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Ebner R, Rübenthaler J, Ricke J, Sheikh GT, Unterrainer LM, Auernhammer CJ, Spitzweg C, Brendel M, Schmid-Tannwald C, Cyran CC. [Imaging of neuroendocrine tumors of the gastrointestinal tract : Value of (hybrid) imaging diagnostics in radiology]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00117-024-01296-y. [PMID: 38713221 DOI: 10.1007/s00117-024-01296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
CLINICAL/METHODICAL ISSUE Neuroendocrine tumors (NET) represent a heterogeneous group of rare tumors that predominantly arise in the gastrointestinal tract. At the time of initial diagnosis, the NET has already spread locoregionally in about half of the patients, and 27% of patients have already developed distant metastases. Since this plays a crucial role in therapy planning, accurate diagnostic imaging is important. STANDARD RADIOLOGICAL METHODS Due to its high temporal and spatial resolution (multiphasic including arterial phase), computed tomography (CT) plays a decisive role in primary staging and follow-up care, while magnetic resonance imaging (MRI) with its excellent soft tissue contrast offers advantages in the assessment of parenchymal organs in the upper abdomen. METHODICAL INNOVATIONS Somatostatin receptor (SSR) positron emission tomography (PET) provides additional functional information that not only helps to detect the primary tumor and distant metastases, but also has a significant influence on therapeutic management in a theranostic approach. PERFORMANCE Hybrid imaging using SSR-PET/CT has proven to be particularly effective in the detection of NET. Compared to conventional imaging, it provides additional information in 68% of patients, which has a significant impact on clinical management. ACHIEVEMENTS Imaging of NET requires the combined use of various methods such as ultrasound, CT, MRI, and PET/CT to enable accurate diagnosis and effective treatment planning. PRACTICAL RECOMMENDATIONS SSR-PET/CT is a valuable tool for the accurate staging of neuroendocrine tumors of the gastrointestinal tract, especially with small metastases, while MRI with hepatocyte-specific contrast agent and diffusion-weighted imaging is useful for the specific assessment of liver metastases.
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Affiliation(s)
- R Ebner
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - J Rübenthaler
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
- Interdisziplinäres Zentrum für Neuroendokrine Tumoren des Gastroenteropankreatischen Systems (GEPNET-KUM), LMU Klinikum, LMU München, München, Deutschland
| | - J Ricke
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
- Interdisziplinäres Zentrum für Neuroendokrine Tumoren des Gastroenteropankreatischen Systems (GEPNET-KUM), LMU Klinikum, LMU München, München, Deutschland
| | - G T Sheikh
- Klinik und Poliklinik für Nuklearmedizin, LMU Klinikum, LMU München, München, Deutschland
| | - L M Unterrainer
- Klinik und Poliklinik für Nuklearmedizin, LMU Klinikum, LMU München, München, Deutschland
| | - C J Auernhammer
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU München, München, Deutschland
- Interdisziplinäres Zentrum für Neuroendokrine Tumoren des Gastroenteropankreatischen Systems (GEPNET-KUM), LMU Klinikum, LMU München, München, Deutschland
| | - C Spitzweg
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU München, München, Deutschland
- Interdisziplinäres Zentrum für Neuroendokrine Tumoren des Gastroenteropankreatischen Systems (GEPNET-KUM), LMU Klinikum, LMU München, München, Deutschland
| | - M Brendel
- Klinik und Poliklinik für Nuklearmedizin, LMU Klinikum, LMU München, München, Deutschland
| | - C Schmid-Tannwald
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - C C Cyran
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
- Interdisziplinäres Zentrum für Neuroendokrine Tumoren des Gastroenteropankreatischen Systems (GEPNET-KUM), LMU Klinikum, LMU München, München, Deutschland
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2
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Zhou W, Li X, Zabihollahy F, Lu DS, Wu HH. Deep learning-based automatic pipeline for 3D needle localization on intra-procedural 3D MRI. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03077-3. [PMID: 38520646 DOI: 10.1007/s11548-024-03077-3] [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: 10/19/2023] [Accepted: 02/09/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Accurate and rapid needle localization on 3D magnetic resonance imaging (MRI) is critical for MRI-guided percutaneous interventions. The current workflow requires manual needle localization on 3D MRI, which is time-consuming and cumbersome. Automatic methods using 2D deep learning networks for needle segmentation require manual image plane localization, while 3D networks are challenged by the need for sufficient training datasets. This work aimed to develop an automatic deep learning-based pipeline for accurate and rapid 3D needle localization on in vivo intra-procedural 3D MRI using a limited training dataset. METHODS The proposed automatic pipeline adopted Shifted Window (Swin) Transformers and employed a coarse-to-fine segmentation strategy: (1) initial 3D needle feature segmentation with 3D Swin UNEt TRansfomer (UNETR); (2) generation of a 2D reformatted image containing the needle feature; (3) fine 2D needle feature segmentation with 2D Swin Transformer and calculation of 3D needle tip position and axis orientation. Pre-training and data augmentation were performed to improve network training. The pipeline was evaluated via cross-validation with 49 in vivo intra-procedural 3D MR images from preclinical pig experiments. The needle tip and axis localization errors were compared with human intra-reader variation using the Wilcoxon signed rank test, with p < 0.05 considered significant. RESULTS The average end-to-end computational time for the pipeline was 6 s per 3D volume. The median Dice scores of the 3D Swin UNETR and 2D Swin Transformer in the pipeline were 0.80 and 0.93, respectively. The median 3D needle tip and axis localization errors were 1.48 mm (1.09 pixels) and 0.98°, respectively. Needle tip localization errors were significantly smaller than human intra-reader variation (median 1.70 mm; p < 0.01). CONCLUSION The proposed automatic pipeline achieved rapid pixel-level 3D needle localization on intra-procedural 3D MRI without requiring a large 3D training dataset and has the potential to assist MRI-guided percutaneous interventions.
