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Chew JJ, Naveeth AM, Lim CHS, Wong AWJ, Lee MYW. Ultrasound-guided preoperative skin-marking for deep inferior epigastric perforator flap surgery. J Ultrasound 2024:10.1007/s40477-024-00953-1. [PMID: 39316294 DOI: 10.1007/s40477-024-00953-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/30/2024] [Indexed: 09/25/2024] Open
Abstract
Deep inferior epigastric artery perforator (DIEP) flaps remain the gold standard of autologous breast reconstruction. However, the surgical technique entails a steeper learning curve and typically requires a higher mean surgical time, in part due to the time and effort involved in physical localization of appropriate perforators at the time of surgery. This is typically performed using Doppler ultrasound, and is a potentially challenging and time-consuming task in the hands of an untrained operator. In order to mitigate these challenges, ease time pressures, promote efficient utilization of our operating theatres and improve surgical outcomes, our institution routinely performs skin-marking in advance at the Breast Radiology department. In this article, we describe our technique and experience with the procedure.
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Affiliation(s)
- Jun Jie Chew
- Department of Radiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore.
| | - Adam Mohamed Naveeth
- Department of Radiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Cheryl Hui Shan Lim
- Department of Radiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Allen Wei-Jiat Wong
- Plastic Reconstructive and Aesthetic Surgery Service, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Margaret Yee Wah Lee
- Department of Radiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
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Adler RS. What is the place of ultrasound in MSK imaging? Skeletal Radiol 2024; 53:1699-1709. [PMID: 38492028 DOI: 10.1007/s00256-024-04642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
During the past four decades, ultrasound has become popular as an imaging modality applied to the musculoskeletal (MSK) system, particularly outside the USA, due to its low cost, accessibility, and lack of ionizing radiation. A basic requirement in performing these examinations is to have a core group of radiologists and ultrasound technologists with expertise in MSK ultrasound. The extent to which ultrasound will be part of the imaging offered by a particular radiology practice or in an academic institution will vary according to expertise, availability, and reimbursements. A brief discussion of the technical capabilities of the current generation of ultrasound scanners will be followed by a description of some of the more prevalent MSK ultrasound imaging applications. The extent to which training to perform these exams within and outside of Radiology plays a role is discussed. Applications that are unique to ultrasound, such as dynamic evaluation of musculoskeletal anatomy and some, US-guided interventions are an important part of MSK imaging. Ultrasound is increasingly important in the assessment of superficial structures, such as tendons, small joints, and peripheral nerves. These applications help to establish the place of ultrasound as an important part of the Radiologists approach to MSK imaging. Outside of radiology, for a variety of clinical subspecialties, ultrasound already plays an integral role in MSK imaging.
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Affiliation(s)
- Ronald S Adler
- Department of Radiology NYU Grossman School of Medicine, 333 East 38Th Street, 6-209, New York, NY, USA.
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Yoo J, Lee DH. Usefulness of contrast-enhanced ultrasound-guided biopsy for suspected viable hepatocellular carcinoma after treatment: a single-arm prospective study. Ultrasonography 2024; 43:88-97. [PMID: 38310870 PMCID: PMC10915121 DOI: 10.14366/usg.23133] [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: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
PURPOSE The utility of contrast-enhanced ultrasound (CEUS)-guided liver biopsy in patients with treated hepatocellular carcinoma (HCC) was evaluated. METHODS This study prospectively enrolled 36 patients (mean age±standard deviation [SD], 65.3±9.2 years; 31 men) who underwent CEUS-guided biopsy for treated HCC between September 2020 and April 2022, constituting the CEUS group. An additional 60 patients (mean age±SD, 60.7±12.3 years; 50 men) who underwent B-mode image-guided biopsy for treated HCC between January 2017 and December 2018 were retrospectively enrolled in the B-mode, or control, group. Biopsy success rates were compared between CEUS and B-mode groups using the chi-square test. RESULTS The biopsy success rate in the CEUS group was 88.9% (32 of 36 patients), which was significantly higher than the 70.0% (42 of 60 patients) observed in the B-mode group (P=0.044). No significant difference was found between CEUS and B-mode groups in the size of the lesions targeted for biopsy (mean±SD, 3.8±2.3 cm vs. 3.7±3.3 cm, respectively; P=0.332). For both the whole tumor and the viable tumor, conspicuity scores were significantly higher on CEUS than on grayscale ultrasound in the CEUS group (whole tumor: 2.7±0.5 vs. 1.8±0.9, P<0.001; viable tumor: 2.6±0.7 vs. 1.4±0.8, P<0.001). Relative to non-diagnostic results, diagnostic results more frequently exhibited a late mild washout pattern (87.5% [28 of 32] vs. 25.0% [1 of 4], P=0.004). No significant difference in the arterial enhancement pattern was noted between these subgroups (P=0.415). CONCLUSION By increasing the viable-tumor conspicuity, CEUS-guided biopsy is useful for confirmative histopathologic diagnosis in patients with treated HCC.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Rosnitskiy PB, Khokhlova TD, Schade GR, Sapozhnikov OA, Khokhlova VA. Treatment Planning and Aberration Correction Algorithm for HIFU Ablation of Renal Tumors. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:341-353. [PMID: 38231825 PMCID: PMC11003458 DOI: 10.1109/tuffc.2024.3355390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
High-intensity focused ultrasound (HIFU) applications for thermal or mechanical ablation of renal tumors often encounter challenges due to significant beam aberration and refraction caused by oblique beam incidence, inhomogeneous tissue layers, and presence of gas and bones within the beam. These losses can be significantly mitigated through sonication geometry planning, patient positioning, and aberration correction using multielement phased arrays. Here, a sonication planning algorithm is introduced, which uses the simulations to select the optimal transducer position and evaluate the effect of aberrations and acoustic field quality at the target region after aberration correction. Optimization of transducer positioning is implemented using a graphical user interface (GUI) to visualize a segmented 3-D computed tomography (CT)-based acoustic model of the body and to select sonication geometry through a combination of manual and automated approaches. An HIFU array (1.5 MHz, 256 elements) and three renal cell carcinoma (RCC) cases with different tumor locations and patient body habitus were considered. After array positioning, the correction of aberrations was performed using a combination of backpropagation from the focus with an ordinary least squares (OLS) optimization of phases at the array elements. The forward propagation was simulated using a combination of the Rayleigh integral and k-space pseudospectral method (k-Wave toolbox). After correction, simulated HIFU fields showed tight focusing and up to threefold higher maximum pressure within the target region. The addition of OLS optimization to the aberration correction method yielded up to 30% higher maximum pressure compared to the conventional backpropagation and up to 250% higher maximum pressure compared to the ray-tracing method, particularly in strongly distorted cases.
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Adler RS. Musculoskeletal ultrasound: a technical and historical perspective. J Ultrason 2023; 23:e172-e187. [PMID: 38020513 PMCID: PMC10668930 DOI: 10.15557/jou.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
During the past four decades, musculoskeletal ultrasound has become popular as an imaging modality due to its low cost, accessibility, and lack of ionizing radiation. The development of ultrasound technology was possible in large part due to concomitant advances in both solid-state electronics and signal processing. The invention of the transistor and digital computer in the late 1940s was integral in its development. Moore's prediction that the number of microprocessors on a chip would grow exponentially, resulting in progressive miniaturization in chip design and therefore increased computational power, added to these capabilities. The development of musculoskeletal ultrasound has paralleled technical advances in diagnostic ultrasound. The appearance of a large variety of transducer capabilities and rapid image processing along with the ability to assess vascularity and tissue properties has expanded and continues to expand the role of musculoskeletal ultrasound. It should also be noted that these developments have in large part been due to a number of individuals who had the insight to see the potential applications of this developing technology to a host of relevant clinical musculoskeletal problems. Exquisite high-resolution images of both deep and small superficial musculoskeletal anatomy, assessment of vascularity on a capillary level and tissue mechanical properties can be obtained. Ultrasound has also been recognized as the method of choice to perform a large variety of interventional procedures. A brief review of these technical developments, the timeline over which these improvements occurred, and the impact on musculoskeletal ultrasound is presented below.
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Affiliation(s)
- Ronald Steven Adler
- Department of Radiology, New York University, Grossman School of Medicine, Langone Orthopedic Center, New York, USA
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Miyatake K, Choe H, Takahiro F, Kawabata Y, Kusaba Y, Inaba Y. Application of Intraoperative CT-Ultrasound Fusion Imaging in Hip Endoscopy for Treatment of Iatrogenic Impingement Due to PLLA Screw: A Novel Surgical Technique. Arthrosc Tech 2023; 12:e801-e805. [PMID: 37424642 PMCID: PMC10323672 DOI: 10.1016/j.eats.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/10/2023] [Indexed: 07/11/2023] Open
Abstract
Ultrasound-assisted surgery is becoming an established tool in the medical field. The addition of imagery to ultrasound-assisted surgery may enable one to perform a procedure in a safer and more accurate manner. This can be achieved through fusion imaging (fusion), a technology that synchronizes MRI or CT images with ultrasound images. We describe intraoperative CT-ultrasound fusion-guided (or -assisted) hip endoscopy for the removal of an impinging poly L-lactic acid screw, which was difficult to identify on fluoroscopy during surgery. The fusion technology enables merging two advantages of ultrasound: the real-time guidance capabilities and CT or MRI and the bird's eye view that makes minimally invasive arthroscopic and endoscopic surgery less invasive, precise, and safe.
