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Zirakchian Zadeh M, Sotirchos VS, Kirov A, Lafontaine D, Gönen M, Yeh R, Kunin H, Petre EN, Kitsel Y, Elsayed M, Solomon SB, Erinjeri JP, Schwartz LH, Sofocleous CT. Three-Dimensional Margin as a Predictor of Local Tumor Progression after Microwave Ablation: Intraprocedural versus 4-8-Week Postablation Assessment. J Vasc Interv Radiol 2024; 35:523-532.e1. [PMID: 38215818 DOI: 10.1016/j.jvir.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024] Open
Abstract
PURPOSE To evaluate the prognostic accuracy of intraprocedural and 4-8-week (current standard) post-microwave ablation zone (AZ) and margin assessments for prediction of local tumor progression (LTP) using 3-dimensional (3D) software. MATERIALS AND METHODS Data regarding 100 colorectal liver metastases (CLMs) in 75 patients were collected from 2 prospective fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT)-guided microwave ablation (MWA) trials. The target CLMs and theoretical 5- and 10-mm margins were segmented and registered intraprocedurally and at 4-8 weeks after MWA contrast-enhanced CT (or magnetic resonance [MR] imaging) using the same methodology and 3D software. Tumor and 5- and 10-mm minimal margin (MM) volumes not covered by the AZ were defined as volumes of insufficient coverage (VICs). The intraprocedural and 4-8-week post-MWA VICs were compared as predictors of LTP using receiver operating characteristic curve analysis. RESULTS The median follow-up time was 19.6 months (interquartile range, 7.97-36.5 months). VICs for 5- and 10-mm MMs were predictive of LTP at both time assessments. The highest accuracy for the prediction of LTP was documented with the intra-ablation 5-mm VIC (area under the curve [AUC], 0.78; 95% confidence interval, 0.66-0.89). LTP for a VIC of 6-10-mm margin category was 11.4% compared with 4.3% for >10-mm margin category (P < .001). CONCLUSIONS A 3D 5-mm MM is a critical endpoint of thermal ablation, whereas optimal local tumor control is noted with a 10-mm MM. Higher AUCs for prediction of LTP were achieved for intraprocedural evaluation than for the 4-8-week postablation 3D evaluation of the AZ.
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Affiliation(s)
| | - Vlasios S Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Assen Kirov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel Lafontaine
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Randy Yeh
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Henry Kunin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuliya Kitsel
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mohammad Elsayed
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph P Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lawrence H Schwartz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Liu J, Guo Y, Sun Y, Liu M, Zhang X, Zheng R, Cong L, Liu B, Xie X, Huang G. Three-dimensional ultrasound fusion imaging in precise needle placement for thermal ablation of hepatocellular carcinoma. Int J Hyperthermia 2024; 41:2316097. [PMID: 38360570 DOI: 10.1080/02656736.2024.2316097] [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: 11/21/2023] [Accepted: 02/03/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To investigate the value of three-dimensional ultrasound fusion imaging (3DUS FI) technique for guiding needle placement in hepatocellular carcinoma (HCC) thermal ablation. METHODS A total of 57 patients with 60 HCCs with 3DUS FI-guided thermal ablation were retrospectively included in the study. 3DUS volume data of liver were acquired preoperatively by freehand scanning with the tumor and predetermined 5 mm ablative margin automatically segmented. Plan of needle placement was made through a predetermined simulated ablation zone to ensure a 5 mm ablative margin with the coverage rate toward tumor and ablative margin. With real-time ultrasound and 3DUS fusion imaging, ablation needles were placed according to the plan. After ablation, the ablative margin was immediately evaluated by contrast-enhanced ultrasound and 3DUS fusion imaging. The rate of adequate ablative margin, complete response (CR), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) was evaluated. RESULTS According to postoperative contrast-enhanced CT or MR imaging, the complete response rate was 100% (60/60), and 83% of tumors (30/36) achieved adequate ablative margin (>5 mm) three-dimensionally. During the follow-up period of 6.0-42.6 months, LTP occurred in 5 lesions, with 1- and 2-year LTP rates being 7.0% and 9.4%. The 1- and 2-year DFS rates were 76.1% and 65.6%, and 1- and 2-year OS rates were 98.1% and 94.0%. No major complications or ablation-related deaths were observed in any patients. CONCLUSIONS Three-dimensional ultrasound fusion imaging technique may improve the needle placement of thermal ablation for HCC and reduce the rate of LTP.
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Affiliation(s)
- Jiaming Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuqing Guo
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yueting Sun
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruiying Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Longfei Cong
- Medical Imaging System Division, Shenzhen Mindray Bio-Medical Electronics Co., Ltd, Shenzhen, China
| | - Baoxian Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guangliang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Medical Ultrasonics, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Nanning, China
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Rainu SK, Ramachandran RG, Parameswaran S, Krishnakumar S, Singh N. Advancements in Intraoperative Near-Infrared Fluorescence Imaging for Accurate Tumor Resection: A Promising Technique for Improved Surgical Outcomes and Patient Survival. ACS Biomater Sci Eng 2023; 9:5504-5526. [PMID: 37661342 DOI: 10.1021/acsbiomaterials.3c00828] [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: 09/05/2023]
Abstract
Clear surgical margins for solid tumor resection are essential for preventing cancer recurrence and improving overall patient survival. Complete resection of tumors is often limited by a surgeon's ability to accurately locate malignant tissues and differentiate them from healthy tissue. Therefore, techniques or imaging modalities are required that would ease the identification and resection of tumors by real-time intraoperative visualization of tumors. Although conventional imaging techniques such as positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), or radiography play an essential role in preoperative diagnostics, these cannot be utilized in intraoperative tumor detection due to their large size, high cost, long imaging time, and lack of cancer specificity. The inception of several imaging techniques has paved the way to intraoperative tumor margin detection with a high degree of sensitivity and specificity. Particularly, molecular imaging using near-infrared fluorescence (NIRF) based nanoprobes provides superior imaging quality due to high signal-to-noise ratio, deep penetration to tissues, and low autofluorescence, enabling accurate tumor resection and improved survival rates. In this review, we discuss the recent developments in imaging technologies, specifically focusing on NIRF nanoprobes that aid in highly specific intraoperative surgeries with real-time recognition of tumor margins.
