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Glielmo P, Fusco S, Gitto S, Zantonelli G, Albano D, Messina C, Sconfienza LM, Mauri G. Artificial intelligence in interventional radiology: state of the art. Eur Radiol Exp 2024; 8:62. [PMID: 38693468 PMCID: PMC11063019 DOI: 10.1186/s41747-024-00452-2] [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: 09/28/2023] [Accepted: 02/26/2024] [Indexed: 05/03/2024] Open
Abstract
Artificial intelligence (AI) has demonstrated great potential in a wide variety of applications in interventional radiology (IR). Support for decision-making and outcome prediction, new functions and improvements in fluoroscopy, ultrasound, computed tomography, and magnetic resonance imaging, specifically in the field of IR, have all been investigated. Furthermore, AI represents a significant boost for fusion imaging and simulated reality, robotics, touchless software interactions, and virtual biopsy. The procedural nature, heterogeneity, and lack of standardisation slow down the process of adoption of AI in IR. Research in AI is in its early stages as current literature is based on pilot or proof of concept studies. The full range of possibilities is yet to be explored.Relevance statement Exploring AI's transformative potential, this article assesses its current applications and challenges in IR, offering insights into decision support and outcome prediction, imaging enhancements, robotics, and touchless interactions, shaping the future of patient care.Key points• AI adoption in IR is more complex compared to diagnostic radiology.• Current literature about AI in IR is in its early stages.• AI has the potential to revolutionise every aspect of IR.
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Affiliation(s)
- Pierluigi Glielmo
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy.
| | - Stefano Fusco
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157, Milan, Italy
| | - Giulia Zantonelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157, Milan, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Via della Commenda, 10, 20122, Milan, Italy
| | - Carmelo Messina
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157, Milan, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157, Milan, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, IEO, IRCCS Istituto Europeo di Oncologia, Milan, Italy
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Biondetti P, Ierardi AM, Casiraghi E, Caruso A, Grillo P, Carriero S, Lanza C, Angileri SA, Sangiovanni A, Iavarone M, Guzzardi G, Carrafiello G. Clinical Impact of a Protocol Involving Cone-Beam CT (CBCT), Fusion Imaging and Ablation Volume Prediction in Percutaneous Image-Guided Microwave Ablation in Patients with Hepatocellular Carcinoma Unsuitable for Standard Ultrasound (US) Guidance. J Clin Med 2023; 12:7598. [PMID: 38137667 PMCID: PMC10743619 DOI: 10.3390/jcm12247598] [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: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE to evaluate the clinical impact of a protocol for the image-guided percutaneous microwave ablation (MWA) of hepatocellular carcinoma (HCC) that includes cone-beam computed tomography (CBCT), fusion imaging and ablation volume prediction in patients with hepatocellular carcinoma unsuitable for standard ultrasound (US) guidance. MATERIALS AND METHODS this study included all patients with HCC treated with MWA between January 2021 and June 2022 in a tertiary institution. Patients were divided into two groups: Group A, treated following the protocol, and Group B, treated with standard ultrasound (US) guidance. Follow-up images were reviewed to assess residual disease (RD), local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Ablation response at 1 month was also evaluated according to mRECIST. Baseline variables and outcomes were compared between the groups. For 1-month RD, propensity score weighting (PSW) was performed. RESULTS 80 consecutive patients with 101 HCCs treated with MWA were divided into two groups. Group A had 41 HCCs in 37 patients, and Group B had 60 HCCs in 43 patients. Among all baseline variables, the groups differed regarding their age (mean of 72 years in Group A and 64 years in Group B, respectively), new vs. residual tumor rates (48% Group A vs. 25% Group B, p < 0.05) and number of subcapsular tumors (56.7% Group B vs. 31.7% Group A, p < 0.05) and perivascular tumors (51.7% Group B vs. 17.1% Group A, p < 0.05). The protocol led to repositioning the antenna in 49% of cases. There was a significant difference in 1-month local response between the groups measured as the RD rate and mRECIST outcomes. LTP rates at 3 and 6 months, and IDR rates at 1, 3 and 6 months, showed no significant differences. Among all variables, logistic regression after PSW demonstrated a protective effect of the protocol against 1-month RD. CONCLUSIONS The use of CBCT, fusion imaging and ablation volume prediction during percutaneous MWA of HCCs provided a better 1-month tumor local control. Further studies with a larger population and longer follow-up are needed.