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Affiliation(s)
| | - Hyonmin Choe
- Address correspondence to Hyonmin Choe M.D., Ph.D., Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan 236-0004.
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Gross JS, Yaeger A, Tchelepi H, Matcuk GR. Ultrasound Fusion: Applications in Musculoskeletal Imaging. Life (Basel) 2023; 13:1278. [PMID: 37374061 DOI: 10.3390/life13061278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Ultrasound fusion is an established technique that pairs real time B-scan ultrasound (US) with other forms of cross-sectional imaging, including computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). Each of these imaging modalities has distinct advantages. CT provides superior anatomic resolution, with improved imaging of bone and calcified structures; MRI has superior contrast resolution; and PET provides physiologic information, identifying processes that are metabolically active (i.e., tumor, inflammatory conditions). However, these modalities are static. A key highlight of ultrasound is its capability of dynamic, real-time scanning. The ability to pair CT, MRI or PET with ultrasound can have significant advantages, both in diagnostic evaluation and when performing difficult or challenging image-guided interventions. Percutaneous interventions using ultrasound fusion have been described in the abdominal imaging literature; however, there have been very few musculoskeletal applications detailed in the literature. The purpose of this article is to review the basic concepts of real-time ultrasound fusion, and to detail, through the use of multiple case examples, its potential use as a safe and effective method for performing image-guided musculoskeletal interventions.
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Affiliation(s)
- Jordan Scott Gross
- Department of Radiology, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - Andrew Yaeger
- Department of Radiology, Kaiser Permanente-Panorama City, Panorama City, CA 91402, USA
| | - Hisham Tchelepi
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - George R Matcuk
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Saukhat O, Mushailov A, Kleinbaum Y, Barash Y, Klang E, Nachmany I, Horesh N. Ultrasound-Tomographic Image Fusion - A Novel Tool for Follow up After Acute Complicated Appendicitis. Surg Innov 2023. [PMID: 36866417 DOI: 10.1177/15533506231161122] [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: 03/04/2023]
Abstract
BACKGROUND Computerized tomography (CT) is an integral part of the follow-up and decision-making process in complicated acute appendicitis (AA) treated non-operatively. However, repeated CT scans are costly and cause radiation exposure. Ultrasound-tomographic image fusion is a novel tool that integrates CT images to an Ultrasound (US) machine, thus allowing accurate assessment of the healing process compared to CT on presentation. In this study, we aimed to assess the feasibility of US-CT fusion as part of the management of appendicitis. MATERIALS AND METHODS We retrospectively collected data of consecutive patients with complicated AA managed non-operatively and followed up with US Fusion for clinical decision-making. Patients demographics, clinical data, and follow-up outcomes were extracted and analyzed. RESULTS Overall, 19 patients were included. An index Fusion US was conducted in 13 patients (68.4%) during admission, while the rest were performed as part of an ambulatory follow-up. Nine patients (47.3%) had more than 1 US Fusion performed as part of their follow-up, and 3 patients underwent a third US Fusion. Eventually, 5 patients (26.3%) underwent elective interval appendectomy based on the outcomes of the US Fusion, due to a non-resolution of imaging findings and ongoing symptoms. In 10 patients (52.6%), there was no evidence of an abscess in the repeated US Fusion, while in 3 patients (15.8%), it significantly diminished to less than 1 cm in diameter. CONCLUSION Ultrasound-tomographic image fusion is feasible and can play a significant role in the decision-making process for the management of complicated AA.
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Affiliation(s)
- Olga Saukhat
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avital Mushailov
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeruham Kleinbaum
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of General Surgery and Transplantations, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of General Surgery and Transplantations, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Singh BS, Cazacu IM, Deza CA, Rigaud BS, Saftoiu A, Gruionu G, Guionu L, Brock KK, Koay EJ, Herman JM, Bhutani MS. Image Fusion Involving Real-Time Transabdominal or Endoscopic Ultrasound for Gastrointestinal Malignancies: Review of Current and Future Applications. Diagnostics (Basel) 2022; 12:diagnostics12123218. [PMID: 36553225 PMCID: PMC9777678 DOI: 10.3390/diagnostics12123218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Image fusion of CT, MRI, and PET with endoscopic ultrasound and transabdominal ultrasound can be promising for GI malignancies as it has the potential to allow for a more precise lesion characterization with higher accuracy in tumor detection, staging, and interventional/image guidance. We conducted a literature review to identify the current possibilities of real-time image fusion involving US with a focus on clinical applications in the management of GI malignancies. Liver applications have been the most extensively investigated, either in experimental or commercially available systems. Real-time US fusion imaging of the liver is gaining more acceptance as it enables further diagnosis and interventional therapy of focal liver lesions that are difficult to visualize using conventional B-mode ultrasound. Clinical studies on EUS guided image fusion, to date, are limited. EUS-CT image fusion allowed for easier navigation and profiling of the target tumor and/or surrounding anatomical structure. Image fusion techniques encompassing multiple imaging modalities appear to be feasible and have been observed to increase visualization accuracy during interventional and diagnostic applications.
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Affiliation(s)
- Ben S. Singh
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Irina M. Cazacu
- Department of Oncology, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
| | - Carlos A. Deza
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bastien S. Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Adrian Saftoiu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Department of Gastroenterology, Ponderas Academic Hospital, 014142 Bucharest, Romania
| | - Gabriel Gruionu
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lucian Guionu
- Department of Mechanics, University of Craiova, 200585 Craiova, Romania
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joseph M. Herman
- Department of Radiation Medicine, Zucher School of Medicine, Hempstead, NY 11549, USA
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
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Peng C, Cai Q, Chen M, Jiang X. Recent Advances in Tracking Devices for Biomedical Ultrasound Imaging Applications. MICROMACHINES 2022; 13:mi13111855. [PMID: 36363876 PMCID: PMC9695235 DOI: 10.3390/mi13111855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 05/27/2023]
Abstract
With the rapid advancement of tracking technologies, the applications of tracking systems in ultrasound imaging have expanded across a wide range of fields. In this review article, we discuss the basic tracking principles, system components, performance analyses, as well as the main sources of error for popular tracking technologies that are utilized in ultrasound imaging. In light of the growing demand for object tracking, this article explores both the potential and challenges associated with different tracking technologies applied to various ultrasound imaging applications, including freehand 3D ultrasound imaging, ultrasound image fusion, ultrasound-guided intervention and treatment. Recent development in tracking technology has led to increased accuracy and intuitiveness of ultrasound imaging and navigation with less reliance on operator skills, thereby benefiting the medical diagnosis and treatment. Although commercially available tracking systems are capable of achieving sub-millimeter resolution for positional tracking and sub-degree resolution for orientational tracking, such systems are subject to a number of disadvantages, including high costs and time-consuming calibration procedures. While some emerging tracking technologies are still in the research stage, their potentials have been demonstrated in terms of the compactness, light weight, and easy integration with existing standard or portable ultrasound machines.
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Affiliation(s)
- Chang Peng
- School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
| | - Qianqian Cai
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Mengyue Chen
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
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Mauri G, Gitto S, Pescatori LC, Albano D, Messina C, Sconfienza LM. Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:387-392. [PMID: 32785900 DOI: 10.1055/a-1194-4225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions. MATERIALS AND METHODS This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded. RESULTS Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ± 5 vs. 26 ± 3 minutes, p = 0.002 and 7; 5.25-8.75 vs. 3; 3-3.25, p = 0.001). In controls, the mean procedure duration was 47 ± 4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5-8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal. CONCLUSION Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes.
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Affiliation(s)
- Giovanni Mauri
- Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
- European Institute of Oncology IRCCS, Division of Interventional Radiology, Milan, Italy
| | - Salvatore Gitto
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
| | | | - Domenico Albano
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
- Università degli Studi di Palermo, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Palermo, Italy
| | - Carmelo Messina
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
| | - Luca Maria Sconfienza
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
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Sassatelli R, Grillo S, Ottone M, Besutti G, Cecinato P, Sereni G, Mirante VG, Iori V, Pattacini P, Rossi PG. Fusion radiology in interventional endoscopy (FRIend): a new approach for pancreatic fluid collections. Endosc Int Open 2022; 10:E622-E633. [PMID: 35571478 PMCID: PMC9106435 DOI: 10.1055/a-1797-8681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background and study aims Fusion imaging consists of overlaying preoperative imaging over live fluoroscopy, providing an augmented live guidance. Since 2017, we have been using a new hybrid operating room (Discovery IGS 740 OR, GE Healthcare) for biliopancreatic endoscopy, combining fusion imaging with traditional endoscopic ultrasound (EUS). This study aimed to assess the advantages that fusion imaging could bring to EUS-guided drainage of post-pancreatitis fluid collections. Patients and methods Thirty-five drainage procedures performed between 2012 and 2019 with traditional guidance and fusion imaging were retrospectively compared, assessing the overall treatment success rate - i. e. symptom improvement with complete PFC emptying - as a primary outcome. Secondary outcomes included technical success rate, time to resolution, hospital stay length, adverse events, recurrence rate, and procedure time. Results Patients treated with standard EUS (n = 17) and with fusion imaging (n = 18) were homogeneous in age, gender, pancreatitis etiology, and indication for drainage; the second group had larger PFCs, more frequently walled-off necrosis than pseudocysts, and were treated more emergently, indicating higher case complexity in this group. During the period when fusion imaging was adopted, procedures had a higher overall treatment success rate than during the period when standard EUS was adopted (83.3 % vs. 52.9 %, P = 0.075), and complete emptying was reached in less time (61.1 % vs. 23.6 % complete emptying within 90 days, P = 0.154), differences compatible with random fluctuations. Conclusions This study suggests that fusion imaging in combination with EUS might improve clinical and procedural outcomes of PFC drainage.