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Affiliation(s)
- Wenqi Zhou
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Xinzhou Li
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Fatemeh Zabihollahy
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA
- Joint Department of Medical Imaging, Sinai Health System and University of Toronto, Toronto, Canada
| | - David S Lu
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA.
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA.
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3
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Schmidt VF, Öcal O, Walther V, Fabritius MP, Dietrich O, Kazmierczak PM, Weiss L, Deniz S, Ümütlü MR, Puhr-Westerheide D, Wildgruber M, Ricke J, Seidensticker M. Clinical benefits of MRI-guided freehand biopsy of small focal liver lesions in comparison to CT guidance. Eur Radiol 2024:10.1007/s00330-024-10623-9. [PMID: 38319427 DOI: 10.1007/s00330-024-10623-9] [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: 08/24/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To compare clinical success, procedure time, and complication rates between MRI-guided and CT-guided real-time biopsies of small focal liver lesions (FLL) < 20 mm. METHODS A comparison of a prospectively collected MRI-guided cohort (n = 30) to a retrospectively collected CT-guided cohort (n = 147) was performed, in which patients underwent real-time biopsies of small FLL < 20 mm in a freehand technique. In both groups, clinical and periprocedural data, including clinical success, procedure time, and complication rates (classified according to CIRSE guidelines), were analyzed. Wilcoxon rank sum test, Pearson's chi-squared test, and Fisher's exact test were used for statistical analysis. Additionally, propensity score matching (PSM) was performed using the following criteria for direct matching: age, gender, presence of liver cirrhosis, liver lobe, lesion diameter, and skin-to-target distance. RESULTS The median FLL diameter in the MRI-guided cohort was significantly smaller compared to CT guidance (p < 0.001; 11.0 mm vs. 16.3 mm), while the skin-to-target distance was significantly longer (p < 0.001; 90.0 mm vs. 74.0 mm). MRI-guided procedures revealed significantly higher clinical success compared to CT guidance (p = 0.021; 97% vs. 79%) as well as lower complication rates (p = 0.047; 0% vs. 13%). Total procedure time was significantly longer in the MRI-guided cohort (p < 0.001; 38 min vs. 28 min). After PSM (n = 24/n = 38), MRI-guided procedures still revealed significantly higher clinical success compared to CT guidance (p = 0.039; 96% vs. 74%). CONCLUSION Despite the longer procedure time, freehand biopsy of small FLL < 20 mm under MR guidance can be considered superior to CT guidance because of its high clinical success and low complication rates. CLINICAL RELEVANCE STATEMENT Biopsy of small liver lesions is challenging due to the size and conspicuity of the lesions on native images. MRI offers higher soft tissue contrast, which translates into a higher success of obtaining enough tissue material with MRI compared to CT-guided biopsies. KEY POINTS • Image-guided biopsy of small focal liver lesions (FLL) is challenging due to inadequate visualization, leading to sampling errors and false-negative biopsies. • MRI-guided real-time biopsy of FLL < 20 mm revealed significantly higher clinical success (p = 0.021; 97% vs. 79%) and lower complication rates (p = 0.047; 0% vs. 13%) compared to CT guidance. • Although the procedure time is longer, MRI-guided biopsy can be considered superior for small FLL < 20 mm.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Viktoria Walther
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Olaf Dietrich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Lena Weiss
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Muzzafer R Ümütlü
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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4
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Di Matteo B, Polignano A, Onorato F, La Porta A, Iacono F, Bonanzinga T, Raspugli G, Marcacci M, Kon E. Knee Intraosseous Injections: A Systematic Review of Clinical Evidence of Different Treatment Alternatives. Cartilage 2021; 13:1165S-1177S. [PMID: 32959675 PMCID: PMC8808871 DOI: 10.1177/1947603520959403] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To systematically review the available clinical evidence regarding the safety and efficacy of knee intraosseous injections for the treatment of bone marrow lesions in patients affected by knee osteoarthritis. DESIGN A literature search was carried out on PubMed, Embase, and Google Scholar databases in January 2020. The following inclusion criteria were adopted: (1) studies of any level of evidence, dealing with subchondral injection of bone substitute materials and/or biologic agents; (2) studies with minimum 5 patients treated; and (3) studies with at least 6 months' follow-up evaluation. All relevant data concerning clinical outcomes, adverse events, and rate of conversion to arthroplasty were extracted. RESULTS A total of 12 studies were identified: 7 dealt with calcium phosphate administration, 3 with platelet-rich plasma, and 2 with bone marrow concentrate injection. Only 2 studies were randomized controlled trials, whereas 6 studies were prospective and the remaining 4 were retrospective. Studies included a total of 459 patients treated with intraosseous injections. Overall, only a few patients experienced adverse events and clinical improvement was documented in the majority of trial. The lack of any comparative evaluation versus subchondral drilling alone is the main limitation of the available evidence. CONCLUSIONS Knee intraosseous injections are a minimally invasive and safe procedure to address subchondral bone damage in osteoarthritic patients. They are able to provide beneficial effects at short-term evaluation. More high-quality evidence is needed to confirm their potential and to identify the best product to adopt in clinical practice.