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Affiliation(s)
- Pierpaolo Biondetti
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Elena Casiraghi
- AnacletoLab, Computer Science Department “Giovanni degli Antoni”-DI, Università degli Studi di Milano, 20133 Milan, Italy;
- CINI National Laboratory in Artificial Intelligence and Intelligent Systems, 00185 Rome, Italy
| | - Alessandro Caruso
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
| | - Pasquale Grillo
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Angelo Sangiovanni
- Department of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy;
| | - Massimo Iavarone
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy;
| | - Giuseppe Guzzardi
- Department of Radiology, Unit of Interventional Radiology, Ospedale Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy;
| | - Gianpaolo Carrafiello
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
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Langenbach MC, Vogl TJ, Buchinger A, Eichler K, Scholtz JE, Hammerstingl R, Gruber-Rouh T. CT-guided biopsies of unspecified suspect intrahepatic lesions: pre-procedure Lipiodol-marking improves the biopsy success rate. Radiol Oncol 2023; 57:158-167. [PMID: 37341197 DOI: 10.2478/raon-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND While computed tomography (CT)-guided liver biopsies are commonly performed using unenhanced images, contrast-enhanced images are beneficial for challenging puncture pathways and lesion locations. This study aimed to evaluate the accuracy of CT-guided biopsies for intrahepatic lesions using unenhanced, intravenous (IV)-enhanced, or intra-arterial Lipiodol-marked CT for lesion marking. PATIENTS AND METHODS Six-hundred-seven patients (men: 358 [59.0%], mean age 61 years; SD ±12.04) with suspect hepatic lesions and CT-guided liver biopsies were retrospectively evaluated. Successful biopsies were histopathological findings other than typical liver tissue or non-specific findings. Data was ascertained regarding the use of contrast medium for the biopsy-planning CT, unenhanced (group 1) vs. Lipiodol (group 2) vs. IV contrast (group 3). Technical success and influencing factors were insulated. Complications were noted. The results were analyzed using the Wilcoxon-Man-Whitney t-test, Chi-square test, and Spearman-Rho. RESULTS Overall lesion hitting rate was 73.1%, with significantly better rates using Lipiodol-marked lesions (79.3%) compared to group 1 (73.8%) and group 3 (65.2%) (p = 0.037). Smaller lesions (<20 mm diameter) benefited significantly from Lipiodol-marking with 71.2% successful biopsy rate compared to group 1 (65.5%) and group 3 (47.7%) (p = 0.021). Liver cirrhosis (p = 0.94) and entity of parenchymal lesions (p = 0.78) had no impact on the hitting rate between the groups. No major complications occurred during the interventions. CONCLUSIONS Pre-biopsy Lipiodol marking of suspect hepatic lesions significantly increases the lesion-hitting rate and is especially beneficial for biopsy of smaller targets below 20 mm diameter. Further, Lipiodol marking is superior to IV contrast for non-visible lesions in unenhanced CT. Target lesion entity has no impact on the hitting rate.
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Affiliation(s)
- Marcel Christian Langenbach
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Joseph Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Amelie Buchinger
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan-Erik Scholtz
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Renate Hammerstingl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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A hybrid deformable registration method to generate motion-compensated 3D virtual MRI for fusion with interventional real-time 3D ultrasound. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02833-1. [PMID: 36648702 DOI: 10.1007/s11548-023-02833-1] [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: 07/28/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE Ultrasound is often the preferred modality for image-guided therapy or treatment in organs such as liver due to real-time imaging capabilities. However, the reduced conspicuity of tumors in ultrasound images adversely impacts the precision and accuracy of treatment delivery. This problem is compounded by deformable motion due to breathing and other physiological activity. This creates the need for a fusion method to align interventional US with pre-interventional modalities that provide superior soft-tissue contrast (e.g., MRI) to accurately target a structure-of-interest and compensate for liver motion. METHOD In this work, we developed a hybrid deformable fusion method to align 3D pre-interventional MRI and 3D interventional US volumes to target the structures-of-interest in liver accurately in real-time. The deformable multimodal fusion method involved an offline alignment of a pre-intervention MRI with a pre-intervention US volume using a traditional registration method, followed by real-time prediction of deformation using a trained deep-learning model between interventional US volumes across different respiratory states. This framework enables motion-compensated MRI-US image fusion in real-time for image-guided treatment. RESULTS The proposed hybrid deformable registration method was evaluated on three healthy volunteers across the pre-intervention MRI and 20 US volume pairs in the free-breathing respiratory cycle. The mean Euclidean landmark distance of three homologous targets in all three volunteers was less than 3 mm for percutaneous liver procedures. CONCLUSIONS Preliminary results show that clinically acceptable registration accuracies for near real-time, deformable MRI-US fusion can be achieved by our proposed hybrid approach. The proposed combination of traditional and deep-learning deformable registration techniques is thus a promising approach for motion-compensated MRI-US fusion to improve targeting in image-guided liver interventions.
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Sub Kim M, Pyo Hong H, Rae Lee Y, Young Choi J, Joong Joo K, Cho YS. Performance of Cone-Beam Computed Tomography (CBCT) Renal Arteriography for Renal Tumor Embolization. Eur J Radiol 2022; 157:110598. [DOI: 10.1016/j.ejrad.2022.110598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/22/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
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Mauri G, Gitto S, Pescatori LC, Albano D, Messina C, Sconfienza LM. Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:387-392. [PMID: 32785900 DOI: 10.1055/a-1194-4225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions. MATERIALS AND METHODS This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded. RESULTS Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ± 5 vs. 26 ± 3 minutes, p = 0.002 and 7; 5.25-8.75 vs. 3; 3-3.25, p = 0.001). In controls, the mean procedure duration was 47 ± 4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5-8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal. CONCLUSION Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes.
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Affiliation(s)
- Giovanni Mauri
- Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
- European Institute of Oncology IRCCS, Division of Interventional Radiology, Milan, Italy
| | - Salvatore Gitto
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
| | | | - Domenico Albano
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
- Università degli Studi di Palermo, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Palermo, Italy
| | - Carmelo Messina
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
| | - Luca Maria Sconfienza
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
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Floridi C, Cellina M, Irmici G, Bruno A, Rossini N, Borgheresi A, Agostini A, Bruno F, Arrigoni F, Arrichiello A, Candelari R, Barile A, Carrafiello G, Giovagnoni A. Precision Imaging Guidance in the Era of Precision Oncology: An Update of Imaging Tools for Interventional Procedures. J Clin Med 2022; 11:jcm11144028. [PMID: 35887791 PMCID: PMC9322069 DOI: 10.3390/jcm11144028] [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: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023] Open
Abstract
Interventional oncology (IO) procedures have become extremely popular in interventional radiology (IR) and play an essential role in the diagnosis, treatment, and supportive care of oncologic patients through new and safe procedures. IR procedures can be divided into two main groups: vascular and non-vascular. Vascular approaches are mainly based on embolization and concomitant injection of chemotherapeutics directly into the tumor-feeding vessels. Percutaneous approaches are a type of non-vascular procedures and include percutaneous image-guided biopsies and different ablation techniques with radiofrequency, microwaves, cryoablation, and focused ultrasound. The use of these techniques requires precise imaging pretreatment planning and guidance that can be provided through different imaging techniques: ultrasound, computed tomography, cone-beam computed tomography, and magnetic resonance. These imaging modalities can be used alone or in combination, thanks to fusion imaging, to further improve the confidence of the operators and the efficacy and safety of the procedures. This article aims is to provide an overview of the available IO procedures based on clinical imaging guidance to develop a targeted and optimal approach to cancer patients.
