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Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.

Li K, Su ZZ, Xu EJ, Ju JX, Meng XC, Zheng RQ - BMC Cancer (2016)

Bottom Line: The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded.The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min.The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.

ABSTRACT

Background: To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation.

Methods: Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.

Results: The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043).

Conclusion: CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.

No MeSH data available.


Related in: MedlinePlus

a1-a3 One delayed phase series of MR in DICOM format was transferred into the navigation system, and the navigation system automatically generated the three-dimensional data and showed the transverse, coronal and sagittal plane of the tumor. b1-b3 The index tumor is outlined in blue. c1-c3 The 5-mm AM is outlined in yellow
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Fig2: a1-a3 One delayed phase series of MR in DICOM format was transferred into the navigation system, and the navigation system automatically generated the three-dimensional data and showed the transverse, coronal and sagittal plane of the tumor. b1-b3 The index tumor is outlined in blue. c1-c3 The 5-mm AM is outlined in yellow

Mentions: A flow diagram of intraoperative AM assessment and management is shown in Fig. 1. The fusion was performed 10–15 min after ablation to decrease the interference of gas in the ablative area. First, one CT/MR portal or delayed phase series in DICOM format was transferred into the navigation system in MyLab Twice, which could be performed before ablation. The navigation system automatically generated the three-dimensional (3D) data and displayed the reconstructed 3D-CT/MR images. The index tumor and 5-mm AM were outlined in different colors (Fig. 2). For co-registration, the axial section of the medial line of the body between the CT/MR and the primary ultrasound scan was used. Vascular structures, such as bifurcations or confluences of the portal and hepatic veins, were frequently chosen as anatomical landmarks. After planar registration, additional refinement was performed to enable more precise fusion. All co-registrations and refinements were performed at the end of expiration, which was controlled by a breathing machine. Image fusion was only achieved at the area around the index lesion rather than the whole liver.Fig. 1


Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.

Li K, Su ZZ, Xu EJ, Ju JX, Meng XC, Zheng RQ - BMC Cancer (2016)

a1-a3 One delayed phase series of MR in DICOM format was transferred into the navigation system, and the navigation system automatically generated the three-dimensional data and showed the transverse, coronal and sagittal plane of the tumor. b1-b3 The index tumor is outlined in blue. c1-c3 The 5-mm AM is outlined in yellow
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4836159&req=5

Fig2: a1-a3 One delayed phase series of MR in DICOM format was transferred into the navigation system, and the navigation system automatically generated the three-dimensional data and showed the transverse, coronal and sagittal plane of the tumor. b1-b3 The index tumor is outlined in blue. c1-c3 The 5-mm AM is outlined in yellow
Mentions: A flow diagram of intraoperative AM assessment and management is shown in Fig. 1. The fusion was performed 10–15 min after ablation to decrease the interference of gas in the ablative area. First, one CT/MR portal or delayed phase series in DICOM format was transferred into the navigation system in MyLab Twice, which could be performed before ablation. The navigation system automatically generated the three-dimensional (3D) data and displayed the reconstructed 3D-CT/MR images. The index tumor and 5-mm AM were outlined in different colors (Fig. 2). For co-registration, the axial section of the medial line of the body between the CT/MR and the primary ultrasound scan was used. Vascular structures, such as bifurcations or confluences of the portal and hepatic veins, were frequently chosen as anatomical landmarks. After planar registration, additional refinement was performed to enable more precise fusion. All co-registrations and refinements were performed at the end of expiration, which was controlled by a breathing machine. Image fusion was only achieved at the area around the index lesion rather than the whole liver.Fig. 1

Bottom Line: The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded.The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min.The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.

ABSTRACT

Background: To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation.

Methods: Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.

Results: The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043).

Conclusion: CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.

No MeSH data available.


Related in: MedlinePlus