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Affiliation(s)
- Berardo Di Matteo
- First Moscow State Medical
University–Sechenov University, Moscow, Russia,Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy,Berardo Di Matteo, Humanitas Clinical and
Research Institute, Via A. Manzoni 113, Rozzano, Milan, 20089, Italy.
| | - Alberto Polignano
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
| | - Francesco Onorato
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
| | - Agostino La Porta
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
| | - Francesco Iacono
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
| | - Tommaso Bonanzinga
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
| | - Giovanni Raspugli
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
| | - Maurilio Marcacci
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
| | - Elizaveta Kon
- Humanitas University, Department of
Biomedical Sciences, Milan, Italy,Humanitas Clinical and Research Center,
IRCCS, Rozzano, Milan, Italy
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5
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Betzler BK, Chee YYJ, Bin Abd Razak HR. Intraosseous Injections Are Safe And Effective in Knee Osteoarthritis: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e1557-e1567. [PMID: 34712993 PMCID: PMC8527247 DOI: 10.1016/j.asmr.2021.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate clinical outcomes after intraosseous injection for knee osteoarthritis systematically with available clinical evidence. Methods A systematic search methodology of the PUBMED, EMBASE, and CINAHL databases was conducted in November 2020. The search workflow was in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following inclusion criteria were adopted: clinical trials of any level of evidence, reporting clinical outcomes following intraosseous injections of bone substitutes or biologic agents, and mesenchymal stem cells or platelet-rich plasma into the knee as treatment modalities for osteoarthritis. Duplicate data and articles not written in English were excluded from this review. Results Six studies were identified and included in this review, with a total of 167 patients. Two studies used subchondroplasty CaP injections, while 4 studies used intraosseous injections of platelet-rich plasma. Two studies provided Level II evidence, 2 studies provided Level III evidence, and a further 2 provided Level IV evidence. Five out of 6 studies reported data using the visual analog scale, 4 studies used the Knee Injury and Osteoarthritis Outcome Score, while 3 studies used the Western Ontario and McMaster Universities Osteoarthritis Index. Clinical improvements in pain and functionality were documented in all trials, with only a few patients experiencing adverse events. Conclusion Intraosseous injections for knee osteoarthritis are safe and effective. However, multiple pertinent variables such as safety, cost of treatment, and performance against placebos and other treatment modalities require further evaluation before intraosseous injections can be considered as standard treatment for patients presenting with osteoarthritis of the knee.
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Affiliation(s)
- Brjan Kaiji Betzler
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yan-Yu Julius Chee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore.,SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Singapore
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6
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Pan L, Valdeig S, Kägebein U, Qing K, Fetics B, Roth A, Nevo E, Hensen B, Weiss CR, Wacker FK. Integration and evaluation of a gradient-based needle navigation system for percutaneous MR-guided interventions. PLoS One 2020; 15:e0236295. [PMID: 32706813 PMCID: PMC7380643 DOI: 10.1371/journal.pone.0236295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
The purpose of the present study was to integrate an interactive gradient-based needle navigation system and to evaluate the feasibility and accuracy of the system for real-time MR guided needle puncture in a multi-ring phantom and in vivo in a porcine model. The gradient-based navigation system was implemented in a 1.5T MRI. An interactive multi-slice real-time sequence was modified to provide the excitation gradients used by two sets of three orthogonal pick-up coils integrated into a needle holder. Position and orientation of the needle holder were determined and the trajectory was superimposed on pre-acquired MR images. A gel phantom with embedded ring targets was used to evaluate accuracy using 3D distance from needle tip to target. Six punctures were performed in animals to evaluate feasibility, time, overall error (target to needle tip) and system error (needle tip to the guidance needle trajectory) in vivo. In the phantom experiments, the overall error was 6.2±2.9 mm (mean±SD) and 4.4±1.3 mm, respectively. In the porcine model, the setup time ranged from 176 to 204 seconds, the average needle insertion time was 96.3±40.5 seconds (min: 42 seconds; max: 154 seconds). The overall error and the system error was 8.8±7.8 mm (min: 0.8 mm; max: 20.0 mm) and 3.3±1.4 mm (min: 1.8 mm; max: 5.2 mm), respectively.
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Affiliation(s)
- Li Pan
- Siemens Healthineers, Baltimore, MD, United States of America
| | - Steffi Valdeig
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, United States of America
| | - Urte Kägebein
- Department of Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE–Research Campus: Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
| | - Kun Qing
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States of America
- Siemens Corporate Technology, Baltimore, MD, United States of America
| | - Barry Fetics
- Robin Medical Inc., Baltimore, MD, United States of America
| | - Amir Roth
- Robin Medical Inc., Baltimore, MD, United States of America
| | - Erez Nevo
- Robin Medical Inc., Baltimore, MD, United States of America
| | - Bennet Hensen
- Department of Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE–Research Campus: Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
- * E-mail:
| | - Clifford R. Weiss
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, United States of America
| | - Frank K. Wacker
- Department of Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE–Research Campus: Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
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7
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Grimm A, Winkelmann M, Weiß J, Gohla G, Blumenstock G, Nikolaou K, Clasen S, Hoffmann R. Artefact and ablation performance of an MR-conditional high-power microwave system in bovine livers: an ex vivo study. Eur Radiol Exp 2019; 3:39. [PMID: 31549338 PMCID: PMC6757083 DOI: 10.1186/s41747-019-0115-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated a magnetic resonance (MR)-conditional high-power microwave ablation system. Methods An exvivo 1.5-T evaluation was conducted by varying the sequence (T1-weighted volume interpolated breath-hold examination, T1w-VIBE; T1-weighted fast low-angle shot, T1w-FLASH; T2-weighted turbo spin-echo, T2w-TSE), applicator angulation to B0 (A-to-B0), slice orientation, and encoding direction. Tip location error (TLE) and artefact diameters were measured, and influence of imaging parameters was assessed with analysis of variance and post hoc testing. Twenty-four exvivo ablations were conducted in three bovine livers at 80 W and 120 W. Ablation durations were 5, 10, and 15 min. Ablation zones were compared for short-axis diameter (SAD), volume, and sphericity index (SI) with unpaired t test. Results The artefact pattern was similar for all sequences. The shaft artefact (4.4 ± 2.9 mm, mean ± standard deviation) was dependent on the sequence (p = 0.012) and the A-to-B0 (p < 0.001); the largest shaft diameter was measured with T1w-FLASH (6.3 ± 3.4 mm) and with perpendicular A-to-B0 (6.7 ± 2.4 mm). The tip artefact (1.6 ± 0.7 mm) was dependent on A-to-B0 (p = 0.001); TLE was -2.6 ± 1.0 mm. Ablation results at the maximum setting (15 min, 120 W) were SAD = 42.0 ± 1.41 mm; volume = 56.78 ± 3.08 cm3, SI = 0.68 ± 0.05. In all ablations, SI ranged 0.68–0.75 with the smallest SI at 15 min and 120 W (p = 0.048). Conclusion The system produced sufficiently large ablation zones and the artefact was appropriate for MR-guided interventions.
