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Zeng Q, Yan R, Zhang L, Yu X, Wu Y, Zheng R, Xu E, Li K. Intelligent automatic registration: is it feasible and efficient for application of ultrasound fusion imaging in liver? Abdom Radiol (NY) 2024:10.1007/s00261-024-04724-8. [PMID: 39613872 DOI: 10.1007/s00261-024-04724-8] [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: 08/09/2024] [Revised: 11/24/2024] [Accepted: 11/25/2024] [Indexed: 12/01/2024]
Abstract
PURPOSE To evaluate the feasibility and efficiency between the two intelligent auto-registrations (based on hepatic vessels or based on liver surface) and manual registration for US-CT/MR fusion imaging of liver tumours. METHODS From May 2017 to December 2017, 30 patients with 30 liver tumours were enrolled in this prospectively study. Two intelligent auto-registrations (based on hepatic vessels or based on liver surface) and manual registration were randomly performed, the registration success rate and efficiency were compared. RESULTS In terms of success rate, auto-registrations based on the hepatic vessels (80%) was lower than auto-registration base on liver surface and manual registration (96.67%), but with no statistical difference (P = 0.125). In comparison of the registration efficiency, the efficiency of the auto-registration based on the hepatic vessels was superior to auto-registration based on liver surface and manual registration (P < 0.05). The one-step success rate of auto-registration based on the hepatic vessels (53.33%, 16/30) was higher than that of other two registrations (P < 0.05). Stratified analysis showed that, for the lesion with display of hepatic vessels in grade 3, the success rate of auto-registration based on vessels (0%) was lower than that of auto-registration based on liver surface and manual registration (100%) (P = 0.031). CONCLUSION Intelligent auto-registration based on hepatic vessels is a feasible and efficient registration method for US-CT/MR fusion imaging of liver tumours for the patients with clear hepatic vessels. The auto-registration based on liver surface and manual registration can be an effective supplement for cases with poor hepatic vessels display.
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Affiliation(s)
- Qingjing Zeng
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ronghua Yan
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Lanxia Zhang
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuan Yu
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuxuan Wu
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Erjiao Xu
- The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China.
| | - Kai Li
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Lu YB, Huang YN, Weng YC, Chiang TY, Fang TK, Chen WT, Lee JC. Contrast-enhanced ultrasonography guidance avoids US-CT/MR fusion error for percutaneous radiofrequency ablation of hepatocellular carcinoma. BMC Med Imaging 2024; 24:323. [PMID: 39609743 PMCID: PMC11605966 DOI: 10.1186/s12880-024-01508-w] [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] [Received: 07/21/2024] [Accepted: 11/20/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND This study evaluated the impact of contrast-enhanced ultrasonography (CEUS) combined with CT or MRI fusion imaging on percutaneous radiofrequency ablation (RFA) outcomes for hepatocellular carcinoma (HCC) inconspicuous on conventional ultrasonography (US). METHODS Patients were categorized into US-inconspicuous (USI) and US-conspicuous (USC) groups based on US imaging. The parameters of viable HCCs ⎯ including diameter, location, and RFA efficacy ⎯ were compared between USI and USC groups. Moreover, the breathing fusion imaging errors were measured. The differences in technical success, technical efficacy, local tumor progression, new tumor occurrence, and overall survival rate between USI and USC groups were analyzed. RESULTS Sixty-five patients with 106 lesions were included. CEUS showed high consistency with CT/MRI but revealed larger diameters (p < 0.001) and more feeding arteries (p = 0.019) than CT/MRI. Breathing fusion imaging errors averaged 17 ± 4 mm, significantly affecting lesions in segments II, III, V, and VI (p < 0.001). The USI group had more lesions ablated per patient in a single RFA procedure (p = 0.001) than the USC group. No significant differences were observed in technical success rate, technical efficacy rate, local tumor progression rate, and overall survival rate between the two groups. CONCLUSIONS CEUS combined with fusion imaging provides detailed information on viable HCCs and their feeding arteries. CEUS-guided RFA avoids fusion imaging errors and achieves comparable efficacy in both US-conspicuous and US-inconspicuous HCCs.
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Affiliation(s)
- Yang-Bor Lu
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Yung-Ning Huang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Yu-Chieh Weng
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Tung-Ying Chiang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Ta-Kai Fang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Wei-Ting Chen
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Chieh Lee
- Department of Ultrasound, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China.
- Xiamen Chang Gung Hospital, No. 123 Xiafei Road, Haicang District, Xiamen, Fujian, 361028, China.
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Bodard S, Guinebert S, Dimopoulos PM, Tacher V, Cornelis FH. Contribution and advances of robotics in percutaneous oncological interventional radiology. Bull Cancer 2024; 111:967-979. [PMID: 39198085 DOI: 10.1016/j.bulcan.2024.06.004] [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: 02/02/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 09/01/2024]
Abstract
The advent of robotic systems in interventional radiology marks a significant evolution in minimally invasive medical procedures, offering enhanced precision, safety, and efficiency. This review comprehensively analyzes the current state and applications of robotic system usage in interventional radiology, which can be particularly helpful for complex procedures and in challenging anatomical regions. Robotic systems can improve the accuracy of interventions like microwave ablation, radiofrequency ablation, and irreversible electroporation. Indeed, studies have shown a notable decrease of an average 30% in the mean deviation of probes, and a 40% lesser need for adjustments during interventions carried out with robotic assistance. Moreover, this review highlights a 35% reduction in radiation dose and a stable-to-30% reduction in operating time associated with robot-assisted procedures compared to manual methods. Additionally, the potential of robotic systems to standardize procedures and minimize complications is discussed, along with the challenges they pose, such as setup duration, organ movement, and a lack of tactile feedback. Despite these advancements, the field still grapples with a dearth of randomized controlled trials, which underscores the need for more robust evidence to validate the efficacy and safety of robotic system usage in interventional radiology.
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Affiliation(s)
- Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Necker Hospital, University of Paris-Cité, 149 rue de Sèvres, 75015 Paris, France; CNRS UMR 7371, Inserm U 1146, laboratoire d'imagerie biomédicale, Sorbonne University, 75006 Paris, France.
| | - Sylvain Guinebert
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Platon M Dimopoulos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Interventional Radiodolgy Dpt, University Hospital of Patras with memorial, 26504 Rio, Greece
| | - Vania Tacher
- Unité Inserm U955 n(o) 18, service d'imagerie médicale, hôpital Henri-Mondor, université Paris-Est, AP-HP, Créteil, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY, Association RCOTKLC. Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Gut Liver 2024; 18:789-802. [PMID: 39223081 PMCID: PMC11391139 DOI: 10.5009/gnl240350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Local ablation for hepatocellular carcinoma, a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage hepatocellular carcinoma. The lack of organized evidence and expert opinions regarding patient selection, preprocedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-Guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hee Yoon
- Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Rossi M, Meomartino L, Pagano L, Follini G, Garberoglio S, Maccario M, Rossetto Giaccherino R, Garberoglio R. Adjustable-tip needles versus fixed-tip needles in radiofrequency ablation of symptomatic benign thyroid nodules: a single-center Italian experience. J Ultrasound 2024; 27:699-706. [PMID: 38907788 PMCID: PMC11333423 DOI: 10.1007/s40477-024-00926-4] [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] [Received: 02/09/2024] [Accepted: 05/18/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE In this retrospective, observational study we aim to compare the outcomes of the RFA treatment of benign thyroid nodules, carried out respectively with the standard fixed-needle approach (FTN) and the adjustable-tip needle technique (ATN), considered a more tailored, quicker and easier technical approach. METHODS We enrolled 36 patients who underwent RFA treatment of symptomatic, benign, thyroid nodule, 18 with the ATN and 18 with the FTN approach, respectively. Data about absolute volume reduction, volume reduction rate (VRR) and success rate (defined as VRR ≥ 50%), after 1, 3 and 6 months of follow-up were compared. RESULTS Our study suggested no substantial difference between the approaches, up to 6 months of follow-up, both in terms of absolute reduction (p = 0.27) and VRR (p = 0.14). These results were confirmed when the success rates, both in terms of 50%-reduction (p = 0.12) and absolute reduction (p = 0.42), was considered. Only at the 6-month evaluation, the FTN procedure showed a better success rate, yet without statistical significance (88.9% vs. 61.1%, p = 0.12). No difference emerged both in terms of patients' satisfaction and safety. CONCLUSION Our small experience suggested no substantial difference between ATN and FTN, in terms of outcomes. On the other hand, ATN was considered to be more straightforward and could consequently allow for a shorter operator learning curve.
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Affiliation(s)
- Mattia Rossi
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti n.14, 10126, Turin, Italy.
| | - Letizia Meomartino
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti n.14, 10126, Turin, Italy
| | - Loredana Pagano
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti n.14, 10126, Turin, Italy
| | - Giulia Follini
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti n.14, 10126, Turin, Italy
| | - Sara Garberoglio
- Thyroid Multidisciplinary Center, Humanitas Cellini, Turin, Italy
| | - Mauro Maccario
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti n.14, 10126, Turin, Italy
| | - Ruth Rossetto Giaccherino
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti n.14, 10126, Turin, Italy
| | - Roberto Garberoglio
- Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti n.14, 10126, Turin, Italy
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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY. Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Korean J Radiol 2024; 25:773-787. [PMID: 39197823 PMCID: PMC11361797 DOI: 10.3348/kjr.2024.0550] [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] [Received: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 09/01/2024] Open
Abstract
Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Hee Yoon
- Department of Radiology, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea.