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Affiliation(s)
- Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
- Correspondence:
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20122 Milan, Italy;
| | - Giovanni Irmici
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Nicolo’ Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Alessandra Borgheresi
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Francesco Arrigoni
- Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Antonio Arrichiello
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy;
- Department of Health Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
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Orlandi D, Viglino U, Dedone G, Leale G, Caruso P, Mauri G, Turtulici G. US-CT fusion-guided percutaneous radiofrequency ablation of large substernal benign thyroid nodules. Int J Hyperthermia 2022; 39:847-854. [PMID: 35757935 DOI: 10.1080/02656736.2022.2091167] [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: 10/17/2022] Open
Abstract
The aim of the present study was to assess feasibility, safety and outcome of ultrasound (US) guided percutaneous radiofrequency (RF) ablation of large substernal benign thyroid nodules assisted by US-computed tomography (CT) fusion imaging and real-time virtual needle tracking (VT) system. Thirty patients (18 females, mean age 56 y, range 32-76 y) with 35 benign nonfunctioning thyroid nodules (mean volume ± SD 26.8 ± 7.6 mL; range 20-38mL) were selected for CT-US fusion guided RF ablation. Nodules' volume was evaluated before treatment and during 12-months follow-up. Complications' rate was also evaluated. US-CT fusion imaging with VT system was feasible in all cases (feasibility 100%) and it was always possible to complete the procedure as planned (technical success 100%). Minor complications occurred in 2/30 cases (6.6%). No major complications occurred. 50% volume reduction (technique efficacy) was achieved in 93% cases, with a significant mean volume reduction at 12 months follow-up (68.7 ± 10.8%), (p < .001). The VT system could be useful in thyroid nodules ablation procedures assistance being able to track the RF electrode tip even when this is obscured by the bubbles produced by the ablative process. The combination of fusion imaging with VT assisted RF ablation represents a safe, non-surgical treatment option for patients with large substernal benign thyroid nodules.
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Affiliation(s)
- Davide Orlandi
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Umberto Viglino
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Genova, Italy
| | - Giorgia Dedone
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Giacomo Leale
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Pietro Caruso
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Giovanni Mauri
- Dipartimento di Oncologia ed Emato-oncologia, Università degli studi di Milano, Milano, Italy.,Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Giovanni Turtulici
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
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Kallini JR, Moriarty JM. Artificial Intelligence in Interventional Radiology. Semin Intervent Radiol 2022; 39:341-347. [PMID: 36062217 PMCID: PMC9433147 DOI: 10.1055/s-0042-1753524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Joseph R. Kallini
- Department of Interventional Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - John M. Moriarty
- Department of Interventional Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
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Mauri G, Papini E, Bernardi S, Barbaro D, Cesareo R, De Feo P, Deandrea M, Fugazzola L, Gambelunghe G, Greco G, Messina C, Monti S, Mormile A, Negro R, Offi C, Palermo A, Persani L, Presciuttini F, Solbiati LA, Spiezia S, Stacul F, Viganò M, Sconfienza LM. Image-guided thermal ablation in autonomously functioning thyroid nodules. A retrospective multicenter three-year follow-up study from the Italian Minimally Invasive Treatment of the Thyroid (MITT) Group. Eur Radiol 2021; 32:1738-1746. [PMID: 34751793 DOI: 10.1007/s00330-021-08289-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. METHODS Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. RESULTS A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. CONCLUSIONS Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. KEY POINTS • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy.
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), via Ripamonti 435, Milan, Italy.
| | - Enrico Papini
- Dipartimento Di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Stella Bernardi
- UCO Medicina Clinica, Ospedale Di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
- Dipartimento Di Scienze Mediche, Università Degli Studi Di Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- Unit of metabolic diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Patophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | | | | | | | - Salvatore Monti
- UOC Di Endocrinologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | | | - Chiara Offi
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Andrea Palermo
- Unit of endocrinology and Diabetes, Campus Bio-Medico university, Roma, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università Degli Studi Di Milano, Milano, Italy
| | | | - Luigi Alessandro Solbiati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Spiezia
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Fulvio Stacul
- SC Radiologia, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milano, Italy
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11
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Beleù A, Drudi A, Giaretta A, De Robertis R, Fedrigo I, Martone E, Simone C, Bovo C, D'Onofrio M. Operator Evaluation of Ultrasound Fusion Imaging Usefulness in the Percutaneous Ablation of Hepatic Malignancies: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3159-3169. [PMID: 34392997 DOI: 10.1016/j.ultrasmedbio.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/05/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
The purpose of the work described here was to evaluate the use of ultrasound fusion imaging (US-FI) in percutaneous ablation of hepatic malignancies with respect to its global usefulness, improvement of conspicuity, confidence increment, needle route changes, and time savings. Thirty-four hepatic tumors (28 hepatocellular carcinomas, 6 metastases) were prospectively ablated in 16 consecutive patients (64 ± 11 y, 75% males), first simulating B-mode-only planning and then synchronizing computed tomography/magnetic resonance images with US and proceeding to needle insertion and tumor ablation under US-FI guidance. Surveys were administered to the operators to evaluate their perception of US-FI advantages. First treatment and local recurrence were also compared. US-FI was judged useful in 91% of cases and more useful when the tumor was not conspicuous in B-mode (p < 0.001), in particular for ablation of local recurrences (p = 0.021). Forty-one percent of tumors were undetectable at B-mode evaluation, and 93% of them were completely ablated under US-FI guidance. The confidence of the operator was highly increased by US-FI in 68% of cases. In 71% of cases, the radiologist saved time using US-FI, especially in treatment of local recurrences (p = 0.024). In conclusion, US-FI significantly increases the detection of target tumors, improves the confidence of the operator and is a time-saving method, especially in the treatment of local recurrences.
