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Heshmat A, O’Connor CS, Albuquerque Marques Silva J, Paolucci I, Jones AK, Odisio BC, Brock KK. Using Patient-Specific 3D Modeling and Simulations to Optimize Microwave Ablation Therapy for Liver Cancer. Cancers (Basel) 2024; 16:2095. [PMID: 38893214 PMCID: PMC11171243 DOI: 10.3390/cancers16112095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Microwave ablation (MWA) of liver tumors presents challenges like under- and over-ablation, potentially leading to inadequate tumor destruction and damage to healthy tissue. This study aims to develop personalized three-dimensional (3D) models to simulate MWA for liver tumors, incorporating patient-specific characteristics. The primary objective is to validate the predicted ablation zones compared to clinical outcomes, offering insights into MWA before therapy to facilitate accurate treatment planning. Contrast-enhanced CT images from three patients were used to create 3D models. The simulations used coupled electromagnetic wave propagation and bioheat transfer to estimate the temperature distribution, predicting tumor destruction and ablation margins. The findings indicate that prolonged ablation does not significantly improve tumor destruction once an adequate margin is achieved, although it increases tissue damage. There was a substantial overlap between the clinical ablation zones and the predicted ablation zones. For patient 1, the Dice score was 0.73, indicating high accuracy, with a sensitivity of 0.72 and a specificity of 0.76. For patient 2, the Dice score was 0.86, with a sensitivity of 0.79 and a specificity of 0.96. For patient 3, the Dice score was 0.8, with a sensitivity of 0.85 and a specificity of 0.74. Patient-specific 3D models demonstrate potential in accurately predicting ablation zones and optimizing MWA treatment strategies.
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Affiliation(s)
- Amirreza Heshmat
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (C.S.O.); (A.K.J.); (K.K.B.)
| | - Caleb S. O’Connor
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (C.S.O.); (A.K.J.); (K.K.B.)
| | - Jessica Albuquerque Marques Silva
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (J.A.M.S.); (I.P.); (B.C.O.)
| | - Iwan Paolucci
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (J.A.M.S.); (I.P.); (B.C.O.)
| | - Aaron Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (C.S.O.); (A.K.J.); (K.K.B.)
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (J.A.M.S.); (I.P.); (B.C.O.)
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (C.S.O.); (A.K.J.); (K.K.B.)
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He B, Zhao S, Dai Y, Wu J, Luo H, Guo J, Ni Z, Wu T, Kuang F, Jiang H, Zhang Y, Jia F. A robust and automatic CT-3D ultrasound registration method based on segmentation, context, and edge hybrid metric. Med Phys 2023; 50:6243-6258. [PMID: 36975007 DOI: 10.1002/mp.16396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The fusion of computed tomography (CT) and ultrasound (US) image can enhance lesion detection ability and improve the success rate of liver interventional radiology. The image-based fusion methods encounter the challenge of registration initialization due to the random scanning pose and limited field of view of US. Existing automatic methods those used vessel geometric information and intensity-based metric are sensitive to parameters and have low success rate. The learning-based methods require a large number of registered datasets for training. PURPOSE The aim of this study is to provide a fully automatic and robust US-3D CT registration method without registered training data and user-specified parameters assisted by the revolutionary deep learning-based segmentation, which can further be used for preparing training samples for the study of learning-based methods. METHODS We propose a fully automatic CT-3D US registration method by two improved registration metrics. We propose to use 3D U-Net-based multi-organ segmentation of US and CT to assist the conventional registration. The rigid transform is searched in the space of any paired vessel bifurcation planes where the best transform is decided by a segmentation overlap metric, which is more related to the segmentation precision than Dice coefficient. In nonrigid registration phase, we propose a hybrid context and edge based image similarity metric with a simple mask that can remove most noisy US voxels to guide the B-spline transform registration. We evaluate our method on 42 paired CT-3D US datasets scanned with two different US devices from two hospitals. We compared our methods with other exsiting methods with both quantitative measures of target registration error (TRE) and the Jacobian determinent with paired t-test and qualitative registration imaging results. RESULTS The results show that our method achieves fully automatic rigid registration TRE of 4.895 mm, deformable registration TRE of 2.995 mm in average, which outperforms state-of-the-art automatic linear methods and nonlinear registration metrics with paired t-test's p value less than 0.05. The proposed overlap metric achieves better results than self similarity description (SSD), edge matching (EM), and block matching (BM) with p values of 1.624E-10, 4.235E-9, and 0.002, respectively. The proposed hybrid edge and context-based metric outperforms context-only, edge-only, and intensity statistics-only-based metrics with p values of 0.023, 3.81E-5, and 1.38E-15, respectively. The 3D US segmentation has achieved mean Dice similarity coefficient (DSC) of 0.799, 0.724, 0.788, and precision of 0.871, 0.769, 0.862 for gallbladder, vessel, and branch vessel, respectively. CONCLUSIONS The deep learning-based US segmentation can achieve satisfied result to assist robust conventional rigid registration. The Dice similarity coefficient-based metrics, hybrid context, and edge image similarity metric contribute to robust and accurate registration.
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Affiliation(s)
- Baochun He
- Center for Medical AI, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Sheng Zhao
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanmei Dai
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiaqi Wu
- Department of Inpatient Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huoling Luo
- Center for Medical AI, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jianxi Guo
- Department of Interventional Radiology, Shenzhen People's Hospital, Shenzhen, China
| | - Zhipeng Ni
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, China
| | - Tianchong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Shenzhen, China
| | - Fangyuan Kuang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Huijie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanfang Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital, Shenzhen, China
| | - Fucang Jia
- Center for Medical AI, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
- Pazhou Lab, Guangzhou, China
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Verdonschot KHM, Arts S, Van den Boezem PB, de Wilt JHW, Fütterer JJ, Stommel MWJ, Overduin CG. Ablative margins in percutaneous thermal ablation of hepatic tumors: a systematic review. Expert Rev Anticancer Ther 2023; 23:977-993. [PMID: 37702571 DOI: 10.1080/14737140.2023.2247564] [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: 02/28/2023] [Accepted: 08/09/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION This study aims to systematically review current evidence on ablative margins and correlation to local tumor progression (LTP) after thermal ablation of hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM). METHODS A systematic search was performed in PubMed (MEDLINE) and Web of Science to identify all studies that reported on ablative margins (AM) and related LTP rates. Studies were assessed for risk of bias and synthesized separately per tumor type. Where possible, results were pooled to calculate risk differences (RD) as function of AM. RESULTS In total, 2910 articles were identified of which 43 articles were eligible for final analysis. There was high variability in AM measurement methodology across studies in terms of measurement technique, imaging modalities, and timing. Most common margin stratification was < 5 mm and > 5 mm, for which data were available in 25/43 studies (58%). Of these, all studies favored AM > 5 mm to reduce the risk of LTP, with absolute RD of 16% points for HCC and 47% points for CRLM as compared to AM < 5 mm. CONCLUSIONS Current evidence supports AM > 5 mm to reduce the risk of LTP after thermal ablation of HCC and CRLM. However, standardization of AM measurement and reporting is critical to allow future meta-analyses and improved identification of optimal threshold value for clinical use.
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Affiliation(s)
- K H M Verdonschot
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Arts
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P B Van den Boezem
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J J Fütterer
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
- The Robotics and Mechatronics research group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - M W J Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C G Overduin
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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Crespo E, Hermosín A, Villalba Á, Daguer E, Flores J, Periañez J, Martínez-Galdámez M, Santos E. Uncooled TATO microwave system for liver ablation. Hepat Oncol 2023; 9:HEP46. [PMID: 37009421 PMCID: PMC10064260 DOI: 10.2217/hep-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
Aim: To evaluate the safety and efficacy of uncooled TATO microwave ablation (MWA) for primary and metastatic liver cancer. Materials & methods: This was a retrospective study on percutaneous liver ablations performed with TATO MWA. Twenty-five ablations were performed; 11 (44%) were performed for hepatocellular carcinoma, 14 (56%) for colorectal carcinoma, gastric and pancreatic metastases. Results: Adverse events were reported only in one (4%) ablation: an abscess that was observed in the ablated area and was resolved with a percutaneous drainage and antibiotic therapy. Local tumor control rate was 92% at the 3-month follow-up. Conclusion: TATO MWA was safe and effective with high reproducibility in treating primary and secondary liver cancer with satisfactory technical and clinical outcomes.
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Affiliation(s)
- Eduardo Crespo
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Hermosín
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Villalba
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo Daguer
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - José Flores
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Periañez
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Mario Martínez-Galdámez
- Department of Vascular & Interventional Radiology, Hospital Clínico Universitario de Valladolid, Spain
| | - Ernesto Santos
- Vascular & Interventional Radiology at Memorial Sloan Kettering Cancer Center, NY 10065, USA
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Shi Q, Zhou X, Zhang Z, Zhang W, Ma J, Yang M, Yu J, Luo J, Liu L, Yan Z. Microwave ablation and synchronous transarterial chemoembolization combined with PD-1 inhibitor in patients with hepatocellular carcinoma following tyrosine kinase inhibitor intolerance. Front Immunol 2023; 13:1097625. [PMID: 36703965 PMCID: PMC9871779 DOI: 10.3389/fimmu.2022.1097625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine the safety and efficacy of microwave ablation (MWA) and synchronous transarterial chemoembolization (TACE) combined with or without PD-1 inhibitor in patients with hepatocellular carcinoma (HCC) following tyrosine kinase inhibitor (TKI) intolerance. Materials and methods This study retrospectively enrolled TKI-intolerant HCC patients who underwent MWA-TACE combined with PD-1 inhibitor (MTP) or MWA-TACE (MT) from January 2019 to June 2021. MWA and TACE were performed simultaneously, and PD-1 inhibitor was administered intravenously at a dose of 200 mg once every three weeks after MWA-TACE. Adverse events (AEs) related to treatment were recorded during the follow-up. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups. Results A total of 87 patients were included and classified into the MTP group (n =42) and MT group (n=45). Complications related to MWA-TACE in the MTP group were similar to that in the MT group (21.4% vs. 24.4%, P = 0.738). Moreover, 35 (83.3%) patients had eighty-four AEs related to PD-1 inhibitor in the MTP group, and 8 (19.0%) patients developed grade 3. Patients who underwent MWA-TACE combined with PD-1 inhibitor had better PFS (median, 10.0 vs. 4.7 months, P < 0.001) and OS (median, 17.0 vs. 8.5 months, P < 0.001) than those who underwent MWA-TACE alone. Treatment method and Child-Pugh class were independent prognostic factors for survival in the univariate and multivariate analysis. Conclusion MWA and synchronous TACE combined with PD-1 inhibitor might be a favorable treatment option in TKI-intolerant HCC patients.
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Affiliation(s)
- Qin Shi
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaze Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Lingxiao Liu, ; Zhiping Yan,
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Lingxiao Liu, ; Zhiping Yan,
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Sebek J, Park WKC, Geimer S, Van Citters DW, Farah A, Dupuy DE, Meaney PM, Prakash P. Computational modeling of microwave ablation with thermal accelerants. Int J Hyperthermia 2023; 40:2255755. [PMID: 37710404 DOI: 10.1080/02656736.2023.2255755] [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: 03/30/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE To develop a computational model of microwave ablation (MWA) with a thermal accelerant gel and apply the model toward interpreting experimental observations in ex vivo bovine and in vivo porcine liver. METHODS A 3D coupled electromagnetic-heat transfer model was implemented to characterize thermal profiles within ex vivo bovine and in vivo porcine liver tissue during MWA with the HeatSYNC thermal accelerant. Measured temperature dependent dielectric and thermal properties of the HeatSYNC gel were applied within the model. Simulated extents of MWA zones and transient temperature profiles were compared against experimental measurements in ex vivo bovine liver. Model predictions of thermal profiles under in vivo conditions in porcine liver were used to analyze thermal ablations observed in prior experiments in porcine liver in vivo. RESULTS Measured electrical conductivity of the HeatSYNC gel was ∼83% higher compared to liver at room temperature, with positive linear temperature dependency, indicating increased microwave absorption within HeatSYNC gel compared to tissue. In ex vivo bovine liver, model predicted ablation zone extents of (31.5 × 36) mm with the HeatSYNC, compared to (32.9 ± 2.6 × 40.2 ± 2.3) mm in experiments (volume differences 4 ± 4.1 cm3). Computational models under in vivo conditions in porcine liver suggest approximating the HeatSYNC gel spreading within liver tissue during ablations as a plausible explanation for larger ablation zones observed in prior in vivo studies. CONCLUSION Computational models of MWA with thermal accelerants provide insight into the impact of accelerant on MWA, and with further development, could predict ablations with a variety of gel injection sites.
