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Vulasala SS, Sutphin P, Shyn P, Kalva S. Intraoperative Imaging Techniques in Oncology. Clin Oncol (R Coll Radiol) 2024; 36:e255-e268. [PMID: 38242817 DOI: 10.1016/j.clon.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Imaging-based procedures have become well integrated into the diagnosis and management of oncological patients and play a significant role in reducing morbidity and mortality rates. Here we describe the established and upcoming surgical oncological imaging techniques and their impact on cancer management.
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Affiliation(s)
- S S Vulasala
- Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
| | - P Sutphin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - S Kalva
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Biondetti P, Ierardi AM, Casiraghi E, Caruso A, Grillo P, Carriero S, Lanza C, Angileri SA, Sangiovanni A, Iavarone M, Guzzardi G, Carrafiello G. Clinical Impact of a Protocol Involving Cone-Beam CT (CBCT), Fusion Imaging and Ablation Volume Prediction in Percutaneous Image-Guided Microwave Ablation in Patients with Hepatocellular Carcinoma Unsuitable for Standard Ultrasound (US) Guidance. J Clin Med 2023; 12:7598. [PMID: 38137667 PMCID: PMC10743619 DOI: 10.3390/jcm12247598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE to evaluate the clinical impact of a protocol for the image-guided percutaneous microwave ablation (MWA) of hepatocellular carcinoma (HCC) that includes cone-beam computed tomography (CBCT), fusion imaging and ablation volume prediction in patients with hepatocellular carcinoma unsuitable for standard ultrasound (US) guidance. MATERIALS AND METHODS this study included all patients with HCC treated with MWA between January 2021 and June 2022 in a tertiary institution. Patients were divided into two groups: Group A, treated following the protocol, and Group B, treated with standard ultrasound (US) guidance. Follow-up images were reviewed to assess residual disease (RD), local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Ablation response at 1 month was also evaluated according to mRECIST. Baseline variables and outcomes were compared between the groups. For 1-month RD, propensity score weighting (PSW) was performed. RESULTS 80 consecutive patients with 101 HCCs treated with MWA were divided into two groups. Group A had 41 HCCs in 37 patients, and Group B had 60 HCCs in 43 patients. Among all baseline variables, the groups differed regarding their age (mean of 72 years in Group A and 64 years in Group B, respectively), new vs. residual tumor rates (48% Group A vs. 25% Group B, p < 0.05) and number of subcapsular tumors (56.7% Group B vs. 31.7% Group A, p < 0.05) and perivascular tumors (51.7% Group B vs. 17.1% Group A, p < 0.05). The protocol led to repositioning the antenna in 49% of cases. There was a significant difference in 1-month local response between the groups measured as the RD rate and mRECIST outcomes. LTP rates at 3 and 6 months, and IDR rates at 1, 3 and 6 months, showed no significant differences. Among all variables, logistic regression after PSW demonstrated a protective effect of the protocol against 1-month RD. CONCLUSIONS The use of CBCT, fusion imaging and ablation volume prediction during percutaneous MWA of HCCs provided a better 1-month tumor local control. Further studies with a larger population and longer follow-up are needed.
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Affiliation(s)
- Pierpaolo Biondetti
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Elena Casiraghi
- AnacletoLab, Computer Science Department “Giovanni degli Antoni”-DI, Università degli Studi di Milano, 20133 Milan, Italy;
- CINI National Laboratory in Artificial Intelligence and Intelligent Systems, 00185 Rome, Italy
| | - Alessandro Caruso
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
| | - Pasquale Grillo
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Angelo Sangiovanni
- Department of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy;
| | - Massimo Iavarone
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy;
| | - Giuseppe Guzzardi
- Department of Radiology, Unit of Interventional Radiology, Ospedale Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy;
| | - Gianpaolo Carrafiello
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
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Hendriks P, Boel F, Oosterveer TTM, Broersen A, de Geus-Oei LF, Dijkstra J, Burgmans MC. Ablation margin quantification after thermal ablation of malignant liver tumors: How to optimize the procedure? A systematic review of the available evidence. Eur J Radiol Open 2023; 11:100501. [PMID: 37405153 PMCID: PMC10316004 DOI: 10.1016/j.ejro.2023.100501] [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: 03/31/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction To minimize the risk of local tumor progression after thermal ablation of liver malignancies, complete tumor ablation with sufficient ablation margins is a prerequisite. This has resulted in ablation margin quantification to become a rapidly evolving field. The aim of this systematic review is to give an overview of the available literature with respect to clinical studies and technical aspects potentially influencing the interpretation and evaluation of ablation margins. Methods The Medline database was reviewed for studies on radiofrequency and microwave ablation of liver cancer, ablation margins, image processing and tissue shrinkage. Studies included in this systematic review were analyzed for qualitative and quantitative assessment methods of ablation margins, segmentation and co-registration methods, and the potential influence of tissue shrinkage occurring during thermal ablation. Results 75 articles were included of which 58 were clinical studies. In most clinical studies the aimed minimal ablation margin (MAM) was ≥ 5 mm. In 10/31 studies, MAM quantification was performed in 3D rather than in three orthogonal image planes. Segmentations were performed either semi-automatically or manually. Rigid and non-rigid co-registration algorithms were used about as often. Tissue shrinkage rates ranged from 7% to 74%. Conclusions There is a high variability in ablation margin quantification methods. Prospectively obtained data and a validated robust workflow are needed to better understand the clinical value. Interpretation of quantified ablation margins may be influenced by tissue shrinkage, as this may cause underestimation.
