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Triggiani S, Contaldo MT, Mastellone G, Cè M, Ierardi AM, Carrafiello G, Cellina M. The Role of Artificial Intelligence and Texture Analysis in Interventional Radiological Treatments of Liver Masses: A Narrative Review. Crit Rev Oncog 2024; 29:37-52. [PMID: 38505880 DOI: 10.1615/critrevoncog.2023049855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Liver lesions, including both benign and malignant tumors, pose significant challenges in interventional radiological treatment planning and prognostication. The emerging field of artificial intelligence (AI) and its integration with texture analysis techniques have shown promising potential in predicting treatment outcomes, enhancing precision, and aiding clinical decision-making. This comprehensive review aims to summarize the current state-of-the-art research on the application of AI and texture analysis in determining treatment response, recurrence rates, and overall survival outcomes for patients undergoing interventional radiological treatment for liver lesions. Furthermore, the review addresses the challenges associated with the implementation of AI and texture analysis in clinical practice, including data acquisition, standardization of imaging protocols, and model validation. Future directions and potential advancements in this field are discussed. Integration of multi-modal imaging data, incorporation of genomics and clinical data, and the development of predictive models with enhanced interpretability are proposed as potential avenues for further research. In conclusion, the application of AI and texture analysis in predicting outcomes of interventional radiological treatment for liver lesions shows great promise in augmenting clinical decision-making and improving patient care. By leveraging these technologies, clinicians can potentially enhance treatment planning, optimize intervention strategies, and ultimately improve patient outcomes in the management of liver lesions.
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Affiliation(s)
- Sonia Triggiani
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Maria T Contaldo
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giulia Mastellone
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Anna M Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy; Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Università di Milano, 20122 Milan, Italy
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Piazza Principessa Clotilde 3, 20121, Milan, Italy
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Kostyrko B, Rubarth K, Althoff C, Poch FGM, Neizert CA, Zibell M, Gebauer B, Lehmann KS, Niehues SM, Mews J, Diekhoff T, Pohlan J. Computed tomography-based thermography (CTT) in microwave ablation: prediction of the heat ablation zone in the porcine liver. Insights Imaging 2023; 14:189. [PMID: 37962712 PMCID: PMC10645839 DOI: 10.1186/s13244-023-01537-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVES The aim of the study was to investigate computed tomography-based thermography (CTT) for ablation zone prediction in microwave ablation (MWA). METHODS CTT was investigated during MWA in an in vivo porcine liver. For CTT, serial volume scans were acquired every 30 s during ablations and every 60 s immediately after MWA. After the procedure, contrast-enhanced computed tomography (CECT) was performed. After euthanasia, the liver was removed for sampling and further examination. Color-coded CTT maps were created for visualization of ablation zones, which were compared with both CECT and macroscopy. Average CT attenuation values in Hounsfield units (HU) were statistically correlated with temperatures using Spearman's correlation coefficient. CTT was retrospectively evaluated in one patient who underwent radiofrequency ablation (RFA) treatment of renal cell carcinoma. RESULTS A significant correlation between HU and temperature was found with r = - 0.77 (95% confidence interval (CI), - 0.89 to - 0.57) and p < 0.001. Linear regression yielded a slope of - 1.96 HU/°C (95% CI, - 2.66 to - 1.26). Color-coded CTT maps provided superior visualization of ablation zones. CONCLUSION Our results show that CTT allows visualization of the ablation area and measurement of its size and is feasible in patients, encouraging further exploration in a clinical setting. CRITICAL RELEVANCE STATEMENT CT-based thermography research software allows visualization of the ablation zone and is feasible in patients, encouraging further exploration in a clinical setting to assess risk reduction of local recurrence.