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Affiliation(s)
- Romano Sassatelli
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Simone Grillo
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Marta Ottone
- Azienda USL, IRCCs di Reggio Emilia, Gastroenterology and Digestive Endoscopy Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Giulia Besutti
- Azienda USL, IRCCs di Reggio Emilia, Radiology Unit Reggio Emilia, Emilia-Romagna, Italy
| | - Paolo Cecinato
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Giuliana Sereni
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | | | - Veronica Iori
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Pierpaolo Pattacini
- Azienda USL, IRCCs di Reggio Emilia, Radiology Unit Reggio Emilia, Emilia-Romagna, Italy
| | - Paolo Giorgi Rossi
- Azienda USL, IRCCs di Reggio Emilia, Gastroenterology and Digestive Endoscopy Unit, Reggio Emilia, Emilia-Romagna, Italy
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Gunabushanam G, Scoutt LM. Ultrasound Image Optimization for the Interventional Radiologist. Tech Vasc Interv Radiol 2021; 24:100766. [PMID: 34861965 DOI: 10.1016/j.tvir.2021.100766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Understanding the basics and nuances of the functionality of ultrasound (US) equipment and of its various knobs and modes will enable the interventional radiologist to acquire higher quality US images. This, in turn will potentially allow US-guided procedures to be performed safely, and with greater operator confidence, and may also allow certain procedures to be performed with US instead of CT or fluoroscopic guidance. In this article, we review the practical aspects of US image optimization for the interventional radiologist, including equipment and transducer selection, depth, focal zone and gain setting adjustment, as well as special considerations for imaging the obese patient. Color Doppler image optimization and recent developments in ultrasound imaging are briefly discussed.
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Affiliation(s)
| | - Leslie M Scoutt
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT
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14
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Lee DH. Recent technical advances in radiofrequency ablations for hepatocellular carcinoma. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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15
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Han S, Lee JM, Lee DH, Yoon JH, Chang W. Utility of Real-time CT/MRI-US Automatic Fusion System Based on Vascular Matching in Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: A Prospective Study. Cardiovasc Intervent Radiol 2021; 44:1579-1596. [PMID: 34312690 DOI: 10.1007/s00270-021-02896-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To prospectively evaluate the technical success rate of real-time computed tomography/magnetic resonance imaging and ultrasound (CT/MRI-US) automatic fusion system and the long-term therapeutic efficacy of radiofrequency ablation (RFA) guided by automatic fusion in hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODS 139 patients with 151 HCCs were prospectively enrolled for RFA guided by an automatic CT/MRI-US fusion system (PercuNav system, Philips, the Netherlands). Automatic fusion imaging, based on vascular segmentation and registration, was performed by sonographic sweeping at the intercostal plane. The fusion quality, tumor localization confidence and technical feasibility were recorded before and after fusion using a scoring system. Technical success rate of the RFA procedure and local tumor progression (LTP) were assessed during follow-up. Analysis of technical success and LTP was performed using generalized estimating equations and Cox proportional hazard regression analysis. RESULTS The success rate of the fusion system was 82.7% (115/139) per patient. The mean sonographic scan time for fusion was 154.4 ± 108.4 s. In patients with successful fusion, the score indicating tumor localization confidence (2.2 ± 0.8 vs. 2.7 ± 0.9) and technical feasibility (2.6 ± 0.8 vs. 3.4 ± 0.7) increased after fusion (p < 0.001). The technical success rate of the RFA procedure was 96.8% (120/124) per tumor in patients with successful fusion, including poorly localized tumors. LTP rates were 8.6%, 12.2% and 15.2% at 1, 2 and 3 years. CONCLUSION The CT/MRI-US automatic fusion system showed a high success rate for image registration and facilitated better feasibility and a high technical success rate of RFA in HCCs, even with poor localization on US. LEVEL OF EVIDENCE Level 3b, Nonrandomized prospective study.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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16
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Feng C, Wang L, Huang S, Xing Q, Zhou X, Xing N, Lv F, Li T. CT-US fusion imaging increases the feasibility of early ultrasound-guided percutaneous intervention of local drug therapy in pancreatic contusion and laceration. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:307. [PMID: 33708934 PMCID: PMC7944287 DOI: 10.21037/atm-20-4426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Multimodal fusion imaging (MMFI) was usually used to assist percutaneous procedures for difficult lesions, with most applications occurring with hepatic and prostatic interventions. This paper aimed to evaluate the precision and effectiveness of computed tomography-ultrasound (CT-US) fusion imaging (CUFI)-assisted US-guided percutaneous intervention (UGPI) in early local drug therapy for pancreatic contusion and laceration (PCL). Methods A total of 12 pigs with PCL were randomly divided into a CUFI-assisted UGPI (MU) group (n=6) and a single UGPI (SU) group (n=6). The MU group underwent CUFI-assisted UGPI of locally applied medical protein glue (1 mL) injection while the SU group received the same therapy using two-dimensional UGPI. The duration and accuracy of each procedure were observed in the 2 groups. Results In the MU group, the overall time of the procedure for locking the plane was 1.85±0.06 minutes. Less time was spent in the selection of the pathway and puncture site in the MU group compared with the SU group (6.56±0.42 vs. 7.61±0.44 minutes, P<0.01). The duration of puncturing and drug injection was also shorter in the MU group than in the SU group (3.41±0.30 vs. 4.20±0.20 minutes, P<0.01) and the MU group had a higher accuracy of medical protein glue injection than the SU group (100% vs. 50%, P<0.05). Conclusions CUFI could increase the precision and effectiveness of early UGPI in the delivery of local drug therapy in PCL.
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Affiliation(s)
- Cong Feng
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Libo Wang
- Department of Ultrasound, Hainan Hospital of the PLA General Hospital, Sanya, China
| | - Sai Huang
- Department of Hematology, Fifth Medical Center, General Hospital of the PLA, Beijing, China
| | - Qinrui Xing
- Department of Emergency, Hainan Hospital of the PLA General Hospital, Sanya, China
| | - Xuan Zhou
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Ning Xing
- Department of Radiology, First Medical Center, General Hospital of the PLA, Beijing, China
| | - Faqin Lv
- Department of Ultrasound, Third Medical Center, General Hospital of the PLA, Beijing, China
| | - Tanshi Li
- Department of Emergency, First Medical Center, General Hospital of the PLA, Beijing, China
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17
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Faustino CB, Ventura C, Portugal MFC, Brunheroto A, Teivelis MP, Wolosker N. Experiência inicial com ultrassom Doppler com contraste por microbolhas em adição ao ultrassom Doppler convencional para seguimento de correção endovascular de aneurisma de aorta abdominal. J Vasc Bras 2021; 20:e20200093. [PMID: 35515084 PMCID: PMC9045535 DOI: 10.1590/1677-5449.200093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background Microbubble contrast enhanced ultrasound (CEUS) is an accurate diagnostic method for follow-up after endovascular abdominal aortic aneurysm repair (EVAR) that has been well-established in international studies. However, there are no Brazilian studies that focus on this follow-up method. Objectives The objective of this study was to report initial experience with CEUS at a tertiary hospital, comparing the findings of CEUS with those of conventional Doppler ultrasound (DUS), with the aim of determining whether addition of contrast to the standard ultrasonographic control protocol resulted in different findings. Methods From 2015 to 2017, 21 patients in follow-up after EVAR underwent DUS followed by CEUS. The findings of these examinations were analyzed in terms of identification of complications and their capacity to identify the origin of endoleaks. Results There was evidence of complications in 10 of the 21 cases examined: seven patients exhibited endoleaks (33.3%); two patients exhibited stenosis of a branch of the endograft (9.52%); and one patient exhibited a dissection involving the external iliac artery (4.76%). In the 21 patients assessed, combined use of both methods identified 10 cases of post-EVAR complications. In six of the seven cases of endoleaks (85.71%), use of the methods in combination was capable of identifying the origin of endoleakage. DUS alone failed to identify endoleaks in two cases (28.5%) and identified doubtful findings in another two cases (28.5%), in which diagnostic definition was achieved after employing CEUS. Conclusions CEUS is a technique that is easy to perform and provides additional support for follow-up of infrarenal EVAR.