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Affiliation(s)
- Simran Kaur Rainu
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Remya Girija Ramachandran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Sowmya Parameswaran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Subramanian Krishnakumar
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Neetu Singh
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Dzaye O, Cornelis FH, Kunin HS, Sofocleous CT. Advancements and Future Outlook of PET/CT-Guided Interventions. Tech Vasc Interv Radiol 2023; 26:100916. [PMID: 38071029 DOI: 10.1016/j.tvir.2023.100916] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Advancements in minimally invasive technology, coupled with imaging breakthroughs, have empowered the field of interventional radiology to achieve unparalleled precision in image-guided diagnosis and treatment while simultaneously reducing periprocedural morbidity. Molecular imaging, which provides valuable physiological and metabolic information alongside anatomical localization, can expand the capabilities of image-guided interventions. Among various molecular imaging techniques, positron emission tomography (PET) stands out for its superior spatial resolution and ability to acquire quantitative data. PET has emerged as a crucial tool for oncologic imaging and plays a pivotal role in both staging and the assessment of treatment responses. Typically used in combination with computed tomography (CT) (PET/CT) and occasionally with magnetic resonance imaging MRI (PET/MRI), PET as a hybrid imaging approach offers enhanced insights into disease progression and response. In recent years, PET has also found its way into image-guided interventions, especially within the rapidly expanding field of interventional oncology. This review aims to explore the current and evolving role of metabolic imaging, specifically PET, in interventional oncology. By delving into the unique advantages and applications of PET in guiding oncological interventions and assessing response, we seek to highlight the increasing significance of this modality in the realm of interventional radiology.
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Affiliation(s)
- Omar Dzaye
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Molecular Imaging & Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Francois H Cornelis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Henry S Kunin
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Jiang L, Jowkar N, King F, Plishker W, Bhagavatula SK, Levesque VM, Kapur T, Shyn PB. PET/CT Fluoroscopy during PET/CT-Guided Interventions: Initial Experience. J Vasc Interv Radiol 2023; 34:1319-1323. [PMID: 37142215 PMCID: PMC10512656 DOI: 10.1016/j.jvir.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
This study assessed the feasibility and functionality of the use of a high-speed image fusion technology to generate and display positron emission tomography (PET)/computed tomography (CT) fluoroscopic images during PET/CT-guided tumor ablation procedures. Thirteen patients underwent 14 PET/CT-guided ablations for the treatment of 20 tumors. A Food and Drug Administration-cleared multimodal image fusion platform received images pushed from a scanner, followed by near-real-time, nonrigid image registration. The most recent intraprocedural PET dataset was fused to each single-rotation CT fluoroscopy dataset as it arrived, and the fused images were displayed on an in-room monitor. PET/CT fluoroscopic images were generated and displayed in all procedures and enabled more confident targeting in 3 procedures. The mean lag time from CT fluoroscopic image acquisition to the in-room display of the fused PET/CT fluoroscopic image was 21 seconds ± 8. The registration accuracy was visually satisfactory in 13 of 14 procedures. In conclusion, PET/CT fluoroscopy was feasible and may have the potential to facilitate PET/CT-guided procedures.
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Affiliation(s)
- Liwei Jiang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nick Jowkar
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Franklin King
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Sharath K Bhagavatula
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
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Burch EA, Bhagavatula SK, Malone FE, Reichert RR, Tuncali K, Levesque VM, Lan Z, Sticka WT, Shyn PB. Tumor and Ablation Margin Visibility during Cryoablation of Musculoskeletal Tumors: Comparing Intraprocedural PET/CT Images with CT-Only Images. J Vasc Interv Radiol 2023; 34:1311-1318. [PMID: 37028704 PMCID: PMC10506080 DOI: 10.1016/j.jvir.2023.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/25/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE To compare tumor and ice-ball margin visibility on intraprocedural positron emission tomography (PET)/computed tomography (CT) and CT-only images and report technical success, local tumor progression, and adverse event rates for PET/CT-guided cryoablation procedures for musculoskeletal tumors. MATERIALS AND METHODS This Health Insurance Portability and Accountability Act (HIPAA)-compliant and institutional review board-approved retrospective study evaluated 20 PET/CT-guided cryoablation procedures performed with palliative and/or curative intent to treat 15 musculoskeletal tumors in 15 patients from 2012 to 2021. Cryoablation was performed using general anesthesia and PET/CT guidance. Procedural images were reviewed to determine the following: (a) whether the tumor borders could be fully assessed on PET/CT or CT-only images; and (b) whether tumor ice-ball margins could be fully assessed on PET/CT or CT-only images. The ability to visualize tumor borders and ice-ball margins on PET/CT images was compared with that on CT-only images. RESULTS Tumor borders were fully assessable for 100% (20 of 20; 95% CI, 0.83-1) of procedures on PET/CT versus 20% (4 of 20; 95 CI, 0.057-0.44) of procedures on CT only (P < .001). The tumor ice-ball margin was fully assessable in 80% (16 of 20; 95% CI, 0.56-0.94) of procedures using PET/CT versus 5% (1 of 20; 95% CI, 0.0013-0.25) of procedures using CT only (P < .001). Primary technical success was achieved in 75% (15 of 20; 95% CI, 0.51-0.91) of procedures. There was local tumor progression in 23% (3/13; 95% CI, 0.050-0.54) of the treated tumors with at least 6 months of follow-up. There were 3 adverse events (1 Grade 3, 1 Grade 2, and 1 Grade 1). CONCLUSIONS PET/CT-guided cryoablation of musculoskeletal tumors can provide superior intraprocedural visualization of the tumor and ice-ball margins compared with that provided by CT alone. Further studies are warranted to confirm the long-term efficacy and safety of this approach.