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY. Local ablation for hepatocellular carcinoma: 2024 expert consensus-based practical recommendation of the Korean Liver Cancer Association. JOURNAL OF LIVER CANCER 2024; 24:131-144. [PMID: 39210668 PMCID: PMC11449576 DOI: 10.17998/jlc.2024.08.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the firstline treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and posttreatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hee Yoon
- Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Research Committee of the Korean Liver Cancer Association
- Department of Radiology, Samsung Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
- Department of Radiology, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Bodard S, Guinebert S, Tacher V, Cornelis FH. The Emergence of robotics in liver interventional radiology: Navigating New Frontiers. Eur J Radiol 2024; 175:111482. [PMID: 38691945 DOI: 10.1016/j.ejrad.2024.111482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Sylvain Bodard
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; University of Paris Cité, Department of Radiology, Necker Hospital, 149 rue de Sèvre, 75015, Paris, France; Sorbonne University, CNRS UMR 7371, INSERM U 1146, Laboratoire d'Imagerie Biomédicale, 75006, Paris, France.
| | - Sylvain Guinebert
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; University of Paris Cité, Department of Radiology, Necker Hospital, 149, Rue de Sèvre, 75015, Paris, France
| | - Vania Tacher
- PARIS EST University, Unité INSERM U955 n°18, AP-HP, Henri Mondor Hospital, Department of Radiology, 94000, Créteil, France
| | - Francois H Cornelis
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; Sorbonne University, Department of Radiology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Xie Y, Lyu T, Song L, Tong X, Wang J, Zou Y. TACE-assisted multi-image guided radiofrequency ablation for the treatment of single hepatocellular carcinoma ≤ 5 cm: a retrospective study. Front Oncol 2024; 14:1347675. [PMID: 38646432 PMCID: PMC11026585 DOI: 10.3389/fonc.2024.1347675] [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: 12/01/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Background/Objective Treatment of hepatocellular carcinoma (HCC) with ablation alone often results in high rates of recurrence and metastasis, reaching up to 25.9% within two years. Therefore, this study aimed to examine the efficacy and safety of transarterial chemoembolization (TACE)-assisted multi-image guided radiofrequency ablation (RFA) for the treatment of stage Ia HCC according to the China liver cancer staging (CNLC). Methods This study enrolled and analyzed a total of 118 patients diagnosed with HCC, each with a single nodular lesion no larger than 5 cm, who received TACE-RFA as first-line therapy between February 1, 2014, and December 31, 2021. The median/mean follow-up period was 29.0 months [95% confidence interval (CI): 21.8-36.2 months] and 31.8 months (95% CI: 27.5-36.0 months), respectively. We assessed the treatment's effectiveness, potential complications, and survival rate. Results The technical success rate was 100% (118/118) after the initial treatment. Out of the total, 3 out of 118 patients (2.5%) developed local tumor progression (LTP) during the follow-up period. The median time for LTP was 29.0 months (95%CI: 21.9-36.1 months; mean: 31.5 months; range 1-92 months). At 1, 3, 5, and 7 years after treatment, the cumulative LTP rates were 0%, 4.6%, 4.6%, and 4.6%, respectively. The overall survival rates at 1, 3, 5, and 7 years were 100%, 95.2%, 95.2%, and 95.2%, respectively. In total, 28 patients experienced minor Grade B complications, and no major complications or treatment-related mortality occurred. Conclusion The treatment of CNLC stage Ia HCC using TACE-assisted multi-image-guided RFA was found to be both safe and feasible.
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Affiliation(s)
| | | | | | | | - Jian Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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Liu J, Guo Y, Sun Y, Liu M, Zhang X, Zheng R, Cong L, Liu B, Xie X, Huang G. Three-dimensional ultrasound fusion imaging in precise needle placement for thermal ablation of hepatocellular carcinoma. Int J Hyperthermia 2024; 41:2316097. [PMID: 38360570 DOI: 10.1080/02656736.2024.2316097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/03/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To investigate the value of three-dimensional ultrasound fusion imaging (3DUS FI) technique for guiding needle placement in hepatocellular carcinoma (HCC) thermal ablation. METHODS A total of 57 patients with 60 HCCs with 3DUS FI-guided thermal ablation were retrospectively included in the study. 3DUS volume data of liver were acquired preoperatively by freehand scanning with the tumor and predetermined 5 mm ablative margin automatically segmented. Plan of needle placement was made through a predetermined simulated ablation zone to ensure a 5 mm ablative margin with the coverage rate toward tumor and ablative margin. With real-time ultrasound and 3DUS fusion imaging, ablation needles were placed according to the plan. After ablation, the ablative margin was immediately evaluated by contrast-enhanced ultrasound and 3DUS fusion imaging. The rate of adequate ablative margin, complete response (CR), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) was evaluated. RESULTS According to postoperative contrast-enhanced CT or MR imaging, the complete response rate was 100% (60/60), and 83% of tumors (30/36) achieved adequate ablative margin (>5 mm) three-dimensionally. During the follow-up period of 6.0-42.6 months, LTP occurred in 5 lesions, with 1- and 2-year LTP rates being 7.0% and 9.4%. The 1- and 2-year DFS rates were 76.1% and 65.6%, and 1- and 2-year OS rates were 98.1% and 94.0%. No major complications or ablation-related deaths were observed in any patients. CONCLUSIONS Three-dimensional ultrasound fusion imaging technique may improve the needle placement of thermal ablation for HCC and reduce the rate of LTP.
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Affiliation(s)
- Jiaming Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuqing Guo
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yueting Sun
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruiying Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Longfei Cong
- Medical Imaging System Division, Shenzhen Mindray Bio-Medical Electronics Co., Ltd, Shenzhen, China
| | - Baoxian Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guangliang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Medical Ultrasonics, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Nanning, China
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11
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Lee Y, Yoon JH, Han S, Joo I, Lee JM. Contrast-enhanced ultrasonography-CT/MRI fusion guidance for percutaneous ablation of inconspicuous, small liver tumors: improving feasibility and therapeutic outcome. Cancer Imaging 2024; 24:4. [PMID: 38172949 PMCID: PMC10762814 DOI: 10.1186/s40644-023-00650-y] [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] [Received: 08/17/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) is pivotal for treating small malignant liver tumors, but tumors often remain inconspicuous on B-mode ultrasound (US). This study evaluates the potential of CEUS-CT/MRI fusion imaging (FI) to improve tumor visibility and the associated RFA outcomes for small (≤ 3 cm) malignant liver tumors that were inconspicuous on US. METHODS Between January 2019 and April 2021, a prospective study enrolled 248 patients with liver malignancies (≤ 3 cm) that were poorly visible on B-mode US. Tumor visibility and ablation feasibility were assessed using B-mode US, US-CT/MRI FI, and CEUS-CT/MRI FI, and graded on a 4-point scale. CEUS was employed post-registration of US and CT/MRI images, utilizing either SonoVue or Sonazoid. Comparisons between US-based and CEUS-based fusion visibility and feasibility scores were undertaken using the Friedman test. Moreover, rates of technical success, technique efficacy, local tumor progression (LTP), and major complications were assessed. RESULTS The cohort included 223 hepatocellular carcinomas (HCCs) (89.9%) and 23 metastases (9.3%), with an average tumor size of 1.6 cm. CEUS-CT/MRI FI demonstrated a significant advantage in tumor visibility (3.4 ± 0.7 vs. 1.9 ± 0.6, P < 0.001) and technical feasibility (3.6 ± 0.6 vs. 2.9 ± 0.8, P < 0.001) compared to US-FI. In 85.5% of patients, CEUS addition to US-FI ameliorated tumor visibility. Technical success was achieved in 99.6% of cases. No severe complications were reported. One and two-year post CEUS-CT/MRI FI-guided RFA estimates for LTP were 9.3% and 10.9%, respectively. CONCLUSIONS CEUS-CT/MRI FI significantly improves the visualization of tumors not discernible on B-mode US, thus augmenting percutaneous RFA success and delivering improved therapeutic outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT05445973. Registered 17 June 2022 - Retrospectively registered, http://clinicaltrials.gov/study/NCT05445973?id=NCT05445973&rank=1 .