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Affiliation(s)
- Antonia Grimm
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Moritz Winkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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8
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Mewes A, Heinrich F, Hensen B, Wacker F, Lawonn K, Hansen C. Concepts for augmented reality visualisation to support needle guidance inside the MRI. Healthc Technol Lett 2018; 5:172-176. [PMID: 30464849 PMCID: PMC6222244 DOI: 10.1049/htl.2018.5076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/20/2018] [Indexed: 11/20/2022] Open
Abstract
During MRI-guided interventions, navigation support is often separated from the operating field on displays, which impedes the interpretation of positions and orientations of instruments inside the patient's body as well as hand–eye coordination. To overcome these issues projector-based augmented reality can be used to support needle guidance inside the MRI bore directly in the operating field. The authors present two visualisation concepts for needle navigation aids which were compared in an accuracy and usability study with eight participants, four of whom were experienced radiologists. The results show that both concepts are equally accurate (\documentclass[12pt]{minimal}
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}{}$2.0 \pm 0.6$\end{document}2.0±0.6 and \documentclass[12pt]{minimal}
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}{}$1.7 \pm 0.5\, {\rm mm}$\end{document}1.7±0.5mm), useful and easy to use, with clear visual feedback about the state and success of the needle puncture. For easier clinical applicability, a dynamic projection on moving surfaces and organ movement tracking are needed. For now, tests with patients with respiratory arrest are feasible.
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Affiliation(s)
- André Mewes
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Germany
| | - Florian Heinrich
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Germany
| | - Bennet Hensen
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Germany.,Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Germany
| | - Frank Wacker
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Germany.,Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Germany
| | - Kai Lawonn
- Faculty of Computer Science, University of Koblenz-Landau, Germany
| | - Christian Hansen
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Germany
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9
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Mewes A, Heinrich F, Kägebein U, Hensen B, Wacker F, Hansen C. Projector-based augmented reality system for interventional visualization inside MRI scanners. Int J Med Robot 2018; 15:e1950. [DOI: 10.1002/rcs.1950] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022]
Affiliation(s)
- André Mewes
- Faculty of Computer Science; Otto von Guericke University Magdeburg; Magdeburg Germany
| | - Florian Heinrich
- Faculty of Computer Science; Otto von Guericke University Magdeburg; Magdeburg Germany
| | - Urte Kägebein
- Faculty of Computer Science; Otto von Guericke University Magdeburg; Magdeburg Germany
| | - Bennet Hensen
- Institute of Diagnostic and Interventional Radiology; Hannover Medical School; Hanover Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology; Hannover Medical School; Hanover Germany
| | - Christian Hansen
- Faculty of Computer Science; Otto von Guericke University Magdeburg; Magdeburg Germany
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Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
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11
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Busse H, Kahn T, Moche M. Techniques for Interventional MRI Guidance in Closed-Bore Systems. Top Magn Reson Imaging 2018; 27:9-18. [PMID: 29406410 DOI: 10.1097/rmr.0000000000000150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Efficient image guidance is the basis for minimally invasive interventions. In comparison with X-ray, computed tomography (CT), or ultrasound imaging, magnetic resonance imaging (MRI) provides the best soft tissue contrast without ionizing radiation and is therefore predestined for procedural control. But MRI is also characterized by spatial constraints, electromagnetic interactions, long imaging times, and resulting workflow issues. Although many technical requirements have been met over the years-most notably magnetic resonance (MR) compatibility of tools, interventional pulse sequences, and powerful processing hardware and software-there is still a large variety of stand-alone devices and systems for specific procedures only.Stereotactic guidance with the table outside the magnet is common and relies on proper registration of the guiding grids or manipulators to the MR images. Instrument tracking, often by optical sensing, can be added to provide the physicians with proper eye-hand coordination during their navigated approach. Only in very short wide-bore systems, needles can be advanced at the extended arm under near real-time imaging. In standard magnets, control and workflow may be improved by remote operation using robotic or manual driving elements.This work highlights a number of devices and techniques for different interventional settings with a focus on percutaneous, interstitial procedures in different organ regions. The goal is to identify technical and procedural elements that might be relevant for interventional guidance in a broader context, independent of the clinical application given here. Key challenges remain the seamless integration into the interventional workflow, safe clinical translation, and proper cost effectiveness.
