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Parvinian A, Morris JM, Johnson-Tesch BA, Kurup AN. Thermoprotection of Neural Structures During Musculoskeletal Ablation. Cardiovasc Intervent Radiol 2023; 46:1495-1503. [PMID: 36944852 DOI: 10.1007/s00270-023-03407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
Percutaneous thermal ablation is widely used for local control and palliation of a variety of lesions throughout the musculoskeletal system. In this setting, safe ablation is predicated on the avoidance of unintentional injury to vulnerable neural structures that are often in proximity to ablation targets. This article highlights key periprocedural considerations in musculoskeletal ablation and reviews the array of active and passive thermoprotective measures that are critical to safe and successful treatment.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Decker JA, Risch F, Schwarz F, Scheurig-Muenkler C, Kroencke TJ. Improved Thermal Sensitivity Using Virtual Monochromatic Imaging Derived from Photon Counting Detector CT Data Sets: Ex Vivo Results of CT-Guided Cryoablation in Porcine Liver. Cardiovasc Intervent Radiol 2023; 46:1385-1393. [PMID: 37700006 PMCID: PMC10547619 DOI: 10.1007/s00270-023-03546-3] [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: 04/18/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To investigate differences in thermal sensitivity of virtual monoenergetic imaging (VMI) series generated from photon-counting detector (PCD) CT data sets, regarding their use to improve discrimination of the ablation zone during percutaneous cryoablation. MATERIALS AND METHODS CT-guided cryoablation was performed using an ex vivo model of porcine liver on a PCD-CT system. The ablation zone was imaged continuously for 8 min by acquiring a CT scan every 5 s. Tissue temperature was measured using fiberoptic temperature probes placed parallel to the cryoprobe. CT-values and noise were measured at the tip of the temperature probes on each scan and on VMI series from 40 to 130 keV. Correlation of CT-values and temperature was assessed using linear regression analyses. RESULTS For the whole temperature range of [- 40, + 20] °C, we observed a linear correlation between CT-values and temperature in reference 70 keV images (R2 = 0.60, p < 0.001) with a thermal sensitivity of 1.4HU/°C. For the most dynamic range of [- 15, + 20] °C, the sensitivity increased to 2.4HU/°C (R2 = 0.50, p < 0.001). Using VMI reconstructions, the thermal sensitivity increased from 1.4 HU/°C at 70 keV to 1.5, 1.7 and 2.0HU/°C at 60, 50 and 40 keV, respectively (range [- 40, + 20] °C). For [- 15, + 20]°C, the thermal sensitivity increased from 2.4HU/°C at 70 keV to 2.5, 2.6 and 2.7HU/°C at 60, 50 and 40 keV, respectively. Both CT-values and noise also increased with decreasing VMI keV-levels. CONCLUSION During CT-guided cryoablation of porcine liver, low-keV VMI reconstructions derived from PCD-CT data sets exhibit improved thermal sensitivity being highest between + 20 and - 15 °C.
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Affiliation(s)
- Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Franka Risch
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
- Medical Faculty, Ludwig Maximilian University Munich, Bavariaring 19, 80336, Munich, Germany
- Diagnostic and Interventional Radiology, Donauisar Klinikum Deggendorf, Perlasberger Str. 41, 94469, Deggendorf, Germany
| | - Christian Scheurig-Muenkler
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Centre for Advanced Analytics and Predictive Sciences, Augsburg University, Universitätsstr. 2, 86159, Augsburg, Germany.
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Lubner MG, Ziemlewicz TJ, Wells SA, Li K, Wu PH, Hinshaw JL, Lee FT, Brace CL. Advanced CT techniques for hepatic microwave ablation zone monitoring and follow-up. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2658-2668. [PMID: 34731282 DOI: 10.1007/s00261-021-03333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate utility of advanced CT techniques including HighlY constrained back-projection and dual-energy CT for intra- and post-procedure hepatic microwave ablation zone monitoring. METHODS 8 hepatic microwave ablations were performed in 4 adult swine (5 min/65 W). Low-dose routine CECT and dual-energy CT images were obtained every 1 min during ablation. Images were reconstructed ± HYPR. Image quality and dose metrics were collected. 21 MWA were performed in 4 adult swine. Immediate post-procedure CECT was performed in the arterial, portal venous, and delayed phases using both routine and DECT imaging with full-dose weight-based IV contrast dosing. An additional 16 MWA were subsequently performed in 2 adult swine. Immediate post-procedure CT was performed with half-dose IV contrast using routine and DECT. 12 patients (10 M/2F, mean age 62.4 yrs) with 14 hepatic tumors (4 HCC, 10 metastatic lesions) treated with MWA were prospectively imaged with DECT 1 month post-procedure. 120 kV equivalent images were compared to DECT [51 keV, iodine material density]. Image quality and dose metrics were collected. RESULTS Gas created during MWA led to high CNR in all intraprocedural CT datasets. Optimal CNRs were noted at 4 min with CNR 6.7, 15.5,15.9, and 21.5 on LD-CECT, LD-CECT + HYPR, DECT, and DECT + HYPR, respectively (p < 0.001). Image quality scores at 4 min were 1.8, 2.8, 2.4, and 3, respectively (p < 0.001). Mean radiation dose (CTDIvol) was eightfold higher for the DECT series. For swine, post-procedural DECT images (IMD/51 keV) showed improved CNR compared to routine CT at all time points with full and with reduced dose contrast (CNR 4.6, 3.2, and 1.5, respectively, at half-contrast dose, p < 0.001). For human subjects, the 51 keV and IMD images showed higher CNRs (5.8, 4.8 vs 4.0, p < 0.001) and SNRs (3.7, 5.9 vs 2.8). Ablation zone sharpness was improved with DECT (routine 3.0 ± 0.7, DECT 3.5 ± 0.5). Diagnostic confidence was higher with DECT (routine 2.3 ± 0.9, DECT 2.6 ± 0.8). Mean DLP for DECT was 905.7 ± 606 mGy-cm, CTDIvol 37.5 ± 21.2 mGy, and effective dose 13.6 ± 9.1 mSv, slightly higher than conventional CT series. CONCLUSION Advanced CT techniques can improve CT image quality in peri-procedural hepatic microwave ablation zone evaluation.
