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Yin Y, de Haas RJ, Alves N, Pennings JP, Ruiter SJS, Kwee TC, Yakar D. Machine learning-based radiomic analysis and growth visualization for ablation site recurrence diagnosis in follow-up CT. Abdom Radiol (NY) 2024; 49:1122-1131. [PMID: 38289352 PMCID: PMC10955006 DOI: 10.1007/s00261-023-04178-4] [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: 10/19/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Detecting ablation site recurrence (ASR) after thermal ablation remains a challenge for radiologists due to the similarity between tumor recurrence and post-ablative changes. Radiomic analysis and machine learning methods may show additional value in addressing this challenge. The present study primarily sought to determine the efficacy of radiomic analysis in detecting ASR on follow-up computed tomography (CT) scans. The second aim was to develop a visualization tool capable of emphasizing regions of ASR between follow-up scans in individual patients. MATERIALS AND METHODS Lasso regression and Extreme Gradient Boosting (XGBoost) classifiers were employed for modeling radiomic features extracted from regions of interest delineated by two radiologists. A leave-one-out test (LOOT) was utilized for performance evaluation. A visualization method, creating difference heatmaps (diff-maps) between two follow-up scans, was developed to emphasize regions of growth and thereby highlighting potential ASR. RESULTS A total of 55 patients, including 20 with and 35 without ASR, were included in the radiomic analysis. The best performing model was achieved by Lasso regression tested with the LOOT approach, reaching an area under the curve (AUC) of 0.97 and an accuracy of 92.73%. The XGBoost classifier demonstrated better performance when trained with all extracted radiomic features than without feature selection, achieving an AUC of 0.93 and an accuracy of 89.09%. The diff-maps correctly highlighted post-ablative liver tumor recurrence in all patients. CONCLUSIONS Machine learning-based radiomic analysis and growth visualization proved effective in detecting ablation site recurrence on follow-up CT scans.
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Affiliation(s)
- Yunchao Yin
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Natalia Alves
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Jan Pieter Pennings
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Simeon J S Ruiter
- Department of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Derya Yakar
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Pan Y, Zhang Y, Shi X, Li D, Xu X, Xiao B, Piao Y, Xiang J, Shao S, Ho FCY, Shen Y, Zhang AP, Tang J. Electrical stimulation induces anti-tumor immunomodulation via a flexible microneedle-array-integrated interdigital electrode. Sci Bull (Beijing) 2023; 68:2779-2792. [PMID: 37863773 DOI: 10.1016/j.scib.2023.10.004] [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: 05/01/2023] [Revised: 09/04/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
Immunotherapy has revolutionized cancer therapy, using chemical or biological agents to reinvigorate the immune system. However, most of these agents have poor tumor penetration and inevitable side effects that complicate therapeutic outcomes. Electrical stimulation (ES) is a promising alternative therapy against cancers that does not involve chemical or biological agents but is limited in the fabrication and operation of complex micrometer-scale ES devices. Here, we present an optically microprinted flexible interdigital electrode with a gold-plated polymer microneedle array to generate alternating electric fields for cancer treatment. A flexible microneedle-array-integrated interdigital electrode (FMIE) was fabricated by combining optical 3D microprinting and electroless plating processes. FMIE-mediated ES of cancer cells induced necrotic cell death through mitochondrial Ca2+ overload and increased intracellular reactive oxygen species (ROS) production. This led to the release of damage-associated molecular patterns that activated the immune response and potentiated immunogenic cell death (ICD). FMIE-based ES has an excellent safety profile and systemic anti-tumor effects, inhibiting the growth of primary and distant tumors as well as melanoma lung metastasis. FMIE-based ES-driven cancer immunomodulation provides a new pathway for drug-free cancer therapy.
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Affiliation(s)
- Yixuan Pan
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
| | - Yangxi Zhang
- Photonics Research Institute, Department of Electrical and Electronic Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xueying Shi
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
| | - Dongdong Li
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
| | - Xiaodan Xu
- ZJU-Hangzhou Global Scientific and Technological Innovation Center, Hangzhou 311215, China
| | - Bing Xiao
- Institute of Pharmaceutics, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Ying Piao
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
| | - Jiajia Xiang
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China; ZJU-Hangzhou Global Scientific and Technological Innovation Center, Hangzhou 311215, China
| | - Shiqun Shao
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China; ZJU-Hangzhou Global Scientific and Technological Innovation Center, Hangzhou 311215, China
| | - Frederic Chun-Yip Ho
- Photonics Research Institute, Department of Electrical and Electronic Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Youqing Shen
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China
| | - A Ping Zhang
- Photonics Research Institute, Department of Electrical and Electronic Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Jianbin Tang
- Key Laboratory of Smart Biomaterials of Zhejiang Province, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, China; ZJU-Hangzhou Global Scientific and Technological Innovation Center, Hangzhou 311215, China.