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Affiliation(s)
- Yuna Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seungchul Han
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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12
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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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Bodard S, Guinebert S, N. Petre E, Marinelli B, Sarkar D, Barral M, H Cornelis F. Percutaneous liver interventions with robotic systems: a systematic review of available clinical solutions. Br J Radiol 2023; 96:20230620. [PMID: 37873927 PMCID: PMC10646656 DOI: 10.1259/bjr.20230620] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Robotic-guided interventions are emerging techniques that are gradually becoming a common tool for performing biopsies and tumor ablations in liver. This systematic review aims to evaluate their advancements, challenges, and outcomes. METHODS A systematic review was conducted using the PubMed database to identify relevant articles published between January 2000 and February 2023. Inclusion criteria focused on studies that assessed robotic systems for percutaneous liver biopsies and tumor ablations. Data extraction was performed to collect information on study characteristics; robotic systems; components and software; imaging modality; degree of freedom; and needle insertion methods. The outcome measures analyzed were procedure time, radiation dose, and accuracy. RESULTS 10 studies met the inclusion criteria. The robotic devices used included MAXIO, EPIONE, ROBIO-EX, AcuBot, and ACE robotic systems. The data set consisted of 429 percutaneous thermal ablations and 57 biopsies, both robot-guided. On average, the mean deviation of probes was reduced by 30% (from 1.6 vs 3.3 mm to 2.4 vs 3.9 mm (p < 0.001)), and 40% (p < 0.05) fewer readjustments were required during the robotic-assisted interventions. Moreover, robotic systems contributed to a reduction in operating time, ranging from 15% (18.3 vs 21.7 min, p < 0.001) to 25% (63.5 vs 87.4 min, p < 0.001). Finally, the radiation dose delivered to both the patient and the operator was decreased by an average of 50% (p < 0.05) compared to manual procedures. ADVANCES IN KNOWLEDGE Robotic systems could provide precise navigation and guidance during liver biopsies and percutaneous ablations.
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Affiliation(s)
| | - Sylvain Guinebert
- Department of Radiology, University of Paris Cité, Necker Hospital, Paris, France
| | - Elena N. Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Debkumar Sarkar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Matthias Barral
- Department of Radiology, Sorbonne University, Tenon Hospital, Paris, France
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Minami Y, Aoki T, Hagiwara S, Kudo M. Tips for Preparing and Practicing Thermal Ablation Therapy of Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:4763. [PMID: 37835456 PMCID: PMC10571938 DOI: 10.3390/cancers15194763] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Thermal ablation therapy, including radiofrequency ablation (RFA) and microwave ablation (MWA), is considered the optimal locoregional treatment for unresectable early-stage hepatocellular carcinomas (HCCs). Percutaneous image-guided ablation is a minimally invasive treatment that is being increasingly performed because it achieves good clinical outcomes with a lower risk of complications. However, the physics and principles of RFA and MWA markedly differ. Although percutaneous thermal ablation under image guidance may be challenging in HCC cases with limited access or a risk of thermal injury, a number of ablative techniques, each of which may be advantageous and disadvantageous for individual cases, are available. Furthermore, even when a HCC is eligible for ablation based on tumor selection and technical factors, additional patient factors may have an impact on whether it is the appropriate treatment choice. Therefore, a basic understanding of the advantages and limitations of each ablation device and imaging guidance technique, respectively, is important. We herein provide an overview of the basic principles of tissue heating in thermal ablation, clinical and laboratory parameters for ablation therapy, preprocedural management, imaging assessments of responses, and early adverse events. We also discuss associated challenges and how they may be overcome using optimized imaging techniques.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan (M.K.)
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15
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Afif AM, Laroco OD, Lau SMD, Teo SM, Rahman ASA, Too CW, Venkatanarasimha N, Gogna A. Usefulness of ultrasound fusion technology for hepatocellular carcinoma localisation, pre- and post-thermal ablation. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:194-200. [PMID: 35936962 PMCID: PMC9354184 DOI: 10.1177/1742271x211049525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/02/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Percutaneous thermal ablation of inconspicuous lesions can be challenging. Fusion ultrasound (FUS) allows the use of previously performed diagnostic imaging like computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET-CT) to localise hepatocellular carcinoma (HCC) for treatment. This paper illustrates FUS case studies of pre-, intra- and post-ablation imaging of inconspicuous HCC, supplemented by use of contrast-enhanced ultrasound (CEUS). METHOD Four prospective cases during September 2014 to October 2018, with HCC amenable to ablation, which were poorly identified on ultrasound, underwent FUS. FUS pre-screening was scheduled within three months of the previous CT or MRI, and between one to four weeks prior to the scheduled ablation date. Post-ablation imaging with FUS was performed between four to six weeks to coincide with their routine follow-up CT or MRI. FINDINGS There were potential benefits observed in the cases with combined techniques of FUS and CEUS for limiting circumstances such as heat sink effect, multiple lesions targeting, inconspicuous lesion detection and pre-ablation technical feasibility assessment. DISCUSSION The combined use of FUS and CEUS improves tumour visibility, increases operator imaging confidence and reduces heat sink effect during percutaneous thermal ablation. CONCLUSION FUS imaging is helpful in targeting poor conspicuity lesions that cannot be detected on grey-scale ultrasound. It facilitates in ensuring optimal treatment of hepatic lesions for improvement of patient prognosis and follow-up imaging.
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Affiliation(s)
- A Mohamed Afif
- A Mohamed Afif, Block 2, Level 1, Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
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Ke S. Advances in the interventional therapy of hepatocellular carcinoma originating from the caudate lobe. J Interv Med 2022; 5:51-56. [PMID: 35936660 PMCID: PMC9349001 DOI: 10.1016/j.jimed.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/05/2022] [Indexed: 11/27/2022] Open
Abstract
Hepatocellular carcinoma originating from the caudate lobe, also known as segment I hepatocellular carcinoma, is difficult to treat because of its special location, complex vascular supply, and the proximity of important vessels, bile ducts, and organs. This research is conducted to examine the efficacy and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe. Conclusion Superselective chemoembolization and ablation techniques for the treatment of caudate lobe hepatocellular carcinoma still need to be improved. The combination of multiple interventional methods and the application of multiple imaging techniques can improve the effectiveness and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe. Multidisciplinary treatment is also essential to improve the prognosis of patients with caudate lobe hepatocellular carcinoma.
The anatomical characteristics of the arteries in the caudate lobe hepatocellular carcinoma remains an important factor restricting the success rate of superselective transcatheter arterial chemoembolization. The application of multiple imaging techniques may improve the effectiveness and safety of interventional therapy. The combination of multiple interventional methods has more advantages than disadvantages. Multidisciplinary treatment is increasingly becoming a trend in the treatment of caudate lobe hepatocellular carcinoma.
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17
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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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18
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Wu CH, Liang PC, Su TH, Lin MC, Chang YH, Shih TTF, Kao JH. Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma. Hepatol Int 2021; 15:1247-1257. [PMID: 34338971 DOI: 10.1007/s12072-021-10236-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Radiofrequency ablation (RFA) is the standard of care for early stage hepatocellular carcinoma (HCC). However, the clinical outcomes of iodized oil computed tomography (IoCT) versus ultrasound (US)-guided RFA for HCC remain unclear. METHODS We retrospectively analyzed consecutive treatment-naïve patients who received curative RFA for HCC within Milan criteria from January 2016 to December 2018. Patients who underwent either IoCT-guided RFA (IoCT group) or US-guided RFA (US group) were included. Various clinical factors, including tumor location, were adjusted with a 1:1 propensity score matching. Subsequently, the cumulative incidence rates for recurrence and hazard ratios for survival were calculated. RESULTS We included 184 (37.9%) and 301 (62.1%) patients who received IoCT- and US-guided RFA, respectively. Before propensity score matching, IoCT guidance was significantly associated with multiple tumors, higher body mass index, lower albumin level, and tumors located at S8. After matching, the 1-, 2-, and 3-year local tumor progression rates of the IoCT group were significantly lower than those of the US group (4.4%, 6.9%, and 7.5% vs. 14.4%, 16.3%, and 16.3%, respectively, at p = 0.002, 0.009, and 0.016, respectively). In univariate analyses and multivariate analyses that adjusted for clinical and tumor location-related parameters, the IoCT group had better recurrence-free survival (hazard ratio = 0.581, 95% confidence interval 0.375-0.899) than those with US guidance but not overall survival. CONCLUSION IoCT-guided RFA had a lower local tumor progression rate and better recurrence-free survival than did US-guided RFA for HCC within the Milan criteria. CT-guide RFA is a safe and effective alternative to US-guided with similar overall survival. IoCT-guided RFA might have a better local tumor control than US-guided. IoCT-guided RFA may be more suitable for male patients, aged < 70 years, a single tumor measuring 2-5 cm, and a tumor located at the subdiaphragmatic/subcardiac region.