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Affiliation(s)
- Pim Hendriks
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fleur Boel
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Timo TM Oosterveer
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander Broersen
- LKEB Laboratory of Clinical and Experimental Imaging, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, the Netherlands
| | - Jouke Dijkstra
- LKEB Laboratory of Clinical and Experimental Imaging, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Barral M, Chevallier O, Cornelis FH. Perspectives of Cone-beam Computed Tomography in Interventional Radiology: Techniques for Planning, Guidance, and Monitoring. Tech Vasc Interv Radiol 2023; 26:100912. [PMID: 38071025 DOI: 10.1016/j.tvir.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Cone-beam computed tomography (CBCT) has emerged as a prominent imaging modality in interventional radiology that offers real-time visualization and precise guidance in various procedures. This article aims to provide an overview of the techniques used to guide and monitor interventions that use CBCT. It discusses the advantages of CBCT, its current applications, and potential future CBCT-related developments in the field of interventional radiology.
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Affiliation(s)
- Matthias Barral
- Department of Radiology, Tenon Hospital, Paris, France; Paris Sorbonne Université, France.
| | | | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medicine Medical College, New York, NY
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Biondetti P, Ascenti V, Shehab A, Ierardi AM, Carriero S, Lanza C, Angileri SA, Guzzardi G, Carrafiello G. Percutaneous Microwave Ablation of Hepatocellular Carcinoma with "Double Fusion" Technique: Technical Note and Single-Center Preliminary Experience. Diagnostics (Basel) 2023; 13:2349. [PMID: 37510092 PMCID: PMC10378322 DOI: 10.3390/diagnostics13142349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Percutaneous image-guided thermal ablation is included in most society guidelines for treatment of hepatocellular carcinoma (HCC). The results of this treatment in terms of efficacy depend on the ability to precisely place the device into the target tumor. Ultrasound (US) is a commonly used imaging guidance modality for its real-time feedback. However, an accurate device deployment remains challenging in some clinical scenarios, including cases of tumors that are undetectable or not clearly visible by US. To overcome this problem, fusion imaging techniques have been developed, which combine images from different modalities. The most widely known technique combines pre-procedural contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) with real-time US scans. Cone beam CT (CBCT) is a technology that can provide intra-procedural cross-sectional images, which can be registered to images from other modalities, including preprocedural CT/MR scans. The aim of our study is to report the preliminary experience on percutaneous microwave ablation (MWA) of patients with HCC that were treated using the "double fusion" technique, which combines the use of US fusion imaging and CBCT fusion imaging. We describe the technical details, feasibility, safety and short-term efficacy of this technique in a small series of eight patients with 11 HCCs.