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Geboers B, van der Lei S, Kloppenborg LT, Boon RM, Timmer FE, Puijk RS, de Vries JJ, Scheffer HJ, Meijerink MR. Transcatheter CT arteriography-guided irreversible electroporation of locally advanced pancreatic adenocarcinoma: A pictorial essay. J Med Imaging Radiat Oncol 2023. [PMID: 37186494 DOI: 10.1111/1754-9485.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Visibility of the tumour and its surroundings during the ablative procedure is crucial for optimal treatment planning, needle placement, ablation zone coverage and postprocedural control. The use of transcatheter CT arteriography providing real-time image guidance has proven to be of additional value for thermal liver ablation. The general advantages of the technique could be of value for other indications and ablation techniques as well, especially when requiring multiple needle placements in the vicinity of precarious vascular structures. This pictorial essay presents six clinical cases that illustrate transcatheter CT arteriography guidance during the treatment of locally advanced pancreatic cancer with irreversible electroporation. The illustrations highlight the technique's ability to improve visibility of vascular structures and the advantage of real-time monitoring and treatment of intraprocedural vascular complications. The use of transcatheter CT arteriography can support the interventionalist with respect to periprocedural safety and accuracy of electrode placement for pancreatic irreversible electroporation.
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Affiliation(s)
- Bart Geboers
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
- Garvan Institute of Medical Research & The Kinghorn Cancer Center, Sydney, New South Wales, Australia
- St. Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Susan van der Lei
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Louiza Te Kloppenborg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Rianne M Boon
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Florentine Ef Timmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Robbert S Puijk
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
- OLVG, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands
| | - Jan Jj de Vries
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hester J Scheffer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Location VUmc) & Cancer Center Amsterdam, Amsterdam, The Netherlands
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Gao X, Zhang Y, Han X, Li Z, Chen B, Li Q, Hu L, Lv Y, Ren F. Numerical analysis and animal study of noninvasive handheld electroporation delivery device for skin superficial lesion treatment. Int J Hyperthermia 2022; 39:1017-1025. [PMID: 35912525 DOI: 10.1080/02656736.2022.2104937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION This study aims to investigate the feasibility of a noninvasive handheld electroporation pulses delivery device (EPDD) for electroporation-based treatment (EBT) of skin superficial lesions through numerical analysis and animal study. METHODS Finite element analysis was performed to investigate the performance of the EPDD. The electric field, temperature, EI and TI were calculated under pulse voltages of 600, 800, and 1000 V. A mouse subcutaneous tumor model was established to evaluate the performance of the EPDD through histopathology and survival analyses. RESULTS The electrical field strength increased from 151 (600 V) to 252 V/cm (1000 V) in the skin and from 1302 (600 V) to 2171 V/cm (1000 V) in the tumor. The volume of EI grew and reached a plateau at the 165th pulse, whereas the maximum volume of EI increased with higher voltage. The growth tendency of TI differed between groups, and it was higher in the high-voltage group (HVG) than in the low-voltage group. Histopathological analysis showed that the depth and range of the ablation area could be controlled by adjusting pulse voltage. Survival analysis showed that the survival of the HVG was better than that of the low-voltage and the control group (p < 0.01). CONCLUSIONS The results demonstrate that the EPDD is feasible, safe, and effective for skin EBT. The volume of EP tissue injury can be controlled by adjusting the pulse voltage, pulse number, and other parameters. The proposed noninvasive handheld EPDD can be a potential therapeutic tool for EBT of superficial skin lesions in the future.