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Affiliation(s)
- Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Chi Lin
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yu-Hsuan Chang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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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: 1.5] [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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20
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Meershoek P, van den Berg NS, Lutjeboer J, Burgmans MC, van der Meer RW, van Rijswijk CSP, van Oosterom MN, van Erkel AR, van Leeuwen FWB. Assessing the value of volume navigation during ultrasound-guided radiofrequency- and microwave-ablations of liver lesions. Eur J Radiol Open 2021; 8:100367. [PMID: 34286051 PMCID: PMC8273361 DOI: 10.1016/j.ejro.2021.100367] [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: 04/28/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The goal of our study was to determine the influence of ultrasound (US)-coupled volume navigation on the use of computed tomography (CT) during minimally-invasive radiofrequency and microwave ablation procedures of liver lesions. Method Twenty-five patients with 40 liver lesions of different histological origin were retrospectively analysed. Lesions were ablated following standard protocol, using 1) conventional US-guidance, 2) manual registered volume navigation (mVNav), 3) automatic registered (aVNav) or 4) CT-guidance. In case of ultrasonographically inconspicuous lesions, conventional US-guidance was abandoned and mVNav was used. If mVNav was also unsuccessful, the procedure was either continued with aVNav or CT-guidance. The number, size and location of the lesions targeted using the different approaches were documented. Results Of the 40 lesions, sixteen (40.0 %) could be targeted with conventional US-guidance only, sixteen (40.0 %) with mVNav, three (7.5 %) with aVNav and five (12.5 %) only through the use of CT-guidance. Of the three alternatives (mVNav, aVNav and CT only) the mean size of the lesions targeted using mVNav (9.1 ± 4.6 mm) was significantly smaller from those targeted using US-guidance only (20.4 ± 9.4 mm; p < 0.001). The location of the lesions did not influence the selection of the modality used to guide the ablation. Conclusions In our cohort, mVNav allowed the ablation procedure to become less dependent on the use of CT. mVNav supported the ablation of lesions smaller than those that could be ablated with US only and doubled the application of minimally-invasive US-guided ablations.
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Affiliation(s)
- Philippa Meershoek
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Nynke S van den Berg
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Jacob Lutjeboer
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Mark C Burgmans
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Rutger W van der Meer
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Catharina S P van Rijswijk
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Arian R van Erkel
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
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21
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Zhou Y, Yang Y, Zhou B, Wang Z, Zhu R, Chen X, Ouyang J, Li Q, Zhou J. Challenges Facing Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Extension of Ablation Criteria. J Hepatocell Carcinoma 2021; 8:625-644. [PMID: 34189133 PMCID: PMC8232857 DOI: 10.2147/jhc.s298709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
As an emerging minimally invasive treatment method, percutaneous ablation is more and more widely used in the treatment of liver tumors. It has been recommended by guidelines for diagnosis and treatment of hepatocellular carcinoma (HCC) as a curative treatment alongside surgical resection and liver transplantation. In recent years, with the continuous advancement and innovation of percutaneous ablation technologies, their clinical efficacy and safety have been significantly improved, which has led to the expanded application of percutaneous ablation in the treatment of HCC—more and more patients who were previously considered unsuitable for ablation therapies are now being treated with percutaneous ablation. Obviously, percutaneous ablation can reduce the risk of treatment changes from curative strategies to palliative strategies. Based on clinical practice experience, this review enumerates the advantages and disadvantages of different ablative modalities and summarizes the existing combinations of ablation techniques, thus will help clinicians choose the most appropriate ablative modality for each patient and will provide scientific guidance for improving prognosis and making evidence-based treatment decisions. In addition, we point out the challenges and future prospects of the ablation therapies, thereby providing direction for future research.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Yi Yang
- 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, People's Republic of China
| | - Bingyan Zhou
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People's Republic of China
| | - Zhengzheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Ruili Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Xun Chen
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Qingjun Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
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22
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Tokunaga K, Furuta A, Iizuka Y, Isoda H, Togashi K. Utility of real-time image fusion technology in ultrasonography-guided fiducial marker implantation for stereotactic body radiation therapy for liver tumors. Acta Radiol 2021; 62:567-573. [PMID: 32586122 DOI: 10.1177/0284185120934479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ultrasonography (US) is useful when implanting fiducial markers in the liver. However, the implant position is sometimes lost. Recently, real-time image fusion technology (Volume Navigation [V-navi]; GE Healthcare, Milwaukee, WI, USA) has been introduced as a technique for using images from different modalities, and its utility for fiducial marker implantation has been hypothesized. PURPOSE To evaluate the utility of US-guided fiducial marker implantation in the liver using V-navi compared to conventional US. MATERIAL AND METHODS We retrospectively reviewed 35 patients who underwent fiducial marker implantation for stereotactic body radiation therapy of liver tumors in 2013-2018. To avoid artifacts obscuring the tumor, the target point of implantation was set 10 mm cranial or caudal to the tumor. Marker implantation was then performed using US alone (US group, n = 24) or V-navi with computed tomography (CT) or magnetic resonance imaging (V-navi group, n = 11). Postprocedural CT was evaluated to determine technical success, distances between marker and either tumor surface or target point, and whether marker-induced artifacts obscured the tumor. Complications were also evaluated. Results were compared between groups. RESULTS Technical success was obtained in 33 patients. Distance between the tumor and marker showed no significant difference between groups. Distance between target point and marker was shorter in the V-navi group (P = 0.0093). Tumor-obscuring artifacts were seen in 12 patients (V-navi group, n = 1; US group, n = 11; P = 0.055). The only complication was minor bleeding in the US group (n = 1). CONCLUSION V-navi appears useful for US-guided fiducial marker implantation in the liver compared with conventional US.
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Affiliation(s)
- Koji Tokunaga
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Iizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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23
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Pan F, Do TD, Vollherbst DF, Pereira PL, Richter GM, Faerber M, Weiss KH, Mehrabi A, Kauczor HU, Sommer CM. Percutaneous Irreversible Electroporation for Treatment of Small Hepatocellular Carcinoma Invisible on Unenhanced CT: A Novel Combined Strategy with Prior Transarterial Tumor Marking. Cancers (Basel) 2021; 13:2021. [PMID: 33922067 PMCID: PMC8122342 DOI: 10.3390/cancers13092021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION To explore the feasibility, safety, and efficiency of ethiodized oil tumor marking combined with irreversible electroporation (IRE) for small hepatocellular carcinomas (HCCs) that were invisible on unenhanced computed tomography (CT). METHODS A retrospective analysis of the institutional database was performed from January 2018 to September 2018. Patients undergoing ethiodized oil tumor marking to improve target-HCC visualization in subsequent CT-guided IRE were retrieved. Target-HCC visualization after marking was assessed, and the signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNR) were compared between pre-marking and post-marking CT images using the paired t-test. Standard IRE reports, adverse events, therapeutic endpoints, and survival were summarized and assessed. RESULTS Nine patients with 11 target-HCCs (11.1-18.8 mm) were included. After marking, all target-HCCs demonstrated complete visualization in post-marking CT, which were invisible in pre-marking CT. Quantitatively, the SNR of the target-HCCs significantly increased after marking (11.07 ± 4.23 vs. 3.36 ± 1.79, p = 0.006), as did the CNR (4.32 ± 3.31 vs. 0.43 ± 0.28, p = 0.023). In sequential IRE procedures, the average current was 30.1 ± 5.3 A, and both the delta ampere and percentage were positive with the mean values of 5.8 ± 2.1 A and 23.8 ± 6.3%, respectively. All procedures were technically successful without any adverse events. In the follow-up, no residual unablated tumor (endpoint-1) was observed. The half-year, one-year, and two-year local tumor progression (endpoint-2) rate was 0%, 9.1%, and 27.3%. The two-year overall survival rate was 100%. CONCLUSIONS Ethiodized oil tumor marking enables to demarcate small HCCs that were invisible on unenhanced CT. It potentially allows a safe and complete ablation in subsequent CT-guided IRE.
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Affiliation(s)
- Feng Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Thuy D. Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
| | - Dominik F. Vollherbst
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
- Department of Neuroradiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Philippe L. Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, 74078 Heilbronn, Germany;
| | - Götz M. Richter
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, 70174 Stuttgart, Germany;
| | - Michael Faerber
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
| | - Karl H. Weiss
- Department of Gastroenterology, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Hans U. Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
| | - Christof M. Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.P.); (T.D.D.); (D.F.V.); (M.F.); (H.U.K.)
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, 70174 Stuttgart, Germany;
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24
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Poch FG, Geyer B, Gemeinhardt O, Klopfleisch R, Niehues SM, Vahldiek JL, Bressem K, Kreis ME, Lehmann KS. Immediate post-interventional contrast-enhanced computed tomography overestimates hepatic microwave ablation - an in vivo animal study. Int J Hyperthermia 2020; 37:463-469. [PMID: 32396401 DOI: 10.1080/02656736.2020.1762936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objectives: Contrast-enhanced computed tomography (CECT) is used to monitor technical success immediately after hepatic microwave ablation (MWA). However, it remains unclear, if CECT shows the exact extend of the thermal destruction zone, or if tissue changes such as peri-lesionary edema are depicted as well. The objective of this study was to correlate immediate post-interventional CECT with histological and macroscopic findings in hepatic MWA in porcine liver in vivo.Methods: Eleven MWA were performed in porcine liver in vivo with a microwave generator (928 MHz; energy input 24 kJ). CECT was performed post-interventionally. Livers were explanted and ablations were bisected immediately after ablation. Samples were histologically analyzed after vital staining (NADH-diaphorase). Ablation zones were histologically and macroscopically outlined. We correlated histologic findings, macroscopic images and CECT.Results: Three ablation zones were identified in histological and macroscopic findings. Only one ablation zone could be depicted in CECT. Close conformity was observed between histological and macroscopic findings. The ablation zone depicted in CECT overestimated the histological avital central zone and inner red zone (p < = .01). No differences were found between CECT and the histological outer red zone (p > .05).Conclusions: Immediate post-interventional CECT overestimated the clinically relevant zone of complete cell ablation after MWA in porcine liver in vivo. This entails the risk of incomplete tumor ablation and could lead to tumor recurrence.