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Affiliation(s)
- Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Velio Ascenti
- Postgraduation School in Radiodiagnostics, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Anas Shehab
- Fellowship in Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Serena Carriero
- Postgraduation School in Radiodiagnostics, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Carolina Lanza
- Postgraduation School in Radiodiagnostics, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Giuseppe Guzzardi
- Unit of Interventional Radiology, Department of Radiology, Ospedale Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
- Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
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Wagner MG, Periyasamy S, Kutlu AZ, Pieper AA, Swietlik JF, Ziemlewicz TJ, Hall TL, Xu Z, Speidel MA, Jr FTL, Laeseke PF. An X-Ray C-Arm Guided Automatic Targeting System for Histotripsy. IEEE Trans Biomed Eng 2023; 70:592-602. [PMID: 35984807 PMCID: PMC9929026 DOI: 10.1109/tbme.2022.3198600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Histotripsy is an emerging noninvasive, nonionizing and nonthermal focal cancer therapy that is highly precise and can create a treatment zone of virtually any size and shape. Current histotripsy systems rely on ultrasound imaging to target lesions. However, deep or isoechoic targets obstructed by bowel gas or bone can often not be treated safely using ultrasound imaging alone. This work presents an alternative x-ray C-arm based targeting approach and a fully automated robotic targeting system. METHODS The approach uses conventional cone beam CT (CBCT) images to localize the target lesion and 2D fluoroscopy to determine the 3D position and orientation of the histotripsy transducer relative to the C-arm. The proposed pose estimation uses a digital model and deep learning-based feature segmentation to estimate the transducer focal point relative to the CBCT coordinate system. Additionally, the integrated robotic arm was calibrated to the C-arm by estimating the transducer pose for four preprogrammed transducer orientations and positions. The calibrated system can then automatically position the transducer such that the focal point aligns with any target selected in a CBCT image. RESULTS The accuracy of the proposed targeting approach was evaluated in phantom studies, where the selected target location was compared to the center of the spherical ablation zones in post-treatment CBCTs. The mean and standard deviation of the Euclidean distance was 1.4 ±0.5 mm. The mean absolute error of the predicted treatment radius was 0.5 ±0.5 mm. CONCLUSION CBCT-based histotripsy targeting enables accurate and fully automated treatment without ultrasound guidance. SIGNIFICANCE The proposed approach could considerably decrease operator dependency and enable treatment of tumors not visible under ultrasound.
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Yao XS, Yan D, Jiang XX, Li X, Zeng HY, Li H. Short-term outcomes of radiofrequency ablation for hepatocellular carcinoma using cone-beam computed tomography for planning and image guidance. World J Clin Cases 2021; 9:1580-1591. [PMID: 33728301 PMCID: PMC7942052 DOI: 10.12998/wjcc.v9.i7.1580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) is an effective treatment for unresectable hepatocellular carcinoma (HCC) and a minimally invasive alternative to hepatectomy for treating tumour recurrence. RFA is often performed using contrast-enhanced computed tomography (CECT) and/or ultrasonography. In recent years, angiographic systems with flat panel image detectors and advanced image reconstruction algorithms have broadened the clinical applications of cone-beam computed tomography (CBCT), including RFA. Several studies have shown the effectiveness of using CBCT for immediate treatment assessments and follow-ups.
AIM To assess the treatment response to RFA for HCC using CBCT.
METHODS Forty-eight patients (44 men; aged 37-89 years) with solitary HCC [median size: 3.2 (1.2-6.6) cm] underwent RFA and were followed for 25.6 (median; 13.5-35.2) mo. Image fusion of CBCT and pre-operative CECT or magnetic resonance imaging (MRI) was used for tumour segmentation and needle path and ablation zone planning. Real-time image guidance was provided by overlaying the three-dimensional image of the tumour and needle path on the fluoroscopy image. Treatment response was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Disease progression, death, time to progression (TTP), and overall survival (OS) were recorded. Kaplan-Meier and Cox regression analyses were performed.
RESULTS Initial post-RFA CECT/MRI showed 38 cases of CR (79.2%), 10 of PR (20.8%), 0 of SD, and 0 of PD, which strongly correlated with the planning estimation (42 CR, 87.5%; 6 PR, 12.5%; 0 SD; and 0 PD; accuracy: 91.7%, P < 0.01). Ten (20.8%) patients died, and disease progression occurred in 31 (35.4%, median TTP: 12.8 mo) patients, resulting in 12-, 24-, and 35-mo OS rates of 100%, 81.2%, and 72.2%, respectively, and progression-free survival (PFS) rates of 54.2%, 37.1%, and 37.1%, respectively. The median dose-area product of the procedures was 79.05 Gy*cm2 (range 40.95-146.24 Gy*cm2), and the median effective dose was 10.27 mSv (range 5.32-19.01 mSv). Tumour size < 2 cm (P = 0.008) was a significant factor for OS, while age (P = 0.001), tumour size < 2 cm (P < 0.001), tumour stage (P = 0.010), and initial treatment response (P = 0.003) were significant factors for PFS.
CONCLUSION Reliable RFA treatment planning and satisfactory outcomes can be achieved with CBCT.