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Affiliation(s)
| | | | | | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Brasil; Universidade de São Paulo, Brasil
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18
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Radu C, Fisher P, Mitrea D, Birlescu I, Marita T, Vancea F, Florian V, Tefas C, Badea R, Ștefănescu H, Nedevschi S, Pisla D, Hajjar NA. Integration of Real-Time Image Fusion in the Robotic-Assisted Treatment of Hepatocellular Carcinoma. BIOLOGY 2020; 9:biology9110397. [PMID: 33198415 PMCID: PMC7697343 DOI: 10.3390/biology9110397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/23/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Simple Summary Hepatocellular carcinoma is one of the leading causes of cancer-related deaths worldwide. An image fusion system is developed for the robotic-assisted treatment of hepatocellular carcinoma, which is not only capable of imaging data interpretation and reconstruction, but also automatic tumor detection. The optimization and integration of the image fusion system within a novel robotic system has the potential to demonstrate the feasibility of the robotic-assisted targeted treatment of hepatocellular carcinoma by showing benefits such as precision, patients safety and procedure ergonomics. Abstract Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide, with its mortality rate correlated with the tumor staging; i.e., early detection and treatment are important factors for the survival rate of patients. This paper presents the development of a novel visualization and detection system for HCC, which is a composing module of a robotic system for the targeted treatment of HCC. The system has two modules, one for the tumor visualization that uses image fusion (IF) between computerized tomography (CT) obtained preoperatively and real-time ultrasound (US), and the second module for HCC automatic detection from CT images. Convolutional neural networks (CNN) are used for the tumor segmentation which were trained using 152 contrast-enhanced CT images. Probabilistic maps are shown as well as 3D representation of HCC within the liver tissue. The development of the visualization and detection system represents a milestone in testing the feasibility of a novel robotic system in the targeted treatment of HCC. Further optimizations are planned for the tumor visualization and detection system with the aim of introducing more relevant functions and increase its accuracy.
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Affiliation(s)
- Corina Radu
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Petra Fisher
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
| | - Delia Mitrea
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Iosif Birlescu
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
- Correspondence: (I.B.); (D.P.)
| | - Tiberiu Marita
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Flaviu Vancea
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Vlad Florian
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Cristian Tefas
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Radu Badea
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Horia Ștefănescu
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
| | - Sergiu Nedevschi
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Doina Pisla
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
- Correspondence: (I.B.); (D.P.)
| | - Nadim Al Hajjar
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
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19
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The role of point of care ultrasound in radiology department: update and prospective. A statement of Italian college ultrasound. Radiol Med 2020; 126:636-641. [PMID: 33146845 DOI: 10.1007/s11547-020-01301-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Ultrasound, in its new point-of-care conception, has been called the stethoscope of the future. Goal-directed bedside ultrasound examination, performed by a healthcare provider to answer a specific diagnostic question or guide an invasive procedure, is currently revolutionizing medical practice. It is used by various specialties in multiple clinical contexts for procedural, diagnostic, and screening applications. Point-of-care ultrasound is also a strategic technique in clinical radiology; it brings the radiologist closer to the patient (in interaction and understanding) like interventional and angiography procedures and, as an integrative imaging modality, is a vital radiological tool for decision-making in many situations. In this commentary, we present our observations on the use of ultrasound, in a sincere appeal to refrain from omitting ultrasound as a diagnostic technique in this era of deep professional change, in which radiologists must return to being a true clinical semiologist.
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20
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Affiliation(s)
- Miguel José Francisco Neto
- Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil. E-mail:
| | - Marcos Roberto Gomes de Queiroz
- Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP, Brasil. E-mail:
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21
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Choi J, Lee SK, Park S. Electromagnetic tracking-based ultrasound/computed tomography fusion imaging in dogs: preliminary application to ocular and periocular regions. J Vet Sci 2020; 20:e51. [PMID: 31565894 PMCID: PMC6769322 DOI: 10.4142/jvs.2019.20.e51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 08/20/2019] [Indexed: 11/20/2022] Open
Abstract
In ultrasound/computed tomography (CT) fusion images, ultrasound allows visualization of the target in real time. CT provides a navigation for ultrasound scanning and improves the overview in areas of limited visualization with ultrasound. This study was performed to investigate the feasibility of ultrasound/CT fusion based on an electromagnetic tracking technique using external fiducial markers for canine ocular and periocular regions. In 7 Beagle dogs, contrast-enhanced CT images of the head were obtained with placing external fiducial markers over the frontal region and both sides of the forepaws of the dog. Ultrasonography was performed under a magnetic field by installing a position sensor in the linear probe, without changing the dog's position. The positions of the external fiducial markers were adjusted and matched, based on the CT images. The execution time of co-registration and the distance between the regions of interest and the co-registration points, the frontal bone, cornea, retina, and optic nerve, were estimated. Approximately 60% of external fiducial markers were properly recognized in all dogs. After adjustment, all external fiducial markers were precisely matched. The co-registration execution time was less than 1 min. The distances between the regions of interest and co-registration points were less than 3 mm in all dogs. The electromagnetic tracking technique using external fiducial markers was a simple and applicable method for fusion imaging of a canine head using real-time ultrasonography and CT. This technique can be useful for interventional procedures of retrobulbar and periorbital lesions.
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Affiliation(s)
- Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea.
| | - Sang Kwon Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Seungjo Park
- Department of Veterinary Medical Imaging, College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
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22
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Yamada A, Tokuda J, Naka S, Murakami K, Tani T, Morikawa S. Magnetic resonance and ultrasound image-guided navigation system using a needle manipulator. Med Phys 2019; 47:850-858. [PMID: 31829440 DOI: 10.1002/mp.13958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Image guidance is crucial for percutaneous tumor ablations, enabling accurate needle-like applicator placement into target tumors while avoiding tissues that are sensitive to injury and/or correcting needle deflection. Although ultrasound (US) is widely used for image guidance, magnetic resonance (MR) is preferable due to its superior soft tissue contrast. The objective of this study was to develop and evaluate an MR and US multi-modal image-guided navigation system with a needle manipulator to enable US-guided applicator placement during MR imaging (MRI)-guided percutaneous tumor ablation. METHODS The MRI-compatible needle manipulator with US probe was installed adjacent to a 3 Tesla MRI scanner patient table. Coordinate systems for the MR image, patient table, manipulator, and US probe were all registered using an optical tracking sensor. The patient was initially scanned in the MRI scanner bore for planning and then moved outside the bore for treatment. Needle insertion was guided by real-time US imaging fused with the reformatted static MR image to enhance soft tissue contrast. Feasibility, targeting accuracy, and MR compatibility of the system were evaluated using a bovine liver and agar phantoms. RESULTS Targeting error for 50 needle insertions was 1.6 ± 0.6 mm (mean ± standard deviation). The experiment confirmed that fused MR and US images provided real-time needle localization against static MR images with soft tissue contrast. CONCLUSIONS The proposed MR and US multi-modal image-guided navigation system using a needle manipulator enabled accurate needle insertion by taking advantage of static MR and real-time US images simultaneously. Real-time visualization helped determine needle depth, tissue monitoring surrounding the needle path, target organ shifts, and needle deviation from the path.
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Affiliation(s)
- Atsushi Yamada
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Junichi Tokuda
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Shigeyuki Naka
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Koichiro Murakami
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Tohru Tani
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Shigehiro Morikawa
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
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Lv S, Long Y, Su Z, Zheng R, Li K, Zhou H, Qiu C, Yin T, Xu E. Investigating the Accuracy of Ultrasound-Ultrasound Fusion Imaging for Evaluating the Ablation Effect via Special Phantom-Simulated Liver Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3067-3074. [PMID: 31447240 DOI: 10.1016/j.ultrasmedbio.2019.07.415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
The goal of this study was to investigate the accuracy of ultrasound-ultrasound (US-US) fusion imaging for evaluating the ablation effect via phantom-simulated liver tumors. Twenty special phantom models were established, ablated and divided into a complete ablation group (n = 10) and an incomplete ablation group (n = 10). US-US fusion imaging was performed to evaluate the ablation effect. Gross specimens were observed as a standard reference. In this US-US fusion imaging study, the registration success rate was 100% (20/20), and the assessment time was 3.8 ± 0.9 min. The accuracy rate of the evaluation was 100% (20/20). There was no significant difference in the residual pseudo-tumoral area between the evaluation with US-US fusion imaging and gross specimen observation (p = 0.811), and the measurement error was 1.1 ± 0.6 mm. In conclusion, the feasibility and accuracy of US-US fusion imaging when evaluating the ablation effect can be investigated with this phantom-simulated liver tumor ablation model in an ideal state.
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Affiliation(s)
- Shumin Lv
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China; Department of Medical Ultrasonics, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong Province, China
| | - Yinglin Long
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China
| | - Zhongzhen Su
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China; Department of Medical Ultrasonics, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China
| | - Kai Li
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China
| | - Huichao Zhou
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China
| | - Chen Qiu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China
| | - Tinghui Yin
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, Guangdong Province, China.