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Affiliation(s)
- Jan Sebek
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, USA
| | | | - Shireen Geimer
- Expeditionary School at Black River, Ludlow, Vermont, USA
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | | | | | | | - Paul M Meaney
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, USA
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Abdalla M, Collings AT, Dirks R, Onkendi E, Nelson D, Ozair A, Miraflor E, Rahman F, Whiteside J, Shah MM, Ayloo S, Abou-Setta A, Sucandy I, Kchaou A, Douglas S, Polanco P, Vreeland T, Buell J, Ansari MT, Pryor AD, Slater BJ, Awad Z, Richardson W, Alseidi A, Jeyarajah DR, Ceppa E. Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis. Surg Endosc 2022; 37:3340-3353. [PMID: 36542137 DOI: 10.1007/s00464-022-09815-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the two most common malignant neoplasms of the liver. The objective of this study was to assess outcomes of surgical approaches to liver ablation comparing laparoscopic versus percutaneous microwave ablation (MWA), and MWA versus radiofrequency ablation (RFA) in patients with HCC or CRLM lesions smaller than 5 cm. METHODS A systematic review was conducted across seven databases, including PubMed, Embase, and Cochrane, to identify all comparative studies between 1937 and 2021. Two independent reviewers screened for eligibility, extracted data for selected studies, and assessed study bias using the modified Newcastle Ottawa Scale. Random effects meta-analyses were subsequently performed on all available comparative data. RESULTS From 1066 records screened, 11 studies were deemed relevant to the study and warranted inclusion. Eight of the 11 studies were at high or uncertain risk for bias. Our meta-analyses of two studies revealed that laparoscopic MW ablation had significantly higher complication rates compared to a percutaneous approach (risk ratio = 4.66; 95% confidence interval = [1.23, 17.22]), but otherwise similar incomplete ablation rates, local recurrence, and oncologic outcomes. The remaining nine studies demonstrated similar efficacy of MWA and RFA, as measured by incomplete ablation, complication rates, local/regional recurrence, and oncologic outcomes, for both HCC and CRLM lesions less than 5 cm (p > 0.05 for all outcomes). There was no statistical subgroup interaction in the analysis of tumors < 3 cm. CONCLUSION The available comparative evidence regarding both laparoscopic versus percutaneous MWA and MWA versus RFA is limited, evident by the few studies that suffer from high/uncertain risk of bias. Additional high-quality randomized trials or statistically matched cohort studies with sufficient granularity of patient variables, institutional experience, and physician specialty/training will be useful in informing clinical decision making for the ablative treatment of HCC or CRLM.
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Affiliation(s)
- Moustafa Abdalla
- Department of Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences, Lubbock, TX, USA
| | - Daniel Nelson
- Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Ahmad Ozair
- King George's Medical University, Chowk, Lucknow, India
| | - Emily Miraflor
- Department of Surgery, University of California, San Francisco - East Bay, CA, USA
| | - Faique Rahman
- Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Subhashini Ayloo
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmed Abou-Setta
- Knowledge Synthesis, University of Manitoba, Winnipeg, MB, Canada
| | - Iswanto Sucandy
- Department of Surgery, University of Central Florida, Tampa, FL, USA
| | - Ali Kchaou
- Department of Surgery, University of Sfax, Sfax, Tunisia
| | | | - Patricio Polanco
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Center, Houston, TX, USA
| | - Joseph Buell
- Department of Surgery and Pediatrics, Tulane University, New Orleans, LA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Aurora D Pryor
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, TX, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
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Zakaria UMU, Mustaza SM, Zaman MHM, Rahni AAA. Development of Real-Time Contact Force Control of a Collaborative Robot for Automated Ultrasound Scanning. 2022 IEEE-EMBS CONFERENCE ON BIOMEDICAL ENGINEERING AND SCIENCES (IECBES) 2022. [DOI: 10.1109/iecbes54088.2022.10079599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Ungku M.Z. Ungku Zakaria
- Universiti Kebangsaan Malaysia,Faculty of Engineering & Built Environment,Bangi,Selangor,Malaysia,43600
| | - Seri M. Mustaza
- Universiti Kebangsaan Malaysia,Faculty of Engineering & Built Environment,Bangi,Selangor,Malaysia,43600
| | - Mohd H. Mohd Zaman
- Universiti Kebangsaan Malaysia,Faculty of Engineering & Built Environment,Bangi,Selangor,Malaysia,43600
| | - Ashrani A. Abd. Rahni
- Universiti Kebangsaan Malaysia,Faculty of Engineering & Built Environment,Bangi,Selangor,Malaysia,43600
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9
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Locatelli A, Treggiari E, Innocenti M, Romanelli G. Percutaneous ultrasound-guided microwave ablation for treatment of hepatocellular carcinomas in dogs: four cases (2019-2020). J Small Anim Pract 2022; 63:897-903. [PMID: 36000486 DOI: 10.1111/jsap.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe ultrasound-guided microwave ablation as a minimally invasive treatment option for primary or metastatic hepatocellular carcinomas. METHODS Four client-owned dogs underwent percutaneous ultrasound-guided microwave ablation of three primary and one metastatic hepatocellular carcinoma, diagnosed on cytology/histopathology. In each case, multiple ultrasound-guided thermal lesions were created in a 10 to 40 minutes ablation at 30 to 35 W. Real-time monitoring was performed using 10 MHz diagnostic ultrasound transducers. The procedures were performed without complication and CT scans or abdominal ultrasounds were repeated immediately after. Patients were discharged on oral analgesia on the same day or 24 hours later. RESULTS Hepatocellular carcinomas were successfully ablated, which in some cases resulted in an improvement in clinical signs and laboratory values. The patients were followed up for a time ranging between 39 and 649 days and no evidence of disease progression was found. Three out of four patients are still alive at the time of writing. CLINICAL SIGNIFICANCE In these four patients, minimally invasive ultrasound-guided microwave ablation was feasible and resulted in no immediate complications. Regular imaging follow-up is recommended after the procedure and further studies on microwave ablation are warranted to establish its effectiveness in dogs with hepatocellular carcinomas.
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Affiliation(s)
- A Locatelli
- Centro Specialistico Veterinario, 20141, Milan, Italy
| | - E Treggiari
- Centro Specialistico Veterinario, 20141, Milan, Italy
| | - M Innocenti
- Centro Specialistico Veterinario, 20141, Milan, Italy
| | - G Romanelli
- Centro Specialistico Veterinario, 20141, Milan, Italy
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Jin X, Liu W, Li Y, Qian L, Zhu Q, Li W, Qian Z. Evaluation method of ex vivo porcine liver reduced scattering coefficient during microwave ablation based on temperature. BIOMED ENG-BIOMED TE 2022; 67:491-501. [DOI: 10.1515/bmt-2022-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/01/2022] [Indexed: 11/15/2022]
Abstract
Abstract
The principle of microwave ablation (MWA) is to cause irreversible damage (protein coagulation, necrosis, etc.) to tumor cells at a certain temperature by heating, thereby destroying the tumor. We have long used functional near-infrared spectroscopy (fNIRs) to monitor clinical thermal ablation efficacy. After a lot of experimental verification, it can be found that there is a clear correlation between the reduced scattering coefficient and the degree of tissue damage. During the MWA process, the reduced scattering coefficient has a stable change. Therefore, both temperature (T) and reduced scattering coefficient (
μ
s
′
${\mu }_{s}^{\prime }$
) are related to the thermal damage of the tissue. This paper mainly studies the changing law of T and
μ
s
′
${\mu }_{s}^{\prime }$
during MWA and establishes a relationship model. The two-parameter simultaneous acquisition system was designed and used to obtain the T and
μ
s
′
${\mu }_{s}^{\prime }$
of the ex vivo porcine liver during MWA. The correlation model between T and
μ
s
′
${\mu }_{s}^{\prime }$
is established, enabling the quantitative estimation of
μ
s
′
${\mu }_{s}^{\prime }$
of porcine liver based on T. The maximum and the minimum relative errors of
μ
s
′
${\mu }_{s}^{\prime }$
are 79.01 and 0.39%, respectively. Through the electromagnetic simulation of the temperature field during MWA, 2D and 3D fields of reduced scattering coefficient can also be obtained using this correlation model. This study contributes to realize the preoperative simulation of the optical parameter field of microwave ablation and provide 2D/3D therapeutic effect for clinic.
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Affiliation(s)
- Xiaofei Jin
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Wenwen Liu
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Yiran Li
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Lu Qian
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Qiaoqiao Zhu
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Weitao Li
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Zhiyu Qian
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
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11
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Belfiore MP, De Chiara M, Reginelli A, Clemente A, Urraro F, Grassi R, Belfiore G, Cappabianca S. An overview of the irreversible electroporation for the treatment of liver metastases: When to use it. Front Oncol 2022; 12:943176. [PMID: 36119531 PMCID: PMC9477084 DOI: 10.3389/fonc.2022.943176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Tumour ablation is an established therapy for local treatment of liver metastases and hepatocellular carcinoma. Most commonly two different kind of thermic ablation, radiofrequency ablation and microwave ablation, are used in clinical practice. The aim of both is to induce thermic damage to the malignant cells in order to obtain coagulative necrosis of the neoplastic lesions. Our main concerns about these procedures are the collateral thermic damage to adjacent structures and heat-sink effect. Irreversible electroporation (IRE) is a recently developed, non-thermal ablation procedure which works applying short pulses of direct current that generate an electric field in the lesion area. The electric field increase the transmembrane potential, changing its permeability to ions.Irreversible electroporation does not generate heat, giving the chance to avoid the heat-sink effect and opening the path to a better treatment of all the lesions located in close proximity to big vessels and bile ducts. Electric fields produced by the IRE may affect endothelial cells and cholangiocytes but they spare the collagen matrix, preserving re-epithelization process as well as the function of the damaged structures. Purpose of the authors is to identify the different scenarios where CT-guided percutaneous IRE of the liver should be preferred to other ablative techniques and why.
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Affiliation(s)
- Maria Paola Belfiore
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
- *Correspondence: Maria Paola Belfiore,
| | - Marco De Chiara
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Alfonso Reginelli
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Alfredo Clemente
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Fabrizio Urraro
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Roberto Grassi
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Giuseppe Belfiore
- Department of Diagnostic Imaging, Nursing home L.Cobellis, Vallo della Lucania Salerno, Italy
| | - Salvatore Cappabianca
- Division of Radiology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
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12
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Gergin ÖÖ, Pehlivan SS, Erkan İ, Bayram A, Aksu R, Biçer C, Yıldız K, Kahriman G. Clinical efficacy of ultrasound guided erector spinae plane block in patients undergoing microwave ablation. Saudi Med J 2022; 43:1027-1034. [PMID: 36104059 PMCID: PMC9987667 DOI: 10.15537/smj.2022.43.9.20220245] [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: 04/25/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the effect of pre-emptive erector spinae plane block (ESPB) applied before the procedure on opioid consumption during the procedure and analgesic demand and opioid consumption after the procedure. METHODS American Society of Anesthesiologists Physical Status Classification (ASA) I-II, 30 patients, with liver tumor and planned for microwave ablation (MWA) treatment were included in the interventional radiology clinic, Erciyes University, Kayseri, Turkey, Turkey between 2021 and 2022. Patients were randomized either to the ESPB or control group. Ultrasound-guided ESPB block with 20 mL of 0.25% bupivacaine was performed preoperatively in the ESPB group patients, and the patients who was not performed the ESPB the control group. All the patients were administered 1 µg/kg fentanyl, 1-2 mg/kg propofol, and 1 mg/kg ketamine for sedation during the MWA procedure after standard monitoring. Total opioid consumption and numeric rating scale (NRS) scores for pain were recorded at 0, 20, 40, and 60 minutes, and at 2, 4, 6, 12, and 24 hours after the procedure. RESULTS Total opioid consumption and total opioid amount during the procedure were statistically significantly lower in the ESPB group (p<0.001). Although all of the patients in the control group needed additional fentanyl throughout the procedure, only 5 patients in the ESPB group needed additional fentanyl (p<0.001). Post-procedure NRS score values were significantly lower in the ESPB group at 40 minutes, 60 minutes and 4 hours (p<0.05). Numeric rating scale values at other times were statistically similar (p>0.05) CONCLUSION: This study showed that ESPB provided effective preemptive analgesia during MWA procedures.