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Affiliation(s)
- Xue-Song Yao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dong Yan
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xian-Xian Jiang
- Australian Research Council Training Centre for Innovation in Biomedical Imaging Technology, University of Queensland, Brisbane 4000, Australia
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hui-Ying Zeng
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Huai Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Abstract
OBJECTIVE. The purpose of this study was to evaluate the efficacy of radiofrequency ablation (RFA) of renal masses comparing a group who did not undergo intraprocedural CT and a group who did. MATERIALS AND METHODS. A retrospective review included 45 consecutively registered patients who underwent RFA of renal masses. If an adequate biopsy specimen was not obtained or follow-up was inadequate, the patient was eliminated from review from calculation of primary technical efficacy. The inclusion criterion was having undergone RFA with two cooled-tip electrodes. Baseline demographics (age, body mass index, and sex), renal mass characteristics (diameter, side, location, position, morphologic features, type of mass, and grade), technical details (repositioning and hydrodissection), and complications were evaluated. Follow-up images were evaluated to determine the presence of recurrence at the ablation site in the two groups. RESULTS. Among the 45 patients who underwent RFA, 13 did not undergo intraprocedural CT and 32 intraprocedural did. Thirty-five patients met the criteria for follow-up and positive biopsy results. For calculation of recurrence, 10 patients were in the group who did not and 25 were in group who did undergo intraprocedural contrast-enhanced CT. No correlation was found between baseline demographics, renal mass characteristics, and technical results of the two groups. There was an 89% overall technical efficacy rate with a 96% primary technical efficacy rate in the group who underwent intraprocedural CT compared with a 70% rate in the group who did not undergo intraprocedural CT. Negative correlation was found between the groups with respect to technical efficacy rate at p < 0.05. CONCLUSION. Intraprocedural contrast-enhanced CT yields important information about completeness of ablation during the procedure, allowing probe repositioning and thus better therapeutic effect.
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Collins JA, Heiselman JS, Clements LW, Brown DB, Miga MI. Multiphysics modeling toward enhanced guidance in hepatic microwave ablation: a preliminary framework. J Med Imaging (Bellingham) 2019; 6:025007. [PMID: 31131291 DOI: 10.1117/1.jmi.6.2.025007] [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: 12/28/2018] [Accepted: 04/23/2019] [Indexed: 12/14/2022] Open
Abstract
We compare a surface-driven, model-based deformation correction method to a clinically relevant rigid registration approach within the application of image-guided microwave ablation for the purpose of demonstrating improved localization and antenna placement in a deformable hepatic phantom. Furthermore, we present preliminary computational modeling of microwave ablation integrated within the navigational environment to lay the groundwork for a more comprehensive procedural planning and guidance framework. To achieve this, we employ a simple, retrospective model of microwave ablation after registration, which allows a preliminary evaluation of the combined therapeutic and navigational framework. When driving registrations with full organ surface data (i.e., as could be available in a percutaneous procedure suite), the deformation correction method improved average ablation antenna registration error by 58.9% compared to rigid registration (i.e., 2.5 ± 1.1 mm , 5.6 ± 2.3 mm of average target error for corrected and rigid registration, respectively) and on average improved volumetric overlap between the modeled and ground-truth ablation zones from 67.0 ± 11.8 % to 85.6 ± 5.0 % for rigid and corrected, respectively. Furthermore, when using sparse-surface data (i.e., as is available in an open surgical procedure), the deformation correction improved registration error by 38.3% and volumetric overlap from 64.8 ± 12.4 % to 77.1 ± 8.0 % for rigid and corrected, respectively. We demonstrate, in an initial phantom experiment, enhanced navigation in image-guided hepatic ablation procedures and identify a clear multiphysics pathway toward a more comprehensive thermal dose planning and deformation-corrected guidance framework.
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Affiliation(s)
- Jarrod A Collins
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Jon S Heiselman
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Logan W Clements
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Daniel B Brown
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
| | - Michael I Miga
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States.,Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
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Bing F, Vappou J, Breton E, Enescu I, Garnon J, Gangi A. Accuracy of a CT-Ultrasound Fusion Imaging Guidance System Used for Hepatic Percutaneous Procedures. J Vasc Interv Radiol 2019; 30:1013-1020. [PMID: 30922795 DOI: 10.1016/j.jvir.2018.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/10/2018] [Accepted: 11/10/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the accuracy of a fusion imaging guidance system using ultrasound (US) and computerized tomography (CT) as a real-time imaging modality for the positioning of a 22-gauge needle in the liver. MATERIALS AND METHODS The spatial coordinates of 23 spinal needles placed at the border of hepatic tumors before radiofrequency thermal ablation were determined in 23 patients. Needles were inserted up to the border of the tumor with the use of CT-US fusion imaging. A control CT scan was carried out to compare real (x, y, z) and virtual (x', y', z') coordinates of the tip of the needle (D for distal) and of a point on the needle located 3 cm proximally to the tip (P for proximal). RESULTS The mean Euclidian distances were 8.5 ± 4.7 mm and 10.5 ± 5.3 mm for D and P, respectively. The absolute value of mean differences of the 3 coordinates (|x' - x|, |y' - y|, and |z' - z|) were 4.06 ± 0.9, 4.21 ± 0.84, and 4.89 ± 0.89 mm for D and 3.96 ± 0.60, 4.41 ± 0.86, and 7.66 ± 1.27 mm for P. X = |x' - x| and Y = |y' - y| coordinates were <7 mm with a probability close to 1. Z = |z' - z| coordinate was not considered to be larger nor smaller than 7 mm (probability >7 mm close to 50%). CONCLUSIONS Positioning errors with the use of US-CT fusion imaging used in this study are not negligible for the insertion of a 22-gauge needle in the liver. Physicians must be aware of such possible errors to adapt the treatment when used for thermal ablation.