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Affiliation(s)
- Bogdan Kostyrko
- Department of Radiology, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Kerstin Rubarth
- Institute of Biometry and Clinical Epidemiology, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Medical Informatics, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Althoff
- Department of Radiology, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Franz Gerd Martin Poch
- Department of General and Visceral Surgery, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Christina Ann Neizert
- Department of General and Visceral Surgery, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Miriam Zibell
- Department of General and Visceral Surgery, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kai Siegfried Lehmann
- Department of General and Visceral Surgery, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Stefan Markus Niehues
- Department of Radiology, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jürgen Mews
- Canon Medical Systems Europe BV, Global Research & Development Center, Amstelveen, the Netherlands
| | - Torsten Diekhoff
- Department of Radiology, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Julian Pohlan
- Department of Radiology, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Kostyrko B, Rubarth K, Althoff C, Zibell M, Neizert CA, Poch F, Torsello GF, Gebauer B, Lehmann K, Niehues SM, Mews J, Diekhoff T, Pohlan J. Evaluation of Different Registration Algorithms to Reduce Motion Artifacts in CT-Thermography (CTT). Diagnostics (Basel) 2023; 13:2076. [PMID: 37370971 DOI: 10.3390/diagnostics13122076] [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: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Computed tomography (CT)-based Thermography (CTT) is currently being investigated as a non-invasive temperature monitoring method during ablation procedures. Since multiple CT scans with defined time intervals were acquired during this procedure, interscan motion artifacts can occur between the images, so registration is required. The aim of this study was to investigate different registration algorithms and their combinations for minimizing inter-scan motion artifacts during thermal ablation. Four CTT datasets were acquired using microwave ablation (MWA) of normal liver tissue performed in an in vivo porcine model. During each ablation, spectral CT volume scans were sequentially acquired. Based on initial reconstructions, rigid or elastic registration, or a combination of these, were carried out and rated by 15 radiologists. Friedman's test was used to compare rating results in reader assessments and revealed significant differences for the ablation probe movement rating only (p = 0.006; range, 5.3-6.6 points). Regarding this parameter, readers assessed rigid registration as inferior to other registrations. Quantitative analysis of ablation probe movement yielded a significantly decreased distance for combined registration as compared with unregistered data. In this study, registration was found to have the greatest influence on ablation probe movement, with connected registration being superior to only one registration process.
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Affiliation(s)
- Bogdan Kostyrko
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Kerstin Rubarth
- Institute for Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10178 Berlin, Germany
| | - Christian Althoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Miriam Zibell
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Christina Ann Neizert
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Franz Poch
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Giovanni Federico Torsello
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Kai Lehmann
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 12203 Berlin, Germany
| | - Stefan Markus Niehues
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Jürgen Mews
- Canon Medical Systems Europe BV, Global Research & Development Center, 2718 RP Zoetermeer, The Netherlands
| | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
| | - Julian Pohlan
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10178 Berlin, Germany
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Fite BZ, Wang J, Ghanouni P, Ferrara KW. A Review of Imaging Methods to Assess Ultrasound-Mediated Ablation. BME FRONTIERS 2022; 2022:9758652. [PMID: 35957844 PMCID: PMC9364780 DOI: 10.34133/2022/9758652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 12/18/2022] Open
Abstract
Ultrasound ablation techniques are minimally invasive alternatives to surgical resection and have rapidly increased in use. The response of tissue to HIFU ablation differs based on the relative contributions of thermal and mechanical effects, which can be varied to achieve optimal ablation parameters for a given tissue type and location. In tumor ablation, similar to surgical resection, it is desirable to include a safety margin of ablated tissue around the entirety of the tumor. A factor in optimizing ablative techniques is minimizing the recurrence rate, which can be due to incomplete ablation of the target tissue. Further, combining focal ablation with immunotherapy is likely to be key for effective treatment of metastatic cancer, and therefore characterizing the impact of ablation on the tumor microenvironment will be important. Thus, visualization and quantification of the extent of ablation is an integral component of ablative procedures. The aim of this review article is to describe the radiological findings after ultrasound ablation across multiple imaging modalities. This review presents readers with a general overview of the current and emerging imaging methods to assess the efficacy of ultrasound ablative treatments.