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Affiliation(s)
- Özlem Öz Gergin
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Sibel Seçkin Pehlivan
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - İbrahim Erkan
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Adnan Bayram
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Recep Aksu
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Cihangir Biçer
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Karamehmet Yıldız
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Güven Kahriman
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
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13
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Jin X, Feng Y, Zhu R, Qian L, Yang Y, Yu Q, Zou Z, Li W, Liu Y, Qian Z. Temperature control and intermittent time-set protocol optimization for minimizing tissue carbonization in microwave ablation. Int J Hyperthermia 2022; 39:868-879. [PMID: 35858640 DOI: 10.1080/02656736.2022.2075041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The charring tissue formation in the ablated lesion during the microwave ablation (MWA) of tumors would induce various unwanted inflammatory responses. This paper aimed to deliver appropriate thermal dose for effective ablations while preventing tissue carbonization by optimizing the treatment protocol during MWA with the set combinations of temperature control and pulsed microwave energy delivery. MATERIAL AND METHODS The thermal phase transition of ex vivo porcine liver tissues were recorded by differential scanning calorimetry (DSC) to determine the temperature threshold during microwave output control. MWA was performed by an in-house built system with the ease of microwave output parameter adjustment and real-time temperature monitoring. The effects of continuous and pulsed microwave deliveries as well as various intermittent time-set of MWA were evaluated by measuring the dimensions of the coagulation zone and the carbonization zone. RESULTS The DSC scans demonstrated that the ex vivo porcine liver tissues have been in a state of endothermic heat during the heating process, where the maximum absorbed heat occurred at the temperature of 105 °C ± 5 °C. The temperature control during MWA resulted in effective coagulative necrosis while preventing tissue carbonization, after setting 100 °C as the upper threshold temperature and 60 °C as the lower threshold. Both the numerical simulation and ex vivo experiments have shown that, upon the optimization of the time-set parameters in the periodic intermittent pulsed microwave output, the tissue carbonization was significantly diminished. CONCLUSION This study developed a straight-forward anti-carbonization strategy in MWA by modulating the pulsing mode and intermittent time. The programmed protocols of intermittent pulsing MWA have demonstrated its potentials toward future expansion of MWA technology in clinical application.
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Affiliation(s)
- Xiaofei Jin
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yu Feng
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Roujun Zhu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lu Qian
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yamin Yang
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Qindong Yu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhihan Zou
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Weitao Li
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yangyang Liu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhiyu Qian
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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14
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Dakua SP, Nayak A. A review on treatments of hepatocellular carcinoma—role of radio wave ablation and possible improvements. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Currently, several treatment options are available for liver cancer depending on various factors such as location, size, shape, and liver function. Image fusion is required for the diagnosis, intervention, and follow-up of certain HCCs. Presently, mental fusion is the only way while diagnosing liver lesions by comparing the ultrasound (US) image with the computed tomography (CT) image. Nevertheless, mental fusion is bound to have errors. The objective of this paper is to study the present treatment options for hepatocellular carcinoma and review the present treatment options, list out their potential limitations, and present a possible alternative solution based on the findings to reduce errors and mistargeting.
Methods
This is a systematic review on the present treatment options for hepatocellular carcinoma, especially radio wave ablation.
Results
It is found that computer fusion is the possible alternative to the present mental registration.
Conclusions
Although computer fusion is the best alternative to use radio wave ablation, there have been a few open-ended questions to further explore.
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15
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CT-monitored minimal ablative margin control in single-session microwave ablation of liver tumors: an effective strategy for local tumor control. Eur Radiol 2022; 32:6327-6335. [PMID: 35389047 PMCID: PMC9381632 DOI: 10.1007/s00330-022-08723-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/21/2022] [Accepted: 03/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the usefulness of minimal ablative margin (MAM) control by intra-procedural contrast-enhanced CT (CECT) in microwave ablation (MWA) of liver tumors. METHODS A total of 334 consecutive liver tumors (240 hepatocellular carcinomas [HCCs] and 94 colorectal liver metastases [CRLMs]) in 172 patients treated with percutaneous MWA were retrospectively included. MAM of each tumor was assessed after expected ablation completion using intra-procedural CECT, allowing within-session additional ablation to any potentially insufficient margin. On immediate post-MWA MRI, complete ablation coverage of tumor and final MAM status were determined. The cumulative local tumor progression (LTP) rate was estimated by using the Kaplan-Meier method. To identify predictors of LTP, Cox regression analysis with a shared frailty model was performed. RESULTS Intra-procedural CECT findings prompted additional ablation in 18.9% (63/334) of tumors. Final complete ablation coverage of tumor and sufficient MAM were determined by MRI to be achieved in 99.4% (332/334) and 77.5% (259/334), and their estimated 6-month, 1-year, and 2-year LTP rates were 3.2%, 7.5%, and 12.9%; and 1.0%, 2.1%, and 6.9%, respectively. Insufficient MAM on post-MWA MRI, perivascular tumor location, and tumor size (cm) were independent risk factors for LTP (hazard ratio = 14.4, 6.0, and 1.1, p < 0.001, p = 0.003, and p = 0.011, respectively), while subcapsular location and histology (HCC vs CRLM) were not. CONCLUSIONS In MWA of liver tumors, intra-procedural CECT monitoring of minimal ablative margin facilitates identification of potentially suboptimal margins and guides immediate additional intra-session ablation to maximize rates of margin-sufficient ablations, the latter being a highly predictive marker for excellent long-term local tumor control. KEY POINTS • In MWA of liver tumors, intra-procedural CECT can identify potentially suboptimal minimal ablative margin, leading to immediate additional ablation in a single treatment session. • Achieving a finally sufficient ablative margin through the MWA with intra-procedural CECT monitoring of minimal ablative margin results in excellent local tumor control.
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16
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Barzakova E, Senthilvel N, Bruners P, Keil S, Lurje G, Zimmermann M, Kuhl CK, Isfort P. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome. ROFO-FORTSCHR RONTG 2021; 194:515-520. [PMID: 34794185 DOI: 10.1055/a-1669-9342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Small hepatic malignancies scheduled for CT-guided percutaneous ablation may have been identified in the hepatobiliary phase of liver MRI or in a specific phase of multi-phase CT but may be occult on unenhanced CT used to guide the ablation. We investigated whether the detectability of the target lesion would impact the efficacy of CT-guided hepatic tumor ablations. MATERIALS AND METHODS We included 69 patients with 99 malignant liver lesions (25 primary, 44 metastases) who underwent IRE (n = 35), RFA (n = 41), or MWA (n = 23) between 01/2015 and 06/2018. All procedures were performed under CT guidance. Lesions not detectable on CT (NDL) were targeted through identification of anatomical landmarks on preinterventional contrast-enhanced CT or MRI. Rates of incomplete ablation, size of ablation zone, local tumor recurrence, intrahepatic progression-free survival (ihPFS), and adverse event rates were compared for detectable lesions (DL) vs. NDL. RESULTS 40 lesions were NDL, and 59 lesions were DL on unenhanced CT. The mean follow-up was 16.2 months (14.8 for DL and 18.2 for NDL). The mean diameter of NDL and DL was similar (12.9 mm vs. 14.9 mm). The mean ablation zone size was similar (37.1 mm vs. 38.8 mm). Incomplete ablation did not differ between NDL vs. DL (5.0 % [2/40; 0.6-16.9 %] vs. 3.4 % [2/59; 0.4-11.7 %]), nor did local tumor recurrence (15.4 % [6/39; 5.7 %-30.5 %] vs. 16.9 % [10/59; 8.4-29.0 %]), or median ihPFS (15.5 months vs. 14.3 months). CONCLUSION Target lesion detectability on interventional CT does not have a significant impact on outcome after percutaneous liver ablation when anatomical landmarks are used to guide needle placement. KEY POINTS · Liver tumors can be successfully ablated even if they are not detectable on the navigational CT scan.. · Anatomical landmarks should be used and compared to preinterventional imaging.. CITATION FORMAT · Barzakova E, Senthilvel N, Bruners P et al. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome . Fortschr Röntgenstr 2021; DOI: 10.1055/a-1669-9342.
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Affiliation(s)
- Emona Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Niveditha Senthilvel
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
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Stillström D, Eigl B, Freedman J. Stereotactic navigation versus ultrasound guidance in placing IRE applicators in a liver phantom. Sci Rep 2021; 11:21031. [PMID: 34702894 PMCID: PMC8548523 DOI: 10.1038/s41598-021-00505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to compare the accuracy of stereotactic CT-guided navigation and ultrasound guided navigation for placing electrodes in Irreversible electroporation in a liver phantom. A liver phantom with multiple tumours was used and interventionists placed four IRE electrodes around each tumour guided either by stereotactic CT-guided navigation or ultrasound. The goal was to place them in a perfect 20 × 20 mm square with parallel electrodes. After each treatment, a CT-scan was performed. The accuracy in pairwise electrode distance, pairwise parallelism and time per tumour was analysed. Eight interventionists placed four electrodes around 55 tumours, 25 with ultrasound and 30 with stereotactic CT-guided navigation. 330 electrode pairs were analysed, 150 with ultrasound and 180 with stereotactic CT-navigation. The absolute median deviation from the optimal distance was 1.3 mm (range 0.0 to 11.3 mm) in the stereotactic CT-navigation group versus 7.1 mm (range 0.3 to 18.1 mm) in the Ultrasound group (p < 0.001). The mean angle between electrodes in each pair was 2.7 degrees (95% CI 2.4 to 3.1 degrees) in the stereotactic CT-navigation group and 5.5 degrees (95% CI 5.0 to 6.1 degrees) in the Ultrasound group (p < 0.001). The mean time for placing the electrodes was 15:11 min (95% CI 13:05 to 17:18 min) in the stereotactic CT-navigation group and 6:40 min (95% CI 5:28 to 7:52 min) in the Ultrasound group. The use of stereotactic CT-navigation in placing IRE-electrodes in a liver phantom is more accurate, but more time consuming, compared to ultrasound guidance.
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Affiliation(s)
- David Stillström
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden. .,Department of Surgery and Urology, Danderyd Hospital, 182 88, Stockholm, Sweden.
| | | | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
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18
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Tao Q, Zeng Q, Liu W, Liu J, Jiang L, Tu X, Li K, Zhao P, Tang X, Liu Z, Wang L, Xu Q, Zheng Y. A novel prognostic nomogram for hepatocellular carcinoma after thermal ablation. Am J Cancer Res 2021; 11:5126-5140. [PMID: 34765316 PMCID: PMC8569373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023] Open
Abstract
It remains impossible to accurately assess the prognosis after thermal ablation in patients with hepatocellular carcinoma (HCC). Our aim was to build a nomogram to predict the survival rate of HCC patients after thermal ablation. We developed and validated a nomogram using data of 959 HCC patients after thermal ablation from two centers. Harrell's concordance index (C-index), calibration plot and Decision curve analysis (DCA) were used to measure the performance of the nomogram, and we compared it with the Barcelona Clinic Liver Cancer (BCLC) staging system and a previous nomogram. Six variables including age, serum albumin, operation method, risk area, tumor number and early recurrence were selected to construct the nomogram. In the training cohort, internal validation cohort, and external validation cohort, the nomogram all had a higher C-index to predict survival rate than both the BCLC staging system and the previous nomogram (0.736, 0.558 and 0.698, respectively; 0.763, 0.621 and 0.740, respectively; and 0.825, 0.551 and 0.737, respectively). Calibration plots showed a high degree of consistency between prediction and actual observation. Decision curve analysis (DCA) presented that compared with BCLC system and the previous nomogram, our nomogram had the highest net benefit. In all three cohorts, the nomogram could accurately divide patients into three subgroups according to predicted survival risk. A nomogram was developed and validated to predict survival of HCC patients who underwent thermal ablation, which is helpful for prognostic prediction and individual surveillance in clinical practice.