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Affiliation(s)
- Franz G Poch
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beatrice Geyer
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ole Gemeinhardt
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Stefan M Niehues
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janis L Vahldiek
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Keno Bressem
- Department of Radiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin E Kreis
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kai S Lehmann
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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25
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Liu J, Zhao J, Gu HAO, Zhu Z. Repeat hepatic resection VS radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma: an updated meta-analysis. MINIM INVASIV THER 2020; 31:332-341. [PMID: 33143517 DOI: 10.1080/13645706.2020.1839775] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND This paper evaluates the efficacy and safety of repeat hepatic resection and radiofrequency ablation in the treatment of recurrent hepatocellular carcinoma. MATERIAL AND METHODS We retrieved and collected all relevant articles from the inception to 8 March 2020. After data extraction, we conducted meta-analysis and carried out the heterogeneity test, sensitivity analysis, and publication bias test to evaluate reliability. RESULTS A total of 12 studies with 1746 patients (rHR 837, RFA 909) were included. rHR was similar to RFA in a one-year overall survival rate (OS), while rHR was superior to RFA in 3- and 5-year OS and 1-, 3-, and 5-year disease-free survival rates (DFS), but the procedure-related complications of RFA were significantly less than those of rHR. Among the subgroups with Milan criteria, rHR was similar to RFA in 1-, 3-, and 5-year OS and 1-year DFS, but superior to RFA in 3- and 5-year DFS. CONCLUSIONS RFA is the first choice for recurrent HCC meeting Milan criteria. When it does not meet the Milan criteria, minimally invasive treatment should not be carried out at the cost of survival, and rHR should be the first choice.
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Affiliation(s)
- Junjie Liu
- Department of Liver transplantation and laparoscopic surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jinming Zhao
- Department of Liver transplantation and laparoscopic surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - H A O Gu
- Department of Liver transplantation and laparoscopic surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhiqiang Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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26
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Gupta P, Kalra N, Keshava SN, Chaluvashetty SB, Mukund A, Roy-Choudhury SH, Baijal SS, Khandelwal A, Ananthashayana VH, R. SN, Kulkarni S, Shetty NS, Gupta A, Gupta S. Indian Society of Vascular and Interventional Radiology Expert Consensus Statements for Ablation in Hepatocellular Carcinoma: Part I. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1715774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractLocoregional therapies play an important role in the management of hepatocellular carcinoma (HCC). Percutaneous ablation is one of the most commonly employed nonsurgical methods for treating very early and early HCC. For small HCCs, ablation is potentially curative and competes with surgical resection. The widespread availability and the spectrum of ablative techniques mandate uniform approach among interventional radiologists. Thus, it is desirable to have a consensus regarding various aspects of liver ablation. This article represents a consensus document of the experts from the Indian Society of Vascular and Interventional Radiology involved in the care of patients with HCC. The statements are presented in two parts.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyamkumar N. Keshava
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sreedhara B. Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | | | - Sanjay Saran Baijal
- Department of Interventional Radiology, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Anubhav Khandelwal
- Department of Interventional Radiology, Medanta, The Medicity, Gurgaon, Haryana, India
| | | | - Sathya Narayanan R.
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suyash Kulkarni
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Sanjay Gupta
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, United States
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27
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Makary MS, Khandpur U, Cloyd JM, Mumtaz K, Dowell JD. Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies. Cancers (Basel) 2020; 12:1914. [PMID: 32679897 PMCID: PMC7409274 DOI: 10.3390/cancers12071914] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and third leading cause of cancer-related mortality worldwide. While surgical resection and transplantation are the standard first-line treatments for early-stage HCC, most patients do not fulfill criteria for surgery. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable HCC. Improved outcomes have been achieved with novel techniques which can be employed for diverse applications ranging from curative-intent for small localized tumors, to downstaging or bridging to resection and transplantation for early and intermediate disease, and locoregional control and palliation for advanced disease. This review explores recent advances in liver-directed techniques for HCC including bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on patient selection, procedural technique, periprocedural management, and outcomes.
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Affiliation(s)
- Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Umang Khandpur
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Jordan M. Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Khalid Mumtaz
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
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28
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Choi MH, Choi JI, Lee YJ. Manual versus automated image fusion of real-time ultrasonography and MR/CT images for radiofrequency ablation of hepatic tumors: results of a randomized prospective trial (NCT02705118). Ultrasonography 2020; 40:237-247. [PMID: 32660211 PMCID: PMC7994745 DOI: 10.14366/usg.20052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/21/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study compared the technical parameters and clinical outcomes of manual and automatic image fusion techniques of ultrasonography and magnetic resonance imaging/computed tomography for radiofrequency ablation (RFA) of hepatic tumors. METHODS Seventy consecutive patients (male:female=47:23, 67.1±10.9 years old) who underwent RFA for hepatic tumors were prospectively enrolled and randomly assigned to the manual or automatic registration group. Two operators performed RFA with one of two imaging fusion techniques. Technical parameters (the registration error, time required for image registration, number of point registrations) and clinical outcomes (technical success, technical effectiveness, local tumor progression [LTP]-free survival, and progression-free survival [PFS]) were compared. RESULTS The automatic group contained 35 patients with hepatocellular carcinoma, while the manual group included 34 hepatocellular carcinoma patients and a patient with colon cancer liver metastasis. The registration error, time required for registration, and number of point registrations were 5.7±4.3 mm, 147.8±78.2 seconds, and 3.26±1.20 in the automatic group, and 6.3±5.0 mm, 150.3±89.7 seconds, and 3.20±1.13 in the manual group, respectively. The technical success and effectiveness rates were both 97.1% in the automatic group and both 100.0% in the manual group. The above differences were not significant. The LTP-free survival and PFS (28.3 and 21.2 months in the automatic group, and 29.0 and 24.9 months in the manual group, respectively) showed no significant between-group differences during a median 20.1-month follow-up period. CONCLUSION The technical parameters and clinical outcomes of automatic image fusion were not significantly different from those of manual image fusion for RFA of hepatic tumors.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute of the Catholic University of Korea, Seoul, Korea
| | - Joon-Il Choi
- Cancer Research Institute of the Catholic University of Korea, Seoul, Korea.,Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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29
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Lee JY, Minami Y, Choi BI, Lee WJ, Chou YH, Jeong WK, Park MS, Kudo N, Lee MW, Kamata K, Iijima H, Kim SY, Numata K, Sugimoto K, Maruyama H, Sumino Y, Ogawa C, Kitano M, Joo I, Arita J, Liang JD, Lin HM, Nolsoe C, Gilja OH, Kudo M. The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid. Ultrasonography 2020; 39:191-220. [PMID: 32447876 PMCID: PMC7315291 DOI: 10.14366/usg.20057] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
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Affiliation(s)
- Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Byung Ihn Choi
- Department of Radiology, Chung Ang University Hospital, Seoul, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Radiology, National Yang Ming University, Taipei, Taiwan
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nobuki Kudo
- Laboratory of Biomedical Engineering, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Hiroko Iijima
- Department of Ultrasound, Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - So Yeon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Tokyo, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Masayuki Kitano
- Department of Gastroenterology and Hepatology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ja-Der Liang
- Department of Gastroenterology and Hepatology, National Taiwan University, Taipei, Taiwan
| | - Hsi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung University, Taipei, Taiwan
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
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Lee JY, Minami Y, Choi BI, Lee WJ, Chou YH, Jeong WK, Park MS, Kudo N, Lee MW, Kamata K, Iijima H, Kim SY, Numata K, Sugimoto K, Maruyama H, Sumino Y, Ogawa C, Kitano M, Joo I, Arita J, Liang JD, Lin HM, Nolsoe C, Gilja OH, Kudo M. The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid. J Med Ultrasound 2020; 28:59-82. [PMID: 32874864 PMCID: PMC7446696 DOI: 10.4103/jmu.jmu_124_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
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Affiliation(s)
- Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Byung Ihn Choi
- Department of Radiology, Chung Ang University Hospital, Seoul, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Department of Radiology, National Yang Ming University, Taipei, Taiwan
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nobuki Kudo
- Laboratory of Biomedical Engineering, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Hiroko Iijima
- Department of Ultrasound, Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - So Yeon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Tokyo, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Masayuki Kitano
- Department of Gastroenterology and Hepatology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ja-Der Liang
- Department of Gastroenterology and Hepatology, National Taiwan University, Taipei, Taiwan
| | - Hsi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung University, Taipei, Taiwan
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
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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: 0.2] [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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Maeda M, Saeki I, Sakaida I, Aikata H, Araki Y, Ogawa C, Kariyama K, Nouso K, Kitamoto M, Kobashi H, Sato S, Shibata H, Joko K, Takaki S, Takabatake H, Tsutsui A, Takaguchi K, Tomonari T, Nakamura S, Nagahara T, Hiraoka A, Matono T, Koda M, Mandai M, Mannami T, Mitsuda A, Moriya T, Yabushita K, Tani J, Yagi T, Yamasaki T. Complications after Radiofrequency Ablation for Hepatocellular Carcinoma: A Multicenter Study Involving 9,411 Japanese Patients. Liver Cancer 2020; 9:50-62. [PMID: 32071909 PMCID: PMC7024979 DOI: 10.1159/000502744] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/15/2019] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is considered a safe and minimally invasive procedure. We previously reported that the mortality and complication rates for RFA were 0.038% (5/13,283 patients) and 3.54% (579 complications/16,346 procedures), respectively, from 1999 to 2010 (previous period). In this study, we investigated the clinical criteria for RFA and the mortality and complication rates from 2011 to 2015 (recent period). METHODS Data were collected from 25 centers by using a questionnaire developed by the Chugoku-Shikoku Society for Local Ablation Therapy of HCC. The criteria for RFA, RFA modification, use of image-guidance modalities, mortality, and complications during the previous and recent periods were compared. RESULTS We evaluated 11,298 procedures for 9,411 patients, including those that involved new devices (bipolar RFA and internally adjustable electrode system). The criterion of hepatic function for RFA increased from a Child-Pugh score ≤8 during the previous period to ≤9 during the recent period. The criteria regarding the tumor location and other risk factors have been expanded recently because of the increased use of several modifications of the RFA procedure and image-guidance modalities. The mortality rate was 0.064% (6/9,411 patients), and the complication rate was 2.92% (330 complications/11,298 procedures). There was no difference in mortality rates between the 2 periods (p = 0.38), but the complication rates was significantly lower during the recent period (p = 0.038). DISCUSSION AND CONCLUSIONS Our findings confirmed that RFA, including the use of new devices, is a low-risk procedure for HCC, despite the expansion of the criteria for RFA during the recent period.