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Affiliation(s)
- Fabrice Bing
- Department of Radiology, Hôpital d'Annecy, 1 avenue de l'Hôpital, 74374 Metz-Tessy, France; ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France.
| | - Jonathan Vappou
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Elodie Breton
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Iulian Enescu
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France; Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Ivashchenko O, Pouw B, de Witt J, Koudounarakis E, Nijkamp J, van Veen R, Ruers T, Karakullukcu B. Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography. Br J Oral Maxillofac Surg 2019; 57:174-181. [DOI: 10.1016/j.bjoms.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/20/2019] [Indexed: 12/30/2022]
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Sutter O, Fihri A, Ourabia-Belkacem R, Sellier N, Diallo A, Seror O. Real-Time 3D Virtual Target Fluoroscopic Display for Challenging Hepatocellular Carcinoma Ablations Using Cone Beam CT. Technol Cancer Res Treat 2018; 17:1533033818789634. [PMID: 30099948 PMCID: PMC6090486 DOI: 10.1177/1533033818789634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Three-dimensional virtual target fluoroscopic display is a new guidance tool that can
facilitate challenging percutaneous ablation. The purpose of this study was to assess the
feasibility, local efficacy, and safety of liver ablation assisted by three-dimensional
virtual target fluoroscopic display. Sixty-seven hepatocellular carcinomas (mean diameter:
31 mm, range: 9-90 mm, 24 ≥ 30 mm, 16 of an infiltrative form) in 53 consecutive patients
were ablated using irreversible electroporation (n = 39), multibipolar radiofrequency (n =
25), or microwave (n = 3) under a combination of ultrasound and three-dimensional virtual
target fluoroscopic display guidance because the procedures were considered to be
unfeasible under ultrasound alone. This guidance technology consisted of real-time
fluoroscopic three-dimensional visualization of the tumor previously segmented from cone
beam computed tomography images acquired at the start of the procedure. The results were
assessed by cross-sectional imaging performed at 1 month and then every 3 months in the
event of complete ablation. Factors associated with overall local tumor progression
(initial treatment failure and subsequent local tumor progression) were assessed using a
logistic regression model. Sixty-one (91%) tumors were completely ablated after 1 (n = 53)
or 2 (n = 8) procedures. After a median follow-up of 12.75 months (1-23.2) of the 61
tumors displaying imaging characteristics consistent with complete ablation at 1 month,
local tumor progression was observed in 9, so the overall local tumor progression rate was
22.3% (15 of 67). Under multivariate analysis, dome locations and infiltrative forms were
associated with local tumor progression. No major complications occurred.
Three-dimensional virtual target fluoroscopic display is a feasible and efficient image
guidance tool to facilitate challenging ablations that are generally considered as
infeasible using ultrasound alone.