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Affiliation(s)
- Qiang Tao
- Department of Liver Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
| | - Qingjing Zeng
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510635, Guangdong, China
| | - Wenwu Liu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- Department of Gastric Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
| | - Jia Liu
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen UniversityShenzhen 518000, Guangdong, China
| | - Lingmin Jiang
- Department of Liver Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
| | - Xinyue Tu
- Department of Liver Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
| | - Kai Li
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510635, Guangdong, China
| | - Peng Zhao
- Department of Liver Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
| | - Xiang Tang
- Department of Liver Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
| | - Zonghao Liu
- Department of Liver Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
| | - Liang Wang
- The First Department of General Surgery, The First People’s Hospital of Kashi PrefectureKashi 844000, The Xinjiang Uygur Autonomous Region, China
| | - Qilin Xu
- The Second Department of General Surgery, The First People’s Hospital of Kashi PrefectureKashi 844000, The Xinjiang Uygur Autonomous Region, China
| | - Yun Zheng
- Department of Liver Surgery, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou 510060, Guangdong, China
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19
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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Bauer U, Gerum S, Roeder F, Münch S, Combs SE, Philipp AB, De Toni EN, Kirstein MM, Vogel A, Mogler C, Haller B, Neumann J, Braren RF, Makowski MR, Paprottka P, Guba M, Geisler F, Schmid RM, Umgelter A, Ehmer U. High rate of complete histopathological response in hepatocellular carcinoma patients after combined transarterial chemoembolization and stereotactic body radiation therapy. World J Gastroenterol 2021; 27:3630-3642. [PMID: 34239274 PMCID: PMC8240047 DOI: 10.3748/wjg.v27.i24.3630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/20/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver transplantation (LT) presents a curative treatment option in patients with early stage hepatocellular carcinoma (HCC) who are not eligible for resection or ablation therapy. Due to a risk of up 30% for waitlist drop-out upon tumor progression, bridging therapies are used to halt tumor growth. Transarterial chemoembolization (TACE) and less commonly stereotactic body radiation therapy (SBRT) or a combination of TACE and SBRT, are used as bridging therapies in LT. However, it remains unclear if one of those treatment options is superior. The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.
AIM To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.
METHODS In this multicenter retrospective study, 27 patients who received liver transplantation for HCC were analyzed. Patients received either TACE or SBRT alone, or a combination of TACE and SBRT as bridging therapy to liver transplantation. Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies. Statistical analysis was performed using Fisher-Freeman-Halton exact test, Kruskal-Wallis and Mann-Whitney-U tests.
RESULTS Fourteen patients received TACE only, four patients SBRT only, and nine patients a combination therapy of TACE and SBRT. There were no significant differences between groups regarding age, sex, etiology of underlying liver disease or number and size of tumor lesions. Strikingly, analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group (8/9, 89%) showed no residual vital tumor tissue by histopathology, whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response (0/14, 0% and 1/4, 25%, respectively, P value < 0.001).
CONCLUSION Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.
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Affiliation(s)
- Ulrike Bauer
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Sabine Gerum
- Department of Radiotherapy and Radiation Oncology, University of Salzburg, Salzburg 5020, Austria
- Department of Radiation Oncology, University Hospital of Munich, Campus Großhadern, LMU Munich, Munich 81377, Germany
| | - Falk Roeder
- Department of Radiotherapy and Radiation Oncology, University of Salzburg, Salzburg 5020, Austria
- Department of Radiation Oncology, University Hospital of Munich, Campus Großhadern, LMU Munich, Munich 81377, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Alexander B Philipp
- Department of Medicine II, Liver Centre, University Hospital, LMU Munich, Munich 81377, Germany
| | - Enrico N De Toni
- Department of Medicine II, Liver Centre, University Hospital, LMU Munich, Munich 81377, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover 30625, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover 30625, Germany
| | - Carolin Mogler
- Institute of Pathology, Technical University of Munich, Munich 81675, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, University Hospital of Munich, Munich 81377, Germany
| | - Rickmer F Braren
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Marcus R Makowski
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Philipp Paprottka
- Institute of Diagnostic and Interventional Radiology, Section for Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Markus Guba
- Department of General-, Visceral-, Vascular- and Transplant-Surgery, University hospital of Munich, Campus Großhadern, LMU Munich, Munich 81377, Germany
| | - Fabian Geisler
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Roland M Schmid
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Andreas Umgelter
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- Emergency Department, Vivantes hospital group, Humboldt hospital, Berlin 13509, Germany
| | - Ursula Ehmer
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
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Radiofrequency and microwave ablation in a porcine liver model: non-contrast CT and ultrasound radiologic-pathologic correlation. Int J Hyperthermia 2021; 37:799-807. [PMID: 32620055 DOI: 10.1080/02656736.2020.1784471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: The goal of this study was to compare intra-procedural radiofrequency (RF) and microwave ablation appearance on non-contrast CT (NCCT) and ultrasound to the zone of pathologic necrosis.Materials and methods: Twenty-one 5-min ablations were performed in vivo in swine liver with (1) microwave at 140 W, (2) microwave at 70 W, or (3) RF at 200 W (n = 7 each). CT and US images were obtained simultaneously at 1, 3, and 5 min during ablation and 2, 5, and 10 min post-ablation. Each ablation was sectioned in the plane of the ultrasound image and underwent vital staining to delineate cellular necrosis. CT was reformatted to the same plane as the ultrasound transducer and transverse diameters of gas and hypoechoic/hypoattenuating zones at each time point were measured. CT, ultrasound and gross pathologic diameter measurements were compared using Student's t-tests and linear regression.Results: Visible gas and the hypoechoic zone on US images were more predictive of the pathologic ablation zone than on NCCT images (p < 0.05). The zone of necrosis was larger than the zone of visible gas on US (mean 3.2 mm for microwave, 6.4 mm for RF) and NCCT (7.6 mm microwave, 13.9 mm RF) images (p < 0.05). The zone of visible gas and hypoechoic zone on US are more predictive of pathology with microwave ablations when compared with RF ablations (p < 0.05).Conclusion: When evaluating images during energy delivery, US is more accurate than CT and microwave- more predictable than RF-ablation based on correlation with in-plane pathology.
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Local control of hepatocellular carcinoma and colorectal liver metastases after surgical microwave ablation without concomitant hepatectomy. Langenbecks Arch Surg 2021; 406:2749-2757. [PMID: 34076718 DOI: 10.1007/s00423-021-02219-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Microwave ablation (MWA) is an accepted technique in the multimodal treatment of hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM). Study endpoints were to evaluate the local efficacy of surgical MWA in selected patients with oligonodular disease without the combination of liver resection to allow a clear interpretation of the follow-up imaging and compare it to the results on percutaneous MWA available in the literature. METHODS Consecutive MWA-only procedures performed between May 2013 and May 2018 for HCC and CRLM with free-hand ultrasound guidance were identified. MWA systems with 2450 MHz were used. Incomplete ablation (IA) was defined as residual disease within 1 cm of the ablation site at the first post-ablation imaging and local recurrence (LR) as the presence of disease after at least one tumor-free imaging. RESULTS A total of 70 tumors in 47 patients were treated with 46 laparoscopic and 1 open procedures. Each patient had no more than 3 tumors, and median size of the lesions was 15 mm (IQR: 10-22). After a median follow-up of 26 months (IQR: 12-40), IA rate was 8.6% and LR rate was 29.4%. Multivariable analysis showed that vascular proximity (OR = 3.4; 95% CI = 1.26-9.22; p=0.016) was the only significant predictor of the combined outcome IA or LR. DISCUSSION In the present study, after mostly laparoscopic MWA, LR was higher than the rates available in the literature for percutaneous MWA of HCC but lower than in the limited studies analyzing isolated percutaneous MWA of liver metastases. Future developments may help establish the role of each therapeutic modality per tumor, in order to improve the outcomes.
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Xu E, Li K, Long Y, Luo L, Zeng Q, Tan L, He X, Huang Q, Wu Y, Zheng R. Intra-Procedural CT/MR-Ultrasound Fusion Imaging Helps to Improve Outcomes of Thermal Ablation for Hepatocellular Carcinoma: Results in 502 Nodules. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:e9-e19. [PMID: 31671457 DOI: 10.1055/a-1021-1616] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim was to assess the value of intra-procedural CT/MR-ultrasound (CT/MR-US) fusion imaging in the management of thermal ablation for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study was approved by the institutional review board. From May 2010 to October 2016, 543 HCC nodules in 440 patients (387 men and 53 women; age range: 25-84 years) that met the Milan Criteria were treated by percutaneous thermal ablation using intra-procedural CT/MR-US fusion imaging. The HCC nodules were divided into subgroups and compared (≤ 3 cm and > 3 cm, or high-risk and low-risk location, or inconspicuous and conspicuous, respectively). Technique efficacy and major complication were calculated. Cumulative local tumor progression (LTP), tumor-free and overall survival rates were estimated with the Kaplan-Meier method. RESULTS CT/MR-US fusion imaging was successfully registered in 419 patients with 502 nodules. The technique efficacy rate of thermal ablation was 99.4 %. The major complication rate was 1.9 %. The cumulative LTP rates were 3.2 %, 5.6 % and 7.2 % at 1, 3, and 5 years, respectively. There were no significant differences for the comparisons of cumulative LTP rates between different subgroups (P = 0.541, 0.314, 0.329). The cumulative tumor-free survival rates were 74.8 %, 54.0 % and 37.5 % at 1, 3, and 5 years, respectively. The cumulative overall survival rates were 97.8 %, 87.1 % and 81.7 % at 1, 3, and 5 years, respectively. CONCLUSION Intra-procedural CT/MR-ultrasound fusion imaging is a useful technique for percutaneous liver thermal ablation. It could help to achieve satisfying survival outcomes for HCC patients who meet the Milan Criteria.
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Affiliation(s)
- Erjiao Xu
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Li
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yinglin Long
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liping Luo
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lei Tan
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuqi He
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiannan Huang
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuxuan Wu
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Ventilatory Effect of Midazolam in Propofol Deep Sedation for Hepatic Tumor Patients Undergoing Percutaneous Radiofrequency Ablation Procedure. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: The aim of the study was to compare the ventilatory effect between propofol deep sedation technique with and without midazolam in hepatic tumor patients undergoing radiofrequency ablation procedure. Methods: Three hundred and seventy-four patients who underwent radiofrequency ablation procedure in a single year were randomly assigned to the deep sedation without midazolam group (A, n = 187) and deep sedation with midazolam group (B, n = 187). Patients in group A received normal saline, and those in group B received 0.02 mg/kg of midazolam intravenously in equivalent volume. All patients were oxygenated with 100% O2 via nasal cannula and sedated with intravenous fentanyl and the titration of intravenous propofol. Ventilatory parameters, including oxygen saturation, end tidal carbon dioxide, and respiratory rate every five minutes, during and after the procedure, as well as the duration of sleep and sedation score in the recovery room, were recorded. Results: There were no significant differences in the patients’ characteristics, duration of procedure, total dose of propofol, ventilatory parameters including oxygen saturation, end tidal carbon dioxide, and respiratory rate, as well as sedation score at 20, 25, 30, 35, and 40 min after the procedure, between the two groups. However, mean sedation score at 5, 10, and 15 min after the procedure, in group B, was significantly lower than in group A. In addition, the duration of sleep after the procedure, in group B, was significantly greater than in group A. No serious ventilatory adverse effects were observed either group. Conclusion: Propofol deep sedation with and without midazolam for hepatic tumor patients who underwent radiofrequency ablation procedure was safe and effective. A low dose of midazolam in propofol deep-sedation technique did not create serious ventilatory effects.