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Tontini GE, Manfredi G, Orlando S, Neumann H, Vecchi M, Buscarini E, Elli L. Endoscopic ultrasonography and small-bowel endoscopy: Present and future. Dig Endosc 2019; 31:627-643. [PMID: 31090965 DOI: 10.1111/den.13429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
Over the last decade, impressive technological advances have occurred in ultrasonography and small-bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device-assisted enteroscopy have quickly become the reference standard for the diagnosis of small-bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up-to-date overview of the latest advances in endoscopic ultrasonography and small-bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Stefania Orlando
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Digestive Endoscopy and Gastroenterology Unit, ASST of Cremona, Cremona, Italy
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Kang TW, Lee MW, Cha DI, Park HJ, Park JS, Bang WC, Kim SW. Usefulness of Virtual Expiratory CT Images to Compensate for Respiratory Liver Motion in Ultrasound/CT Image Fusion: A Prospective Study in Patients with Focal Hepatic Lesions. Korean J Radiol 2019; 20:225-235. [PMID: 30672162 PMCID: PMC6342754 DOI: 10.3348/kjr.2018.0320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To assess whether virtual expiratory (VE)-computed tomography (CT)/ultrasound (US) fusion imaging is more effective than conventional inspiratory (CI)-CT/US fusion imaging for hepatic interventional procedures. Materials and Methods This prospective study was approved by the Institutional Review Board, and informed consent was obtained from each patient. In total, 62 patients with focal hepatic lesions referred for hepatic interventional procedures were enrolled. VE-CT images were generated from CI-CT images to reduce the effects of respiration-induced liver motion. The two types of CT images were fused with real-time US images for each patient. The operators scored the visual similarity with the liver anatomy upon initial image fusion and the summative usability of complete image fusion using the respective five-point scales. The time required for complete image fusion and the number of point locks used were also compared. Results In comparison with CI-CT/US fusion imaging, VE-CT/US fusion imaging showed significantly higher visual similarity with the liver anatomy on the initial image fusion (mean score, 3.9 vs. 1.7; p < 0.001) and higher summative usability for complete image fusion (mean score, 4.0 vs. 1.9; p < 0.001). The required time (mean, 11.1 seconds vs. 22.5 seconds; p < 0.001) and the number of point locks (mean, 1.6 vs. 3.0; p < 0.001) needed for complete image fusion using VE-CT/US fusion imaging were significantly lower than those needed for CI-CT/US fusion imaging. Conclusion VE-CT/US fusion imaging is more effective than CI-CT/US fusion imaging for hepatic interventional procedures.
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jung Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jun Sung Park
- Medical Imaging R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Seoul, Korea
| | - Won Chul Bang
- Medical Imaging R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Seoul, Korea
| | - Seon Woo Kim
- Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
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Seifert P, Winkens T, Kühnel C, Gühne F, Freesmeyer M. I-124-PET/US Fusion Imaging in Comparison to Conventional Diagnostics and Tc-99m Pertechnetate SPECT/US Fusion Imaging for the Function Assessment of Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2298-2308. [PMID: 31196748 DOI: 10.1016/j.ultrasmedbio.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study is to investigate I-124 positron emission tomography (PET)/ultrasound (US) fusion imaging for function assessment of thyroid nodules. In 70 patients, 201 lesions were examined with conventional diagnostics (CD) (thyroid US, laboratory findings and Tc-99m pertechnetate scintigraphy), Tc-99m pertechnetate single photon emission computed tomography (SPECT) and I-124 PET/computed tomography (CT). Subsequently, US fusion imaging (SPECT/US and PET/US) was performed by three experienced investigators. Patients referred for thyroid diagnostics in a clinical routine setting were included in this study if CD produced equivocal results. PET/US was superior to CD and SPECT/US in 96% and 86%, respectively, and ambiguous findings in CD were clarified by PET/US in 96% of the 70 patients. Regarding nodule-based function assessment, 10% (66%), 39% (14%) and 71% (4%) of the 201 lesions were rated with absolute certainty (equivocal or uncertain) using CD, SPECT/US and PET/US, respectively (p < 0.001). PET/US has the potential to improve the function assessment of thyroid nodules in comparison to CD.
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Affiliation(s)
- Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany.
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Calandri M, Ruggeri V, Carucci P, Mirabella S, Veltri A, Fonio P, Gazzera C. Thermal ablation with fusion imaging guidance of hepatocellular carcinoma without conspicuity on conventional or contrast-enhanced US: surrounding anatomical landmarks matter. Radiol Med 2019; 124:1043-1048. [PMID: 31270723 DOI: 10.1007/s11547-019-01057-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/18/2019] [Indexed: 12/15/2022]
Abstract
AIM Evaluating clinical and technical factors affecting thermal ablation of B-Mode/CEUS inconspicuous HCC nodules, relying only on fusion imaging (FI) performed under conscious sedation and using previously acquired CT or MR. MATERIALS AND METHODS Among 367 HCC nodules treated in the study period, data of 37 B-mode/CEUS undetectable HCC nodules treated with FI-guided ablation were extracted from our prospectively collected institutional database. Analyzed variables included patients' sex, age, cirrhosis etiology, Child-Pugh status, size of the lesion, liver segment, subcapsular or central liver site, type of imaging used for fusion (MR/CT), and the presence of surrounding anatomical landmarks (SAL) < 3 cm from the index lesion. RESULTS The primary efficacy was 59.4% (22/37 nodules); nine lesions (24.3%) were partially ablated (PA), six lesions (16.7%) were mistargeted (MA). Eight nodules were retreated with a CA obtained in all cases (100% CA, secondary efficacy in 30/37-81.1%). LTP was observed in 2/30 cases (6.7%). Two minor complications were registered (Clavien-Dindo, Grade1, CIRSE Classification Grade 2). SAL were related to a better ablation outcome (37.5% vs 84.6% p = 0.01). No differences were observed between CA group and PA-MA group in terms of lesion size (15.4 mm vs 14.9 mm p = 0.63), liver segment (p = 0.58), subcapsular or central liver site (8/22 36% vs 4/15 26.7% p = 0.84), and imaging (MR vs CT, p = 0.72). CONCLUSION Even in the presence of potentially critical conditions (completely B-Mode/CEUS inconspicuous nodules, spontaneous breathing, and previously acquired CT or MRI), FI-only guidance is safe and allows having good primary, secondary efficacy and LTP rates. The outcome of the procedure is heavily affected by the presence of SAL.
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Affiliation(s)
- Marco Calandri
- Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy.
| | - Valeria Ruggeri
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
| | - Patrizia Carucci
- Gastro-Hepatology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Stefano Mirabella
- Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Veltri
- Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
| | - Carlo Gazzera
- Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy
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Pohlman RM, Turney MR, Wu P, Brace CL, Ziemlewicz TJ, Varghese T. Two-dimensional ultrasound-computed tomography image registration for monitoring percutaneous hepatic intervention. Med Phys 2019; 46:2600-2609. [PMID: 31009079 PMCID: PMC6758542 DOI: 10.1002/mp.13554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Deformable registration of ultrasound (US) and contrast enhanced computed tomography (CECT) images are essential for quantitative comparison of ablation boundaries and dimensions determined using these modalities. This comparison is essential as stiffness-based imaging using US has become popular and offers a nonionizing and cost-effective imaging modality for monitoring minimally invasive microwave ablation procedures. A sensible manual registration method is presented that performs the required CT-US image registration. METHODS The two-dimensional (2D) virtual CT image plane that corresponds to the clinical US B-mode was obtained by "virtually slicing" the 3D CT volume along the plane containing non-anatomical landmarks, namely points along the microwave ablation antenna. The initial slice plane was generated using the vector acquired by rotating the normal vector of the transverse (i.e., xz) plane along the angle subtended by the antenna. This plane was then further rotated along the ablation antenna and shifted along with the direction of normal vector to obtain similar anatomical structures, such as the liver surface and vasculature that is visualized on both the CT virtual slice and US B-mode images on 20 patients. Finally, an affine transformation was estimated using anatomic and non-anatomic landmarks to account for distortion between the colocated CT virtual slice and US B-mode image resulting in a final registered CT virtual slice. Registration accuracy was measured by estimating the Euclidean distance between corresponding registered points on CT and US B-mode images. RESULTS Mean and SD of the affine transformed registration error was 1.85 ± 2.14 (mm), computed from 20 coregistered data sets. CONCLUSIONS Our results demonstrate the ability to obtain 2D virtual CT slices that are registered to clinical US B-mode images. The use of both anatomical and non-anatomical landmarks result in accurate registration useful for validating ablative margins and comparison to electrode displacement elastography based images.
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Affiliation(s)
- Robert M. Pohlman
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Michael R. Turney
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Po‐Hung Wu
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Christopher L. Brace
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Timothy J. Ziemlewicz
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Tomy Varghese
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
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Degrauwe N, Hocquelet A, Digklia A, Schaefer N, Denys A, Duran R. Theranostics in Interventional Oncology: Versatile Carriers for Diagnosis and Targeted Image-Guided Minimally Invasive Procedures. Front Pharmacol 2019; 10:450. [PMID: 31143114 PMCID: PMC6521126 DOI: 10.3389/fphar.2019.00450] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
We are continuously progressing in our understanding of cancer and other diseases and learned how they can be heterogeneous among patients. Therefore, there is an increasing need for accurate characterization of diseases at the molecular level. In parallel, medical imaging and image-guided therapies are rapidly developing fields with new interventions and procedures entering constantly in clinical practice. Theranostics, a relatively new branch of medicine, refers to procedures combining diagnosis and treatment, often based on patient and disease-specific features or molecular markers. Interventional oncology which is at the convergence point of diagnosis and treatment employs several methods related to theranostics to provide minimally invasive procedures tailored to the patient characteristics. The aim is to develop more personalized procedures able to identify cancer cells, selectively reach and treat them, and to assess drug delivery and uptake in real-time in order to perform adjustments in the treatment being delivered based on obtained procedure feedback and ultimately predict response. Here, we review several interventional oncology procedures referring to the field of theranostics, and describe innovative methods that are under development as well as future directions in the field.