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Affiliation(s)
- Ezra A Burch
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharath K Bhagavatula
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Fiona E Malone
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan R Reichert
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhou Lan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William T Sticka
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Brock KK, Chen SR, Sheth RA, Siewerdsen JH. Imaging in Interventional Radiology: 2043 and Beyond. Radiology 2023; 308:e230146. [PMID: 37462500 PMCID: PMC10374939 DOI: 10.1148/radiol.230146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 07/21/2023]
Abstract
Since its inception in the early 20th century, interventional radiology (IR) has evolved tremendously and is now a distinct clinical discipline with its own training pathway. The arsenal of modalities at work in IR includes x-ray radiography and fluoroscopy, CT, MRI, US, and molecular and multimodality imaging within hybrid interventional environments. This article briefly reviews the major developments in imaging technology in IR over the past century, summarizes technologies now representative of the standard of care, and reflects on emerging advances in imaging technology that could shape the field in the century ahead. The role of emergent imaging technologies in enabling high-precision interventions is also briefly reviewed, including image-guided ablative therapies.
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Affiliation(s)
- Kristy K. Brock
- From the Departments of Imaging Physics (K.K.B., J.H.S.),
Interventional Radiology (S.R.C., R.A.S.), Neurosurgery (J.H.S.), and Radiation
Physics (J.H.S.), The University of Texas MD Anderson Cancer Center, 1400
Pressler St, FCT14.6050 Pickens Academic Tower, Houston, TX 77030-4000
| | - Stephen R. Chen
- From the Departments of Imaging Physics (K.K.B., J.H.S.),
Interventional Radiology (S.R.C., R.A.S.), Neurosurgery (J.H.S.), and Radiation
Physics (J.H.S.), The University of Texas MD Anderson Cancer Center, 1400
Pressler St, FCT14.6050 Pickens Academic Tower, Houston, TX 77030-4000
| | - Rahul A. Sheth
- From the Departments of Imaging Physics (K.K.B., J.H.S.),
Interventional Radiology (S.R.C., R.A.S.), Neurosurgery (J.H.S.), and Radiation
Physics (J.H.S.), The University of Texas MD Anderson Cancer Center, 1400
Pressler St, FCT14.6050 Pickens Academic Tower, Houston, TX 77030-4000
| | - Jeffrey H. Siewerdsen
- From the Departments of Imaging Physics (K.K.B., J.H.S.),
Interventional Radiology (S.R.C., R.A.S.), Neurosurgery (J.H.S.), and Radiation
Physics (J.H.S.), The University of Texas MD Anderson Cancer Center, 1400
Pressler St, FCT14.6050 Pickens Academic Tower, Houston, TX 77030-4000
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Predictive Factors for Local Recurrence after Intraoperative Microwave Ablation for Colorectal Liver Metastases. Cancers (Basel) 2022; 15:cancers15010122. [PMID: 36612119 PMCID: PMC9817841 DOI: 10.3390/cancers15010122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
This study aimed to clarify local recurrence (LR) predictive factors following intraoperative microwave ablation (MWA) for colorectal liver metastases. The data from 195 patients with 1392 CRLM lesions, who were preoperatively diagnosed by gadolinium-enhanced MRI with diffusion-weighted imaging and dynamic CT and treated with intraoperative MWA (2450 MHz) with or without hepatectomy, from January 2005 to December 2019, were retrospectively reviewed and analyzed using logistic regression. In addition, the margins were measured on contrast-enhanced CT 6 weeks post-ablation. Overall, 1066 lesions were ablated. The LRs occurred in 44 lesions (4.1%) among 39 patients (20.0%). The multivariate analysis per patient showed that tumor size > 20 mm and ablation margin < 5 mm were significant predictors for LR. Furthermore, multivariate analysis per lesion revealed that segments 1, 7, and 8 and tumor size > 15 mm, ablation margin < 5 mm, tumor size > 20 mm, and proximity to the Glisson were significant LR predictors. Finally, the outcome of this study may help determine indications for MWA.