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Affiliation(s)
- Xuyao Gao
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yuchi Zhang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Electrical Science and Technology Research Institute, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Han
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhuoqun Li
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bowen Chen
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qingshan Li
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liangshuo Hu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fenggang Ren
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Investigating the effect of electrode orientation on irreversible electroporation with experiment and simulation. Int J Comput Assist Radiol Surg 2022; 17:1399-1407. [PMID: 35451675 PMCID: PMC9307545 DOI: 10.1007/s11548-022-02618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/23/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE In recent years, irreversible electroporation (IRE) has been developed to specifically destroy undesirable tissues as an alternative to surgical resection. In this treatment, placing multiple electrodes in parallel is required to create a uniform electric field distribution. The process of maintaining parallel electrodes is challenging, and the effect of the electrodes' orientation accuracy has not been investigated quantitatively. This study investigates the impact of the electrode orientation along with various electrode and pulse parameters on the outcomes of IRE. METHODS The electrode configurations that were considered were parallel, forward, and sideward orientation. A numerical model was developed to study the effect of electrode orientation on the electric field distribution, which was validated experimentally on potato tubers as it has similar properties to biological tissue. In addition, a conductivity test was performed to evaluate the conductivity and electroporation threshold of the potatoes. RESULTS The developed numerical model was validated by comparing the electroporated volumes between potatoes from the experiment and simulation, which achieved a mean dice score of [Formula: see text]. The potato has an electrical conductivity of 0.044-0.454 S/m with an electroporation threshold of 375 V/cm. ANOVA test showed that the difference in the electroporated regions obtained between a parallel orientation and a 5[Formula: see text] forward and sideward orientation was not significant. CONCLUSION This study showed that the developed numerical models were validated and able to predict the outcome of IRE on potatoes. In addition, a 5[Formula: see text] tolerance on the electrode orientation can be defined to obtain a similar response to the parallel orientation.
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Bäumler W, Beyer LP, Lürken L, Wiggermann P, Stroszczynski C, Dollinger M, Schicho A. Detection of Incomplete Irreversible Electroporation (IRE) and Microwave Ablation (MWA) of Hepatocellular Carcinoma (HCC) Using Iodine Quantification in Dual Energy Computed Tomography (DECT). Diagnostics (Basel) 2022; 12:diagnostics12040986. [PMID: 35454034 PMCID: PMC9026630 DOI: 10.3390/diagnostics12040986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Early detection of local tumor progression (LTP) after irreversible electroporation (IRE) and microwave ablation (MWA) of hepatocellular carcinoma (HCC) remains challenging. The goal of this study was to identify cases with insufficient ablation and prevent HCC recurrencies by measuring iodine uptake using dual-energy computed tomography (DECT). In 54 HCC-patients, the volumetric iodine concentration (VIC) of the central and peripheral ablation area was evaluated by DECT within 24 h after IRE or MWA. Follow-up was performed with CT and/or MRI at 6 weeks, 3, 6, 9, and 12 months, respectively. In both groups, LTP was solely detected in the peripheral area (IRE: n = 4; MWA: n = 4) and LTP patients showed significantly higher VIC values in the peripheral zone than patients without LTP (IRE: * p = 0.0005; MWA: * p = 0.000). In IRE-LTP patients, no significant difference between the VIC values of non-ablated liver tissue and the peripheral zone was detected (p = 0.155). The peripheral zones of IRE patients without LTP (* p = 0.000) and MWA patients, irrespective of the presence of LTP (LTP: * p = 0.005; without LTP: * p = 0.000), showed significantly lower VIC values than non-ablated liver parenchyma. Higher BCLC tumor stages were indicative for LTP (* p = 0.008). The study suggests that elevated iodine uptake in the peripheral ablation zone could help identify LTP after IRE and MWA of HCC.
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Affiliation(s)
- Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
- Correspondence: ; Tel.: +49-941-944-7401; Fax: +49-941-944-7402
| | - Lukas Philipp Beyer
- Department of Diagnostic and Interventional Radiology, Ernst von Bergmann Hospital, Charlottenstraße 72, 14467 Potsdam, Germany;
| | - Lukas Lürken
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
| | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Salzdahlumer Straße 90, 38126 Braunschweig, Germany;
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
| | - Marco Dollinger
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
| | - Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (L.L.); (C.S.); (M.D.); (A.S.)
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Zhao Y, McKillop IH, Davalos RV. Modeling of a single bipolar electrode with tines for irreversible electroporation delivery. Comput Biol Med 2022; 142:104870. [PMID: 35051854 PMCID: PMC10037907 DOI: 10.1016/j.compbiomed.2021.104870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/24/2021] [Accepted: 09/12/2021] [Indexed: 01/07/2023]
Abstract
Irreversible electroporation (IRE) is a non-thermal tumor ablation technology employed to treat solid tumors not amenable to resection or thermal ablation. The IRE systems currently in clinical use deliver electrical pulses via multiple monopolar electrodes. This approach can present significant technical challenges due to the requirement for accurate placement of multiple electrodes and maintenance of parallel electrode alignment during pulse delivery. In this study, we sought to evaluate a novel IRE electrode configuration consisting of a single bipolar electrode with deployable tines. Using commercial finite element software predicted ablation outcomes, thermal damage, ablation sphericity, and energy delivery were calculated for existing monopolar and bipolar electrodes, and bipolar electrodes with either 4 or 8 deployable tines. The bipolar electrodes with tines generated larger predicted ablations compared to existing monopolar (>100%) and bipolar (>10%) arrangements, and the ablation shape using bipolar electrodes with tines were more spherical than those modeled for bipolar electrodes. Thermal damage modeled for bipolar electrodes and bipolar electrodes with tines was less than that of monopolar electrodes (using identical pulse parameters), and bipolar electrodes with tines delivered less energy than monopolar or bipolar electrodes. These studies using a single point of device insertion suggest the potential for developing alternative IRE delivery techniques, and may simplify clinical use and increase the predicted ablation shape/volume.