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Affiliation(s)
- Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
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Koch G, Garnon J, Tsoumakidou G, Edalat F, Caudrelier J, Cazzato RL, Gangi A. Adrenal Biopsy under Wide-Bore MR Imaging Guidance. J Vasc Interv Radiol 2018; 29:285-290. [DOI: 10.1016/j.jvir.2017.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/02/2017] [Accepted: 04/24/2017] [Indexed: 01/20/2023] Open
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Kessler DE, Weiss J, Rempp H, Pereira PL, Nikolaou K, Clasen S, Hoffmann R. In vitro artifact assessment of an MR-compatible, microwave antenna device for percutaneous tumor ablation with fluoroscopic MRI-sequences. MINIM INVASIV THER 2017; 27:60-68. [PMID: 29231067 DOI: 10.1080/13645706.2017.1414062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate artifact configuration and diameters of a magnetic resonance (MR) compatible microwave (MW) applicator using near-realtime MR-fluoroscopic sequences for percutaneous tumor ablation procedures. MATERIAL AND METHODS Two MW applicators (14 G and 16 G) were tested in an ex-vivo phantom at 1.5 T with two 3 D fluoroscopic sequences: T1-weighted spoiled Gradient Echo (GRE) and T1/T2-weighted Steady State Free Precession (SSFP) sequence. Applicator orientation to main magnetic field (B0), slice orientation and phase encoding direction (PED) were systematically varied. The influence of these variables was assessed with ANOVA and post-hoc testing. RESULTS The artifact was homogenous along the whole length of both antennas with all tested parameters. The tip artifact diameter of the 16 G antenna measured 6.9 ± 1.0 mm, the shaft artifact diameter 8.6 ± 1.2 mm and the Tip Location Error (TLE) was 1.5 ± 1.2 mm.The tip artifact diameter of the 14 G antenna measured 7.7 ± 1.2 mm, the shaft artifact diameter 9.6 ± 1.5 mm and TLE was 1.6 ± 1.2 mm. Orientation to B0 had no statistically significant influence on tip artifact diameters (16 G: p = .55; 14 G: p = .07) or TLE (16 G: p = .93; 14 G: p = .26). GRE sequences slightly overestimated the antenna length with TLE(16 G) = 2.6 ± 0.5 mm and TLE(14 G) = 2.7 ± 0.7 mm. CONCLUSIONS The MR-compatible MW applicator's artifact seems adequate with an acceptable TLE for safe applicator positioning during near-realtime fluoroscopic MR-guidance.
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Affiliation(s)
- David-Emanuel Kessler
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Jakob Weiss
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Hansjörg Rempp
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Philippe L Pereira
- b Department of Radiology, Minimally Invasive Therapies and Nuclear Medicine , SLK-Kliniken Heilbronn , Heilbronn , Germany
| | - Konstantin Nikolaou
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Stephan Clasen
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Rüdiger Hoffmann
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
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MRI guided needle localization in a patient with recurrence pleomorphic sarcoma and post-operative scarring. Skeletal Radiol 2017; 46:975-981. [PMID: 28280850 DOI: 10.1007/s00256-017-2614-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 02/06/2023]
Abstract
MRI-guided wire localization is commonly used for surgical localization of breast lesions. Here we introduce an alternative use of this technique to help with surgical resection of a recurrent pleomorphic sarcoma embedded in extensive post-treatment scar tissue. We describe a case of recurrent pleomorphic soft tissue sarcoma in the thigh after treatment with neoadjuvant therapy, surgery, and radiation. Due to the distortion of the normal tissue architecture and formation of extensive scar tissue from prior treatment, wire localization under MRI was successfully used to assist the surgeon in identifying the recurrent tumor for removal.
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Hoffmann R, Rempp H, Keßler DE, Weiß J, Pereira PL, Nikolaou K, Clasen S. MR-guided microwave ablation in hepatic tumours: initial results in clinical routine. Eur Radiol 2016; 27:1467-1476. [PMID: 27553935 DOI: 10.1007/s00330-016-4517-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/11/2016] [Accepted: 07/19/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Evaluation of the technical success, patient safety and technical effectiveness of magnetic resonance (MR)-guided microwave ablation of hepatic malignancies. METHODS Institutional review board approval and informed patient consent were obtained. Fifteen patients (59.8 years ± 9.5) with 18 hepatic malignancies (7 hepatocellular carcinomas, 11 metastases) underwent MR-guided microwave ablation using a 1.5-T MR system. Mean tumour size was 15.4 mm ± 7.7 (7-37 mm). Technical success and ablation zone diameters were assessed by post-ablative MR imaging. Technique effectiveness was assessed after 1 month. Complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). Mean follow-up was 5.8 months ± 2.6 (1-10 months). RESULTS Technical success and technique effectiveness were achieved in all lesions. Lesions were treated using 2.5 ± 1.2 applicator positions. Mean energy and ablation duration per tumour were 37.6 kJ ± 21.7 (9-87 kJ) and 24.7 min ± 11.1 (7-49 min), respectively. Coagulation zone short- and long-axis diameters were 31.5 mm ± 10.5 (16-65 mm) and 52.7 mm ± 15.4 (27-94 mm), respectively. Two CTCAE-2-complications occurred (pneumothorax, pleural effusion). Seven patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed. CONCLUSIONS Microwave ablation is feasible under near real-time MR guidance and provides effective treatment of hepatic malignancies in one session. KEY POINTS • Planning, applicator placement and therapy monitoring are possible without using contrast enhancement • Energy transmission from the generator to the scanner room is safely possible • MR-guided microwave ablation provides effective treatment of hepatic malignancies in one session • Therapy monitoring is possible without applicator retraction from the ablation site.