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Affiliation(s)
- Alessandro Beleù
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy.
| | - Alessandro Drudi
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Alvise Giaretta
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | | | - Ilaria Fedrigo
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Enrico Martone
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Conci Simone
- Department of Surgery, G. B. Rossi Hospital, University of Verona, Verona, Italy
| | - Chiara Bovo
- Health Director, Azienda Ospedaliera Universitaria Integrata, Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy
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12
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Gennaro N, Schiaffino S, Mauri G, Monfardini L. The What, the Why, and the How of Liver Ablations: A Practical Guide for the Medical Oncologist. Oncology 2021; 99:722-731. [PMID: 34515198 DOI: 10.1159/000518358] [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: 06/13/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
Interventional oncology plays a major role within modern oncological patient management. Image-guided thermal ablation has been recognized as a successful local therapeutic option in patients with primary and secondary malignant liver diseases, as also recalled by the recent European Society of Medical Oncology (ESMO) guidelines on colorectal metastases. As image-guided treatments may be as effective as surgery in selected patients with liver lesions, the clinical oncologist should be familiar with the indications, risks, and technical aspects of liver ablation in order to provide their patients with the best outcomes. This article provides a broad overview of the most commonly used ablation techniques and highlights the most relevant technical aspects such as the ideal setting in the operating theatre; which image-guided methods are available, including the growing application of fusion imaging; or contrast-enhanced ultrasound for guiding/monitoring the procedure. A further aim is to expand the knowledge among medical oncologists about liver ablation procedures and to provide insights into the future perspectives of percutaneous minimally invasive procedures in the liver.
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Affiliation(s)
- Nicolò Gennaro
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Simone Schiaffino
- Radiology Unit IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
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13
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Li J, Tao H, Zhang E, Huang Z. Diagnostic value of gamma-glutamyl transpeptidase to alkaline phosphatase ratio combined with gamma-glutamyl transpeptidase to aspartate aminotransferase ratio and alanine aminotransferase to aspartate aminotransferase ratio in alpha-fetoprotein-negative hepatocellular carcinoma. Cancer Med 2021; 10:4844-4854. [PMID: 34145988 PMCID: PMC8290252 DOI: 10.1002/cam4.4057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/23/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the diagnostic value of gamma-glutamyl transpeptidase to alkaline phosphatase ratio (GAPR) combined with gamma-glutamyl transpeptidase to aspartate aminotransferase ratio (GAR) and alanine aminotransferase to aspartate aminotransferase ratio (AAR) in alpha-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC). METHODS A total of 925 AFP-negative patients, including 235 HCC patients, 213 chronic hepatitis (CH) patients, and 218 liver cirrhosis (LC) patients, as well as 259 healthy controls were enrolled in this study. The differences of laboratory parameters and clinical characteristics were analyzed by Mann-Whitney U or Kruskal-Wallis H-test. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of GAPR, GAR, and AAR in AFP-negative HCC (AFP-NHCC) patients. RESULTS GAPR, GAR, and AAR were important parameters closely related to AFP-NHCC. The combination of GAPR, GAR, and AAR was most effective in differentiating AFP-NHCC group from control group (AUC = 0.875), AFP-negative CH group (AUC = 0.733), and AFP-negative LC group (AUC = 0.713). GAPR combined with GAR and AAR exhibited a larger AUC than single ratio or pairwise combination for distinguishing AFP-NHCC group with TNMⅠstage, BCLC stage A, and tumor size less than 3 cm. The diagnostic value of GAPR combined with GAR and AAR was higher in AFP-NHCC and was also reflected in the TNM stage, Barcelona Clinic Liver Cancer (BCLC) stage and tumor size. CONCLUSIONS GAPR combined with GAR and AAR were effective diagnostic markers of AFP-NHCC, especially in patients with good liver function, early stage or small size.
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Affiliation(s)
- Jiang Li
- Hepatic Surgery CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Haisu Tao
- Hepatic Surgery CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Erlei Zhang
- Hepatic Surgery CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Zhiyong Huang
- Hepatic Surgery CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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14
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Monfardini L, Gennaro N, Orsi F, Della Vigna P, Bonomo G, Varano G, Solbiati L, Mauri G. Real-time US/cone-beam CT fusion imaging for percutaneous ablation of small renal tumours: a technical note. Eur Radiol 2021; 31:7523-7528. [PMID: 33871707 DOI: 10.1007/s00330-021-07930-w] [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] [Received: 01/19/2021] [Revised: 02/24/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Fusion imaging is gaining attention as an imaging technique to assist minimally invasive tumour ablation. Ultrasound (US) and computed tomography (CT) are the most common imaging modalities to guide thermal ablation of renal tumours, yet cone-beam CT (CBCT) has recently been described to successfully assist percutaneous renal interventions. Our goal was to evaluate primary technical success and correct lesion targeting of US/CBCT fusion imaging to guide the ablation of kidney masses < 2 cm in a small group of patients. MATERIAL AND METHODS Six renal lesions (maximum diameter 11-17 mm) were treated with RFA in 5 different patients using real-time US/CBCT. Fusion imaging was used to identify and monitor tumour ablation. Demographics, tumour characteristics and mean serum creatinine levels were recorded before and after the procedure. Primary technical success and correct lesion targeting represented the main endpoints of the study. Primary technique efficacy was confirmed at 1-month and 3-month contrast-enhanced CT follow-ups. RESULTS In all cases, a confident US/CBCT synchronisation was reached and allowed for a correct targeting and a successful percutaneous ablation. Primary technique efficacy was 100%. No recurrence was observed at the follow-up that ranged from 8 to 26 months (mean 16 months). CONCLUSIONS US/CBCT fusion proved to be a viable method to precisely guide safe and effective percutaneous thermal ablation in patients with small renal tumours, especially when hardly detectable on US. KEY POINTS • US/CBCT fusion imaging for renal ablation is safe and feasible. • US/CBCT fusion imaging allows for an improved targeting and complete ablation of small RCC with poor US-conspicuity.