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Affiliation(s)
- Nils Degrauwe
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Abstract
OBJECTIVE. The purpose of this article is to describe the use of ultrasound-MRI fusion imaging to guide precise and targeted muscle biopsy in patients with suspected myopathies. CONCLUSION. Ultrasound-MRI fusion-guided muscle biopsy allows targeted sampling of tissues with active inflammatory changes and facilitates diagnosis of myopathies.
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Fusion Imaging and Virtual Navigation to Guide Percutaneous Thermal Ablation of Hepatocellular Carcinoma: A Review of the Literature. Cardiovasc Intervent Radiol 2019; 42:639-647. [PMID: 30809699 DOI: 10.1007/s00270-019-02167-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
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Cotta BH, Meagher MF, Bradshaw A, Ryan ST, Rivera-Sanfeliz G, Derweesh IH. Percutaneous renal mass biopsy: historical perspective, current status, and future considerations. Expert Rev Anticancer Ther 2019; 19:301-308. [DOI: 10.1080/14737140.2019.1571915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Brittney H. Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F. Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Stephen T. Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Gerant Rivera-Sanfeliz
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
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D'Onofrio M, Beleù A, De Robertis R. Ultrasound-guided percutaneous procedures in pancreatic diseases: new techniques and applications. Eur Radiol Exp 2019; 3:2. [PMID: 30671676 PMCID: PMC6342746 DOI: 10.1186/s41747-018-0081-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/14/2018] [Indexed: 02/08/2023] Open
Abstract
Ultrasound (US) is not only an important diagnostic tool for the evaluation of the pancreas, but is also a fundamental imaging technique to guide percutaneous interventions for several pancreatic diseases (fluid aspiration and drainage; invasive diagnosis by means fine-needle aspiration and core-needle biopsy; tumour ablation by radiofrequency, microwaves, irreversible electroporation, cryoablation, and high-intensity focused US). Technical improvements, such as contrast media and fusion imaging, have recently increased precision and safety and reduced procedure-related complications. New treatment US techniques for the ablation of pancreatic tumours, such as contrast-enhanced US and multimodality fusion imaging, have been recently developed and have elicited a growing interest worldwide. The purpose of this article was to review the most up-to-date role of US in percutaneous procedures for pancreatic diseases.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alessandro Beleù
- Department of Radiology, G.B. Rossi Hospital - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Riccardo De Robertis
- PhD Programme in Inflammation, Immunity and Cancer, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Efficacy of Second-Look Ultrasound with MR Coregistration for Evaluating Additional Enhancing Lesions of the Breast: Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3896946. [PMID: 30420960 PMCID: PMC6215588 DOI: 10.1155/2018/3896946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 09/26/2018] [Indexed: 01/06/2023]
Abstract
Contrast enhanced magnetic resonance imaging (CE-MRI) has acquired a central role in the field of diagnosis and evaluation of breast cancer due to its high sensitivity; on the other hand, MRI has shown a variable specificity because of the wide overlap between the imaging features of benign and malignant lesions. Therefore, when an additional breast lesion is identified at CE-MRI, a second look with targeted US is generally performed because it provides additional information to further characterise the target lesion and makes it possible to perform US-guided biopsies which are costless and more comfortable for patients compared with MRI-guided ones. Nevertheless, there is not always a correspondence between CE-MR findings and targeted US due to several factors including different operator's experience and position of patients. A new technique has recently been developed in order to overcome these limitations: US with MR coregistration, which can synchronise a sonography image and the MR image with multiplanar reconstruction (MPR) of the same section in real time. The aim of our study is to review the literature concerning the second look performed with this emerging and promising technique, showing both advantages and limitations in comparison with conventional targeted US.
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Abstract
Today medical imaging is an essential component of the entire health-care continuum, from wellness and screening, to early diagnosis, treatment selection, and follow-up. Patient triage in both acute care and chronic disease, imaging-guided interventions, and optimization of treatment planning are now integrated into routine clinical practice in all subspecialties. This paper provides a brief review of major milestones in medical imaging from its inception to date, with a few considerations regarding future directions in this important field.
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Affiliation(s)
- Eyal Bercovich
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Marcia C. Javitt
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
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Rübenthaler J, Wilson S, Clevert DA. Multislice computed tomography/contrast-enhanced ultrasound image fusion as a tool for evaluating unclear renal cysts. Ultrasonography 2018; 38:181-187. [PMID: 30531649 PMCID: PMC6443590 DOI: 10.14366/usg.18024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/03/2018] [Indexed: 12/13/2022] Open
Abstract
Ultrasonography is a generally accepted imaging technique for diagnosing and monitoring cystic renal lesions. The widely used Bosniak classification (I-IV) categorizes renal cystic lesions into five distinctive groups according to ultrasonography and computed tomography (CT) image criteria. For solid renal lesions, determination of vascularity is discriminatory for malignancy in most instances. In indeterminate cases, contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging/CT-ultrasound image fusion are able to detect and characterize difficult pathologies, with superior performance to either technique alone. In contrast to multislice CT (MS-CT), ultrasound image fusion is a real-time imaging technique that can be used in combination with other cross-sectional imaging modalities. This technical note describes state-of-the-art image fusion of CEUS and MS-CT to detect and characterize unclear renal pathologies.
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Affiliation(s)
- Johannes Rübenthaler
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-MaximiliansUniversity of Munich-Grosshadern Campus, Munich, Germany
| | - Stephanie Wilson
- Department of Radiology, University of Calgary, Foothills Medical Centre, Calgary, Canada
| | - Dirk-Andre Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-MaximiliansUniversity of Munich-Grosshadern Campus, Munich, Germany
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Yoon JH, Lee JM, Lee YJ, Lee KB, Han JK. Added Value of sequentially performed gadoxetic acid-enhanced liver MRI for the diagnosis of small (10-19 mm) or atypical hepatic observations at contrast-enhanced CT: A prospective comparison. J Magn Reson Imaging 2018; 49:574-587. [PMID: 30102433 DOI: 10.1002/jmri.26199] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Small hepatocellular carcinomas (HCCs) often show atypical features at cross-sectional imaging, yet there is no preferred recommendation for the diagnosis or characterization of small observations (10-19 mm) at present. PURPOSE To determine the added value of sequentially performed gadoxetic acid-enhanced liver MRI for contrast-enhanced computed tomography (CECT)-detected small (10-19 mm) or atypical hepatic observations ≥20 mm in the diagnosis of HCC. STUDY TYPE Prospective, cross-sectional, intraindividual comparison. POPULATION In all, 110 patients at high risk of developing HCC. FIELD STRENGTH/SEQUENCE 1.5T and 3T/T1 -weighted imaging. ASSESSMENT Hepatic observations were classified into HCCs or benign non-HCCs based on imaging features of arterial phase hyperenhancement (APHE) and portal or delayed washout at CT or APHE and portal washout at MRI. Final diagnoses were established using a composite algorithm and diagnostic performances of MRI and CT were compared in all observations. In addition, in a subgroup of histologically confirmed observations and stable benign observations during follow-up (n = 94), sensitivity and specificity of MRI were compared between the aforementioned criteria and LR-5 of Liver Imaging Reporting and Data System v2014. STATISTICAL TEST χ2 test. RESULTS MRI provided higher sensitivity than CT (62.2% vs. 27.0%, P = 0.0001) while maintaining specificity (97.2%, each) at the per-patient level. Among 124 observations, 10-19 mm in size, MRI showed significantly higher sensitivity in diagnosing HCCs (62.5%, 50/80) than CT (25%, 20/80, P < 0.0001) with comparable specificity (97.7% [43/44], each). However, seven atypical observations (≥20 mm) at CT remained atypical at MRI. In the subgroup analysis, the diagnostic criteria of APHE and portal washout showed a significantly higher sensitivity (44.2%, 19/43) than LR-5 (23.2%, 10/43, P = 0.004), without compromising specificity (97.7% vs. 95.5%). DATA CONCLUSION Sequentially performed gadoxetic acid-enhanced MRI provided added value to CECT for the diagnosis of HCCs in small observations by improving sensitivity while maintaining specificity. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:574-587.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kyung Bun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.,College of Medicine, Seoul, Republic of Koreas
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Lee DH, Lee JM. Recent Advances in the Image-Guided Tumor Ablation of Liver Malignancies: Radiofrequency Ablation with Multiple Electrodes, Real-Time Multimodality Fusion Imaging, and New Energy Sources. Korean J Radiol 2018; 19:545-559. [PMID: 29962861 PMCID: PMC6005950 DOI: 10.3348/kjr.2018.19.4.545] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/27/2018] [Indexed: 02/06/2023] Open
Abstract
Radiofrequency ablation (RFA) has emerged as an effective loco-regional treatment modality for malignant hepatic tumors. Indeed, studies have demonstrated that RFA of early stage hepatocellular carcinomas can provide comparable overall survival to surgical resection. However, the incidence of local tumor progression (LTP) after RFA is significantly higher than that of surgical resection. Thus, to overcome this limitation, multiple electrode radiofrequency (RF) systems that use a multi-channel RF generator have been developed, and they demonstrate better efficiency in creating larger ablation zones than that using the conventional RFA with a single electrode. Furthermore, RFA with multiple electrodes can allow the “no-touch” ablation technique which may also help to reduce LTP. Another technique that would be helpful in this regard is multi-modality-ultrasound fusion imaging, which helps to not only more accurately determine the target lesion by enabling the RFA of small, poorly visible or invisible tumors, but also improve the monitoring of procedures and determine the appropriateness of the ablation margin. In addition, new energy sources, including microwave and cryoablation, have been introduced in imaging-guided tumor ablation. In this review, these recently introduced ablation techniques and the results of the most current animal and clinical studies are discussed.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
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Liu TJ, Shen F, Zhang C, Huang PT, Zhu YJ. Real-time ultrasound-MRI fusion image virtual navigation for locating intraspinal tumour in a pregnant woman. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:436-439. [PMID: 29380148 DOI: 10.1007/s00586-017-5442-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standard fluoroscopic guidance (C-arm fluoroscopy) has been routinely used for intraoperative localization of spinal level for surgical removal of intraspinal tumour, while it is not suitable for selected patients, e.g. pregnant women, who need to avoid radiation exposure. Fusion imaging of real-time ultrasound (US) and magnetic resonance imaging (MRI) is a radiation-free technique which has been reported to have good localization accuracy in managing several conditions. CLINICAL PRESENTATION A 37-year-old pregnant patient, presented with a progressively aggravating lower back pain for 20 days and was incapable of lying supine with lower extremities swelling for 1 week, was referred to our hospital in her 18th week of gestation. Lumbar MRI identified an L1 level intraspinal lesion, and surgery was planned. To avoid the ionizing radiation generated by fluoroscopy, volume navigation technique (VNT) based fusion imaging of US and MRI was used to localize the intraspinal lesion, which was removed entirely via minimally invasive interlaminar approach. Pathological examination confirmed the diagnosis of ependymoma of the conus medullaris. Her symptoms were largely relieved after the operation, and a healthy baby was delivered at the 40th week of pregnancy. CONCLUSION We presented the first case of using VNT based fusion imaging of real-time US/MRI to guide the surgical resection of an intraspinal tumour. Future study with larger patient number is needed to validate this technique as an alternative to fluoroscopy in patients who need to avoid radiation exposure.