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Andrasina T, Juracek J, Zavadil J, Cechova B, Rohan T, Vesela P, Paldor M, Slaby O, Goldberg SN. Thermal Ablation and Transarterial Chemoembolization are Characterized by Changing Dynamics of Circulating MicroRNAs. J Vasc Interv Radiol 2021; 32:403-411. [PMID: 33495063 DOI: 10.1016/j.jvir.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/30/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine whether the levels of circulating microRNAs (miRNAs) are altered in patients undergoing thermal ablation and chemoembolization and whether these changes are predictive of a clinical outcome. MATERIAL AND METHODS This prospective study consisted of 43 patients diagnosed with hepatocellular carcinoma (n = 15) and intrahepatic colorectal cancer metastases (n = 28) treated with thermal ablation (n = 23; radiofrequency [n = 6] or microwave [n = 19]), chemoembolization using drug-eluting embolics (n = 18), or both (n = 2). Four blood samples (immediately before the intervention and 60-90 minutes, 24 hours, and 7 days after the intervention) were taken to measure the plasma concentrations of miRNAs related to hypoxia (miR-21 and miR-210), liver injury (miR-122), epithelial-mesenchymal transition (miR-200a), and apoptosis (miR-34a) using miRNA-specific TaqMan assays and quantitative real-time polymerase chain reaction. Tumor burden and treatment response at 3 months were evaluated using the modified response evaluation criteria in solid tumors. The miRNA results were compared with clinical outcomes (Mann-Whitney U test, Wilcoxon matched-pair test). RESULTS Dynamic changes in the circulating miRNA levels were observed following both the interventions. For thermal ablation, significant increases in miR-21, miR-210, miR-122, miR-200a, and miR-34a concentrations peaked 60-90 minutes after the intervention (P < .01). However, for transarterial chemoembolization, maximum increases in the miRNA concentrations were observed at 24 hours after the intervention for miR-21, miR-210, miR-122, miR-200a, and miR-34a (P < .05). The increased concentrations of the circulating miRNAs were followed by a subsequent decline to baseline by 7 days. For the thermal ablation (but not chemoembolization) patients, elevations in the miR-210 and miR-200a levels were associated with early progressive disease at 3 months (P = .040 and P = .012, respectively). CONCLUSIONS Increased but dynamic levels of circulating miRNAs are present following interventional oncologic procedures and may prove useful as biomarkers for the monitoring of clinical outcomes.
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Affiliation(s)
- Tomas Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic.
| | - Jaroslav Juracek
- Masaryk University, Central European Institute of Technology, Brno, Czech Republic
| | - Jan Zavadil
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Barbora Cechova
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic; Masaryk University, Central European Institute of Technology, Brno, Czech Republic
| | - Tomas Rohan
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Petra Vesela
- Masaryk University, Central European Institute of Technology, Brno, Czech Republic
| | - Mor Paldor
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ondrej Slaby
- Masaryk University, Central European Institute of Technology, Brno, Czech Republic; Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
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Accuracy of Electrode Placement in IRE Treatment with Navigated Guidance. Cardiovasc Intervent Radiol 2021; 44:968-975. [PMID: 33474604 PMCID: PMC8172499 DOI: 10.1007/s00270-020-02762-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/24/2020] [Indexed: 01/03/2023]
Abstract
Purpose Evaluate the accuracy of multiple electrode placements in IRE treatment of liver tumours using a stereotactic CT-based navigation system. Method Analysing data from all IRE treatments of liver tumours at one institution until 31 December 2018. Comparing planned with validated electrode placement. Analysing lateral and angular errors and parallelism between electrode pairs Results Eighty-four tumours were treated in 60 patients. Forty-six per cent were hepatocellular carcinoma, and 36% were colorectal liver metastases. The tumours were located in all segments of the liver. Data were complete from 51 treatments. Two hundred and six electrodes and 336 electrode pairs were analysed. The median lateral and angular error, comparing planned and validated electrode placement, was 3.6 mm (range 0.2–13.6 mm) and 3.1° (range 0°–16.1°). All electrodes with a lateral error >10 mm were either re-positioned or excluded before treatment. The median angle between the electrode pairs was 3.8° (range 0.3°–17.2°). There were no electrode placement-related complications. Conclusion The use of a stereotactic CT-based system for navigation of electrode placement in IRE treatment of liver tumours is safe, accurate and user friendly.
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Parametric evaluation of impedance curve in radiofrequency ablation: A quantitative description of the asymmetry and dynamic variation of impedance in bovine ex vivo model. PLoS One 2021; 16:e0245145. [PMID: 33449951 PMCID: PMC7810295 DOI: 10.1371/journal.pone.0245145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/22/2020] [Indexed: 01/03/2023] Open
Abstract
Radiofrequency ablation (RFA) is a treatment for liver tumors with advantages over the traditional treatment of surgical resection. This procedure has the shortest recovery time in early stage tumors. The objective of this study is to parameterize the impedance curve of the RFA procedure in an ex vivo model by defining seven parameters (t1/2, tminimum, tend, Zinitial, Z1/2, Zminimum and Zend). Based on these parameters, three performance indices are defined: one to identify the magnitude of impedance curve asymmetry (δ), one Drop ratio (DR) describing the percentage of impedance decrease until the minimum impedance point is reached, and Ascent Ratio (AR) describing the magnitude of increase in impedance from the minimum impedance point to its maximum point. Fifty ablations were performed in a bovine ex vivo model to measure and evaluate the proposed parameters and performance index. The results show that the groups had an average δ of 29.02%, DR of 22.41%, and AR of 545.33% for RFA without the use of saline or deionized solutions. The saline solution and deionized water-cooled groups indicated the correlation of performance indices δ, DR, and AR with the obtained final ablation volume. Therefore, by controlling these parameters and indices, lower recurrence is achieved.
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Brock RM, Beitel-White N, Davalos RV, Allen IC. Starting a Fire Without Flame: The Induction of Cell Death and Inflammation in Electroporation-Based Tumor Ablation Strategies. Front Oncol 2020; 10:1235. [PMID: 32850371 PMCID: PMC7399335 DOI: 10.3389/fonc.2020.01235] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
New therapeutic strategies and paradigms are direly needed for the treatment of cancer. While the surgical removal of tumors is favored in most cancer treatment plans, resection options are often limited based on tumor localization. Over the last two decades, multiple tumor ablation strategies have emerged as promising stand-alone or combination therapeutic options for patients. These strategies are often employed to treat tumors in areas where surgical resection is not possible or where chemotherapeutics have proven ineffective. The type of cell death induced by the ablation modality is a critical aspect of therapeutic success that can impact the efficacy of the treatment and systemic anti-tumor immune system responses. Electroporation-based ablation technologies include electrochemotherapy, irreversible electroporation, and other modalities that rely on pulsed electric fields to create pores in cell membranes. These pores can either be reversible or irreversible depending on the electric field parameters and can induce cell death either alone or in combination with a therapeutic agent. However, there have been many controversial findings among these technologies as to the cell death type initiated, from apoptosis to pyroptosis. As cell death mechanisms can impact treatment side effects and efficacy, we review the main types of cell death induced by electroporation-based treatments and summarize the impact of these mechanisms on treatment response. We also discuss potential reasons behind the variability of findings such as the similarities between cell death pathways, differences between cell-types, and the variation in electric field strength across the treatment area.
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Affiliation(s)
- Rebecca M. Brock
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, United States
| | - Natalie Beitel-White
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
- Department of Electrical and Computer Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Irving C. Allen
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, United States
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Science, Blacksburg, VA, United States
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Gillies DJ, Bax J, Barker K, Gardi L, Kakani N, Fenster A. Geometrically variable three-dimensional ultrasound for mechanically assisted image-guided therapy of focal liver cancer tumors. Med Phys 2020; 47:5135-5146. [PMID: 32686142 DOI: 10.1002/mp.14405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/02/2020] [Accepted: 06/27/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Image-guided focal ablation procedures are first-line therapy options in the treatment of liver cancer tumors that provide advantageous reductions in patient recovery times and complication rates relative to open surgery. However, extensive physician training is required and image guidance variabilities during freehand therapy applicator placement limit the sufficiency of ablation volumes and the overall potential of these procedures. We propose the use of three-dimensional ultrasound (3D US) to provide guidance and localization of therapy applicators, augmenting current ablation therapies without the need for specialized procedure suites. We have developed a novel scanning mechanism for geometrically variable 3D US images, a mechanical tracking system, and a needle applicator insertion workflow using a custom needle applicator guide for targeted image-guided procedures. METHODS A three-motor scanner was designed to use any commercially available US probe to generate accurate, consistent, and geometrically variable 3D US images. The designed scanner was mounted on a counterbalanced stabilizing and mechanical tracking system for determining the US probe orientation, which was assessed using optical tracking. Further exploiting the utility of the motorized scanner, an image-guidance workflow was developed that moved the probe to any identified target within an acquired 3D US image. The complete 3D US guidance system was used to perform mock targeted interventional procedures on a phantom by selecting a target in a 3D US image, navigating to the target, and performing needle insertion using a custom 3D-printed needle applicator guide. Registered postinsertion 3D US images and cone-beam computed tomography (CBCT) images were used to evaluate tip targeting errors when using the motors, tracking system, or mixed navigation approaches. Two 3D US image geometries were investigated to assess the accuracy of a small-footprint tilt approach and a large field-of-view hybrid approach for a total of 48 targeted needle insertions. 3D US image quality was evaluated in a healthy volunteer and compared to a commercially available matrix array US probe. RESULTS A mean positioning error of 1.85 ± 1.33 mm was observed when performing compound joint manipulations with the mechanical tracking system. A combined approach for navigation that incorporated the motorized movement and the in-plane tracking system corrections performed the best with a mean tip error of 3.77 ± 2.27 mm and 4.27 ± 2.47 mm based on 3D US and CBCT images, respectively. No significant differences were observed between hybrid and tilt image acquisition geometries with all mean registration errors ≤1.2 mm. 3D US volunteer images resulted in clear reconstruction of clinically relevant anatomy. CONCLUSIONS A mechanically tracked system with geometrically variable 3D US provides a utility that enables enhanced applicator guidance, placement verification, and improved clinical workflow during focal liver tumor ablation procedures. Evaluations of the tracking accuracy, targeting capabilities, and clinical imaging feasibility of the proposed 3D US system, provided evidence for clinical translation. This system could provide a workflow for improving applicator placement and reducing local cancer recurrence during interventional procedures treating liver cancer and has the potential to be expanded to other abdominal interventions and procedures.
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Affiliation(s)
- Derek J Gillies
- Department of Medical Biophysics, Robarts Research Institute, Western University, London, ON, N6A 3K7, Canada.,Robarts Research Institute, Western University, London, ON, N6A 3K7, Canada
| | - Jeffery Bax
- Robarts Research Institute, Western University, London, ON, N6A 3K7, Canada
| | - Kevin Barker
- Robarts Research Institute, Western University, London, ON, N6A 3K7, Canada
| | - Lori Gardi
- Robarts Research Institute, Western University, London, ON, N6A 3K7, Canada
| | - Nirmal Kakani
- Department of Radiology, Manchester Royal Infirmary, Manchester, M13 9WL, UK
| | - Aaron Fenster
- Department of Medical Biophysics, Robarts Research Institute, Western University, London, ON, N6A 3K7, Canada.,Robarts Research Institute, Western University, London, ON, N6A 3K7, Canada
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Bottiglieri A, Ruvio G, O’Halloran M, Farina L. Exploiting Tissue Dielectric Properties to Shape Microwave Thermal Ablation Zones. SENSORS 2020; 20:s20143960. [PMID: 32708680 PMCID: PMC7411896 DOI: 10.3390/s20143960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
The dielectric characterization of tissue targets of microwave thermal ablation (MTA) have improved the efficacy and pre-procedural planning of treatment. In some clinical scenarios, the tissue target lies at the interface with an external layer of fat. The aim of this work is to investigate the influence of the dielectric contrast between fat and target tissue on the shape and size of the ablation zone. A 2.45 GHz monopole antenna is placed parallel to an interface modelled by fat and a tissue characterized by higher dielectric properties and powered at 30 and 60 W for 60 s. The performances of MTA are numerically investigated considering different interface scenarios (i.e., different widths of fat layer, shifts in the antenna alignment) and a homogeneous reference scenario. Experiments (N = 10) are conducted on ex vivo porcine tissue to validate the numerical results. Asymmetric heating patterns are obtained in the interface scenario, the ablation zone in the target tissue is two-fold to ten-fold the size of the zone in the adipose tissue, and up to four times larger than the homogenous scenario. The adipose tissue reflects the electromagnetic energy into the adjacent tissue target, reducing the heating in the opposite direction.