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Affiliation(s)
- Lorenzo Monfardini
- Division of Interventional Radiology, Fondazione Poliambulanza, 25124, Brescia, Italy.
| | - Nicolò Gennaro
- Departament of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy.,Departament of Radiology, Humanitas Clinical and Research Center, 20089, Rozzano, Italy
| | - Franco Orsi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Paolo Della Vigna
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Guido Bonomo
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Gianluca Varano
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Luigi Solbiati
- Departament of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy.,Department of Radiology, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy.,Department of Oncology and Hematolgy-Oncology, Universita` degli studi di Milano, 20122, Milan, Italy
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15
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Role of Fusion Imaging in Image-Guided Thermal Ablations. Diagnostics (Basel) 2021; 11:diagnostics11030549. [PMID: 33808572 PMCID: PMC8003372 DOI: 10.3390/diagnostics11030549] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Abstract
Thermal ablation (TA) procedures are effective treatments for several kinds of cancers. In the recent years, several medical imaging advancements have improved the use of image-guided TA. Imaging technique plays a pivotal role in improving the ablation success, maximizing pre-procedure planning efficacy, intraprocedural targeting, post-procedure monitoring and assessing the achieved result. Fusion imaging (FI) techniques allow for information integration of different imaging modalities, improving all the ablation procedure steps. FI concedes exploitation of all imaging modalities’ strengths concurrently, eliminating or minimizing every single modality’s weaknesses. Our work aims to give an overview of FI, explain and analyze FI technical aspects and its clinical applications in ablation therapy and interventional oncology.
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16
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Zhou D, Liu X, Wang X, Yan F, Wang P, Yan H, Jiang Y, Yang Z. A prognostic nomogram based on LASSO Cox regression in patients with alpha-fetoprotein-negative hepatocellular carcinoma following non-surgical therapy. BMC Cancer 2021; 21:246. [PMID: 33685417 PMCID: PMC7938545 DOI: 10.1186/s12885-021-07916-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis. The aim of this study was to apply a new method to establish and validate a new model for predicting the prognosis of patients with AFP-NHCC. Methods A total of 410 AFP-negative patients with clinical diagnosed with HCC following non-surgical therapy as a primary cohort; 148 patients with AFP-NHCC following non-surgical therapy as an independent validation cohort. In primary cohort, independent factors for overall survival (OS) by LASSO Cox regression were all contained into the nomogram1; by Forward Stepwise Cox regression were all contained into the nomogram2. Nomograms performance and discriminative power were assessed with concordance index (C-index) values, area under curve (AUC), Calibration curve and decision curve analyses (DCA). The results were validated in the validation cohort. Results The C-index of nomogram1was 0.708 (95%CI: 0.673–0.743), which was superior to nomogram2 (0.706) and traditional modes (0.606–0.629). The AUC of nomogram1 was 0.736 (95%CI: 0.690–0.778). In the validation cohort, the nomogram1 still gave good discrimination (C-index: 0.752, 95%CI: 0.691–0.813; AUC: 0.784, 95%CI: 0.709–0.847). The calibration curve for probability of OS showed good homogeneity between prediction by nomogram1 and actual observation. DCA demonstrated that nomogram1 was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram1: low-risk group, middle-risk group and high-risk group, respectively. Conclusions Novel nomogram based on LASSO Cox regression presents more accurate and useful prognostic prediction for patients with AFP-NHCC following non-surgical therapy. This model could help patients with AFP-NHCC following non-surgical therapy facilitate a personalized prognostic evaluation.
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Affiliation(s)
- Dongdong Zhou
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Xiaoli Liu
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Xinhui Wang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Fengna Yan
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Peng Wang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Huiwen Yan
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China.,First Clinical Medical College, Beijing University of Chinese Medicine, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Yuyong Jiang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Zhiyun Yang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China.
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17
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Zhao QY, Xie LT, Chen SC, Xu X, Jiang TA, Zheng SS. Virtual navigation-guided radiofrequency ablation for recurrent hepatocellular carcinoma invisible on ultrasound after hepatic resection. Hepatobiliary Pancreat Dis Int 2020; 19:532-540. [PMID: 33020034 DOI: 10.1016/j.hbpd.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND No reports are available on the technical efficiency and therapeutic response of virtual navigation (VN)-guided radiofrequency ablation (RFA) for patients with recurrent hepatocellular carcinoma (HCC) after hepatic resection. The aim of this study was to investigate the overall technical performance and outcome of VN-guided RFA in recurrent HCC patients. In addition, a nomogram model was developed to predict the factors influencing the overall survival (OS). METHODS This was a prospective study on 76 recurrent HCC patients who underwent VN-guided RFA between June 2015 and February 2018. The technical feasibility, success, and efficiency, OS, local tumor progression, and complications were evaluated. A multivariate Cox regression analysis was conducted to predict the significant factors, and a nomogram including independent predictive factors was subsequently plotted to predict OS. RESULTS The technical feasibility, success, and efficiency rates of VN-guided RFA were 86.4%, 94.7%, and 97.4%, respectively. The cumulative OS rates at 1-, 2-, and 3-year were 88.1%, 79.7%, and 71.0%, respectively. The cumulative local tumor progression rates at 1-, 2-, and 3-year were 5.5%, 8.7%, and 14.0%, respectively. In addition, the minor and major complication rates were 5.3% and 3.9%, respectively. No intervention-related deaths occurred during the follow-up period. The C-index of the OS nomogram in this study was 0.737. CONCLUSIONS VN-guided RFA is an effective therapeutic option in recurrent HCC patients and improves the long-term outcomes especially for the lesions that cannot be detected in the two-dimensional ultrasound. Besides, the nomogram may be a useful supporting tool in predicting OS to estimate the individual survival probability, optimize treatment options, and facilitate decision-making.