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Affiliation(s)
- Olivier Sutter
- 1 Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Bondy, France.,2 Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Paris, France
| | - Amina Fihri
- 1 Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Bondy, France
| | - Rafik Ourabia-Belkacem
- 1 Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Bondy, France
| | - Nicolas Sellier
- 1 Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Bondy, France.,2 Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Paris, France
| | - Abou Diallo
- 3 Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Bobigny, France
| | - Olivier Seror
- 1 Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Bondy, France.,2 Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Paris, France.,4 Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France
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13
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Meram E, Longhurst C, Brace CL, Laeseke PF. Comparison of Conventional and Cone-Beam CT for Monitoring and Assessing Pulmonary Microwave Ablation in a Porcine Model. J Vasc Interv Radiol 2018; 29:1447-1454. [PMID: 30217749 DOI: 10.1016/j.jvir.2018.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare cone-beam computed tomography (CT) with conventional CT for assessing the growth and postprocedural appearance of pulmonary microwave ablation zones. MATERIALS AND METHODS A total of 17 microwave ablations were performed in porcine lung in vivo by applying 65 W for 5 minutes through a single 17-gauge antenna. Either CT (n = 8) or CBCT (n = 9) was used for guidance and ablation zone monitoring at 1-minute intervals. Postprocedural noncontrast images were acquired with both modalities. Three independent readers measured the length, width, cross-sectional area, and circularity of the ablation zones on gross tissue samples and CT and cone-beam CT images. The measurements were compared via linear mixed-effects models for postprocedural appearance and with a polynomial mixed effects model for ablation zone growth curves. RESULTS On postprocedural images, the differences between cone-beam CT and CT in mean length (3.84 vs 3.86 cm; Δ = -0.02; P = .70), width (2.61 vs 2.56 cm; Δ = 0.06; P = .46), area (7.84 vs 7.65 cm2; Δ = 0.19; P = .35), and circularity (0.85 vs 0.85; Δ = 0.01; P = .62) were not statistically significant after accounting for intersubject and interrater variability. Also, there was no significant difference between CT and cone-beam CT growth curves of the ablation zones during monitoring in terms of length (pInt. = 1.00; pLin.Slope = 0.52; pQuad.Slope = 0.69); width (pInt. = 0.83; pLin.Slope = 0.98; pQuad.Slope = 0.79), area (pInt. = 0.47; pLin.Slope = 0.27; pQuad.Slope = 0.57), or circularity (pInt. = 0.54; pLin.Slope = 0.74; pQuad.Slope = 0.80). Both CT and cone-beam CT overestimated gross pathologic observations of ablation length, width, and area (P < .001 for all). CONCLUSIONS Cone-beam CT was similar to conventional CT when assessing the growth, final size, and shape of pulmonary microwave ablation zones and may be useful for monitoring and evaluating microwave ablations in the lung.
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Affiliation(s)
- Ece Meram
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, D4-352, Madison, WI 53792.
| | - Colin Longhurst
- Department of Radiology, and Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Chris L Brace
- Tumor Ablation Laboratory, University of Wisconsin, Madison, Wisconsin
| | - Paul F Laeseke
- Section of Interventional Radiology, University of Wisconsin, Madison, Wisconsin
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14
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Monfardini L, Orsi F, Caserta R, Sallemi C, Della Vigna P, Bonomo G, Varano G, Solbiati L, Mauri G. Ultrasound and cone beam CT fusion for liver ablation: technical note. Int J Hyperthermia 2018; 35:500-504. [PMID: 30204007 DOI: 10.1080/02656736.2018.1509237] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Lorenzo Monfardini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Franco Orsi
- Interventional Radiology, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Rosalba Caserta
- Intensive Care Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Claudio Sallemi
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Paolo Della Vigna
- Interventional Radiology, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Guido Bonomo
- Interventional Radiology, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Gianluca Varano
- Interventional Radiology, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Luigi Solbiati
- Department of Radiology, Istituto Clinico Humanitas, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Mauri
- Interventional Radiology, IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy
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15
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Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, Schirmacher P, Vilgrain V. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69:182-236. [PMID: 29628281 DOI: 10.1016/j.jhep.2018.03.019] [Citation(s) in RCA: 5141] [Impact Index Per Article: 856.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023]
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16
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Solbiati M, Passera KM, Goldberg SN, Rotilio A, Ierace T, Pedicini V, Poretti D, Solbiati L. A Novel CT to Cone-Beam CT Registration Method Enables Immediate Real-Time Intraprocedural Three-Dimensional Assessment of Ablative Treatments of Liver Malignancies. Cardiovasc Intervent Radiol 2018; 41:1049-1057. [PMID: 29492634 PMCID: PMC5976710 DOI: 10.1007/s00270-018-1909-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/17/2018] [Indexed: 12/19/2022]
Abstract
Aim To evaluate a novel contrast-enhanced cone-beam computed tomography (CE-CBCT) registration method for accurate immediate assessment of ablation outcomes. Materials and Methods Contrast-enhanced computed tomography (CECT) was registered with CE-CBCT by applying semiautomatic landmark registration followed by automatic affine and non-rigid registration to correct for respiratory phase differences and liver deformation. This scheme was retrospectively applied to 30 patients who underwent 38 percutaneous microwave liver ablations. Three datasets were obtained for each case: (1) conventional CECT scans 24 h before ablation, (2) intraprocedural CE-CBCT scans, and (3) CECT scans 24 h post-ablation. Using a five-point scale, two experienced radiologists qualitatively assessed registration quality, equivalence of CE-CBCT assessment of ablation outcome to 24 h post-ablation CECT, and perceived increase of confidence using the fusion method to CBCT alone. Additionally, residual post-ablation tumor volumes were measured at both CE-CBCT and 24 h CECT and compared to the pre-CECT. Results Registration quality was high for both radiologists (R1: 4.3 ± 0.6, R2: 4.4 ± 0.5; p = 0.87). Comparisons between the registration of pre-ablation CECT with CE-CBCT versus post-ablation CECT regarding the position of the ablated area to the treated target (R1: 4.4 ± 0.6, R2: 4.6 ± 0.4) and treatment outcome (R1: 4.5 ± 0.5, R2: 4.6 ± 0.4) were equivalent (p > 0.35). Increased confidence was noted when using fusion (R1: 4.6 ± 0.4, R2: 4.6 ± 0.4; p = 0.84). Moreover, in 6 ablations (15.8%) the intraprocedural registered CBCT showed residual tumor precisely where identified on the 24 h post-ablation CECT. Conclusions Combined CE-CBCT holds the potential to change the current workflow of mini-invasive cancer local treatments. Given earlier visual identification of residual tumor post-ablation, this includes potentially eliminating the need for some additional treatments.