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Affiliation(s)
- Brett Z. Fite
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - James Wang
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
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Subregion Radiomics Analysis to Display Necrosis After Hepatic Microwave Ablation-A Proof of Concept Study. Invest Radiol 2021; 55:422-429. [PMID: 32028297 DOI: 10.1097/rli.0000000000000653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to improve the visualization of coagulation necrosis after computed tomography (CT)-guided microwave ablation (MWA) in routine postablational imaging. MATERIALS AND METHODS Ten MWAs were performed in 8 pigs under CT guidance. After each ablation, we obtained contrast-enhanced CT scans in venous phase. Ablations were then resected as a whole, and histologic slices were obtained orthogonally through the ablation center. Subsequently, a vital stain was applied to the sections for visualization of coagulation necrosis. Computed tomography images were reformatted to match the histologic slices. Afterwards, quantitative imaging features were extracted from the subregions of all images, and binary classifiers were used to predict the presence of coagulation necrosis for each subregion. From this, heatmaps could be created, which visually represented the extent of necrosis in each CT image. Two independent observers evaluated the extent of coagulative necrosis between the heat maps and histological sections. RESULTS We applied 4 different classifiers, including a generalized linear mixed model (GLMM), a stochastic gradient boosting classifier, a random forest classifier, and a k-nearest neighbor classifier, out of which the GLMM showed the best performance to display coagulation necrosis. The GLMM resulted in an area under the curve of 0.84 and a Jaccard index of 0.6 between the generated heat map and the histologic reference standard as well as a good interobserver agreement with a Jaccard index of 0.9. CONCLUSIONS Subregion radiomics analysis may improve visualization of coagulation necrosis after hepatic MWA in an in vivo porcine model.
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Kobe A, Kindler Y, Klotz E, Puippe G, Messmer F, Alkadhi H, Pfammatter T. Fusion of Preinterventional MR Imaging With Liver Perfusion CT After RFA of Hepatocellular Carcinoma: Early Quantitative Prediction of Local Recurrence. Invest Radiol 2021; 56:188-196. [PMID: 32932379 DOI: 10.1097/rli.0000000000000726] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the ability of fusion of pretreatment magnetic resonance (MR) imaging with posttreatment perfusion-CT (P-CT) after radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) and to determine treatment success in an objective, quantitative way. MATERIALS AND METHODS In this institutional review board-approved study, 39 patients (78.4% male; mean age 68.2 ± 8.5 years) with a total of 43 HCCs, who underwent RFA at our institution and had diagnostic pre-RFA MR imaging and post-RFA P-CT, were included in the study. Post-RFA P-CT was performed within 24 hours after RFA. In a first step, the pre-RFA MR imaging, depicting the HCC, was registered onto the post-RFA P-CT using nonrigid image registration. After image registration, the MR data were reloaded jointly with the calculated perfusion parameter volumes into the perfusion application for quantitative analysis. A 3-dimensional volume of interest was drawn around the HCC and the ablation zone; both outlines were automatically projected onto all perfusion maps. Resulting perfusion values (normalized peak enhancement [NPE, %]; arterial liver perfusion [ALP, in mL/min/100 mL]; BF [blood flow, mL/100 mL/min]; and blood volume [BV, mL/100 mL]) and histogram data were recorded. Local tumor recurrence was defined in follow-up imaging according to the EASL guidelines. RESULTS Image registration of MR imaging and CT data was successful in 37 patients (94.9%). Local tumor recurrence was observed in 5 HCCs (12%). In the local tumor recurrence group (LTR-group), HCC size was significantly larger (22.7 ± 3.9 cm vs 17.8 ± 5.3 cm, P = 0.035) and the ablation zone was significantly smaller (29.8 ± 6.9 cm vs 39.3 ± 6.8 cm, P = 0.014) compared with the no-local tumor recurrence group (no-LTR group). The differences (ablation zone - tumor) of the perfusion parameters NPE, ALP, BF, and BV significantly differed between the 2 groups (all P's < 0.005). Especially, the difference (ablation zone - tumor) of NPE and ALP, with a cutoff value of zero, accurately differentiated between LTR or no-LTR in all cases. A negative difference of these perfusion parameters identified local tumor recurrence in all cases. CONCLUSIONS Image registration of pre-RFA MR imaging onto post-RFA P-CT is feasible and allows to predict local tumor recurrence within 24 hours after RFA in an objective, quantitative manner and with excellent accuracy.