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Affiliation(s)
- Qi-Yu Zhao
- Department of Ultrasound, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Li-Ting Xie
- Department of Ultrasound, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shuo-Chun Chen
- Department of Ultrasound, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao Xu
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Tian-An Jiang
- Department of Ultrasound, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Spinczyk D, Stronczek M, Badura A, Sperka P, Krywalska D, Wolinska A, Krasoń A, Fabian S, Bas M, Woloshuk A, Zylkowski J, Rosiak G, Konecki D, Milczarek K, Rowinski O, Pietka E. Initial clinical evaluation of image fusion based on rigid registration and supporting percutaneous liver tumor ablation. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Thermal Ablation of Liver Tumours: The Crucial Role of 3D Imaging. Cardiovasc Intervent Radiol 2020; 43:1416-1417. [PMID: 32556608 DOI: 10.1007/s00270-020-02560-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 01/03/2023]
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20
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Filippiadis D, Mauri G, Marra P, Charalampopoulos G, Gennaro N, De Cobelli F. Percutaneous ablation techniques for renal cell carcinoma: current status and future trends. Int J Hyperthermia 2020; 36:21-30. [PMID: 31537160 DOI: 10.1080/02656736.2019.1647352] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Percutaneous ablation is an increasingly applied technique for the treatment of localized renal tumors, especially for elderly or co-morbid patients, where co-morbidities increase the risk of traditional nephrectomy. Ablative techniques are technically suited for the treatment of tumors generally not exceeding 4 cm, which has been set as general consensus cutoff and is described as the upper threshold of T1a kidney tumors. This threshold cutoff is being challenged, but with still limited evidence. Percutaneous ablation techniques for the treatment of renal cell carcinoma (RCC) include radiofrequency ablation, cryoablation, laser or microwave ablation; the main advantage of all these techniques over surgery is less invasiveness, lower complication rates and better patient tolerability. Currently, international guidelines recommend percutaneous ablation either as intervention for frail patients or as a first line tool, provided that the tumor can be radically ablated. The purpose of this article is to describe the basic concepts of percutaneous ablation in the treatment of RCC. Controversies concerning techniques and products and the need for patient-centered tailored approaches during selection among the different techniques available will be discussed.
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Affiliation(s)
- D Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - G Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS , Milan , Italy
| | - P Marra
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute , Milan , Italy
| | - G Charalampopoulos
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - N Gennaro
- Division of Interventional Radiology, European Institute of Oncology, IRCCS , Milan , Italy
| | - F De Cobelli
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute , Milan , Italy
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21
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Reproducibility of Ablated Volume Measurement Is Higher with Contrast-Enhanced Ultrasound than with B-Mode Ultrasound after Benign Thyroid Nodule Radiofrequency Ablation-A Preliminary Study. J Clin Med 2020; 9:jcm9051504. [PMID: 32429487 PMCID: PMC7291258 DOI: 10.3390/jcm9051504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
The reproducibility of contrast-enhanced ultrasound (CEUS) and standard B-mode ultrasound in the assessment of radiofrequency-ablated volume of benign thyroid nodules was compared. A preliminary study was conducted on consecutive patients who underwent radiofrequency ablation (RFA) of benign thyroid nodules between 2014 and 2016, with available CEUS and B-mode post-ablation checks. CEUS and B-mode images were retrospectively evaluated by two radiologists to assess inter- and intra-observer agreement in the assessment of ablated volume (Bland–Altman test). For CEUS, the mean inter-observer difference (95% limits of agreement) was 0.219 mL (-0.372–0.809 mL); for B-mode, the mean difference was 0.880 mL (-1.655–3.414 mL). Reproducibility was significantly higher for CEUS (85%) than for B-mode (27%). Mean intra-observer differences (95% limits of agreement) were 0.013 mL (0.803–4.097 mL) for Reader 1 and 0.031 mL (0.763–3.931 mL) for Reader 2 using CEUS, while they were 0.567 mL (-2.180–4.317 mL, Reader 1) and 0.759 mL (-2.584–4.290 mL, Reader 2) for B-mode. Intra-observer reproducibility was significantly higher for CEUS (96% and 95%, for the two readers) than for B-mode (21% and 23%). In conclusion, CEUS had higher reproducibility and inter- and intra-observer agreement compared to conventional B-mode in the assessment of radiofrequency-ablated volume of benign thyroid nodules.