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Affiliation(s)
| | | | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Tiziana Ierace
- Department of Radiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Vittorio Pedicini
- Department of Radiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Dario Poretti
- Department of Radiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Luigi Solbiati
- Department of Radiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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17
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Yi PS, Huang M, Zhang M, Xu L, Xu MQ. Comparison of Transarterial Chemoembolization Combined with Radiofrequency Ablation Therapy versus Surgical Resection for Early Hepatocellular Carcinoma. Am Surg 2018. [DOI: 10.1177/000313481808400238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Both radiofrequency ablation (RFA) and surgical resection (SR) are radical treatment recommended for early hepatocellular carcinoma (HCC). Transarterial chemoembolization (TACE) is a palliative treatment for intermediate HCC, and TACE1RFA combined therapy is considered superior to TACE or RFA alone for management of early HCC. This systematic review compared the efficacy and safety of TACE1RFA combined therapy with SR for early HCC. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for literatures related with our topic. The primary endpoint was overall survival (OS), and the secondary endpoint was the recurrence-free survival (RFS) rate; safety was measured by the rate of major complications. The effect sizes of OS, RFS, and local progression rates were expressed by odds ratio (OR), while the effect size of complications was presented using relative risk. TACE1RFA combined therapy and SR had a similar 1-year OS rate [OR: 1.84; 95% confidence interval (CI): 0.82, 4.14; P > 0.05], 3-year OS rate (OR: 0.84; 95% CI: 0.43, 1.67; P > 0.05), 1-year RFS rate (OR: 0.77; 95% CI: 0.53, 1.11; P > 0.05), and 3-year RFS rate (OR: 0.88; 95% CI: 0.48, 1.42; P > 0.05) for early HCC. However, the 5-year OS rate (OR: 0.54; 95% CI: 0.40, 0.73; P < 0.05) and 5-year RFS rate (OR: 0.49; 95% CI: 0.27, 0.90; P < 0.05) were lower in patients with TACE1RFA than in those with SR. SR is associated with better long-term survival outcomes and a lower recurrence rate than TACE1RFA for patients with early HCC and is the optimal choice for patients with early HCC.
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Affiliation(s)
- Peng-Sheng Yi
- Department of hepato-biliary-pancrease, Institute of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China and
| | - Min Huang
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Zhang
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liangliang Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Qing Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
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18
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Abstract
The clinical management of hepatocellular carcinoma has evolved greatly in the last decade mostly through recent technical innovations. In particular, the application of cutting-edge image guidance has led to minimally invasive solutions for complex clinical problems and rapid advances in the field of interventional oncology. Many image-guided therapies, such as transarterial chemoembolization and radiofrequency ablation, have meanwhile been fully integrated into interdisciplinary clinical practice, whereas others are currently being investigated. This review summarizes and evaluates the most relevant completed and ongoing clinical trials, provides a synopsis of recent innovations in the field of intraprocedural imaging and tumor response assessment, and offers an outlook on new technologies, such as radiopaque embolic materials. In addition, combination therapies consisting of locoregional therapies and systemic molecular targeted agents (e.g., sorafenib) remain of major interest to the field and are also discussed. Finally, we address the many substantial advances in immune response pathways that have been related to the systemic effects of locoregional therapies. Knowledge of these new developments is crucial as they continue to shape the future of cancer treatment, further establishing interventional oncology along with surgical, medical, and radiation oncology as the fourth pillar of cancer care.