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Zirakchian Zadeh M, Yeh R, Kunin HS, Kirov AS, Petre EN, Gönen M, Silk M, Cornelis FH, Soares KC, Ziv E, Solomon SB, Sotirchos VS, Sofocleous CT. Real-Time Split-Dose PET/CT-Guided Ablation Improves Colorectal Liver Metastasis Detection and Ablation Zone Margin Assessments without the Need for Repeated Contrast Injection. Cancers (Basel) 2022; 14:cancers14246253. [PMID: 36551738 PMCID: PMC9777508 DOI: 10.3390/cancers14246253] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Real-time split-dose PET can identify the targeted colorectal liver metastasis (CLM) and eliminate the need for repeated contrast administration before and during thermal ablation (TA). This study aimed to assess the added value of pre-ablation real-time split-dose PET when combined with non-contract CT in the detection of CLM for ablation and the evaluation of the ablation zone and margins. METHODS A total of 190 CLMs/125 participants from two IRB-approved prospective clinical trials using PET/CT-guided TA were analyzed. Based on detection on pre-TA imaging, CLMs were categorized as detectable, non-detectable, and of poor conspicuity on CT alone, and detectable, non-detectable, and low FDG-avidity on PET/CT after the initial dose. Ablation margins around the targeted CLM were evaluated using a 3D volumetric approach. RESULTS We found that 129/190 (67.9%) CLMs were detectable on CT alone, and 61/190 CLMs (32.1%) were undetectable or of poor conspicuity, not allowing accurate depiction and targeting by CT alone. Thus, the theoretical 5- and 10-mm margins could not be defined in these tumors (32.1%) using CT alone. When TA intraprocedural PET/CT images are obtained and inspected (fused PET/CT), only 4 CLM (2.1%) remained undetectable or had a low FDG avidity. CONCLUSIONS The addition of PET to non-contrast CT improved CLM detection for ablation targeting, margin assessments, and continuous depiction of the FDG avid CLMs during the ablation without the need for multiple intravenous contrast injections pre- and intra-procedurally.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Randy Yeh
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Henry S. Kunin
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Assen S. Kirov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elena N. Petre
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mithat Gönen
- Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mikhail Silk
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Francois H. Cornelis
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kevin C. Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Etay Ziv
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen B. Solomon
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Vlasios S. Sotirchos
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Constantinos T. Sofocleous
- Interventional Radiology/Oncology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence:
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Uddin MJ, Lo JHJ, Oltman CG, Crews BC, Huda T, Liu J, Kingsley PJ, Lin S, Milad M, Aleem AM, Asaduzzaman A, McIntyre JO, Duvall CL, Marnett LJ. Discovery of a Redox-Activatable Chemical Probe for Detection of Cyclooxygenase-2 in Cells and Animals. ACS Chem Biol 2022; 17:1714-1722. [PMID: 35786843 PMCID: PMC10464600 DOI: 10.1021/acschembio.1c00961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cyclooxygenase-2 (COX-2) expression is up-regulated in inflammatory tissues and many premalignant and malignant tumors. Assessment of COX-2 protein in vivo, therefore, promises to be a powerful strategy to distinguish pathologic cells from normal cells in a complex disease setting. Herein, we report the first redox-activatable COX-2 probe, fluorocoxib Q (FQ), for in vivo molecular imaging of pathogenesis. FQ inhibits COX-2 selectively in purified enzyme and cell-based assays. FQ exhibits extremely low fluorescence and displays time- and concentration-dependent fluorescence enhancement upon exposure to a redox environment. FQ enters the cells freely and binds to the COX-2 enzyme. FQ exhibits high circulation half-life and metabolic stability sufficient for target site accumulation and demonstrates COX-2-targeted uptake and retention in cancer cells and pathologic tissues. Once taken up, it undergoes redox-mediated transformation into a fluorescent compound fluorocoxib Q-H that results in high signal-to-noise contrast and differentiates pathologic tissues from non-pathologic tissues for real-time in vivo imaging.
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Affiliation(s)
- Md. Jashim Uddin
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Justin Han-Je Lo
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Connor G. Oltman
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Brenda C. Crews
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Tamanna Huda
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Justin Liu
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
- Department of Neuroscience, Columbia University, New York City, New York, 10027 USA
| | - Philip J. Kingsley
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Shuyang Lin
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Mathew Milad
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Ansari M. Aleem
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Abu Asaduzzaman
- Department of Electrical Engineering and Computer Science, Wichita State University, Wichita, Kansas 67260 USA
| | - J. Oliver McIntyre
- Departments of Radiology and Radiological Sciences, and Pharmacology, Vanderbilt Institute of Imaging Science, Vanderbilt University School of Medicine, Nashville, Tennessee 37232 USA
| | - Craig L. Duvall
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37232 USA
| | - Lawrence J. Marnett
- Departments of Biochemistry, Chemistry, and Pharmacology, Vanderbilt Institute of Chemical Biology, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee 37232 USA
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11
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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: 7] [Impact Index Per Article: 3.5] [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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12
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Hunt S, Zandifar A, Alavi A. Molecular imaging in management of colorectal metastases by the interventional oncologist. Int J Hyperthermia 2022; 39:675-681. [DOI: 10.1080/02656736.2021.1998657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Stephen Hunt
- Penn Image-Guided Interventions Lab, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Abass Alavi
- University of Pennsylvania, Philadelphia, PA, USA
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13
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Lin YM, Bale R, Brock KK, Odisio BC. Contemporary evidence on colorectal liver metastases ablation: toward a paradigm shift in locoregional treatment. Int J Hyperthermia 2022; 39:649-663. [DOI: 10.1080/02656736.2021.1970245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Kamarinos NV, Vakiani E, Fujisawa S, Gonen M, Fan N, Romin Y, Do RKG, Ziv E, Erinjeri JP, Petre EN, Sotirchos VS, Camacho JC, Solomon SB, Manova K, Sofocleous CT. Immunofluorescence Assay of Ablated Colorectal Liver Metastases: The Frozen Section of Image-Guided Tumor Ablation? J Vasc Interv Radiol 2022; 33:308-315.e1. [PMID: 34800623 PMCID: PMC9531411 DOI: 10.1016/j.jvir.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/20/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To validate an immunofluorescence assay (IFA) detecting residual viable tumor (VT) as intraprocedural thermal ablation (TA) zone assessment and demonstrate its prognostic value for local tumor progression (LTP) after colorectal liver metastasis (CLM) TA. MATERIALS AND METHODS This prospective study, approved by the institutional review board, included 99 patients with 155 CLMs ablated between November 2009 and January 2019. Tissue samples from the ablation zone (AZ) center and minimal margin underwent immunofluorescent microscopic examination interrogating cellular morphology and mitochondrial viability (IFA) within 30 minutes after ablation. The same tissue samples were subsequently evaluated with standard morphologic and immunohistochemical methods. The sensitivity, specificity, and overall accuracy of IFA versus standard morphologic and immunohistochemical examination were calculated. The LTP-free survival rates were evaluated for the 12-month follow-up period. RESULTS Of the 311 tissue samples stained, 304 (98%) were deemed evaluable. Of these specimens, 27% (81/304) were considered positive for the presence of VT. The accuracy of IFA was 94% (286/304). The sensitivity and specificity were 100% (63/63) and 93% (223/241), respectively. The 18 false-positive IFA assessments corresponded to samples that included viable cholangiocytes. The 12-month LTP-free survival was 59% versus 78% for IFA positive versus negative for VT AZs, respectively (P < .001). There was no difference in LTP between margin positive only and central AZ-positive tumors (25% vs 31%, P = 1). CONCLUSIONS The IFA assessment of the AZ can be completed intraprocedurally and serve as a valid real-time biomarker of complete tumor eradication or detect residual VT after TA. This method could improve tumor control by TA.