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Affiliation(s)
- Yajun Zhao
- College of Electrical Engineering and Control Science, Nanjing Tech. University, Nanjing, 211816, China; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA.
| | - Iain H McKillop
- Department of Surgery, Atrium Health, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA
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Andrade DLLS, Guedert R, Pintarelli GB, Rangel MMM, Oliveira KD, Quadros PG, Suzuki DOH. Electrochemotherapy treatment safety under parallel needle deflection. Sci Rep 2022; 12:2766. [PMID: 35177779 PMCID: PMC8854592 DOI: 10.1038/s41598-022-06747-x] [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: 10/25/2021] [Accepted: 02/02/2022] [Indexed: 11/09/2022] Open
Abstract
Electrochemotherapy is a selective electrical-based cancer treatment. A thriving treatment depends on the local electric field generated by pairs of electrodes. Electrode damage as deflection can directly affect this treatment pillar, the distribution of the electric field. Mechanical deformations such as tip misshaping and needle deflection are reported with needle electrode reusing in veterinary electrochemotherapy. We performed in vitro and in silico experiments to evaluate potential problems with ESOPE type II electrode deflection and potential treatment pitfalls. We also investigated the extent to which the electric currents of the electroporation model can describe deflection failure by comparing in vitro with the in silico model of potato tuber (Solanum tuberosum). The in silico model was also performed with the tumor electroporation model, which is more conductive than the vegetal model. We do not recommend using deflected electrodes. We have found that a deflection of ± 2 mm is unsafe for treatment. Inward deflection can cause dangerous electrical current levels when treating a tumor and cannot be described with the in silico vegetal model. Outward deflection can cause blind spots in the electric field.
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Affiliation(s)
- Daniella L L S Andrade
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | - Raul Guedert
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | - Guilherme B Pintarelli
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | | | | | | | - Daniela O H Suzuki
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil.
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Pan F, Do TD, Vollherbst DF, Pereira PL, Richter GM, Faerber M, Weiss KH, Mehrabi A, Kauczor HU, Sommer CM. Percutaneous Irreversible Electroporation for Treatment of Small Hepatocellular Carcinoma Invisible on Unenhanced CT: A Novel Combined Strategy with Prior Transarterial Tumor Marking. Cancers (Basel) 2021; 13:cancers13092021. [PMID: 33922067 PMCID: PMC8122342 DOI: 10.3390/cancers13092021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION To explore the feasibility, safety, and efficiency of ethiodized oil tumor marking combined with irreversible electroporation (IRE) for small hepatocellular carcinomas (HCCs) that were invisible on unenhanced computed tomography (CT). METHODS A retrospective analysis of the institutional database was performed from January 2018 to September 2018. Patients undergoing ethiodized oil tumor marking to improve target-HCC visualization in subsequent CT-guided IRE were retrieved. Target-HCC visualization after marking was assessed, and the signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNR) were compared between pre-marking and post-marking CT images using the paired t-test. Standard IRE reports, adverse events, therapeutic endpoints, and survival were summarized and assessed. RESULTS Nine patients with 11 target-HCCs (11.1-18.8 mm) were included. After marking, all target-HCCs demonstrated complete visualization in post-marking CT, which were invisible in pre-marking CT. Quantitatively, the SNR of the target-HCCs significantly increased after marking (11.07 ± 4.23 vs. 3.36 ± 1.79, p = 0.006), as did the CNR (4.32 ± 3.31 vs. 0.43 ± 0.28, p = 0.023). In sequential IRE procedures, the average current was 30.1 ± 5.3 A, and both the delta ampere and percentage were positive with the mean values of 5.8 ± 2.1 A and 23.8 ± 6.3%, respectively. All procedures were technically successful without any adverse events. In the follow-up, no residual unablated tumor (endpoint-1) was observed. The half-year, one-year, and two-year local tumor progression (endpoint-2) rate was 0%, 9.1%, and 27.3%. The two-year overall survival rate was 100%. CONCLUSIONS Ethiodized oil tumor marking enables to demarcate small HCCs that were invisible on unenhanced CT. It potentially allows a safe and complete ablation in subsequent CT-guided IRE.