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Affiliation(s)
- Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
| | - Hansjörg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - David-Emanuel Keßler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclear Medicine, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
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Kaltenbach B, Roman A, Eichler K, Nour-Eldin NEA, Vogl TJ, Zangos S. Real-time qualitative MR monitoring of microwave ablation in ex vivo livers. Int J Hyperthermia 2016; 32:757-64. [DOI: 10.1080/02656736.2016.1204629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Benjamin Kaltenbach
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
| | - Andrei Roman
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
| | - Nour-Eldin A. Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
| | - Stephan Zangos
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
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Garnon J, Ramamurthy N, Caudrelier J J, Erceg G, Breton E, Tsoumakidou G, Rao P, Gangi A. MRI-Guided Percutaneous Biopsy of Mediastinal Masses Using a Large Bore Magnet: Technical Feasibility. Cardiovasc Intervent Radiol 2015; 39:761-767. [PMID: 26604114 DOI: 10.1007/s00270-015-1246-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 09/11/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy and safety of magnetic resonance imaging (MRI)-guided percutaneous biopsy of mediastinal masses performed using a wide-bore high-field scanner. MATERIALS AND METHODS This is a retrospective study of 16 consecutive patients (8 male, 8 female; mean age 74 years) who underwent MRI-guided core needle biopsy of a mediastinal mass between February 2010 and January 2014. Size and location of lesion, approach taken, time for needle placement, overall duration of procedure, and post-procedural complications were evaluated. Technical success rates and correlation with surgical pathology (where available) were assessed. RESULTS Target lesions were located in the anterior (n = 13), middle (n = 2), and posterior mediastinum (n = 1), respectively. Mean size was 7.2 cm (range 3.6-11 cm). Average time for needle placement was 9.4 min (range 3-18 min); average duration of entire procedure was 42 min (range 27-62 min). 2-5 core samples were obtained from each lesion (mean 2.6). Technical success rate was 100%, with specimens successfully obtained in all 16 patients. There were no immediate complications. Histopathology revealed malignancy in 12 cases (4 of which were surgically confirmed), benign lesions in 3 cases (1 of which was false negative following surgical resection), and one inconclusive specimen (treated as inaccurate since repeat CT-guided biopsy demonstrated thymic hyperplasia). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in our study were 92.3, 100, 100, 66.7, and 87.5%, respectively. CONCLUSION MRI-guided mediastinal biopsy is a safe procedure with high diagnostic accuracy, which may offer a non-ionizing alternative to CT guidance.
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Affiliation(s)
- J Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France.
| | - N Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - J Caudrelier J
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France
| | - G Erceg
- ICube, University of Strasbourg, CNRS, Strasbourg, France
| | - E Breton
- ICube, University of Strasbourg, CNRS, Strasbourg, France
| | - G Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France
| | - P Rao
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France.,ICube, University of Strasbourg, CNRS, Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France.,ICube, University of Strasbourg, CNRS, Strasbourg, France
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Navigated MRI-guided liver biopsies in a closed-bore scanner: experience in 52 patients. Eur Radiol 2015; 26:2462-70. [PMID: 26563349 PMCID: PMC4927599 DOI: 10.1007/s00330-015-4097-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/26/2015] [Accepted: 10/28/2015] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To evaluate clinical effectiveness and diagnostic efficiency of a navigation device for MR-guided biopsies of focal liver lesions in a closed-bore scanner. METHODS In 52 patients, 55 biopsies were performed. An add-on MR navigation system with optical instrument tracking was used for image guidance and biopsy device insertion outside the bore. Fast control imaging allowed visualization of the true needle position at any time. The biopsy workflow and procedure duration were recorded. Histological analysis and clinical course/outcome were used to calculate sensitivity, specificity and diagnostic accuracy. RESULTS Fifty-four of 55 liver biopsies were performed successfully with the system. No major and four minor complications occurred. Mean tumour size was 23 ± 14 mm and the skin-to-target length ranged from 22 to 177 mm. In 39 cases, access path was double oblique. Sensitivity, specificity and diagnostic accuracy were 88 %, 100 % and 92 %, respectively. The mean procedure time was 51 ± 12 min, whereas the puncture itself lasted 16 ± 6 min. On average, four control scans were taken. CONCLUSIONS Using this navigation device, biopsies of poorly visible and difficult accessible liver lesions could be performed safely and reliably in a closed-bore MRI scanner. The system can be easily implemented in clinical routine workflow. KEY POINTS • Targeted liver biopsies could be reliably performed in a closed-bore MRI. • The navigation system allows for image guidance outside of the scanner bore. • Assisted MRI-guided biopsies are helpful for focal lesions with a difficult access. • Successful integration of the method in clinical workflow was shown. • Subsequent system installation in an existing MRI environment is feasible.