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Affiliation(s)
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sho Fujisawa
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Mithat Gonen
- Department of Statistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ning Fan
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Yevgeniy Romin
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Richard KG Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Etay Ziv
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P. Erinjeri
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N. Petre
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vlasios S. Sotirchos
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juan C. Camacho
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen B. Solomon
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katia Manova
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
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Abstract
PURPOSE OF REVIEW This review presents the current state of imaging approaches that enable real-time molecular imaging in the interventional suite and discusses the potential future use of integrated nuclear imaging and fluoroscopy for intraprocedural guidance in the evaluation and treatment of both cardiovascular and oncological diseases. RECENT FINDINGS Although there are no commercially available real-time hybrid nuclear imaging devices that are approved for use in the interventional suite, prototype open gantry hybrid nuclear imaging and x-ray c-arm imaging systems and theranostic catheter for location radiotracer detection are currently undergoing development and testing by multiple groups. The integration of physiological and molecular targeted nuclear imaging for real-time delivery of targeted theranostics in the interventional laboratory may enable more personalized care for a wide variety of cardiovascular procedures and improve patient outcomes.
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16
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Biopsy and Margins Optimize Outcomes after Thermal Ablation of Colorectal Liver Metastases. Cancers (Basel) 2022; 14:cancers14030693. [PMID: 35158963 PMCID: PMC8833800 DOI: 10.3390/cancers14030693] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Thermal ablation (TA) is a non-surgical treatment of cancer that has been used with success in the treatment of colorectal liver metastases (CLM). TA consists of burning the cancer and a rim of surrounding tissue (margin) with a special needle placed in the tumor under image guidance. Despite the technological evolution of TA, tumor progression/recurrence rates remain higher than expected. We present a method that combines tissue and imaging tests performed immediately after ablation to determine whether there is complete tumor destruction or remaining live cancer cells that can cause tumor progression/recurrence. This information can provide guidance for additional treatments for patients with evidence of residual cancer, i.e.,: additional TA at the same or subsequent sitting, or additional chemotherapy and short-interval imaging follow-up to detect recurrence. The presented method proposes a clinical practice paradigm change that can improve clinical outcomes in a large population of patients with CLM treated by TA. Abstract Background: Thermal ablation is a definitive local treatment for selected colorectal liver metastases (CLM) that can be ablated with adequate margins. A critical limitation has been local tumor progression (LTP). Methods: This prospective, single-group, phase 2 study enrolled patients with CLM < 5 cm in maximum diameter, at a tertiary cancer center between November 2009 and February 2019. Biopsy of the ablation zone center and margin was performed immediately after ablation. Viable tumor in tissue biopsy and ablation margins < 5 mm were assessed as predictors of 12-month LTP. Results: We enrolled 107 patients with 182 CLMs. Mean tumor size was 2.0 (range, 0.6–4.6) cm. Microwave ablation was used in 51% and radiofrequency ablation in 49% of tumors. The 12- and 24-month cumulative incidence of LTP was 22% (95% confidence interval [CI]: 17, 29) and 29% (95% CI: 23, 36), respectively. LTP at 12 months was 7% (95% CI: 3, 14) for the biopsy tumor-negative ablation zone with margins ≥ 5 mm vs. 63% (95% CI: 35, 85) for the biopsy-positive ablation zone with margins < 5 mm (p < 0.001). Conclusions: Biopsy-proven complete tumor ablation with margins of at least 5 mm achieves optimal local tumor control for CLM, regardless of the ablation modality used.
