensor in the linear probe, without changing the dog's position. The positions of the external fiducial markers were adjusted and matched, based on the CT images. The execution time of co-registration and the distance between the regions of interest and the co-registration points, the frontal bone, cornea, retina, and optic nerve, were estimated. Approximately 60% of external fiducial markers were properly recognized in all dogs. After adjustment, all external fiducial markers were precisely matched. The co-registration execution time was less than 1 min. The distances between the regions of interest and co-registration points were less than 3 mm in all dogs. The electromagnetic tracking technique using external fiducial markers was a simple and applicable method for fusion imaging of a canine head using real-time ultrasonography and CT. This technique can be useful for interventional procedures of retrobulbar and periorbital lesions.

Two-dimensional ultrasound-computed tomography image registration for monitoring percutaneous hepatic intervention

PURPOSE

Deformable registration of ultrasound (US) and contrast enhanced computed tomography (CECT) images are essential for quantitative comparison of ablation boundaries and dimensions determined using these modalities. This comparison is essential as stiffness-based imaging using US has become popular and offers a nonionizing and cost-effective imaging modality for monitoring minimally invasive microwave ablation procedures. A sensible manual registration method is presented that performs the required CT-US image registration.

METHODS

The two-dimensional (2D) virtual CT image plane that corresponds to the clinical US B-mode was obtained by "virtually slicing" the 3D CT volume along the plane containing non-anatomical landmarks, namely points along the microwave ablation antenna. The initial slice plane was generated using the vector acquired by rotating the normal vector of the transverse (i.e., xz) plane along the angle subtended by the antenna. This plane was then further rotated along the ablation antenna and shifted along with the direction of normal vector to obtain similar anatomical structures, such as the liver surface and vasculature that is visualized on both the CT virtual slice and US B-mode images on 20 patients. Finally, an affine transformation was estimated using anatomic and non-anatomic landmarks to account for distortion between the colocated CT virtual slice and US B-mode image resulting in a final registered CT virtual slice. Registration accuracy was measured by estimating the Euclidean distance between corresponding registered points on CT and US B-mode images.

RESULTS

Mean and SD of the affine transformed registration error was 1.85 ± 2.14 (mm), computed from 20 coregistered data sets.

CONCLUSIONS

Our results demonstrate the ability to obtain 2D virtual CT slices that are registered to clinical US B-mode images. The use of both anatomical and non-anatomical landmarks result in accurate registration useful for validating ablative margins and comparison to electrode displacement elastography based images.