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Affiliation(s)
- Adrian Kobe
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Yanick Kindler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Gilbert Puippe
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Florian Messmer
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Pfammatter
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Huh J, Kim B, Lee JH, Won JH, Kim J, Kwon Y, Kim JK. Added Value of CT Arterial Subtraction Images in Liver Imaging Reporting and Data System Treatment Response Categorization for Transcatheter Arterial Chemoembolization-Treated Hepatocellular Carcinoma. Invest Radiol 2021; 56:109-116. [PMID: 33405431 DOI: 10.1097/rli.0000000000000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to assess the benefit of adding arterial subtraction images from computed tomography (CT) to the Liver Imaging Reporting and Data System (LI-RADS) v2018 treatment response (LR-TR) categorization in patients treated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study included 115 patients with 151 HCCs treated by TACE using an emulsion of doxorubicin and iodized oil who underwent multiphasic CT protocol that additionally generated arterial subtraction images based on nonrigid anatomic correction algorithm. Of 151 HCCs, 67 (44.4%) were viable and 84 (55.6%) were nonviable. Two independent readers assessed the per-lesion LR-TR categories in set 1 of multiphasic CT images alone and set 2 including both set 1 and CT arterial subtraction images, besides diagnostic confidence, and the quality of subtraction images. The sensitivity and specificity of LR-TR viable category between the sets were compared using the generalized estimating equation. Interobserver agreements of LR-TR categorization in each set and the quality of subtraction images were assessed by Cohen κ. RESULTS The quality of subtraction images was mostly good to perfect (98.7%) with good interobserver agreement (κ = 0.71), and none were nondiagnostic. For detecting viable HCC, LR-TR viable category showed sensitivity of 53.7% to 56.7% and specificity of 96.4% to 98.8% in set 1. In comparison, set 2 showed significantly higher sensitivity of 88.1% to 89.6% (P < 0.002) and equivalent specificity of 94% to 95.2% (P > 0.13) for the same category. In sets 1 and 2, 31.3% to 34.3% and 9% to 10.4% of viable HCC were miscategorized as LR-TR nonviable, respectively. LR-TR equivocal category was less assigned in set 2 (1.3%) than in set 1 (6.6%-7.9%). Set 2 showed slightly higher level of confidence for LR-TR categorization compared with set 1 (3.4 ± 0.8 vs 3.8 ± 0.5). Interobserver agreement was excellent in both sets (κ = 0.85 in set 1 and 0.97 in set 2). CONCLUSIONS The LR-TR viable category is highly specific but inadequately sensitive for detecting viable tumor in TACE-treated HCC on conventional multiphasic CT. Adding arterial subtraction images to the conventional CT images significantly increases sensitivity without compromising the specificity and improves the diagnostic confidence of LR-TR viable category.
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Affiliation(s)
- Jimi Huh
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Bohyun Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jei Hee Lee
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Je Hwan Won
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Jinoo Kim
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Yohan Kwon
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Jai Keun Kim
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
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Poch FG, Geyer B, Gemeinhardt O, Klopfleisch R, Niehues SM, Vahldiek JL, Bressem K, Kreis ME, Lehmann KS. Immediate post-interventional contrast-enhanced computed tomography overestimates hepatic microwave ablation - an in vivo animal study. Int J Hyperthermia 2020; 37:463-469. [PMID: 32396401 DOI: 10.1080/02656736.2020.1762936] [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: 10/24/2022] Open
Abstract
Objectives: Contrast-enhanced computed tomography (CECT) is used to monitor technical success immediately after hepatic microwave ablation (MWA). However, it remains unclear, if CECT shows the exact extend of the thermal destruction zone, or if tissue changes such as peri-lesionary edema are depicted as well. The objective of this study was to correlate immediate post-interventional CECT with histological and macroscopic findings in hepatic MWA in porcine liver in vivo.Methods: Eleven MWA were performed in porcine liver in vivo with a microwave generator (928 MHz; energy input 24 kJ). CECT was performed post-interventionally. Livers were explanted and ablations were bisected immediately after ablation. Samples were histologically analyzed after vital staining (NADH-diaphorase). Ablation zones were histologically and macroscopically outlined. We correlated histologic findings, macroscopic images and CECT.Results: Three ablation zones were identified in histological and macroscopic findings. Only one ablation zone could be depicted in CECT. Close conformity was observed between histological and macroscopic findings. The ablation zone depicted in CECT overestimated the histological avital central zone and inner red zone (p < = .01). No differences were found between CECT and the histological outer red zone (p > .05).Conclusions: Immediate post-interventional CECT overestimated the clinically relevant zone of complete cell ablation after MWA in porcine liver in vivo. This entails the risk of incomplete tumor ablation and could lead to tumor recurrence.