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Lin YM, Paolucci I, Brock KK, Odisio BC. Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward. Cancers (Basel) 2021; 13:3926. [PMID: 34439081 PMCID: PMC8394430 DOI: 10.3390/cancers13163926] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Iwan Paolucci
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Kristy K. Brock
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bruno C. Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
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18
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F-18 FDG perfusion PET: intraprocedural assessment of the liver tumor ablation margin. Abdom Radiol (NY) 2021; 46:3437-3447. [PMID: 33606061 DOI: 10.1007/s00261-021-02970-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/19/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate 18F-fluorodeoxyglucose (FDG) perfusion PET during FDG PET/CT-guided liver tumor microwave ablation procedures for assessing the ablation margin and correlating minimum margin measurements with local progression. METHODS This IRB-approved, HIPAA-compliant study included 20 adult patients (11 M, 9 F; mean age 65) undergoing FDG PET/CT-guided liver microwave ablation to treat 31 FDG-avid tumors. Intraprocedural FDG perfusion PET was performed to assess the ablation margin. Intraprocedural decisions regarding overlapping ablations were recorded. Two readers retrospectively interpreted intraprocedural perfusion PET and postprocedural contrast-enhanced MRI. Assessability of the ablation margin and minimum margin measurements were recorded. Imaging follow-up for local progression ranged from 30 to 574 days (mean 310). Regression modeling of minimum margin measurements was performed. Hazard ratios were calculated to correlate an ablation margin threshold of 5 mm with outcomes. RESULTS Intraprocedural perfusion PET prompted additional overlapping ablations of two tumors, neither of which progressed. Incomplete ablation or local progression occurred in 8/31 (26%) tumors. With repeat ablation, secondary efficacy was 26 (84%) of 31. Both study readers deemed ablation margins fully assessable more often using perfusion PET than MRI (OR 69.7; CI 6.0, 806.6; p = 0.001). Minimum ablation margins ≥ 5 mm on perfusion PET correlated with a low risk of incomplete ablation/local progression by both study readers (HR 0.08 and 0.02, p < 0.001). CONCLUSION Intraprocedural FDG perfusion PET consistently enabled complete liver tumor microwave ablation margin assessments, and the perfusion PET minimum ablation margin measurements correlated well with local outcomes. Clinical trial registration clinicaltrials.gov (NCT02018107).
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19
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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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20
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Bogoni M, Cerci JJ, Cornelis FH, Nanni C, Tabacchi E, SchÖder H, Shyn PB, Sofocleous CT, Solomon SB, Kirov AS. Practice and prospects for PET/CT guided interventions. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:20-31. [PMID: 33494585 PMCID: PMC10446123 DOI: 10.23736/s1824-4785.21.03291-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the past 10 years, performing real-time molecular imaging with positron emission tomography (PET) in combination with computed tomography (CT) during interventional procedures has undergone rapid development. Keeping in mind the interest of the nuclear medicine readers, an update is provided of the current workflows using real-time PET/CT in percutaneous biopsies and tumor ablations. The clinical utility of PET/CT guided biopsies in cancer patients with lung, liver, lymphoma, and bone tumors are reviewed. Several technological developments, including the introduction of new PET tracers and robotic arms as well as opportunities provided through acquiring radioactive biopsy specimens are briefly reviewed.
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Affiliation(s)
| | | | | | - Cristina Nanni
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Tabacchi
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Heiko SchÖder
- Unit of Nuclear Medicine, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Constantinos T Sofocleous
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Assen S Kirov
- Unit of Molecular Imaging and Therapy Physics, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA -
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21
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Assessing ablation margins of FDG-avid liver tumors during PET/CT-guided thermal ablation procedures: a retrospective study. Eur J Nucl Med Mol Imaging 2021; 48:2914-2924. [PMID: 33559712 DOI: 10.1007/s00259-021-05206-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To retrospectively assess liver tumor ablation margins using intraprocedural PET/CT images from FDG PET/CT-guided microwave or cryoablation procedures and to correlate minimum margin measurements with local progression outcomes. METHODS Fifty-six patients (ages 36 to 85, median 62; 32 females) with 77 FDG-avid liver tumors underwent 60 FDG PET/CT guided, percutaneous microwave, or cryoablation procedures. Single breath-hold PET/CT images were used for intraprocedural assessment of the tumor ablation margin: liver tumors remained visible on PET immediately following ablation; microwave ablation zones were visible using contrast-enhanced CT; cryoablation zones (ice balls) were visible using unenhanced CT. Two readers retrospectively determined ablation margin assessability and measured the minimum ablation margin on intraprocedural PET/CT (n = 77) and postprocedural MRI (n = 56). Local tumor progression was assessed on all available follow-up imaging (1-49 months, mean 15). Local tumor progression was correlated with PET/CT minimum margin measurements using clustered survival models for 61 tumors. RESULTS Minimum ablation margins were more often assessable using intraprocedural PET/CT (≥ 73/77 tumors, 95%) than postprocedural MRI (≤ 35/56 tumors, 63%). In 61 tumors with PET/CT-assessable margins (excluding tumors with overlapping ablations after PET/CT), there was a 6-fold increased risk of local tumor progression [hazard ratio (HR) 6.05; P = 0.004] for minimum ablation margins < 5 mm. CONCLUSION Breath-hold PET/CT scans, during PET/CT-guided microwave or cryoablation procedures for FDG-avid liver tumors, enable reliable intraprocedural assessment of the entire tumor ablation margin; a minimum PET/CT ablation margin threshold of 5 mm correlates well with local tumor progression outcomes.