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Affiliation(s)
- Masaki Maeda
- aDepartment of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Issei Saeki
- aDepartment of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Isao Sakaida
- aDepartment of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroshi Aikata
- cDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yasuyuki Araki
- dDivision of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Chikara Ogawa
- eDivision of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Kagawa, Japan
| | - Kazuya Kariyama
- fDivision of Gastroenterology and Hepatology, Okayama City Hospital, Okayama, Japan
| | - Kazuhiro Nouso
- fDivision of Gastroenterology and Hepatology, Okayama City Hospital, Okayama, Japan
| | - Mikiya Kitamoto
- gDepartment of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Haruhiko Kobashi
- hDivision of Gastroenterology and Hepatology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Shuichi Sato
- iDepartment of Hepatology, Shimane University Hospital, Shimane, Japan
| | - Hiroshi Shibata
- jDivision of Gastroenterology and Hepatology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kouji Joko
- kDivision of Gastroenterology and Hepatology, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Shintaro Takaki
- lDivision of Gastroenterology and Hepatology, Hiroshima Red Cross and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Hiroyuki Takabatake
- mDivision of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Akemi Tsutsui
- nDepartment of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Koichi Takaguchi
- nDepartment of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Tetsu Tomonari
- oDepartment of Gastroenterology and Hepatology, Tokushima University Graduate School, Tokushima, Japan
| | - Shinichiro Nakamura
- pDepartment of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Takakazu Nagahara
- qDivision of Gastroenterology and Hepatology, Tottori Prefectural Kousei Hospital, Tottori, Japan
| | - Atsushi Hiraoka
- rGastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Tomomitsu Matono
- sDivision of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Tottori, Japan
| | - Masahiko Koda
- tDepartment of Internal Medicine, Hino Hospital, Tottori, Japan
| | - Mari Mandai
- uDivision of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Tomohiko Mannami
- vDivision of Gastroenterology and Hepatology, Chugoku Central Hospital, Hiroshima, Japan,wDepartment of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Akeri Mitsuda
- xDivision of Gastroenterology and Hepatology, Tottori Red Cross Hospital, Tottori, Japan
| | - Takashi Moriya
- yDivision of Gastroenterology and Hepatology, Chugoku Rousai Hospital, Hiroshima, Japan
| | - Kazuhisa Yabushita
- zDivision of Internal Medicine, Fukuyama City Hospital, Hiroshima, Japan
| | - Joji Tani
- aDepartment of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takahito Yagi
- bDepartment of Oncology and Laboratory, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takahiro Yamasaki
- aDepartment of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan,bDepartment of Oncology and Laboratory, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan,*Takahiro Yamasaki, MD, PhD, Department of Oncology and Laboratory, Yamaguchi University Graduate School of Medicine, Minami-kogushi, Ube, Yamaguchi 755-8505 (Japan), E-Mail
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Yoon GY, Eom HJ, Choi WJ, Chae EY, Cha JH, Shin HJ, Ko BS, Kim HH. Feasibility of supine MRI (Magnetic Resonance Imaging)-navigated ultrasound in breast cancer patients. Asian J Surg 2019; 43:787-794. [PMID: 31806212 DOI: 10.1016/j.asjsur.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/26/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility of image fusion between US and supine MRI in breast cancer patients, and to evaluate differences in tumor location between prone and supine positions. METHODS This prospective study included 88 patients who underwent an additional supine MRI (MRsup) sequence following routine prone MRI (MRpro) for breast cancer between May 2016 and December 2017. The location of the tumor and discrepancies in the distances from nipple to lesion (NLD), skin to lesion (SLD), and chest wall to lesion (CLD) were evaluated between MRpro and MRsup (MRpro-sup), MRpro and MRsup-navigated US (MRpro-USnav), and MRsup and USnav (MRsup-USnav). Associations between breast thickness and measurement discrepancies were analyzed. RESULTS Total 91 index lesions were evaluated. The intraclass correlation coefficients (ICCs) for the location of MRpro and MRsup compared with USnav were 0.994 (range: 0.990-0.996) and 0.998 (range: 0.996-0.999), respectively. The mean MRpro-sup and MRpro-USnav measurement discrepancies were greater than those of MRsup-USnav, significantly. Most outer locations showed greater mean measurement discrepancies than inner locations, and each NLD, SLD, and CLD mean measurement discrepancy showed different tendencies according to location (upper or lower) and lesion depth (superficial, middle, or deep). High breast thickness showed significantly greater mean measurement discrepancies than low breast thickness. CONCLUSION Image fusion between US and supine MRI is feasible in breast cancer patients, although there is a considerable difference in tumor location measurements between prone and supine positions, especially with thicker breasts.
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Affiliation(s)
- Ga Young Yoon
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, South Korea; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye-Joung Eom
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Millischer AE, Brasseur-Daudruy M, Mahallati H, Salomon LJ. The use of image fusion in prenatal medicine. Prenat Diagn 2019; 40:18-27. [PMID: 31508835 DOI: 10.1002/pd.5558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/28/2019] [Indexed: 12/27/2022]
Abstract
Fusion imaging (FI), the simultaneous display of the same anatomical region using two imaging modalities, has been used in other areas of medicine for both diagnosis and guiding interventions. Examples include positron emission tomography-computed tomography (PET-CT) imaging in oncology and ultrasound-magnetic resonance imaging (US-MRI) fusion in biopsies of the prostate gland. The underlying principle is to take advantage of the complementary information in each modality to improve accuracy, be it diagnostic accuracy or targeting accuracy in biopsies. For example, PET-CT overlays the metabolic activity of lesions on the superb spatial and anatomical detail of CT. While the historical mainstay of fetal imaging has been ultrasound, advances in ultrafast MR imaging together with advances in fetal MRI over the past two decades, have resulted in the opportunity to explore fusion imaging in fetal medicine. We present an overview of the principles of US-MRI fusion imaging in prenatal medicine, report our local experience, and review the literature in this emerging area. We share our perspective on how FI can improve diagnostic confidence, be used as an educational tool, and potentially enhance guidance in certain fetal procedures.