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Affiliation(s)
- Anna Bottiglieri
- Electrical and Electronic Engineering, National University of Ireland Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, National University of Ireland Galway, H91 TK33 Galway, Ireland; (G.R.); (L.F.)
- Correspondence: (A.B.); (M.O.)
| | - Giuseppe Ruvio
- Translational Medical Device Lab, National University of Ireland Galway, H91 TK33 Galway, Ireland; (G.R.); (L.F.)
- Endowave Ltd., National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - Martin O’Halloran
- Translational Medical Device Lab, National University of Ireland Galway, H91 TK33 Galway, Ireland; (G.R.); (L.F.)
- Correspondence: (A.B.); (M.O.)
| | - Laura Farina
- Translational Medical Device Lab, National University of Ireland Galway, H91 TK33 Galway, Ireland; (G.R.); (L.F.)
- CÚRAM, SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
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Figini M, Zhou K, Pan L, Sun C, Wang B, Hu S, Yang J, Shangguan J, Eresen A, Velichko Y, Yaghmai V, Zhang Z. Transcatheter intra-arterial perfusion (TRIP)-MRI biomarkers help detect immediate response to irreversible electroporation of rabbit VX2 liver tumor. Magn Reson Med 2020; 84:365-374. [PMID: 31850550 PMCID: PMC7083687 DOI: 10.1002/mrm.28104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Irreversible electroporation (IRE) is a nonthermal tissue ablation technique that represents a promising treatment option for unresectable liver tumors, but the effectively treated zone cannot be reliably predicted. We investigate the potential benefit of transcatheter intra-arterial perfusion (TRIP) -MRI for the early noninvasive differentiation of IRE zone from surrounding reversibly electroporated (RE) zone. METHODS Seventeen rabbits with VX2 liver tumors were scanned with morphological and contrast-enhanced MRI sequences approximately 30 min after IRE tumor ablation. Quantitative TRIP-MRI perfusion parameters were evaluated in IRE zone and RE zone, defined according to histology. MRI and histology results were compared among zones using Wilcoxon rank-sum tests and correlations were evaluated by Pearson's correlation coefficient. RESULTS There were significant differences in area under the curve, time to peak, maximum and late enhancement, wash-in and wash-out rates in the tumor IRE zones compared with the boundary tumor RE zones and untreated tumors. Histology showed significantly fewer tumor cells, microvessels and significantly more apoptosis in tumor IRE zones compared with tumor RE zones (-51%, -66% and +185%, respectively) and untreated tumors (-60%, -67%, and +228%, respectively). A strong correlation was observed between MRI and histology measurements of IRE zones (r = 0.948) and RE zones (r = 0.951). CONCLUSION TRIP-MRI demonstrated the potential to detect immediate perfusion changes following IRE liver tumor ablation and effectively differentiate the IRE zone from the surrounding tumor RE zone.
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Affiliation(s)
- Matteo Figini
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kang Zhou
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Pan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, The Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Chong Sun
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bin Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, China
| | - Su Hu
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jia Yang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aydin Eresen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yury Velichko
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Jin X, Li Y, Liu W, Mu Y, Wang J, Qian Z, Li W, Zhou J. Study on the relationship between reduced scattering coefficient and Young's modulus of tumors in microwave ablation. MINIM INVASIV THER 2020; 30:347-355. [PMID: 32459544 DOI: 10.1080/13645706.2020.1742742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE In the clinical treatment of tumors using microwave ablation (MWA), although temperature can be used as an important reference index for evaluating the curative effect of ablation, it cannot fully reflect the biological activity status of tumor tissue during thermal ablation. Finding multi-parameter comprehensive evaluation factors to achieve real-time evaluation of therapeutic effects has become the key for precise ablation. More and more scholars use the reduced scattering coefficient (μs') and Young's modulus (E) to evaluate the treatment outcomes of MWA. However, the intrinsic relationship between these parameters is unclear. This paper aims to investigate the specific relationship between μs' and E during MWA. MATERIAL AND METHODS The MWA experiment was conducted on porcine liver in vitro, the two-parameter simultaneous acquisition system was designed to obtain the reduced scattering coefficient and Young's modulus of the liver tissue during MWA. The relationship between reduced scattering coefficient and Young's modulus was investigated. RESULTS It is found that the trend of change of μs' is very similar to E in the process of MWA, i.e. first increasing and then reaching a steady state, and in some experiments there are synchronous changes. Based on this, the quantitative relationship between E-μs' is established, enabling the quantitative estimation of Young's modulus of liver tissue based on reduced scattering coefficient. The maximum absolute error is 29.37 kPa and the minimum absolute error is 0.88 kPa. CONCLUSION This study contributes to the further establishment of a multi-parameter MWA effectiveness evaluation model. It is also valuable for clinically evaluating the ablation outcomes of tumor in real time.
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Affiliation(s)
- Xiaofei Jin
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yiran Li
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Wenwen Liu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yongjie Mu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Juan Wang
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhiyu Qian
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Weitao Li
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Juan Zhou
- Lauterberg Imaging Center, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Shi H, Ong YT, Gogna A, Venkatanarasimha N, Sanamandra SK, Leong S, Irani FG, Lo RHG, Too CW. Perfluorobutane contrast-enhanced ultrasonography: a new standard for ultrasonography-guided thermal ablation of sonographically occult liver tumours? Singapore Med J 2020; 62:546-553. [PMID: 32299186 DOI: 10.11622/smedj.2020061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Image-guided thermal ablation, preferably with ultrasonography (US), is increasingly used for treatment of small liver tumours. Perfluorobutane-contrast enhanced US (pCEUS) is a promising tool that may allow for targeting of tumours that are otherwise imperceptible on greyscale US. Although pCEUS has been reported to be effective, the literature has been limited outside of Japan and South Korea. We aimed to provide data that supports the use of pCEUS in thermal ablation of sonographically occult liver tumours. METHODS We conducted a retrospective single-centre study of 35 consecutive patients who underwent pCEUS-guided ablation of 48 liver tumours with a median size of 1.2 cm. Periprocedural, one-month post-treatment, and relevant follow-up imaging studies were reviewed. Electronic records were also obtained, with long-term follow-up data of 12-28 months being available for 32 patients. RESULTS 36 (75%) of tumours that were imperceptible on greyscale US became visible with pCEUS. Overall, complete tumour ablation at one month was 89%. 1 (3%) patient developed a major complication following treatment, while 6 (17%) had minor post-treatment complaints. The local tumour progression rate was 17% with a median time of 14 months. CONCLUSION pCEUS has a role in US-guided thermal ablation of liver tumours, offering a high technical success rate that is comparable to reported data. Additional benefits may include improved procedural time and freedom from ionising radiation.
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Affiliation(s)
- Haiyuan Shi
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| | | | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Nanda Venkatanarasimha
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Sarat Kumar Sanamandra
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Farah Gillan Irani
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Richard Hoau Gong Lo
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
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Ma QP, Xu EJ, Zeng QJ, Su ZZ, Tan L, Chen JX, Zheng RQ, Li K. Intraprocedural computed tomography/magnetic resonance-contrast-enhanced ultrasound fusion imaging improved thermal ablation effect of hepatocellular carcinoma: Comparison with conventional ultrasound. Hepatol Res 2019; 49:799-809. [PMID: 30907477 DOI: 10.1111/hepr.13336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/24/2019] [Accepted: 03/16/2019] [Indexed: 12/13/2022]
Abstract
AIM To retrospectively compare the treatment effect of intraprocedural computed tomography/magnetic resonance-contrast-enhanced ultrasound (CT/MR-CEUS) fusion imaging (FI) with that of conventional ultrasound (US) in the guidance and assessment of thermal ablation of hepatocellular carcinoma (HCC). METHODS The FI group (112 patients with 129 HCC) was treated between April 2010 and December 2012, whereas the US group (83 patients with 90 HCC) was treated between January 2008 and March 2010. Either CT/MR-CEUS FI or US was used to guide puncture, provide immediate assessment, and guide supplementary ablation. Technical efficacy, cumulative local tumor progression rate (LTP), recurrence-free survival (RFS), and overall survival (OS) were evaluated and compared during follow-up. Technical success rate of CT/MR-CEUS FI was also recorded. RESULTS Technical efficacy was significantly higher in the FI group than in the US group (100% vs. 86.7%, P < 0.001). The 1-, 2-, 3-, 4-, 5-, and 6-year cumulative LTP rates in the FI group were significantly lower than in the US group (3.8%, 4.9%, 6.0%, 6.0%, 7.2%, and 7.2% vs. 16.9%, 20.1%, 25%, 25%, 25%, and 25%, respectively; P < 0.001); RFS and OS were significantly higher in the FI group than in the US group (P = 0.027 and P = 0.049, respectively). The technical success rate of FI was 85.3%. CONCLUSIONS Intraprocedural CT/MR-CEUS FI improved the treatment effect of thermal ablation of HCC by immediately assessing treatment response and guiding supplementary ablation relative to those resulting from the use of conventional US.
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Affiliation(s)
- Qiu-Ping Ma
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Er-Jiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Jing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhong-Zhen Su
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Xin Chen
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rong-Qin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Liu W, Yang Z, Zou R, Qiu J, Shen J, Liao Y, Wang C, Zhang Y, Wang Y, Yuan Y, Li K, Zuo D, He W, Zheng Y, Li B, Yuan Y. Resection vs Ablation for Multifocal Hepatocellular Carcinomas meeting the Barcelona-Clinic Liver Cancer A Classification: A Propensity Score Matching Study. J Cancer 2019; 10:2857-2867. [PMID: 31281462 PMCID: PMC6590028 DOI: 10.7150/jca.31246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/14/2019] [Indexed: 12/13/2022] Open
Abstract
With development of surgical technology, we aimed to investigate whether resection could challenge the standard treatment, ablation, in treating multifocal hepatocellular carcinomas meeting the Barcelona-Clinic Liver Cancer A stage. From January 2005 to January 2017, the oncological outcomes of patients undergoing resection (n = 72) or ablation (n = 63) were retrospectively analysed using propensity score matching. At baseline, patients in the ablation group had more tri-focal lesions (30.2% vs. 6.9%, P = 0.001) and smaller tumours (2.00 cm vs. 2.50 cm, P = 0.002) than resection group. After matching, the baseline was well-balanced between treatments (n = 46 pairs); resection provided comparable 5-year overall survival (77.0% vs. 83.6, P = 0.790) and superior 5-year recurrence-free survival (40.4% vs. 16.9%, P = 0.022) to ablation. The multivariate Cox model confirmed that ablation was not associated with worse overall survival (HR = 0.89; 95% CI, 0.33 - 2.42, P = 0.819), but identified ablation as an unfavourable predictor of recurrence-free survival (HR = 2.13; 95% CI, 1.27 - 3.57, P <0.001). For subgroup patients with multifocal tumours located in different segments, both treatments offered similar 5-year overall survival (74.3% vs. 95.5%, P = 0.190) and 5-year recurrence-free survival (42.9 vs. 25.9%, P = 0.170). Additionally, ablation resulted in less major complications than resection (3.2% vs 13.9%, P = 0.035). Compared with ablation, resection achieved comparable overall survival and even superior recurrence-free survival for patients with multifocal hepatocellular carcinomas meeting the BCLC A stage.