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19
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Clinical impact of cone beam computed tomography on iterative treatment planning during ultrasound-guided percutaneous ablation of liver malignancies. Med Oncol 2017; 34:113. [PMID: 28470535 DOI: 10.1007/s12032-017-0954-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/05/2017] [Indexed: 12/13/2022]
Abstract
A standardized cone beam computed tomography (CBCT) protocol may impact optimal ablation probe(s) positioning during ultrasound-guided microwave ablation (MWA). To evaluate this hypothesis, 15 patients underwent ultrasound-guided percutaneous MWA of 15 liver lesions (10 hepatocellular carcinomas, 5 metastasis ranging 11-41 mm) with the ultrasound guidance assisted by a dedicated CBCT protocol. Pre-procedural enhanced CBCT (ceCBCT) was performed after intravenous contrast administration to visualize the lesion and determine the optimal approach using CBCT-based ablation planning software. MW antennas were positioned under ultrasound guidance, and non-enhanced CBCT was performed after deployment and fused with pre-procedural ceCBCT to assess tumor targeting and modify subsequent steps of the procedure. CBCT lesion detection accuracy and number of needle repositioning on the basis of CBCT information were recorded. Clinical success was measured on 1-month follow-up contrast-enhanced CT. The target lesion was detected on ceCBCT in 13 out of 15 patients (87%). The undetected lesions were only visible on diagnostic contrast-enhanced magnetic resonance imaging, which was then fused to the CBCT and fluoroscopy to facilitate targeting. MW antennas were repositioned on the basis of CBCT in 11 lesions (73%). Clinical success was achieved in 14/15 ablations (93%) with a mean follow-up of X months. The only case of local recurrence was expected, as the intent was tumor debulking. CBCT imaging during ultrasound-guided liver ablation is feasible and leads to ablation device repositioning in the majority of cases.
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20
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Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related deaths worldwide with rapidly growing incidence rates in the USA and Europe. Despite improving surveillance programs, most patients are diagnosed at intermediate to advanced stages and are no longer amenable to curative therapies, such as ablation, surgical resection and liver transplantation. For such patients, catheter-based image-guided embolotherapies such as transarterial chemoembolization (TACE) represent the standard of care and mainstay therapy, as recommended and endorsed by a variety of national guidelines and staging systems. The main benefit of these therapies is explained by the preferentially arterial blood supply of liver tumors, which allows to deliver the anticancer therapy directly to the tumor-feeding artery while sparing the healthy hepatic tissue mainly supplied by the portal vein. The tool box of an interventional oncologist contains several different variants of transarterial treatment modalities. Ever since the first TACE more than 30 years ago, these techniques have been progressively refined, both with respect to drug delivery materials and with respect to angiographic micro-catheter and image-guidance technology, thus substantially improving therapeutic outcomes of HCC. This review will summarize the fundamental principles, technical and clinical data on the application of different embolotherapies, such as bland transarterial embolization, Lipiodol-based conventional transarterial chemoembolization as well as TACE with drug-eluting beads (DEB-TACE). Clinical data on 90Yttrium radioembolization as an emerging alternative, mostly applied for niche indications such as HCC with portal vein invasion, will be discussed. Furthermore, we will summarize the principle of HCC staging, patient allocation and response assessment in the setting of HCC embolotherapy. In addition, we will evaluate the role of cone-beam computed tomography as a novel intra-procedural image-guidance technology. Finally, this review will touch on new technical developments such as radiopaque, imageable DEBs and the rationale and role of combined systemic and locoregional therapies, mostly in combination with Sorafenib.
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21
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Bouda D, Lagadec M, Alba CG, Barrau V, Dioguardi Burgio M, Moussa N, Vilgrain V, Ronot M. Imaging review of hepatocellular carcinoma after thermal ablation: The good, the bad, and the ugly. J Magn Reson Imaging 2016; 44:1070-1090. [DOI: 10.1002/jmri.25369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/16/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Damien Bouda
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Matthieu Lagadec
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Carmela Garcia Alba
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Vincent Barrau
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Marco Dioguardi Burgio
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Nadia Moussa
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Valérie Vilgrain
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
- University Paris Diderot; Sorbonne Paris Cité, INSERM UMR 1149 Paris France
| | - Maxime Ronot
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
- University Paris Diderot; Sorbonne Paris Cité, INSERM UMR 1149 Paris France
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22
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Patni PM, Jain P, Patni MJ. Cutaneous sinus tract of dental origin. Postgrad Med J 2016; 92:625. [PMID: 27129910 DOI: 10.1136/postgradmedj-2016-134122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/17/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Pallav Mahesh Patni
- Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Devi Ahilya University, Indore, Madhya Pradesh, India
| | - Pradeep Jain
- Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Devi Ahilya University, Indore, Madhya Pradesh, India
| | - Mona Jain Patni
- Dr. Mahesh Chandra Patni Memorial Dental Clinic, Indore, Madhya Pradesh, India
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Cone Beam Computed Tomography (CBCT) in the Field of Interventional Oncology of the Liver. Cardiovasc Intervent Radiol 2015; 39:8-20. [DOI: 10.1007/s00270-015-1180-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/27/2015] [Indexed: 12/21/2022]
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