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Affiliation(s)
- Franz G Poch
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beatrice Geyer
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ole Gemeinhardt
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Stefan M Niehues
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janis L Vahldiek
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Keno Bressem
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin E Kreis
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kai S Lehmann
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Computed Tomography Thermography for Ablation Zone Prediction in Microwave Ablation and Cryoablation: Advantages and Challenges in an Ex Vivo Porcine Liver Model. J Comput Assist Tomogr 2020; 44:744-749. [PMID: 32842063 DOI: 10.1097/rct.0000000000001081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the diagnostic accuracy of computed tomography (CT) for the prediction of ablation zones from microwave ablation (MWA) and cryoablation (CA) in an ex vivo porcine liver model. METHODS Sequential (30 seconds) CT scans were acquired during and after MWA and CA in an ex vivo porcine liver model. We generated 120-kVp equivalent reconstructions of generic dual-energy CT data sets, and comprehensive region-of-interest measurements were statistically correlated with invasive temperature monitoring using Pearson correlation coefficient. Binary logistic regression was performed for prediction of successful ablation. RESULTS With the use of pooled data from 6 lesions in 2 separate experiments, correlation analysis of attenuation in Hounsfield units (HU) and temperature yielded r = -0.79 [confidence interval (CI), -0.85 to -0.71] for MWA and r = 0.62 (CI, 0.55 to 0.67) for CA.For MWA, there was a linear association between attenuation and temperature up to 75°C; thus, linear regression yielded a slope of -2.00 HU/°C (95% CI, -1.58 to -2.41). For CA, a linear association between attenuation and temperature was observed in the cooling phase with a slope of 2.11 HU/°C (95% CI, 1.79 to 2.58). In MWA treatment, binary logistic regression separated less than 70°C and greater than 70°C with 89.2% accuracy. Within the ice ball, temperatures above and below -20°C were distinguished with 65.3% accuracy. CONCLUSIONS Our experiments reveal several difficulties in predicting ablation zone temperature from CT attenuation. Microwave ablation leads to gas production in the tissue, which degrades the accuracy of noninvasive temperature measurement, especially at higher temperatures. In CA, CT thermometry is limited by ice ball formation, which leads to homogeneous attenuation, nearly independent of temperature. Further research is needed to define the role of CT thermography in ablation zone monitoring in liver malignancies.
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Bressem KK, Vahldiek JL, Erxleben C, Poch F, Shnaiyen S, Geyer B, Lehmann KS, Hamm B, Niehues SM. Exploring Patterns of Dynamic Size Changes of Lesions after Hepatic Microwave Ablation in an In Vivo Porcine Model. Sci Rep 2020; 10:805. [PMID: 31965024 PMCID: PMC6972764 DOI: 10.1038/s41598-020-57859-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/08/2020] [Indexed: 11/09/2022] Open
Abstract
Microwave ablation (MWA) is a type of minimally invasive cancer therapy that uses heat to induce necrosis in solid tumours. Inter- and post-ablational size changes can influence the accuracy of control imaging, posing a risk of incomplete ablation. The present study aims to explore post-ablation 3D size dynamics in vivo using computed tomography (CT). Ten MWA datasets obtained in nine healthy pigs were used. Lesions were subdivided along the z-axis with an additional planar subdivision into eight subsections. The volume of the subsections was analysed over different time points, subsequently colour-coded and three-dimensionally visualized. A locally weighted polynomial regression model (LOESS) was applied to describe overall size changes, and Student's t-tests were used to assess statistical significance of size changes. The 3D analysis showed heterogeneous volume changes with multiple small changes at the lesion margins over all time points. The changes were pronounced at the upper and lower lesion edges and characterized by initially eccentric, opposite swelling, followed by shrinkage. In the middle parts of the lesion, we observed less dimensional variations over the different time points. LOESS revealed a hyperbolic pattern for the volumetric changes with an initially significant volume increase of 11.6% (111.6% of the original volume) over the first 32 minutes, followed by a continuous decrease to 96% of the original volume (p < 0.05).