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Huang L, Mo Z, Hu Z, Zhang L, Qin S, Qin X, Li S. Diagnostic value of fibrinogen to prealbumin ratio and gamma-glutamyl transpeptidase to platelet ratio in the progression of AFP-negative hepatocellular carcinoma. Cancer Cell Int 2020; 20:77. [PMID: 32190001 PMCID: PMC7066792 DOI: 10.1186/s12935-020-1161-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background This study aimed to comprehensively assess the diagnostic value of fibrinogen to prealbumin ratio (FPR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) as single markers or in combination in patients with alpha-fetoprotein-negative (AFP-negative) hepatocellular carcinoma (HCC). Methods A total of 199 healthy controls and 515 AFP-negative patients were enrolled in this study, including 180 HCC inpatients, 151 liver cirrhosis (LC) patients, and 184 chronic hepatitis (CH) cases. Mann-Whitney U or Kruskal-Wallis H test were used to analyze differences between groups in laboratory parameters and clinicopathological features. The diagnostic value of FPR and GPR, alone or in combination, in AFP-negative HCC (AFP-NHCC) patients was determined via a receiver operating characteristic (ROC) curve. Results The levels of FPR and GPR were gradually increased in the development of AFP-NHCC and positively correlated with the tumor size and Barcelona Clinic Liver Cancer (BCLC) stages. Moreover, GPR was associated with Edmondson-Steiner grades. After univariate logistic regression analysis, FPR and GPR remained independent predictors of adverse outcomes. The combination of FPR and GPR had a good ability to detect AFP-NHCC from the control group (area under curve [AUC] = 0.977), AFP-negative CH (AUC = 0.745), and AFP-negative LC (AUC = 0.666). FPR combined with GPR possessed a larger area (0.943, 0.971) and sensitivity (87.50%, 89.81%) than FPR or GPR alone for differentiating AFP-NHCC with tumor size < 3 cm or at the BCLC-A stage. Conclusions The pretreatment levels of FPR and GPR played vital roles in the development of AFP-NHCC, especially in patients with early or small AFP-NHCC.
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Affiliation(s)
- Li Huang
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Zhuning Mo
- 2Department of Blood Transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region China
| | - Zuojian Hu
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Linyan Zhang
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Shanzi Qin
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Xue Qin
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
| | - Shan Li
- 1Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Zhuang Autonomous Region China
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Tian Z, Yu T, Wei H, Ning N. Clinical value of LHPP-associated microRNAs combined with protein induced by vitamin K deficiency or antagonist-II in the diagnosis of alpha-fetoprotein-negative hepatocellular carcinoma. J Clin Lab Anal 2019; 34:e23071. [PMID: 31693242 PMCID: PMC7031545 DOI: 10.1002/jcla.23071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/22/2019] [Accepted: 09/29/2019] [Indexed: 12/13/2022] Open
Abstract
Background Alpha‐fetoprotein (AFP) has received extensive attention in the differential diagnosis of hepatocellular carcinoma (HCC), especially for AFP‐negative HCC (AFP‐NHCC). The current study aimed to explore the value of targeted regulation of LHPP expression‐related microRNAs (miRs) and protein induced by vitamin K deficiency or antagonist‐II (PIVKA‐II) in the differential diagnosis of AFP‐NHCC. Methods A retrospective study was conducted on a testing set—including 214 AFP‐NHCC patients, 200 cirrhosis, and 210 controls, and a validation set—including 140 AFP‐NHCC patients, 134 cirrhosis, and 128 controls recruited from The First Affiliated Hospital of Hunan Normal University. Serum miRs were examined using quantitative real‐time PCR method. Serum PIVKA‐II was measured by enzyme‐linked immunosorbent assay. Results Compared with adjacent tissues, LHPP protein levels in cancer tissues were significantly decreased (P < .05). Predictive software and dual‐luciferase reporter assays showed that miR‐363‐5p and miR‐765 can target LHPP expression. Serum miR‐363‐5p, miR‐765, and PIVKA‐II levels were significantly higher in AFP‐HCC patients than in cirrhosis and controls. A logistic regression model combining miR‐363‐5p, miR‐765, and PIVKA‐II was performed. This model presented a high discriminating value (AUC: 0.930, sensitivity/specificity: 79.4%/95.4%) than any single indicator. In the validation set, this model still showed a high discriminating value (AUC: 0.936, sensitivity/specificity: 83.6%/94.7%). Conclusion Current model combining serum miR‐363‐5p, miR‐765, and PIVKA‐II has potential significance for diagnosis of AFP‐NHCC.
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Affiliation(s)
- Zeyu Tian
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Tanbo Yu
- Department of Pharmacy, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hongyan Wei
- Department of Pharmacy, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Ning Ning
- Department of Medical Administration, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Differential Expression and Diagnostic Significance of Pre-Albumin, Fibrinogen Combined with D-Dimer in AFP-Negative Hepatocellular Carcinoma. Pathol Oncol Res 2019; 26:1669-1676. [PMID: 31578661 DOI: 10.1007/s12253-019-00752-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most malignant cancers with high morbidity and mortality. Nowadays, AFP-negative hepatocellular carcinoma (AFP-NHCC) has been found in many HCC patients and AFP analysis can't be used to screen HCC in these cases. In this study, we have examined the expression patterns of pre-albumin (PA), fibrinogen, D-Dimer and their clinical significance in AFP-NHCC. We recruited 214 AFP-NHCC patients and 210 controls in the study. PA, fibrinogen and D-Dimer levels were detected by turbidimetry, clauss and immunoturbidimetry methods, respectively. Serum PA levels were significantly lower in AFP-NHCC (84.5 ± 24.7 mg/L) than that in the controls (240.6 ± 59.4 mg/L, P < 0.05). For plasma fibrinogen levels, there was no difference between the controls (2.9 ± 0.7 g/L) and AFP-NHCC (2.5 ± 0.7 g/L). Compared with AFP-NHCC (0.8 ± 0.2 mg/L), plasma D-Dimer levels were significantly lower in controls (0.1 ± 0.0 mg/L, P < 0.05). The levels of PA, fibrinogen and D-Dimer were significantly correlated with differentiation (P < 0.01), and the PA and D-Dimer values were correlated with TNM stage (P < 0.05). Moreover, PA levels were correlated with tumor size (P = 0.034). Receiver operating characteristic curve (ROC) analyses elaborated that combination of PA, fibrinogen and D-Dimer possessed a higher sensitivity (93.4%) for differentiating AFP-NHCC from the controls, but the diagnostic specificity was reduced due to the combination of fibrinogen. After adjusting for all significant outcome predictors of the univariate logistic regression analysis, low levels of PA and high levels of D-Dimer were remained independent unfavorable outcome predictors (P < 0.05). Our data suggested that the expression levels of PA, fibrinogen and D-Dimer played critical roles in AFP-NHCC tumorigenesis. Moreover, PA and D-Dimer might be considered as potential diagnostic indicators in AFP-NHCC.