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Affiliation(s)
- Anne-Elodie Millischer
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
| | | | - Houman Mahallati
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
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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: 1.7] [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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Ma QP, Xu EJ, Zeng QJ, Su ZZ, Tan L, Chen JX, Zheng RQ, Li K. Intraprocedural computed tomography/magnetic resonance-contrast-enhanced ultrasound fusion imaging improved thermal ablation effect of hepatocellular carcinoma: Comparison with conventional ultrasound. Hepatol Res 2019; 49:799-809. [PMID: 30907477 DOI: 10.1111/hepr.13336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/24/2019] [Accepted: 03/16/2019] [Indexed: 12/13/2022]
Abstract
AIM To retrospectively compare the treatment effect of intraprocedural computed tomography/magnetic resonance-contrast-enhanced ultrasound (CT/MR-CEUS) fusion imaging (FI) with that of conventional ultrasound (US) in the guidance and assessment of thermal ablation of hepatocellular carcinoma (HCC). METHODS The FI group (112 patients with 129 HCC) was treated between April 2010 and December 2012, whereas the US group (83 patients with 90 HCC) was treated between January 2008 and March 2010. Either CT/MR-CEUS FI or US was used to guide puncture, provide immediate assessment, and guide supplementary ablation. Technical efficacy, cumulative local tumor progression rate (LTP), recurrence-free survival (RFS), and overall survival (OS) were evaluated and compared during follow-up. Technical success rate of CT/MR-CEUS FI was also recorded. RESULTS Technical efficacy was significantly higher in the FI group than in the US group (100% vs. 86.7%, P < 0.001). The 1-, 2-, 3-, 4-, 5-, and 6-year cumulative LTP rates in the FI group were significantly lower than in the US group (3.8%, 4.9%, 6.0%, 6.0%, 7.2%, and 7.2% vs. 16.9%, 20.1%, 25%, 25%, 25%, and 25%, respectively; P < 0.001); RFS and OS were significantly higher in the FI group than in the US group (P = 0.027 and P = 0.049, respectively). The technical success rate of FI was 85.3%. CONCLUSIONS Intraprocedural CT/MR-CEUS FI improved the treatment effect of thermal ablation of HCC by immediately assessing treatment response and guiding supplementary ablation relative to those resulting from the use of conventional US.
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Affiliation(s)
- Qiu-Ping Ma
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Er-Jiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Jing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhong-Zhen Su
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Xin Chen
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rong-Qin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Bartolotta TV, Taibbi A, Midiri M, Lagalla R. Contrast-enhanced ultrasound of hepatocellular carcinoma: where do we stand? Ultrasonography 2019; 38:200-214. [PMID: 31006227 PMCID: PMC6595127 DOI: 10.14366/usg.18060] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/09/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasively assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy.
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Affiliation(s)
| | - Adele Taibbi
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology, University of Palermo, Palermo, Italy
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Auer T, Heidegger I, DE Zordo T, Junker D, Jaschke W, Steinkohl F, Aigner F. Fusion Imaging of Contrast-enhanced Ultrasound With CT or MRI for Kidney Lesions. In Vivo 2019; 33:203-208. [PMID: 30587624 DOI: 10.21873/invivo.11460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 01/04/2023]
Abstract
AIM To evaluate the feasibility of ultrasound (US) computed tomography (CT) or magnetic resonance imaging (MRI) fusion imaging (FI) for localization and assessment of kidney lesions. MATERIALS AND METHODS Twenty-eight patients with kidney lesions previously detected on CT or MRI were included in this retrospective study. All 28 patients with kidney lesions, which were indefinable (42.9%) or hard to localize (57.1%) on gray-scale US alone, underwent FI of US with CT/MRI datasets. In 23 (82%) patients with indeterminate kidney lesions, FI including contrast-enhanced US was conducted. RESULTS FI was successfully performed in 25 out of 28 (89.3%) patients. FI with contrast-enhanced US was able to clarify the previously detected kidney lesions in 21 out of 23 patients (91.3%). CONCLUSION FI is a feasible technique for localizing kidney lesions that are hard to define by grayscale US alone and the additional application of contrast-enhanced US is useful in clarifying indeterminate CT or MRI findings.
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Affiliation(s)
- Thomas Auer
- Department of Radiology, Landeskrankenhaus Hall, Hall in Tirol, Austria.,Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Tobias DE Zordo
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.,Department of Radiology, Brixana Private Clinic, Brixen, Italy
| | - Daniel Junker
- Department of Radiology, Landeskrankenhaus Hall, Hall in Tirol, Austria.,Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Steinkohl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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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: 1.0] [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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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: 6.8] [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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Ren C, Liu SR, Wu WB, Yu XL, Cheng ZG, Liu FY, Liang P. Experimental and Preliminary Clinical Study of Real-Time Registration in Liver Tumors During Respiratory Motion Based on a Multimodality Image Navigation System. Technol Cancer Res Treat 2019; 18:1533033819857767. [PMID: 31390948 PMCID: PMC6686313 DOI: 10.1177/1533033819857767] [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] [Indexed: 11/15/2022] Open
Abstract
Purpose: To develop a fusion imaging system that combines ultrasound and computed tomography for real-time tumor tracking and to validate the accuracy of performing registration via this approach during a specific breathing phase. Materials and Methods: The initial part of the experimental study was performed using iodized oil injection in pig livers and was focused on determining the accuracy of registration. Eight points (A1-4 and B1-4) at different positions and with different target sizes were selected as target points. During respiratory motion, we used our self-designed system to perform the procedure either with (experimental group, E) or without (control group, C) the respiratory monitoring module. The registration errors were then compared between the 2 groups and within group E. The second part of this study was designed as a preliminary clinical study and was performed in 18 patients. Screening was performed to determine the combination of points on the body surface that provided the highest sensitivity to respiratory motion. Registration was performed either with (group E) or without (group C) the respiratory monitoring module. Registration errors were compared between the 2 groups. Results: In part 1 of this study, there were fewer registration errors at each point in group E than at the corresponding points in group C (P < .01). In group E, there were more registration errors at points A1 and B1 than at the other points (P < .05). There was no significant difference in registration errors among the remaining points. During part 2 of the study, there was a significant difference in the registration errors between the 2 groups (P < .01). Conclusions: Real-time fusion registration is feasible and can be accurately performed during respiratory motions when using this system.
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Affiliation(s)
- Chao Ren
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Shi-Rong Liu
- 2 Peking University Third Hospital, Beijing, China
| | - Wen-Bo Wu
- 3 Baihui Weikang Medical Robot Technology Co, Ltd, Beijing, China
| | - Xiao-Ling Yu
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Lee MW, Lim HK. Management of sub-centimeter recurrent hepatocellular carcinoma after curative treatment: Current status and future. World J Gastroenterol 2018; 24:5215-5222. [PMID: 30581270 PMCID: PMC6295838 DOI: 10.3748/wjg.v24.i46.5215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/24/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinomas (HCCs) frequently recur despite initial successful surgical resection or local ablation therapy. Diagnostic methods for small HCCs have improved with the introduction of gadoxetic acid-enhanced liver magnetic resonance imaging and diffusion-weighted imaging (DWI). Currently, sub-centimeter recurrent nodules showing typical hallmark imaging findings of HCC are frequently detected in patients with a treatment history for HCC. With five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and DWI, and low signal intensity on hepatobiliary phase, sub-centimeter recurrent HCC can be diagnosed with high accuracy. Although more information is needed to determine the treatment of choice, local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seem to be promising as they are effective and safe for the management of sub-centimeter recurrent HCCs.
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Affiliation(s)
- Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, South Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, South Korea
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Lee H, Yoon CJ, Seong NJ, Jeong SH, Kim JW. Comparison of Combined Therapy Using Conventional Chemoembolization and Radiofrequency Ablation Versus Conventional Chemoembolization for Ultrasound-Invisible Early-Stage Hepatocellular Carcinoma (Barcelona Clinic Liver Cancer Stage 0 or A). Korean J Radiol 2018; 19:1130-1139. [PMID: 30386144 PMCID: PMC6201969 DOI: 10.3348/kjr.2018.19.6.1130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To compare the therapeutic efficacy between conventional transarterial chemoembolization (cTACE) and combined therapy using cTACE and radiofrequency ablation (RFA) in ultrasound (US)-invisible early stage hepatocellular carcinoma (HCC). Materials and Methods From January 2008 to June 2016, 167 patients with US-invisible early stage HCCs were treated with cTACE alone (cTACE group; n = 85) or cTACE followed by immediate fluoroscopy-guided RFA targeting intratumoral iodized oil retention (combined group; n = 82). Procedure-related complications, local tumor progression (LTP), time to progression (TTP), and overall survival (OS) were compared between the two groups. Multivariate analyses were performed to identify prognostic factors. Results There was no major complication in either group. The cTACE group showed higher 1-, 3-, and 5-year LTP rates than the combined group; i.e., 12.5%, 31.7%, and 37.0%, respectively, in the cTACE group; compared to 7.3%, 16.5%, and 16.5%, respectively, in the combined group; p = 0.013. The median TTP was 18 months in the cTACE group and 24 months in the combined group (p = 0.037). Cumulative 1-, 3-, and 5-year OS rates were 100%, 93.2%, and 87.7%, respectively, in the cTACE group and 100%, 96.6%, and 87.4%, respectively, in the combined group (p = 0.686). Tumor diameter > 20 mm and cTACE monotherapy were independent risk factors for LTP and TTP. Conclusion Combined therapy using cTACE followed by fluoroscopy-guided RFA is a safe and effective treatment in US-invisible early stage HCCs. It provides less LTP and longer TTP than cTACE alone.