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Closed-Bore Interventional MRI: Percutaneous Biopsies and Ablations. AJR Am J Roentgenol 2015; 205:W400-10. [DOI: 10.2214/ajr.15.14732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Targeting Accuracy, Procedure Times and User Experience of 240 Experimental MRI Biopsies Guided by a Clinical Add-On Navigation System. PLoS One 2015. [PMID: 26222443 PMCID: PMC4519044 DOI: 10.1371/journal.pone.0134370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES MRI is of great clinical utility for the guidance of special diagnostic and therapeutic interventions. The majority of such procedures are performed iteratively ("in-and-out") in standard, closed-bore MRI systems with control imaging inside the bore and needle adjustments outside the bore. The fundamental limitations of such an approach have led to the development of various assistance techniques, from simple guidance tools to advanced navigation systems. The purpose of this work was to thoroughly assess the targeting accuracy, workflow and usability of a clinical add-on navigation solution on 240 simulated biopsies by different medical operators. METHODS Navigation relied on a virtual 3D MRI scene with real-time overlay of the optically tracked biopsy needle. Smart reference markers on a freely adjustable arm ensured proper registration. Twenty-four operators - attending (AR) and resident radiologists (RR) as well as medical students (MS) - performed well-controlled biopsies of 10 embedded model targets (mean diameter: 8.5 mm, insertion depths: 17-76 mm). Targeting accuracy, procedure times and 13 Likert scores on system performance were determined (strong agreement: 5.0). RESULTS Differences in diagnostic success rates (AR: 93%, RR: 88%, MS: 81%) were not significant. In contrast, between-group differences in biopsy times (AR: 4:15, RR: 4:40, MS: 5:06 min:sec) differed significantly (p<0.01). Mean overall rating was 4.2. The average operator would use the system again (4.8) and stated that the outcome justifies the extra effort (4.4). Lowest agreement was reported for the robustness against external perturbations (2.8). CONCLUSIONS The described combination of optical tracking technology with an automatic MRI registration appears to be sufficiently accurate for instrument guidance in a standard (closed-bore) MRI environment. High targeting accuracy and usability was demonstrated on a relatively large number of procedures and operators. Between groups with different expertise there were significant differences in experimental procedure times but not in the number of successful biopsies.
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Hoffmann R, Rempp H, Eibofner F, Keßler DE, Blumenstock G, Weiß J, Pereira PL, Nikolaou K, Clasen S. In vitro artefact assessment of a new MR-compatible microwave antenna and a standard MR-compatible radiofrequency ablation electrode for tumour ablation. Eur Radiol 2015; 26:771-9. [DOI: 10.1007/s00330-015-3891-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 12/13/2022]
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Guimarães MD, Hochhegger B, Benveniste MFK, Odisio BC, Gross JL, Zurstrassen CE, Tyng CC, Bitencourt AGV, Marchiori E. Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging. Clinics (Sao Paulo) 2014; 69:787-91. [PMID: 25518038 PMCID: PMC4255081 DOI: 10.6061/clinics/2014(11)13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/17/2014] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To evaluate the preliminary results obtained using diffusion-weighted magnetic resonance imaging and the apparent diffusion coefficient for planning computed tomography-guided biopsies of selected mediastinal lesions. METHODS Eight patients with mediastinal lesions suspicious for malignancy were referred for computed tomography-guided biopsy. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient measurement were performed to assist in biopsy planning with diffusion/computed tomography fused images. We selected mediastinal lesions that could provide discordant diagnoses depending on the biopsy site, including large heterogeneous masses, lesions associated with lung atelectasis or consolidation, lesions involving large mediastinal vessels and lesions for which the results of biopsy using other methods and histopathological examination were divergent from the clinical and radiological suspicion. RESULTS In all cases, the biopsy needle was successfully directed to areas of higher signal intensity on diffusion-weighted sequences and the lowest apparent diffusion coefficient within the lesion (mean, 0.8 [range, 0.6-1.1]×10-3 mm2/s), suggesting high cellularity. All biopsies provided adequate material for specific histopathological diagnoses of four lymphomas, two sarcomas and two thymomas. CONCLUSION Functional imaging tools, such as diffusion-weighted imaging and the apparent diffusion coefficient, are promising for implementation in noninvasive and imaging-guided procedures. However, additional studies are needed to confirm that mediastinal biopsy can be improved with these techniques.
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Affiliation(s)
| | - Bruno Hochhegger
- Department of Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Bruno Calazans Odisio
- Department of Diagnostic and Interventional Radiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | | | - Chiang Cheng Tyng
- Department of Imaging, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro, Petrópolis, RJ, Brazil
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Garnon J, Schlier A, Buy X, Tsoumakidou G, de Mathelin M, Breton E, Gangi A. Evaluation of percutaneous biopsies of renal masses under MRI-guidance: a retrospective study about 26 cases. Eur Radiol 2014; 25:617-23. [DOI: 10.1007/s00330-014-3449-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/11/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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Wireless mobile technology to improve workflow and feasibility of MR-guided percutaneous interventions. Int J Comput Assist Radiol Surg 2014; 10:665-76. [PMID: 25179151 DOI: 10.1007/s11548-014-1109-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE A wireless interactive display and control device combined with a platform-independent web-based user interface (UI) was developed to improve the workflow for interventional magnetic resonance imaging (iMRI). METHODS The iMRI-UI enables image acquisition of up to three independent slices using various pulse sequences with different contrast weighting. Pulse sequence, scan geometry and related parameters can be changed on the fly via the iMRI-UI using a tablet computer for improved lesion detection and interventional device targeting. The iMRI-UI was validated for core biopsies with a liver phantom ([Formula: see text] [Formula: see text] 40) and Thiel soft-embalmed human cadavers ([Formula: see text] [Formula: see text] 24) in a clinical 1.5T MRI scanner. RESULTS The iMRI-UI components and setup were tested and found conditionally MRI-safe to use according to current ASTM standards. Despite minor temporary touch screen interference at a close distance to the bore ([Formula: see text]20 cm), no other issues regarding quality or imaging artefacts were observed. The 3D root-mean-square distance error was [Formula: see text] (phantom)/[Formula: see text] mm (cadaver), and overall procedure times ranged between 12 and 22 (phantom)/20 and 55 min (cadaver). CONCLUSION The wireless iMRI-UI control setup enabled fast and accurate interventional biopsy needle placements along complex trajectories and improved the workflow for percutaneous interventions under MRI guidance in a preclinical trial.