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van Steenbergen TRF, Smits M, Scheenen TWJ, van Oort IM, Nagarajah J, Rovers MM, Mehra N, Fütterer JJ. 68Ga-PSMA-PET/CT and Diffusion MRI Targeting for Cone-Beam CT-Guided Bone Biopsies of Castration-Resistant Prostate Cancer Patients. Cardiovasc Intervent Radiol 2019; 43:147-154. [PMID: 31444628 PMCID: PMC6940314 DOI: 10.1007/s00270-019-02312-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
Introduction Precision medicine expands the treatment options for metastatic castration-resistant prostate cancer (mCRPC) by targeting druggable genetic aberrations. Aberrations can be identified following molecular analysis of metastatic tissue. Bone metastases, commonly present in mCRPC, hinder precision medicine due to a high proportion of biopsies with insufficient tumor cells for next-generation DNA sequencing. We aimed to investigate the feasibility of incorporating advanced target planning and needle guidance in bone biopsies and whether this procedure increases biopsy tumor yield and success rate of molecular analysis as compared to the current standards, utilizing only CT guidance. Materials and Methods In a pilot study, ten mCRPC patients received 68Ga-prostate-specific membrane antigen (PSMA)-PET/CT and diffusion-weighted MRI as biopsy planning images. These datasets were fused for targeting metastatic lesions with high tumor densities. Biopsies were performed under cone-beam CT (CBCT) guidance. Feasibility of target planning and needle guidance was assessed, and success of molecular analysis and tumor yield were reported. Results Fusion target planning and CBCT needle guidance were feasible. Nine out of ten biopsies contained prostate cancer cells, with a median of 39% and 40% tumor cells by two different sequencing techniques. Molecular analysis was successful in eight of ten patients (80%). This exceeds previous reports on CT-guided biopsies that ranged from 33 to 44%. In two patients, important druggable aberrations were found. Discussion A biopsy procedure using advanced target planning and needle guidance is feasible and can increase the success rate of molecular analysis in bone metastases, thereby having the potential of improving treatment outcome for patients with mCRPC. Level of Evidence Level 4, case series.
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Affiliation(s)
- T R F van Steenbergen
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - M Smits
- Department of Medical Oncology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T W J Scheenen
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - I M van Oort
- Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Nagarajah
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - M M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Mehra
- Department of Medical Oncology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Monfardini L, Gennaro N, Della Vigna P, Bonomo G, Varano G, Maiettini D, Bonello L, Solbiati L, Orsi F, Mauri G. Cone-Beam CT-Assisted Ablation of Renal Tumors: Preliminary Results. Cardiovasc Intervent Radiol 2019; 42:1718-1725. [PMID: 31367773 DOI: 10.1007/s00270-019-02296-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Renal ablation is a recognized treatment modality for small renal masses. Cone-beam CT (CBCT) has been recently used in interventional oncology as a promising new guidance device, but this technology still needs to be validated for renal ablations. We aimed to assess the technical success of CBCT applications in renal ablative treatments. MATERIALS AND METHODS Between March 2016 and June 2018, 14 patients (mean age 69, range 54-83, 7F, 7M) underwent 21 renal ablations for histologically proven renal cell carcinoma (RCC). All treatments were performed with ultrasound (US) and CBCT guidance under general anesthesia in a dedicated angiography room setting. CBCT was mainly used to assess needle placement and to exclude complications at the end of the procedure. In two small lesions (< 1 cm), pre-acquired CBCT was co-registered with real-time US to obtain a US-CBCT fusion image guidance for tumor ablation. RESULTS Whether used alone or in combination with other imaging modalities, CBCT was proven to be technically successful in all 21 procedures to guide or assist tumor ablation. A primary technical efficacy of thermal ablation was achieved in 19/21 ablations (90.1%) at 1 month. Mean procedure duration was 100.2 min (range 160-64). Mean length of hospital stay was 2 days (range 1-10 days). All patients are still under active surveillance for a mean follow-up of 14.5 months (range 4-26 months). CONCLUSIONS CBCT for renal ablation guidance is a viable tool. Larger series are needed to compare it to MDCT.
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Affiliation(s)
- Lorenzo Monfardini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, 25124, Brescia, Italy
| | - Nicolò Gennaro
- Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
| | - Paolo Della Vigna
- Division of Interventional Radiology, European Institute of Oncology, IEO, IRCCS, 20141, Milan, Italy
| | - Guido Bonomo
- Division of Interventional Radiology, European Institute of Oncology, IEO, IRCCS, 20141, Milan, Italy
| | - Gianluca Varano
- Division of Interventional Radiology, European Institute of Oncology, IEO, IRCCS, 20141, Milan, Italy
| | - Daniele Maiettini
- Division of Interventional Radiology, European Institute of Oncology, IEO, IRCCS, 20141, Milan, Italy
| | - Luke Bonello
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, Msida, 2090, Malta
| | - Luigi Solbiati
- Department of Radiology, Humanitas Clinical and Research Hospital, 20089, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, 20089, Pieve Emanuele, Milan, Italy
| | - Franco Orsi
- Division of Interventional Radiology, European Institute of Oncology, IEO, IRCCS, 20141, Milan, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IEO, IRCCS, 20141, Milan, Italy
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