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22
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Liver tumor F-18 FDG-PET before and immediately after microwave ablation enables imaging and quantification of tumor tissue contraction. Eur J Nucl Med Mol Imaging 2020; 48:1618-1625. [PMID: 33175240 DOI: 10.1007/s00259-020-05104-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Poor liver tumor visibility after microwave ablation (MWA) limits direct tumor ablation margin assessments using contrast-enhanced CT or ultrasound (US). Positron emission tomography (PET) or PET/CT may offer improved intraprocedural assessment of liver tumor ablation margins versus current imaging techniques, as 18F-fluorodeoxyglucose (18F-FDG)-avid tumors remain visible on PET immediately following ablation. The purpose of this study was to assess intraprocedural 18F-FDG PET scans before and immediately after PET/CT-guided MWA for visualization and quantification of metabolic liver tumor tissue contraction resulting from MWA. METHODS This retrospective study, conducted at a large academic medical center after Institutional Review Board approval, included 36 patients (20 men; mean age 63 [range 37-85]) who underwent PET/CT-guided MWA of 42 18F-FDG-avid liver tumors from May 2013 to March 2018. Tumor metabolic diameters (short/long axes) were measured for each tumor on pre- and post-ablation PET images. Tumor metabolic volumes were calculated using tumor diameter measurements and compared with automated volumes using an SUV threshold algorithm. A two-tailed paired t test was used for the analyses. RESULTS Comparing intraprocedural pre- and post-ablation PET images, mean metabolic tumor short- and long-axis diameters decreased from 21.4 to 14.9 mm [- 29%, p < 0.001, standard deviation (SD) 18%] and from 24.0 to 18.0 mm (- 24%, p < 0.001, SD 16%), respectively. The mean calculated tumor metabolic volume decreased from 10.5 to 4.6 mm3 (- 55%, p < 0.001, SD 26%). The mean automated tumor metabolic volume decreased from 10.6 to 5.8 mm3 (- 45%, p < 0.001, SD 30%). CONCLUSION Intraprocedural PET images of 18F-FDG-avid liver tumors allow visualization and quantification of MWA-induced metabolic tumor tissue contraction during 18F-FDG PET/CT-guided procedures. The ability to visualize contracted tumor immediately post-MWA may facilitate emerging intraprocedural PET and PET/CT imaging techniques that address a clinical gap in directly assessing the ablation margin.
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23
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Gou Q, Zhou Z, Zhao M, Chen X, Zhou Q. [Advances and Challenges of Local Thermal Ablation in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:111-117. [PMID: 32093455 PMCID: PMC7049787 DOI: 10.3779/j.issn.1009-3419.2020.02.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
非小细胞肺癌(non-small cell lung cancer, NSCLC)是原发性肺癌的主要类型,手术切除、放化疗、靶向治疗及免疫治疗等是其主要的治疗模式。近年来,热消融在各期NSCLC的临床应用中受到越来越多的关注。热消融作为一种安全、高效的局部治疗手段,合理的临床应用可以给NSCLC患者带来更多的临床获益。然而其在NSCLC中的应用仍然存在许多尚待研究探讨的问题。本文对近年来热消融在NSCLC中的应用现状作以综述,旨在探讨目前存在的争议问题和未来研究方向。
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Affiliation(s)
- Qing Gou
- Department of Interventional Oncology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Zejian Zhou
- Department of Interventional Oncology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Mingfang Zhao
- The First Hospital of China Medical University, Department of Medical Oncology, Shenyang 110001, China
| | - Xiaoming Chen
- Department of Interventional Oncology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Qing Zhou
- Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Lung Cancer Institute, Guangzhou 510080, China
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Kishore SA, Drabkin MJ, Sofocleous CT. Fluorodeoxyglucose-PET for Ablation Treatment Planning, Intraprocedural Monitoring, and Response. PET Clin 2020; 14:427-436. [PMID: 31472740 DOI: 10.1016/j.cpet.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PET has become an essential tool for staging and response assessment in oncologic imaging. Over the past decade it has also evolved into a tool for image-guided interventions, specifically in the rapidly growing field of interventional oncology. PET-guided biopsies have greater sensitivity and diagnostic yield for fluorodeoxyglucose-avid lesions. Real-time PET imaging can also provide valuable image guidance during therapeutic minimally invasive procedures such as ablation of PET-avid tumors. The increasing use of PET in the assessment of therapeutic response results in earlier identification of disease that is amenable to image-guided therapies.
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Affiliation(s)
- Sirish A Kishore
- Interventional Radiology Service, Memorial Sloan Kettering Cancer, 1275 York, IR Suite H118, New York City, NY 10065, USA
| | - Michael J Drabkin
- Interventional Radiology Service, Memorial Sloan Kettering Cancer, New York City, NY, USA
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Memorial Sloan Kettering Cancer, 1275 York, IR Suite H118, New York City, NY 10065, USA.
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25
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Hu EY, Levesque VM, Bay CP, Seol JG, Shyn PB. Liver Tumor Ablation Procedure Duration and Estimated Patient Radiation Dose: Comparing Positron Emission Tomography/CT and CT Guidance. J Vasc Interv Radiol 2020; 31:1052-1059. [PMID: 32534979 DOI: 10.1016/j.jvir.2019.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare procedure duration and patient radiation dose in positron emission tomography/computed tomography (PET/CT) and CT-guided liver tumor ablation procedures. MATERIALS AND METHODS In this retrospective, case-control study, 275 patients underwent 368 image-guided ablation procedures to treat 537 tumors. Radiologists used PET/CT guidance for 117 procedures and CT guidance for 251 procedures. PET/CT-guided procedures were performed by one radiologist (C: P.B.S.). All 3 radiologists (A: J.G.S., B: a radiologist who is not an author on this article, and C: P.B.S.) performed CT-guided procedures. Potential confounders included patient demographics, clinical and tumor characteristics, and procedural variables. RESULTS The mean duration and estimated patient radiation dose of PET/CT-guided procedures performed by radiologist C were 21.5 ± 4.9 minutes longer and 0.7 ± 2.8 mSv higher than CT-guided procedures performed by all radiologists in an unadjusted comparison. Adjusting for confounding, mean duration and estimated dose of PET/CT-guided procedures performed by radiologist C were 28.3 ± 3.8 minutes longer (P < .0001) and 6.2 ± 2.9 mSv higher (P = .03) than CT-guided procedures performed by the same radiologist. Comparing CT-guided procedures performed by all 3 radiologists, adjusted mean durations and estimated patient doses of procedures by the least experienced radiologist, radiologist A, and the second most experienced radiologist, radiologist B, were 24.2 ± 5.1 (P < .0001) and 18.1 ± 8.9 (P = .04) minutes longer and 13.1 ± 3.7 (P < .001) and 14.5 ± 6.4 (P = .02) mSv higher, respectively, than procedures performed by the most experienced radiologist, radiologist C. CONCLUSIONS PET/CT-guided liver ablations had a slightly longer duration with slightly higher estimated patient radiation dose than similar CT-guided liver ablations. Procedure duration and patient dose do not appear to be major impediments to the emerging field of PET/CT-guided tumor ablation.