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Affiliation(s)
- Keno K Bressem
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany.
| | - Janis L Vahldiek
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Christoph Erxleben
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Franz Poch
- Department of Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Seyd Shnaiyen
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Beatrice Geyer
- Department of Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Kai S Lehmann
- Department of Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Stefan M Niehues
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
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Geyer B, Poch FGM, Gemeinhardt O, Neizert CA, Niehues SM, Vahldiek JL, Klopfleisch R, Lehmann KS. Microwave ablation zones are larger than they macroscopically appear - Reevaluation based on NADH vitality staining ex vivo. Clin Hemorheol Microcirc 2019; 73:371-378. [DOI: 10.3233/ch-190583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Beatrice Geyer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral and Vascular Surgery – Campus Benjamin Franklin, Berlin, Germany
| | - Franz G. M. Poch
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral and Vascular Surgery – Campus Benjamin Franklin, Berlin, Germany
| | - Ole Gemeinhardt
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology – Campus Mitte, Berlin, Germany
| | - Christina A. Neizert
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral and Vascular Surgery – Campus Benjamin Franklin, Berlin, Germany
| | - Stefan M. Niehues
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology – Campus Benjamin Franklin, Berlin, Germany
| | - Janis L. Vahldiek
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology – Campus Benjamin Franklin, Berlin, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Kai S. Lehmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral and Vascular Surgery – Campus Benjamin Franklin, Berlin, Germany
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Bressem KK, Vahldiek JL, Erxleben C, Shnayien S, Poch F, Geyer B, Lehmann KS, Hamm B, Niehues SM. Improved Visualization of the Necrotic Zone after Microwave Ablation Using Computed Tomography Volume Perfusion in an In Vivo Porcine Model. Sci Rep 2019; 9:18506. [PMID: 31811190 PMCID: PMC6898643 DOI: 10.1038/s41598-019-55026-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/21/2019] [Indexed: 01/02/2023] Open
Abstract
After hepatic microwave ablation, the differentiation between fully necrotic and persistent vital tissue through contrast enhanced CT remains a clinical challenge. Therefore, there is a need to evaluate new imaging modalities, such as CT perfusion (CTP) to improve the visualization of coagulation necrosis. MWA and CTP were prospectively performed in five healthy pigs. After the procedure, the pigs were euthanized, and the livers explanted. Orthogonal histological slices of the ablations were stained with a vital stain, digitalized and the necrotic core was segmented. CTP maps were calculated using a dual-input deconvolution algorithm. The segmented necrotic zones were overlaid on the DICOM images to calculate the accuracy of depiction by CECT/CTP compared to the histological reference standard. A receiver operating characteristic analysis was performed to determine the agreement/true positive rate and disagreement/false discovery rate between CECT/CTP and histology. Standard CECT showed a true positive rate of 81% and a false discovery rate of 52% for display of the coagulation necrosis. Using CTP, delineation of the coagulation necrosis could be improved significantly through the display of hepatic blood volume and hepatic arterial blood flow (p < 0.001). The ratios of true positive rate/false discovery rate were 89%/25% and 90%/50% respectively. Other parameter maps showed an inferior performance compared to CECT.
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Affiliation(s)
- Keno K Bressem
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Janis L Vahldiek
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christoph Erxleben
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Franz Poch
- Department of Surgery, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Beatrice Geyer
- Department of Surgery, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kai S Lehmann
- Department of Surgery, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - B Hamm
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan M Niehues
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
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