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Affiliation(s)
- Hyukjoon Lee
- Division of Vascular and Interventional Radiology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Chang Jin Yoon
- Division of Vascular and Interventional Radiology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Nak Jong Seong
- Division of Vascular and Interventional Radiology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sook-Hyang Jeong
- Division of Internal Medicines, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jin-Wook Kim
- Division of Internal Medicines, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Xu E, Long Y, Li K, Zeng Q, Tan L, Luo L, Huang Q, Zheng R. Comparison of CT/MRI-CEUS and US-CEUS fusion imaging techniques in the assessment of the thermal ablation of liver tumors. Int J Hyperthermia 2018; 35:159-167. [PMID: 30300032 DOI: 10.1080/02656736.2018.1487591] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Erjiao Xu
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yinglin Long
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingjing Zeng
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Tan
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liping Luo
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiannan Huang
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Medical Ultrasonic, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Weiss J, Hoffmann R, Rempp H, Keβler DE, Pereira PL, Nikolaou K, Clasen S. Feasibility, efficacy, and safety of percutaneous MR-guided ablation of small (≤12 mm) hepatic malignancies. J Magn Reson Imaging 2018; 49:374-381. [PMID: 30221797 DOI: 10.1002/jmri.26252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Percutaneous tumor ablation is commonly performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor may be challenging. MRI guidance provides more reliable visualization of target tumors and allows for real-time imaging and multiplanar capabilities, making it the modality of choice, in particular if lesions are small. PURPOSE To investigate the feasibility, technical success, and safety of percutaneous MR-guided ablation (RFA n = 27 / MWA n = 16) of small (≤12 mm) hepatic malignancies. STUDY TYPE Retrospective case study. POPULATION In all, 45 patients (age: 61.1 ± 11.8) with hepatic malignancies and a lesion diameter of ≤12 mm scheduled for percutaneous MR-guided tumor ablation based on a tumor board decision were included. FIELD STRENGTH A 1.5T MR system was used for planning, targeting, and monitoring. ASSESSMENT Feasibility assessment included the detection of the target tumor, tumor delineation during MR-fluoroscopy guided targeting, and the number of attempts needed for precise applicator placement. Technical success was defined as successful performance of the procedure including a safety margin of 5 mm. Safety evaluation was based on procedure-related complications. STATISTICAL TEST Frequency. RESULTS Tumor ablation (mean diameter 9.0 ± 2.1 mm) was successfully completed in 43/45 patients. Planning imaging was conducted without a contrast agent in 79% (n = 37). In 64% (n = 30), the target tumors were visible with MR-fluoroscopy. In six patients (13%), planning imaging revealed new, unexpected small lesions, which were either treated in the same session (n = 4) or changed therapy management (n = 2) due to diffuse tumor progress. Postprocedural imaging revealed a technical success of 100% (43/43), with no major complications. During follow-up, no local tumor progression was observed (mean follow-up 24.7 ± 14.0 months) although 28% (12) patients developed new hepatic lesions distant to the ablation zone. No major complications were observed. DATA CONCLUSION MR-guided ablation is a feasible approach for an effective and safe treatment of small hepatic malignancies. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2019;49:374-381.
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Hansjoerg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - David-Emanuel Keβler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
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Favazza CP, Gorny KR, Callstrom MR, Kurup AN, Washburn M, Trester PS, Fowler CL, Hangiandreou NJ. Development of a robust MRI fiducial system for automated fusion of MR-US abdominal images. J Appl Clin Med Phys 2018; 19:261-270. [PMID: 29785834 PMCID: PMC6036384 DOI: 10.1002/acm2.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022] Open
Abstract
We present the development of a two‐component magnetic resonance (MR) fiducial system, that is, a fiducial marker device combined with an auto‐segmentation algorithm, designed to be paired with existing ultrasound probe tracking and image fusion technology to automatically fuse MR and ultrasound (US) images. The fiducial device consisted of four ~6.4 mL cylindrical wells filled with 1 g/L copper sulfate solution. The algorithm was designed to automatically segment the device in clinical abdominal MR images. The algorithm's detection rate and repeatability were investigated through a phantom study and in human volunteers. The detection rate was 100% in all phantom and human images. The center‐of‐mass of the fiducial device was robustly identified with maximum variations of 2.9 mm in position and 0.9° in angular orientation. In volunteer images, average differences between algorithm‐measured inter‐marker spacings and actual separation distances were 0.53 ± 0.36 mm. “Proof‐of‐concept” automatic MR‐US fusions were conducted with sets of images from both a phantom and volunteer using a commercial prototype system, which was built based on the above findings. Image fusion accuracy was measured to be within 5 mm for breath‐hold scanning. These results demonstrate the capability of this approach to automatically fuse US and MR images acquired across a wide range of clinical abdominal pulse sequences.
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Affiliation(s)
| | | | | | - Anil N. Kurup
- Department of Radiology; Mayo Clinic; Rochester MN USA
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Song KD, Lee MW, Rhim H, Kang TW, Cha DI, Sinn DH, Lim HK. Percutaneous US/MRI Fusion-guided Radiofrequency Ablation for Recurrent Subcentimeter Hepatocellular Carcinoma: Technical Feasibility and Therapeutic Outcomes. Radiology 2018; 288:878-886. [PMID: 29916771 DOI: 10.1148/radiol.2018172743] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To evaluate the technical feasibility and therapeutic outcomes of percutaneous US/MRI fusion-guided radiofrequency ablation (RFA) of recurrent subcentimeter-sized hepatocellular carcinomas (HCCs). Materials and Methods For this retrospective study, between January 2012 and December 2014 a total of 194 planning US examinations were performed in 186 patients (159 men and 27 women; mean age, 61.1 years ± 10.0 [standard deviation]) for newly developed subcentimeter recurrent HCCs. These recurrent HCCs were defined as hypervascular nodules (>5.5 mm and <10 mm) with typical MRI findings of HCC. The study assessed how often US/MRI fusion-guided percutaneous RFA was deemed technically feasible at planning US examination (the feasibility rate) and the therapeutic outcomes after RFA, including the rates of technical success, technique efficacy, local tumor progression (LTP), and major complications. Cumulative LTP rates were estimated with the Kaplan-Meier method. Results The feasibility rate of percutaneous RFA at planning US examination was 65.7% (138 of 210 HCCs). The most common reason for RFA infeasibility was that an index tumor was inconspicuous at US. Among 138 subcentimeter HCCs feasible for RFA, 125 lesions underwent percutaneous RFA. The rates of both technical success and technique efficacy were 98.4% (123 of 125). The cumulative LTP rates at 1, 2, and 3 years were 3.6%, 5.4%, and 7.4%, respectively. The major complication rate was 2.5% (three of 119). Conclusion Percutaneous US/MRI fusion-guided radiofrequency ablation (RFA) was feasible in approximately two-thirds of subcentimeter recurrent hepatocellular carcinomas (HCCs). Percutaneous US/MRI fusion-guided RFA is a safe and effective treatment modality for patients with subcentimeter recurrent HCCs.
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Affiliation(s)
- Kyoung Doo Song
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Min Woo Lee
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Hyunchul Rhim
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Tae Wook Kang
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Dong Ik Cha
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Dong Hyun Sinn
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
| | - Hyo Keun Lim
- From the Departments of Radiology (K.D.S., M.W.L., H.R., T.W.K., D.I.C., H.K.L.) and Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R., H.K.L.)
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Percutaneous Radiofrequency Ablation of Small (1-2 cm) Hepatocellular Carcinomas Inconspicuous on B-Mode Ultrasonographic Imaging: Usefulness of Combined Fusion Imaging with MRI and Contrast-Enhanced Ultrasonography. Can J Gastroenterol Hepatol 2018; 2018:7926923. [PMID: 30013957 PMCID: PMC6022314 DOI: 10.1155/2018/7926923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/04/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To assess usefulness of adding contrast-enhanced ultrasonography (CEUS) to fusion imaging (FI) for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) inconspicuous on FI alone. Therapeutic outcomes of RFA under CEUS-added FI guidance for HCCs inconspicuous on FI alone were also evaluated. METHODS This prospective study was approved by the institutional review board and informed consent was obtained from all patients. Planning US was performed with FI for 126 patients with a single HCC (1-2 cm) to evaluate the feasibility of RFA by grading lesion conspicuity score using a four-point scale. RFA was performed under CEUS-added FI guidance for HCCs inconspicuous on FI alone. We evaluated how many HCCs initially inconspicuous on FI became conspicuous after adding CEUS. After CEUS-added FI-guided RFA, therapeutic outcomes including rates of technical success, primary technique efficacy, major complications, and local tumor progression were assessed. RESULTS After adding CEUS, 90.5% (19/21) of all tumors initially inconspicuous on FI became conspicuous, thus enabling direct targeting for RFA. Technical success and primary technique efficacy rates were 94.7% (18/19) and 100% (19/19), respectively. No major complications were observed after RFA. Cumulative local tumor progression rates after RFA were estimated to be 5.3%, 10.8%, and 10.8% at 1, 2, and 3 years, respectively. CONCLUSION Adding CEUS to FI is useful for improving the conspicuity of HCCs inconspicuous on FI alone, thus enabling successful percutaneous RFA with excellent therapeutic outcomes.
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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: 7.1] [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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50
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Kim S, Kang T, Kim M, Lee M, Cho S, Paik Y, Kim MJ. Initial radiofrequency ablation failure for hepatocellular carcinoma: repeated radiofrequency ablation versus transarterial chemoembolisation. Clin Radiol 2018; 73:216.e1-216.e8. [DOI: 10.1016/j.crad.2017.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023]
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