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Affiliation(s)
- Emmy Y Hu
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Camden P Bay
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Julia G Seol
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
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Safety margin assessment after microwave ablation of liver tumors: inter- and intrareader variability. Radiol Oncol 2020; 54:57-61. [PMID: 32053495 PMCID: PMC7087417 DOI: 10.2478/raon-2020-0004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/10/2020] [Indexed: 01/20/2023] Open
Abstract
Background The aim of the study was to evaluate the inter- and intrareader variability of the safety margin assessment after microwave ablation of liver tumors using post-procedure computed tomography (CT) images as well as to determine the sensitivity and specificity of identification remnant tumor tissue. Patients and methods A retrospective analysis of 58 patients who underwent microwave ablation (MWA) of primary or secondary liver malignancies (46 hepatocellular carcinoma, 9 metastases of a colorectal cancer and 3 metastases of pancreatic cancer) between September 2017 and June 2019 was conducted. Three readers estimated the minimal safety margin in millimeters using side-by-side comparison of the 1-day pre-ablation CT and 1-day post-ablation CT and judged whether ablation was complete or incomplete. One reader estimated the safety margin again after 6 weeks. Magnetic resonance imaging (MRI) after 6 weeks was the gold standard. Results The intraclass correlation coefficient (ICC) for estimation of the minimal safety margin of all three readers was 0.357 (95%-confidence interval 0.194–0.522). The ICC for repeated assessment (reader 1) was 0.774 (95%-confidence interval 0.645–0.860). Sensitivity and specificity of the detection of complete tumor ablation, defined as no remnant tumor tissue in 6 weeks follow-up MRI, were 93%/82%/82% and 33%/17%/83%, respectively. Conclusions In clinical practice, the safety margin after liver tumor ablation is often assessed using side-by-side comparison of CT images. In the study, we were able to show, that this technique has a poor reliability (ICC 0.357). From our point of view, this proves the necessity of new technical procedures for the assessment of the safety distance.
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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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Albano D, Giubbini R, Bertagna F. 13N-NH 3 PET/CT in oncological disease. Jpn J Radiol 2019; 37:799-807. [PMID: 31599383 DOI: 10.1007/s11604-019-00883-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/30/2019] [Indexed: 01/21/2023]
Abstract
13N-Ammonia (13N-NH3) is widely used positron emission tomography/computed tomography (PET/CT) radiotracer for the measurement of myocardial blood perfusion; the possible role of 13N-NH3 PET or PET/CT in oncological disease is not yet clear. Aim of this review is to evaluate the diagnostic performances of 13N-NH3 PET in this field. A comprehensive computer literature search of the PubMed/MEDLINE, Scopus, and Embase databases was conducted including articles up to June 2019. Eighteen articles were finally included in the review. From the analyses of the selected studies, the following main findings could be drawn: (1) 13N-NH3 PET is useful in discriminating between gliomas and non-neoplastic brain lesions, and among gliomas between high-grade and low-grade gliomas; (2) 13N-NH3 PET have better diagnostic performance than 18F-FDG in studying gliomas; (3) a combination of 13N-NH3 PET and 18F-FDG PET may be useful to differentiate between several cerebral lesions (gliomas, cerebral lymphoma, meningioma); (4) only preliminary results about the positive impact in liver and prostate cancer.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1; 25123, Brescia, Italy.
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1; 25123, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1; 25123, Brescia, Italy
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Abstract
OBJECTIVE. The purpose of this study was to evaluate the efficacy of radiofrequency ablation (RFA) of renal masses comparing a group who did not undergo intraprocedural CT and a group who did. MATERIALS AND METHODS. A retrospective review included 45 consecutively registered patients who underwent RFA of renal masses. If an adequate biopsy specimen was not obtained or follow-up was inadequate, the patient was eliminated from review from calculation of primary technical efficacy. The inclusion criterion was having undergone RFA with two cooled-tip electrodes. Baseline demographics (age, body mass index, and sex), renal mass characteristics (diameter, side, location, position, morphologic features, type of mass, and grade), technical details (repositioning and hydrodissection), and complications were evaluated. Follow-up images were evaluated to determine the presence of recurrence at the ablation site in the two groups. RESULTS. Among the 45 patients who underwent RFA, 13 did not undergo intraprocedural CT and 32 intraprocedural did. Thirty-five patients met the criteria for follow-up and positive biopsy results. For calculation of recurrence, 10 patients were in the group who did not and 25 were in group who did undergo intraprocedural contrast-enhanced CT. No correlation was found between baseline demographics, renal mass characteristics, and technical results of the two groups. There was an 89% overall technical efficacy rate with a 96% primary technical efficacy rate in the group who underwent intraprocedural CT compared with a 70% rate in the group who did not undergo intraprocedural CT. Negative correlation was found between the groups with respect to technical efficacy rate at p < 0.05. CONCLUSION. Intraprocedural contrast-enhanced CT yields important information about completeness of ablation during the procedure, allowing probe repositioning and thus better therapeutic effect.
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