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Affiliation(s)
- Tian-Jian Liu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Fang Shen
- Department of Orthopaedic Surgery's Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Chao Zhang
- Ultrasound Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pin-Tong Huang
- Ultrasound Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China.
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Guo R, Lu G, Qin B, Fei B. Ultrasound Imaging Technologies for Breast Cancer Detection and Management: A Review. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:37-70. [PMID: 29107353 PMCID: PMC6169997 DOI: 10.1016/j.ultrasmedbio.2017.09.012] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 05/25/2023]
Abstract
Ultrasound imaging is a commonly used modality for breast cancer detection and diagnosis. In this review, we summarize ultrasound imaging technologies and their clinical applications for the management of breast cancer patients. The technologies include ultrasound elastography, contrast-enhanced ultrasound, 3-D ultrasound, automatic breast ultrasound and computer-aided detection of breast ultrasound. We summarize the study results seen in the literature and discuss their future directions. We also provide a review of ultrasound-guided, breast biopsy and the fusion of ultrasound with other imaging modalities, especially magnetic resonance imaging (MRI). For comparison, we also discuss the diagnostic performance of mammography, MRI, positron emission tomography and computed tomography for breast cancer diagnosis at the end of this review. New ultrasound imaging techniques, ultrasound-guided biopsy and the fusion of ultrasound with other modalities provide important tools for the management of breast patients.
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Affiliation(s)
- Rongrong Guo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Ultrasound, Shanxi Provincial Cancer Hospital, Taiyuan, Shanxi, China
| | - Guolan Lu
- The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Binjie Qin
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Baowei Fei
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA; The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA; Department of Mathematics and Computer Science, Emory College of Emory University, Atlanta, Georgia, USA; Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
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Lee J, Lee MW, Choi D, Cha DI, Lee S, Kang TW, Yang J, Jo J, Bang WC, Kim J, Shin D. Active contour configuration model for estimating the posterior ablative margin in image fusion of real-time ultrasound and 3D ultrasound or magnetic resonance images for radiofrequency ablation: an experimental study. Ultrasonography 2017; 37:337-344. [PMID: 29458238 PMCID: PMC6177685 DOI: 10.14366/usg.17065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/21/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the accuracy of an active contour model for estimating the posterior ablative margin in images obtained by the fusion of real-time ultrasonography (US) and 3-dimensional (3D) US or magnetic resonance (MR) images of an experimental tumor model for radiofrequency ablation. Methods Chickpeas (n=12) and bovine rump meat (n=12) were used as an experimental tumor model. Grayscale 3D US and T1-weighted MR images were pre-acquired for use as reference datasets. US and MR/3D US fusion was performed for one group (n=4), and US and 3D US fusion only (n=8) was performed for the other group. Half of the models in each group were completely ablated, while the other half were incompletely ablated. Hyperechoic ablation areas were extracted using an active contour model from real-time US images, and the posterior margin of the ablation zone was estimated from the anterior margin. After the experiments, the ablated pieces of bovine rump meat were cut along the electrode path and the cut planes were photographed. The US images with the estimated posterior margin were compared with the photographs and post-ablation MR images. The extracted contours of the ablation zones from 12 US fusion videos and post-ablation MR images were also matched. Results In the four models fused under real-time US with MR/3D US, compression from the transducer and the insertion of an electrode resulted in misregistration between the real-time US and MR images, making the estimation of the ablation zones less accurate than was achieved through fusion between real-time US and 3D US. Eight of the 12 post-ablation 3D US images were graded as good when compared with the sectioned specimens, and 10 of the 12 were graded as good in a comparison with nicotinamide adenine dinucleotide staining and histopathologic results. Conclusion Estimating the posterior ablative margin using an active contour model is a feasible way of predicting the ablation area, and US/3D US fusion was more accurate than US/MR fusion.
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Affiliation(s)
- Junkyo Lee
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Medical Imaging R&D Group, SAMSUNG MEDISON Co., Ltd., Seoul, Korea
| | - Min Woo Lee
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongil Choi
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sunyoung Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jehoon Yang
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, Seoul, Korea
| | - Jaemoon Jo
- Advanced R&D Team, Samsung Electronics, Suwon, Korea
| | - Won-Chul Bang
- Medical Imaging R&D Group, Samsung Electronics, Suwon, Korea
| | - Jongsik Kim
- Medical Imaging R&D Group, SAMSUNG MEDISON Co., Ltd., Seoul, Korea
| | - Dongkuk Shin
- Medical Imaging R&D Group, SAMSUNG MEDISON Co., Ltd., Seoul, Korea
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Wang H, Felt SA, Guracar I, Taviani V, Zhou J, Sigrist RMS, Zhang H, Liau J, Vilches-Moure JG, Tian L, Saenz Y, Bettinger T, Hargreaves BA, Lutz AM, Willmann JK. Anatomical Road Mapping Using CT and MR Enterography for Ultrasound Molecular Imaging of Small Bowel Inflammation in Swine. Eur Radiol 2017; 28:2068-2076. [PMID: 29170798 DOI: 10.1007/s00330-017-5148-6] [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: 07/24/2017] [Revised: 09/27/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the feasibility and time saving of fusing CT and MR enterography with ultrasound for ultrasound molecular imaging (USMI) of inflammation in an acute small bowel inflammation of swine. METHODS Nine swine with ileitis were scanned with either CT (n = 3) or MR (n = 6) enterography. Imaging times to load CT/MR images onto a clinical ultrasound machine, fuse them to ultrasound with an anatomical landmark-based approach, and identify ileitis were compared to the imaging times without anatomical road mapping. Inflammation was then assessed by USMI using dual selectin-targeted (MBSelectin) and control (MBControl) contrast agents in diseased and healthy control bowel segments, followed by ex vivo histology. RESULTS Cross-sectional image fusion with ultrasound was feasible with an alignment error of 13.9 ± 9.7 mm. Anatomical road mapping significantly reduced (P < 0.001) scanning times by 40%. Localising ileitis was achieved within 1.0 min. Subsequently performed USMI demonstrated significantly (P < 0.001) higher imaging signal using MBSelectin compared to MBControl and histology confirmed a significantly higher inflammation score (P = 0.006) and P- and E-selectin expression (P ≤ 0.02) in inflamed vs. healthy bowel. CONCLUSIONS Fusion of CT and MR enterography data sets with ultrasound in real time is feasible and allows rapid anatomical localisation of ileitis for subsequent quantification of inflammation using USMI. KEY POINTS • Real-time fusion of CT/MRI with ultrasound to localise ileitis is feasible. • Anatomical road mapping using CT/MRI significantly decreases the scanning time for USMI. • USMI allows quantification of inflammation in swine, verified with ex vivo histology.
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Affiliation(s)
- Huaijun Wang
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | - Stephen A Felt
- Department of Comparative Medicine, Stanford University, Stanford, CA, USA
| | - Ismayil Guracar
- Siemens Healthcare, Ultrasound Business Unit, Mountain View, CA, USA
| | - Valentina Taviani
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | - Jianhua Zhou
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | - Rosa Maria Silveira Sigrist
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | - Huiping Zhang
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | - Joy Liau
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | | | - Lu Tian
- Department of Health, Research & Policy, Stanford University, Stanford, CA, USA
| | - Yamil Saenz
- Department of Comparative Medicine, Stanford University, Stanford, CA, USA
| | | | - Brian A Hargreaves
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | - Amelie M Lutz
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA
| | - Jürgen K Willmann
- Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Room H1307, Stanford, CA, 94305-5621, USA.