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Rube MA, Fernandez-Gutierrez F, Cox BF, Holbrook AB, Houston JG, White RD, McLeod H, Fatahi M, Melzer A. Preclinical feasibility of a technology framework for MRI-guided iliac angioplasty. Int J Comput Assist Radiol Surg 2014; 10:637-50. [PMID: 25102933 DOI: 10.1007/s11548-014-1102-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/02/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Interventional MRI has significant potential for image guidance of iliac angioplasty and related vascular procedures. A technology framework with in-room image display, control, communication and MRI-guided intervention techniques was designed and tested for its potential to provide safe, fast and efficient MRI-guided angioplasty of the iliac arteries. METHODS A 1.5-T MRI scanner was adapted for interactive imaging during endovascular procedures using new or modified interventional devices such as guidewires and catheters. A perfused vascular phantom was used for testing. Pre-, intra- and post-procedural visualization and measurement of vascular morphology and flow was implemented. A detailed analysis of X-ray fluoroscopic angiography workflow was conducted and applied. Two interventional radiologists and one physician in training performed 39 procedures. All procedures were timed and analyzed. RESULTS MRI-guided iliac angioplasty procedures were successfully performed with progressive adaptation of techniques and workflow. The workflow, setup and protocol enabled a reduction in table time for a dedicated MRI-guided procedure to 6 min 33 s with a mean procedure time of 9 min 2 s, comparable to the mean procedure time of 8 min 42 s for the standard X-ray-guided procedure. CONCLUSIONS MRI-guided iliac vascular interventions were found to be feasible and practical using this framework and optimized workflow. In particular, the real-time flow analysis was found to be helpful for pre- and post-interventional assessments. Design optimization of the catheters and in vivo experiments are required before clinical evaluation.
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Affiliation(s)
- Martin A Rube
- Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 1FD, UK,
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Hoffmann R, Rempp H, Pereira PL, Clasen S. [Image-guided therapy with closed MRI: an update]. Radiologe 2013; 53:986-92. [PMID: 24170285 DOI: 10.1007/s00117-012-2461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STANDARD RADIOLOGICAL METHODS Standard imaging modalities for percutaneous minimally invasive therapy are ultrasound, fluoroscopy and computed tomography. METHODICAL INNOVATIONS Magnetic resonance imaging is becoming increasingly more popular for minimally invasive procedures. The advantages are high soft-tissue contrast, the possibility of free selection of multiple imaging slices, multiple tools for intrainterventional monitoring and the absence of ionizing radiation for the patient and the interventional radiologist. ACHIEVEMENTS Magnetic resonance imaging is a promising imaging modality for minimally invasive procedures. The most common clinical applications are thermoablative procedures for treatment of hepatic, renal and prostatic malignancies.
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Affiliation(s)
- R Hoffmann
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland,
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Rothgang E, Gilson WD, Wacker F, Hornegger J, Lorenz CH, Weiss CR. Rapid freehand MR-guided percutaneous needle interventions: An image-based approach to improve workflow and feasibility. J Magn Reson Imaging 2013; 37:1202-12. [DOI: 10.1002/jmri.23894] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 09/17/2012] [Indexed: 11/11/2022] Open
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Meyer BC, Brost A, Kraitchman DL, Gilson WD, Strobel N, Hornegger J, Lewin JS, Wacker FK. Percutaneous punctures with MR imaging guidance: comparison between MR imaging-enhanced fluoroscopic guidance and real-time MR Imaging guidance. Radiology 2013; 266:912-9. [PMID: 23297324 DOI: 10.1148/radiol.12120117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate and compare the technical accuracy and feasibility of magnetic resonance (MR) imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance for percutaneous puncture procedures in phantoms and animals. MATERIALS AND METHODS The experimental protocol was approved by the institutional animal care and use committee. Punctures were performed in phantoms, aiming for markers (20 each for MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance), and pigs, aiming for anatomic landmarks (10 for MR imaging-enhanced fluoroscopic guidance and five for MR imaging guidance). To guide the punctures, T1-weighted three-dimensional (3D) MR images of the phantom or pig were acquired. Additional axial and coronal T2-weighted images were used to visualize the anatomy in the animals. For MR imaging-enhanced fluoroscopic guidance, phantoms and pigs were transferred to the fluoroscopic system after initial MR imaging and C-arm computed tomography (CT) was performed. C-arm CT and MR imaging data sets were coregistered. Prototype navigation software was used to plan a puncture path with use of MR images and to superimpose it on fluoroscopic images. For real-time MR imaging, an interventional MR imaging prototype for interactive real-time section position navigation was used. Punctures were performed within the magnet bore. After completion, 3D MR imaging was performed to evaluate the accuracy of insertions. Puncture durations were compared by using the log-rank test. The Mann-Whitney U test was applied to compare the spatial errors. RESULTS In phantoms, the mean total error was 8.6 mm ± 2.8 with MR imaging-enhanced fluoroscopic guidance and 4.0 mm ± 1.2 with real-time MR imaging guidance (P < .001). The mean puncture time was 2 minutes 10 seconds ± 44 seconds with MR imaging-enhanced fluoroscopic guidance and 37 seconds ± 14 with real-time MR imaging guidance (P < .001). In the animal study, a tolerable distance (<1 cm) between target and needle tip was observed for both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance. The mean total error was 7.7 mm ± 2.4 with MR imaging-enhanced fluoroscopic guidance and 7.9 mm ± 4.9 with real-time MR imaging guidance (P = .77). The mean puncture time was 5 minutes 43 seconds ± 2 minutes 7 seconds with MR imaging-enhanced fluoroscopic guidance and 5 minutes 14 seconds ± 2 minutes 25 seconds with real-time MR imaging guidance (P = .68). CONCLUSION Both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance demonstrated reasonable and similar accuracy in guiding needle placement to selected targets in phantoms and animals.
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