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Affiliation(s)
- Wenwu Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Zhiwen Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Ruhai Zou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Ultrasound, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Jiliang Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Jingxian Shen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Medical Imaging, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yadi Liao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Chenwei Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yuanping Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yongjin Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yichuan Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Kai Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Dinglan Zuo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
| | - Wei He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yun Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Binkui Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yunfei Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
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Abstract
The most common primary liver malignancy, hepatocellular carcinoma (HCC), has a high likelihood of mortality, and much effort into early detection and treatment has occurred. Multiple staging systems have surfaced of which some guide treatment. Curative intent is a goal of early-staged HCC treatment, and this can be achieved with surgical resection, liver transplantation, and minimally invasive percutaneous therapies such as tumor ablation. Many of the newer ablation techniques have evolved from shortcomings of prior methods which have resulted in an expanded number of applications for tumor ablation. Our review focuses on current mainstream image-guided percutaneous ablation modalities which are commonly performed as an alternative to surgery.
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Initial experience with irreversible electroporation of liver tumours. Eur J Radiol Open 2019; 6:62-67. [PMID: 30723754 PMCID: PMC6351588 DOI: 10.1016/j.ejro.2019.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Thermal ablation of liver tumours is an established technique used in selected patients with relatively small tumours that can be ablated with margin. Thermal ablation methods are not advisable near larger bile ducts that are sensitive to thermal injury causing strictures and severe morbidity. Irreversible electroporation (IRE) has the possibility to treat these tumours without harming the bile tree. The method is relatively new and has been proven to be feasible and safe with promising oncological results. Methods 50 treatments were performed on 42 patients that were not resectable or treatable by thermal ablation (12 women and 30 men) with 59 tumours in total. 51% were colorectal cancer liver metastases (CRCLM) and 34% were hepatocellular carcinomas (HCC). 70% of the treatments were performed using stereotactic CT-guidance for needle placement. Results 81% of the treatments were performed with initial success. All patients with missed ablations were re-treated. Local recurrence rate at 3 months was 3% and 37% at one year. The complication rate was low with 2 patients having major complications (Clavien-Dindo grade 3b-5) and without 30-day mortality. Conclusion IRE is safe for treating tumours not suitable for thermal ablation with 63% of patients being without local recurrence after one year in a group of patients with tumours deemed unresectable. IRE has a role in the treatment of unresectable liver tumours close to heat-sensitive structures not suitable for thermal ablation. Level of Evidence: Level 4, Case Series.
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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Wells SA, Ziemlewicz TJ, Lubner MG. Primer on Percutaneous Ablation of Benign Liver Tumors. Clin Liver Dis (Hoboken) 2018; 12:69-73. [PMID: 30988914 PMCID: PMC6385919 DOI: 10.1002/cld.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/19/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Shane A. Wells
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Timothy J. Ziemlewicz
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Meghan G. Lubner
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
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Abbass MA, Garbo AJ, Mahalingam N, Killin JK, Mast TD. Optimized Echo Decorrelation Imaging Feedback for Bulk Ultrasound Ablation Control. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:1743-1755. [PMID: 29994657 PMCID: PMC6294441 DOI: 10.1109/tuffc.2018.2847599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Feasibility of controlling bulk ultrasound (US) thermal ablation using echo decorrelation imaging was investigated in ex vivo bovine liver. The first of two ablation and control procedures used a sequence of constant-intensity sonication cycles, ceased when the minimum echo decorrelation within a control region of interest (ROI) exceeded a predetermined threshold. The second procedure used a variable-intensity sonication sequence, with spatially averaged decorrelation as the stopping criterion. US exposures and echo decorrelation imaging were performed by a linear image-ablate array. Based on preliminary experiments, control ROIs and thresholds for the minimum-decorrelation and average-decorrelation criteria were specified. Controlled trials for the minimum-decorrelation and average-decorrelation criteria were compared with uncontrolled trials employing 9 or 18 cycles of matching sonication sequences. Lesion dimensions, treatment times, ablation rates, and areas under receiver operating characteristic curves were statistically compared. Successfully controlled trials using both criteria required significantly shorter treatment times than corresponding 18-cycle treatments, with better ablation prediction performance than uncontrolled 9-cycle and 18-cycle treatments. Either control approach resulted in greater ablation rate than corresponding 9-cycle or 18-cycle uncontrolled approaches. A post hoc analysis studied the effect of exchanging control criteria between the two series of controlled experiments. For either group, the average time needed to exceed the alternative decorrelation threshold approximately matched the average duration of successfully controlled experimental trials. These results indicate that either approach, using minimum-decorrelation or average-decorrelation criteria, is feasible for control of bulk US ablation. In addition, use of a variable-intensity sonication sequence for bulk US thermal ablation can result in larger ablated regions compared to constant-intensity sonication sequences.
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Liu W, Zheng Y, He W, Zou R, Qiu J, Shen J, Yang Z, Zhang Y, Wang C, Wang Y, Zuo D, Li B, Yuan Y. Microwave vs radiofrequency ablation for hepatocellular carcinoma within the Milan criteria: a propensity score analysis. Aliment Pharmacol Ther 2018; 48:671-681. [PMID: 30063081 DOI: 10.1111/apt.14929] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/09/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whether microwave ablation (MWA) challenges the standard role of radiofrequency ablation (RFA) in treating early-stage hepatocellular carcinoma (HCC) remains unclear. AIM To compare the efficacy of MWA vs RFA for treating primary HCC within the Milan criteria. METHODS From January 2002 to January 2017, the oncological outcomes after MWA (126 patients) and RFA (436 patients) were analysed by propensity score matching. RESULTS Before propensity score matching, for overall patients, MWA resulted in similar 5-year overall survival to RFA (80.1% vs 75.8%, P = 0.190) but better 5-year recurrence-free survival (28.1% vs 19.6%, P = 0.036). For solitary HCC ≤ 3 cm, MWA resulted in comparable 5-year overall survival (81.8% vs 77.1%, P = 0.170) to RFA but better 5-year recurrence-free survival (34.6% vs 24.0%, P = 0.042). After propensity score matching, MWA resulted in better 5-year overall survival (79.3% vs 68.4%, P = 0.021) and 5-year recurrence-free survival (27.9% vs 6.4%, P < 0.001) than RFA for HCC. For solitary HCC ≤3 cm, MWA resulted in comparable 5-year overall survival (81.2% vs 66.3%, P = 0.062) and 5-year recurrence-free survival (37.7% vs 17.4%, P = 0.088) to RFA. In Cox analysis, RFA modality, tumours located in risk areas and low serum albumin levels were unfavourable prognostic factors for overall survival. RFA modality, multiple tumours, tumour size and low serum albumin levels were unfavourable prognostic factors for recurrence-free survival (all P < 0.05). CONCLUSIONS RFA is inferior to MWA for treating HCC within the Milan criteria, but has comparable efficacy to MWA for solitary HCC ≤ 3 cm.
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Affiliation(s)
- Wenwu Liu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yun Zheng
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Wei He
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Ruhai Zou
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Ultrasound, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Jiliang Qiu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Jingxian Shen
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Medical Imaging, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Zhiwen Yang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yuanping Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Chenwei Wang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yongjin Wang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Dinglan Zuo
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Binkui Li
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Yunfei Yuan
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, China.,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
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Zhao J, Zhao Q, Jiang Y, Li W, Yang Y, Qian Z, Liu J. Feasibility study of modeling liver thermal damage using minimally invasive optical method adequate for in situ measurement. JOURNAL OF BIOPHOTONICS 2018; 11:e201700302. [PMID: 29316303 DOI: 10.1002/jbio.201700302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/06/2018] [Indexed: 06/07/2023]
Abstract
Liver thermal ablation techniques have been widely used for the treatment of liver cancer. Kinetic model of damage propagation play an important role for ablation prediction and real-time efficacy assessment. However, practical methods for modeling liver thermal damage are rare. A minimally invasive optical method especially adequate for in situ liver thermal damage modeling is introduced in this paper. Porcine liver tissue was heated by water bath under different temperatures. During thermal treatment, diffuse reflectance spectrum of liver was measured by optical fiber and used to deduce reduced scattering coefficient (μ's ). Arrhenius parameters were obtained through non-isothermal heating approach with damage marker of μ's . Activation energy (Ea ) and frequency factor (A) was deduced from these experiments. A pair of averaged value is 1.200 × 105 J mol-1 and 4.016 × 1017 s-1 . The results were verified for their reasonableness and practicality. Therefore, it is feasible to modeling liver thermal damage based on minimally invasive measurement of optical property and in situ kinetic analysis of damage progress with Arrhenius model. These parameters and this method are beneficial for preoperative planning and real-time efficacy assessment of liver ablation therapy.
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Affiliation(s)
- Jinzhe Zhao
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Qi Zhao
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yingxu Jiang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Weitao Li
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yamin Yang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhiyu Qian
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jia Liu
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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43
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Perkons NR, Stein EJ, Nwaezeapu C, Wildenberg JC, Saleh K, Itkin-Ofer R, Ackerman D, Soulen MC, Hunt SJ, Nadolski GJ, Gade TP. Electrolytic ablation enables cancer cell targeting through pH modulation. Commun Biol 2018; 1:48. [PMID: 30271931 PMCID: PMC6123816 DOI: 10.1038/s42003-018-0047-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/05/2018] [Indexed: 02/07/2023] Open
Abstract
Minimally invasive ablation strategies enable locoregional treatment of tumors. One such strategy, electrolytic ablation, functions through the local delivery of direct current without thermal effects, facilitating enhanced precision. However, the clinical application of electrolytic ablation is limited by an incompletely characterized mechanism of action. Here we show that acid and base production at the electrodes precipitates local pH changes causing the rapid cell death that underlies macroscopic tumor necrosis at pH > 10.6 or < 4.8. The extent of cell death can be modulated by altering the local buffering capacity and antioxidant availability. These data demonstrate that electrolytic ablation is distinguished from other ablation strategies via its ability to induce cellular necrosis by directly altering the tumor microenvironment. These findings may enable further development of electrolytic ablation as a curative therapy for primary, early stage tumors.
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Affiliation(s)
- Nicholas R Perkons
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA
- Department of Bioengineering, 210S 33rd St., Suite 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
| | - Elliot J Stein
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA
| | - Chike Nwaezeapu
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Joseph C Wildenberg
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Kamiel Saleh
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Roni Itkin-Ofer
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Daniel Ackerman
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Michael C Soulen
- Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Stephen J Hunt
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Gregory J Nadolski
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Terence P Gade
- Penn Image-Guided Interventions Laboratory, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA.
- Department of Bioengineering, 210S 33rd St., Suite 240 Skirkanich Hall, Philadelphia, PA, 19104, USA.
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
- Department of Cancer Biology, 421 Curie Boulevard, BRB II/III, Philadelphia, PA, 19104, USA.
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44
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Klubien J, Kohl AP, Nolsøe CP, Rosenberg J, Pommergaard HC. Prognostic factors after ultrasound-guided percutaneous ablation of colorectal liver metastases: A systematic review. Australas J Ultrasound Med 2018; 21:87-95. [PMID: 34760508 DOI: 10.1002/ajum.12088] [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: 11/05/2022] Open
Abstract
Introduction Liver metastases from colorectal cancer are common and ablation therapy is a favourable treatment option for selected patients not suited for surgical resection. This study aimed to systematically review the literature and present prognostic factors associated with survival and local recurrence after percutaneous ultrasound-guided ablation treatment. Materials and methods This review is reported according to the PRISMA. PubMed, Embase and Scopus were searched and records were independently screened by two authors, initially on title and abstract and subsequently on full-text basis. The quality of the studies was assessed using the Newcastle-Ottawa quality assessment scale. Results Of 2.882 records screened, 18 studies were included. The median survival was 23 months. One-year survival was median 95% and 3-year survival was median 58%. Complete ablation response and adjuvant chemotherapy produce considerably improved survival and low local recurrence rate outcomes. Conclusion Percutaneous ultrasound-guided ablation technique for colorectal liver metastases provides impressive survival rates for patients not suited for surgical resection. However, there are some factors related to poorer prognosis, which may be considered when selecting patients.