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Ultrasound-Unenhanced CT Fusion for Detection and Localization of Ureteral Stones. AJR Am J Roentgenol 2017; 210:W8-W11. [PMID: 29140115 DOI: 10.2214/ajr.17.17840] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The standard of care for the diagnosis and follow-up of urolithiasis is unenhanced CT. The hypothesis of this study was that that by using image fusion of subsequent ultrasound (US) with the initial unenhanced CT, ureteral stones can be precisely localized. CONCLUSION Of the 25 stones founds on unenhanced CT studies, 22 (88%) were confidently identified using US-unenhanced CT fusion within 72 hours after the initial CT scan was obtained. US-unenhanced CT fusion might obviate the need for repeated CT scans for monitoring urolithiasis.
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Liver investigations: Updating on US technique and contrast-enhanced ultrasound (CEUS). Eur J Radiol 2017; 96:65-73. [PMID: 29103478 DOI: 10.1016/j.ejrad.2017.08.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/15/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
Abstract
Over the past few years, the cross sectional imaging techniques (Computed Tomography - CT and Magnetic Resonance - MR) have improved, allowing a more efficient study of focal and diffuse liver diseases. Many papers had been published about the results of a routinely clinical use of the dual source/dual energy CT techniques and the use of hepatobiliary contrast agents in MR liver studies. As a consequence, these new improvements have diverted the attention away from the Ultrasound technique and its technical and conceptual evolutions. In these years of disinterest, US and especially Contrast Enhanced Ultrasound (CEUS) have consolidated and grown in their application in clinical routine for liver pathologies. In particular, thanks to the introduction of new, dedicated software packages, CEUS has allowed not only qualitative, but also quantitative analysis of lesion microcirculation, thus opening a new era in the evaluation of lesion characterization and response to therapy. Moreover, the renewed interest in liver elastography, a baseline ultrasound-based imaging modality, has led to the development of a competitive technique to assess liver stiffness and then for the evaluation of the progression towards cirrhosis, and characterization of focal liver lesions, opening the way to avoid, in selected cases, liver biopsy. The aim of this review is to offer an up-to-date overview on the state of the art of clinical applications of US and CEUS in the study of focal and diffuse liver pathologies. Besides, it aims to highlight the emerging role of perfusion techniques in the assessment of local and systemic treatment response and to show how the liver evolution from steatosis to fibrosis can be revealed by elastography.
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Multimodal image registration based on binary gradient angle descriptor. Int J Comput Assist Radiol Surg 2017; 12:2157-2167. [PMID: 28861704 DOI: 10.1007/s11548-017-1661-y] [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: 01/13/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Multimodal image registration plays an important role in image-guided interventions/therapy and atlas building, and it is still a challenging task due to the complex intensity variations in different modalities. METHODS The paper addresses the problem and proposes a simple, compact, fast and generally applicable modality-independent binary gradient angle descriptor (BGA) based on the rationale of gradient orientation alignment. The BGA can be easily calculated at each voxel by coding the quadrant in which a local gradient vector falls, and it has an extremely low computational complexity, requiring only three convolutions, two multiplication operations and two comparison operations. Meanwhile, the binarized encoding of the gradient orientation makes the BGA more resistant to image degradations compared with conventional gradient orientation methods. The BGA can extract similar feature descriptors for different modalities and enable the use of simple similarity measures, which makes it applicable within a wide range of optimization frameworks. RESULTS The results for pairwise multimodal and monomodal registrations between various images (T1, T2, PD, T1c, Flair) consistently show that the BGA significantly outperforms localized mutual information. The experimental results also confirm that the BGA can be a reliable alternative to the sum of absolute difference in monomodal image registration. The BGA can also achieve an accuracy of [Formula: see text], similar to that of the SSC, for the deformable registration of inhale and exhale CT scans. Specifically, for the highly challenging deformable registration of preoperative MRI and 3D intraoperative ultrasound images, the BGA achieves a similar registration accuracy of [Formula: see text] compared with state-of-the-art approaches, with a computation time of 18.3 s per case. CONCLUSIONS The BGA improves the registration performance in terms of both accuracy and time efficiency. With further acceleration, the framework has the potential for application in time-sensitive clinical environments, such as for preoperative MRI and intraoperative US image registration for image-guided intervention.
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Park AY, Seo BK, Han H, Cho KR, Woo OH, Cha SH, Cha J. Clinical Value of Real-Time Ultrasonography-MRI Fusion Imaging for Second-Look Examination in Preoperative Breast Cancer Patients: Additional Lesion Detection and Treatment Planning. Clin Breast Cancer 2017; 18:261-269. [PMID: 28774783 DOI: 10.1016/j.clbc.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to evaluate the clinical effect of real-time magnetic resonance imaging (MRI)-navigated ultrasonography (US) for preoperative second-look examination in patients with breast cancer. PATIENTS AND METHODS Between October 2013 and February 2015, 232 patients with breast cancer underwent MRI for staging; second-look US was performed in 70 patients to evaluate additional lesions suspected to be disease detected using MRI. We retrospectively included 67 lesions in 55 patients. Lesions were classified as detected on conventional US (group 1), and not visible on conventional US, but detected on MRI-navigated US (group 2). The imaging features between groups 1 and 2 were compared using Student t, χ2, or Fisher exact tests. We compared the detection rate and histopathology of additional lesions using a McNemar test. RESULTS Heterogeneous background echotexture (69.6% [16 of 23] vs. 34.1% [14 of 41]) and lesion isoechogenicity (65.2% [15 of 23] vs. 7.3% [3 of 41]) on US and middle or posterior lesion depth on MRI (78.3% [18 of 23] vs. 46.3% [19 of 41]) were more common in group 2 (P < .05). More lesions were detected using MRI-navigated US (64 of 67; 95.5%) than conventional US (41 of 67; 61.2%; P < .01). Using MRI-navigated US we found more high-risk or malignant lesions than conventional US (21 vs. 11; P < .01). The optimal treatment plan was determined for 9 of 16 (56.3%) patients by virtue of MRI-navigated US. CONCLUSION Real-time MRI-navigated US significantly improved the detection of additional high-risk or malignant lesions during second-look US in preoperative evaluation of patients with breast cancer and ultimately determined the optimal treatment plan.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea; Department of Radiology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon-si, Republic of Korea; Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea.
| | - Heon Han
- Department of Radiology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon-si, Republic of Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
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Kambadakone A, Baliyan V, Kordbacheh H, Uppot RN, Thabet A, Gervais DA, Arellano RS. Imaging guided percutaneous interventions in hepatic dome lesions: Tips and tricks. World J Hepatol 2017; 9:840-849. [PMID: 28740595 PMCID: PMC5504359 DOI: 10.4254/wjh.v9.i19.840] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/06/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
Percutaneous hepatic interventions are generally safe given the fact that liver closely abuts the abdominal wall and hence it is easily accessible. However, the superior portion of liver, adjacent to the diaphragm, commonly referred as the “hepatic dome”, presents unique challenges for interventionists. Percutaneous access to the hepatic dome may be restricted by anatomical factors and special considerations may be required to avoid injury to the surrounding organs. The purpose of this review article is to discuss certain specific maneuvers and techniques that can enhance the success and safety of interventions in the hepatic dome.
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Ferrante E, Paragios N. Slice-to-volume medical image registration: A survey. Med Image Anal 2017; 39:101-123. [DOI: 10.1016/j.media.2017.04.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/08/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
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Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1873209. [PMID: 28396863 PMCID: PMC5371225 DOI: 10.1155/2017/1873209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/29/2017] [Indexed: 01/06/2023]
Abstract
Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21–36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; p = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552–1023] versus 196 [167–228], p < 0.001 and 333 [254–439] versus 216 [176–294], p = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
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Nagaraj Y, Benedicks C, Matthies P, Friebe M. Advanced inside-out tracking approach for real-time combination of MRI and US images in the radio-frequency shielded room using combination markers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2558-2561. [PMID: 28268844 DOI: 10.1109/embc.2016.7591252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For the real-time fusion of different modalities, a variety of tracking methods are available including the optical, electromagnetic (EM) and image-based tracking. But as a drawback optical tracking suffers from line of sight issues and EM tracking requires the manual referencing for the fusion procedure and is not usable in Magnetic Resonance Imaging (MRI) environment. To avoid these issues, we propose a real-time setup containing a camera capable of inside-Out tracking using combined circular markers attached to Ultrasound (US) probe and a suitable platform for automatic overlay of MRI and US image using markers. This new approach could help clinicians carry out successful surgical procedures by requiring least system interaction and solving line of sight issues. As a proof-of-concept, we show our first result by mimicking common liver tumor intervention using framed marker fusion technique in a candle gel phantom. We evaluated the tracking error distances using the combination of special markers with Inside-Out approach and conventional optical tracking. The results achieved show comparable performance to the standard Outside-In tracking and manual reference approach, while easing the interventional procedure in terms of hardware and line of sight requirements.
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