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Affiliation(s)
- Feng Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Thuy D. Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
| | - Dominik F. Vollherbst
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
- Department of Neuroradiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Philippe L. Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, 74078 Heilbronn, Germany;
| | - Götz M. Richter
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, 70174 Stuttgart, Germany;
| | - Michael Faerber
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
| | - Karl H. Weiss
- Department of Gastroenterology, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Hans U. Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
| | - Christof M. Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, 70174 Stuttgart, Germany;
- Correspondence: ; Tel.: +49-(0)6221-5638534; Fax: +49-(0)6221-564194
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Bäumler W, Wiggermann P, Lürken L, Dollinger M, Stroszczynski C, Beyer LP, Schicho A. Early Detection of Local Tumor Progression after Irreversible Electroporation (IRE) of a Hepatocellular Carcinoma Using Gd-EOB-DTPA-Based MR Imaging at 3T. Cancers (Basel) 2021; 13:cancers13071595. [PMID: 33808336 PMCID: PMC8037433 DOI: 10.3390/cancers13071595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary Liver tumors like hepatocellular carcinoma (HCC) can be treated minimally invasive, e.g., by Irreversible Electroporation (IRE), which destroys the cancer. As it is possible that the tumor re-grows due to single tumor cells inadvertently not covered by the treatment, follow-up imaging of the liver is important for early detection of local tumor progression. As ablation leaves scarred tissue, recurrent tumor after IRE can appear vastly different than before treatment and thus can be hard to detect on MRI via classical imaging features. We here examined cases of local tumor progression after IRE of HCC and found distinct MR-imaging features helpful for the identification of re-grown viable tumor, namely T2 BLADE and diffusion weighted images (DWI) at the ablation zone border and T1 portal-venous and delayed phase post-contrast images in the center of the ablation zone. This knowledge will help in early detection and re-treatment of HCC for a prolonged survival. Abstract This single-center retrospective study was conducted to improve the early detection of local tumor progression (LTP) after irreversible electroporation (IRE) of a hepatocellular carcinoma (HCC) using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-based 3T MR imaging and to identify helpful signal characteristics by comparing 23 patients with and 60 patients without LTP. To identify the differences in the sensitivity of MRI sequences, the specificity, positive prediction value, negative prediction value (NPV) and diagnostic odds ratio were calculated. A chi-squared test, two-tailed student’s t-test and binary logistic regression model were used to detect distinct patient characteristics and variables for the prediction of LTP. LTP was mostly detected in the peripheral ablation zone (82.6%) within the first six months (87.0%). The central LTP ablation area presented more hypointensities in T1 p.v. (sensitivity: 95.0%; NPV: 90.0%) and in T1 d.p. (sensitivity: 100.0%; NPV: 100.0) while its peripheral part showed more hyperintensities in T2 BLADE (sensitivity: 95.5%; NPV: 80.0%) and in diffusion sequences (sensitivity: 90.0%). Liver cirrhosis seems to be an unfavorable prognosticator for LTP (p = 0.039). In conclusion, LTP mostly occurs in the peripheral ablation zone within six months after IRE. Despite often exhibiting atypical Gd-EOB-DTPA MR signal characteristics, T2 BLADE and diffusion sequences were helpful for their detection in the peripheral zone while T1 p.v. and T1 d.p. had the highest sensitivity in the central zone.
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Affiliation(s)
- Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, 93042 Regensburg, Germany; (W.B.); (L.L.); (M.D.); (C.S.)
| | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Städtisches Klinikum Braunschweig, 38114 Braunschweig, Germany;
| | - Lukas Lürken
- Department of Radiology, University Hospital Regensburg, 93042 Regensburg, Germany; (W.B.); (L.L.); (M.D.); (C.S.)
| | - Marco Dollinger
- Department of Radiology, University Hospital Regensburg, 93042 Regensburg, Germany; (W.B.); (L.L.); (M.D.); (C.S.)
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, 93042 Regensburg, Germany; (W.B.); (L.L.); (M.D.); (C.S.)
| | - Lukas P. Beyer
- Department of Radiology, Klinikum Ernst von Bergmann, 14467 Potsdam, Germany;
| | - Andreas Schicho
- Department of Radiology, University Hospital Regensburg, 93042 Regensburg, Germany; (W.B.); (L.L.); (M.D.); (C.S.)
- Correspondence:
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