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Affiliation(s)
- Jeanett Klubien
- Center for Perioperative Optimization Department of Surgery Herlev Hospital Herlev Ringvej 75 2730 Herlev Denmark.,Faculty of Health and Medical Sciences University of Copenhagen Blegdamsvej 3B 2200 København N Denmark
| | - Andreas P Kohl
- Center for Perioperative Optimization Department of Surgery Herlev Hospital Herlev Ringvej 75 2730 Herlev Denmark.,Faculty of Health and Medical Sciences University of Copenhagen Blegdamsvej 3B 2200 København N Denmark
| | - Christian P Nolsøe
- Center for Perioperative Optimization Department of Surgery Herlev Hospital Herlev Ringvej 75 2730 Herlev Denmark.,Faculty of Health and Medical Sciences University of Copenhagen Blegdamsvej 3B 2200 København N Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization Department of Surgery Herlev Hospital Herlev Ringvej 75 2730 Herlev Denmark.,Faculty of Health and Medical Sciences University of Copenhagen Blegdamsvej 3B 2200 København N Denmark
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45
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Peng S, Huang P, Yu H, Wen Y, Luo Y, Wang X, Zhou J, Qin S, Li T, Chen Y, Liu G, Huang M. Prognostic value of carcinoembryonic antigen level in patients with colorectal cancer liver metastasis treated with percutaneous microwave ablation under ultrasound guidance. Medicine (Baltimore) 2018; 97:e0044. [PMID: 29517661 PMCID: PMC5882454 DOI: 10.1097/md.0000000000010044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Thermal ablation is an alternative treatment for colorectal cancer liver metastasis (CRLM). However, prognostic factors in patients with CRLM who have undergone microwave ablation (MWA) have not been clearly defined. Therefore, this study aimed to analyze the risk factors associated with early recurrence in patients with CRLM treated with MWA.Herein, we retrospectively analyzed data for 140 patients with CRLM who underwent MWA from 2013 to 2015 in our institution. Patients were grouped by median pretreatment carcinoembryonic antigen (CEA) level into the high CEA level (>3.7 ng/mL) group and low CEA level (≤3.7 ng/mL) group. Variables that might affect overall survival were subjected to univariable and multivariable Cox regression analysis.Our results showed a median progression-free survival (PFS) and median liver progression-free survival (LPFS) of 9 and 11.5 months, respectively, for the 99 CRLM patients analyzed. Both the median PFS duration (7.5 vs. 12.0 months; hazard ratio [HR]: 1.852; 95% confidence interval [CI]: 1.131-3.034; P = .014) and LPFS duration (7.5 vs 14.0 months; HR: 2.117; 95% CI: 1.247-3.593; P = .005) were significantly shorter in the high CEA level group than in the low level group. In multivariable analysis, high CEA level, >3 tumors, and positive node status for the primary tumor were independent factors for PFS, with corrected HRs of 2.11 (95% CI: 1.257-3.555; P = .005), 2.450 (95% CI: 1.420-4.226; P = .001), and 2.265 (95% CI: 1.304-3.935; P = .004), respectively. However, age, tumor size, regional lymph node were not associated with LPFS.CEA level could be a valuable prognostic factor for early recurrence in patients with CRLM after MWA irrespective of the presence of early local recurrence in the liver or disease progression.
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Affiliation(s)
- Shaoyong Peng
- Department of Colon and Rectum Surgery
- Guangdong Institute of Gastroenteroloy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Pinzhu Huang
- Department of Colon and Rectum Surgery
- Guangdong Institute of Gastroenteroloy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Huichuan Yu
- Guangdong Institute of Gastroenteroloy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Yanlin Wen
- Department of Ultrasound, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, Guangdong,China
| | - Yanxin Luo
- Department of Colon and Rectum Surgery
- Guangdong Institute of Gastroenteroloy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Xiaolin Wang
- Guangdong Institute of Gastroenteroloy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | | | - Si Qin
- Department of Ultrasound, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, Guangdong,China
| | | | - Yao Chen
- Department of Ultrasound, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, Guangdong,China
| | - Guangjian Liu
- Department of Ultrasound, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, Guangdong,China
| | - Meijin Huang
- Department of Colon and Rectum Surgery
- Guangdong Institute of Gastroenteroloy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
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46
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Abbass MA, Killin JK, Mahalingam N, Hooi FM, Barthe PG, Mast TD. Real-Time Spatiotemporal Control of High-Intensity Focused Ultrasound Thermal Ablation Using Echo Decorrelation Imaging in ex Vivo Bovine Liver. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:199-213. [PMID: 29074273 PMCID: PMC5712268 DOI: 10.1016/j.ultrasmedbio.2017.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 05/05/2023]
Abstract
The ability to control high-intensity focused ultrasound (HIFU) thermal ablation using echo decorrelation imaging feedback was evaluated in ex vivo bovine liver. Sonications were automatically ceased when the minimum cumulative echo decorrelation within the region of interest exceeded an ablation control threshold, determined from preliminary experiments as -2.7 (log-scaled decorrelation per millisecond), corresponding to 90% specificity for local ablation prediction. Controlled HIFU thermal ablation experiments were compared with uncontrolled experiments employing two, five or nine sonication cycles. Means and standard errors of the lesion width, area and depth, as well as receiver operating characteristic curves testing ablation prediction performance, were computed for each group. Controlled trials exhibited significantly smaller average lesion area, width and treatment time than five-cycle or nine-cycle uncontrolled trials and also had significantly greater prediction capability than two-cycle uncontrolled trials. These results suggest echo decorrelation imaging is an effective approach to real-time HIFU ablation control.
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Affiliation(s)
- Mohamed A Abbass
- Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jakob K Killin
- Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Fong Ming Hooi
- Ultrasound Division, Siemens Healthcare, Issaquah, Washington, USA
| | | | - T Douglas Mast
- Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA.
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47
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Sastry AV, Swet JH, Murphy KJ, Baker EH, Vrochides D, Martinie JB, McKillop IH, Iannitti DA. A novel 3-dimensional electromagnetic guidance system increases intraoperative microwave antenna placement accuracy. HPB (Oxford) 2017; 19:1066-1073. [PMID: 28917643 DOI: 10.1016/j.hpb.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Failure to locate lesions and accurately place microwave antennas can lead to incomplete tumor ablation. The Emprint™ SX Ablation Platform employs real-time 3D-electromagnetic spatial antenna tracking to generate intraoperative laparoscopic antenna guidance. We sought to determine whether Emprint™ SX affected time/accuracy of antenna-placement in a laparoscopic training model. METHODS Targets (7-10 mm) were set in agar within a laparoscopic training device. Novices (no surgical experience), intermediates (surgical residents), and experts (HPB-surgeons) were asked to locate and hit targets using a MWA antenna (10-ultrasound only, 10-Emprint™ SX). Time to locate target, number of attempts to hit the target, first-time hit rate, and time from initiating antenna advance to hitting the target were measured. RESULTS Participants located 100% of targets using ultrasound, with experts taking significantly less time than novices and intermediates. Using ultrasound only, successful hit-rates were 70% for novices and 90% for intermediates and experts. Using Emprint™ SX, successful hit rates for all 3-groups were 100%, with significantly increased first-time hit-rates and reduced time required to hit targets compared to ultrasound only. DISCUSSION Emprint™ SX significantly improved accuracy and speed of antenna-placement independent of experience, and was particularly beneficial for novice users.
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Affiliation(s)
- Amit V Sastry
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Jacob H Swet
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Keith J Murphy
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Erin H Baker
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - John B Martinie
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Iain H McKillop
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
| | - David A Iannitti
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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48
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Yang W, Varghese T, Ziemlewicz T, Alexander M, Lubner M, Hinshaw JL, Wells S, Lee FT. Delineation of Post-Procedure Ablation Regions with Electrode Displacement Elastography with a Comparison to Acoustic Radiation Force Impulse Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1953-1962. [PMID: 28595851 PMCID: PMC5523876 DOI: 10.1016/j.ultrasmedbio.2017.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/12/2017] [Accepted: 04/20/2017] [Indexed: 05/03/2023]
Abstract
We compared a quasi-static ultrasound elastography technique, referred to as electrode displacement elastography (EDE), with acoustic radiation force impulse imaging (ARFI) for monitoring microwave ablation (MWA) procedures on patients diagnosed with liver neoplasms. Forty-nine patients recruited to this study underwent EDE and ARFI with a Siemens Acuson S2000 system after an MWA procedure. On the basis of visualization results from two observers, the ablated region in ARFI images was recognizable on 20 patients on average in conjunction with B-mode imaging, whereas delineable ablation boundaries could be generated on 4 patients on average. With EDE, the ablated region was delineable on 40 patients on average, with less imaging depth dependence. Study of tissue-mimicking phantoms revealed that the ablation region dimensions measured on EDE and ARFI images were within 8%, whereas the image contrast and contrast-to-noise ratio with EDE was two to three times higher than that obtained with ARFI. This study indicated that EDE provided improved monitoring results for minimally invasive MWA in clinical procedures for liver cancer and metastases.
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Affiliation(s)
- Wenjun Yang
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Marci Alexander
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Meghan Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - James Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shane Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Samimi K, White JK, Brace CL, Varghese T. Monitoring Microwave Ablation of Ex Vivo Bovine Liver Using Ultrasonic Attenuation Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1441-1451. [PMID: 28454843 PMCID: PMC5450944 DOI: 10.1016/j.ultrasmedbio.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 05/10/2023]
Abstract
Thermal ablation of soft tissue changes the tissue microstructure and, consequently, induces changes in its acoustic properties. Although B-mode ultrasound provides high-resolution and high-frame-rate images of ablative therapeutic procedures, it is not particularly effective at delineating boundaries of ablated regions because of poor contrast in echogenicity between ablated and surrounding normal tissue. Quantitative ultrasound techniques can provide quantitative estimates of acoustic properties, such as backscatter and attenuation coefficients, and differentiate ablated and unablated regions more effectively, with the potential for monitoring minimally invasive thermal therapies. In this study, a previously introduced attenuation estimation method was used to create quantitative attenuation coefficient maps for 11 microwave ablation procedures performed on refrigerated ex vivo bovine liver. The attenuation images correlate well with the pathologic images of the ablated region. The mean attenuation coefficient for regions of interest drawn inside and outside the ablated zones were 0.9 (±0.2) and 0.45 (±0.15) dB/cm/MHz, respectively. These estimates agree with reported values in the literature and establish the usefulness of non-invasive attenuation imaging for monitoring therapeutic procedures in the liver.
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Affiliation(s)
- Kayvan Samimi
- Department of Electrical and Computer Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin, USA.
| | - James K White
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tomy Varghese
- Department of Electrical and Computer Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Sartori S, Di Vece F, Ermili F, Tombesi P. Laser ablation of liver tumors: An ancillary technique, or an alternative to radiofrequency and microwave? World J Radiol 2017; 9:91-96. [PMID: 28396723 PMCID: PMC5368631 DOI: 10.4329/wjr.v9.i3.91] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Radiofrequency ablation (RFA) is currently the most popular and used ablation modality for the treatment of non surgical patients with primary and secondary liver tumors, but in the last years microwave ablation (MWA) is being technically improved and widely rediscovered for clinical use. Laser thermal ablation (LTA) is by far less investigated and used than RFA and MWA, but the available data on its effectiveness and safety are quite good and comparable to those of RFA and MWA. All the three hyperthermia-based ablative techniques, when performed by skilled operators, can successfully treat all liver tumors eligible for thermal ablation, and to date in most centers of interventional oncology or interventional radiology the choice of the technique usually depends on the physician’s preference and experience, or technical availability. However, RFA, MWA, and LTA have peculiar advantages and limitations that can make each of them more suitable than the other ones to treat patients and tumors with different characteristics. When all the three thermal ablation techniques are available, the choice among RFA, MWA, and LTA should be guided by their advantages and disadvantages, number, size, and location of the liver nodules, and cost-saving considerations, in order to give patients the best treatment option.
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