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Affiliation(s)
- Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Ke Li
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Po-Hung Wu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.,Department of Biomedical and Electrical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Electrical and Computer Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Chris L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Biomedical and Electrical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Autrusseau PA, Cazzato RL, De Marini P, Auloge P, Koch G, Dalili D, Weiss J, Mayer T, Garnon J, Gangi A. Pain relief and local tumour control following percutaneous image-guided cryoablation for spine metastasis: a 12-year single-centre experience. Clin Radiol 2021; 76:674-680. [PMID: 34120732 DOI: 10.1016/j.crad.2021.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
AIM To assess pain relief and local tumour control retrospectively in spinal metastases undergoing cryoablation. MATERIALS AND METHODS Between May 2008 and September 2020, 46 metastases in 41 consecutive patients (mean age 59.7±4.4 [SD] years; range 27-84) were treated with cryoablation in 42 interventional sessions. Patient demographics, procedural data, complications, pain, and local tumour control were analysed retrospectively. RESULTS Thirty-one patients (36 spine metastases; 32 sessions) were treated for pain relief and 10 (10 metastases; 10 sessions) for local tumour control. Clinical success was reached in 30/32 (93.8%) interventional palliative sessions. Mean pre-procedural numerical pain rate scale was 6.2±1.7 (SD), and dropped significantly to 3.5±1.8 (SD), 1.9±1.7 (SD), and 1.9±1.8 (SD) at 24-h, 1-month and at the last available follow-up (median 16.5±23.2 [SD] months), respectively. For patients requiring local tumour control, primary clinical success was reached in 6/10 (60%) spinal metastases at median 25-months follow-up. The overall complication rate was 8%, with no secondary fractures or iatrogenic thermal-mediated nerve injuries reported. CONCLUSION Percutaneous image-guided cryoablation of spinal metastases is safe and effective in achieving pain relief and local tumour control.
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Affiliation(s)
- P-A Autrusseau
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - P De Marini
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - P Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - G Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - D Dalili
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - J Weiss
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - T Mayer
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - J Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - A Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
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Hübner F, Schreiner R, Panahi B, Vogl TJ. Evaluation of the thermal sensitivity of porcine liver in CT-guided cryoablation: an initial study. Med Phys 2020; 47:4997-5005. [PMID: 32748398 DOI: 10.1002/mp.14432] [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] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate computed tomography (CT)-based thermometry in cryoablation, the thermal sensitivity of an ex-vivo porcine liver was determined in an initial study design. METHODS The CT-guided cryoablation was performed in three porcine liver samples over a period of 10 min. Fiber optic temperature probes were positioned parallel to the shaft of the cryoprobe in an axial slice orientation. During ablation, temperature measurements were performed simultaneously with CT imaging at 5 s intervals. On the CT images, the average CT number was calculated for a region of interest of 3 × 3 pixels just below the tip of each temperature probe. A linear regression analysis was performed using eleven data sets to determine the dependence of the CT number on the temperature. RESULTS With decreasing temperature, an increasing hypodense area around the tip of the cryoprobe was observed on the CT images and decreasing values of the CT number were determined. Starting at a temperature of - 40°C a linear relation between the CT number and the temperature was determined and a thermal sensitivity of 0.95 HU/°C (R2 = 0.73) was obtained. The thermal sensitivity was used to calculate color-coded temperature maps. The calculated temperature distribution corresponds quantitatively to the increasing hypodense area. CONCLUSIONS A noninvasive CT-based temperature determination during cryoablation in a normal ex vivo porcine liver is feasible. A thermal sensitivity of 0.95 HU/°C was determined by linear regression analysis. A color-coded map of the temperature distribution was presented.
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Affiliation(s)
- Frank Hübner
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
| | - Roland Schreiner
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
| | - Bita Panahi
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
| | - Thomas Josef Vogl
- Institute of Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany
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Parvinian A, Welch BT, Callstrom MR, Kurup AN. Trends in Musculoskeletal Ablation: Emerging Indications and Techniques. Tech Vasc Interv Radiol 2020; 23:100678. [PMID: 32591190 DOI: 10.1016/j.tvir.2020.100678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Image-guided percutaneous thermal ablation plays an increasingly important role in the multidisciplinary management of musculoskeletal lesions. Established indications for ablation in this setting include the treatment of osteoid osteomas, palliation of painful skeletal metastases, local control of oligometastatic disease, and consolidation of bone tumors at risk for fracture. Emerging indications include the treatment of symptomatic soft tissue masses such as extra-abdominal desmoid tumors and abdominal wall endometriosis. This review will discuss considerations in patient selection and preprocedural workup, ablation technology and techniques, strategies to avoid complications, and expected outcomes of ablation in the musculoskeletal system.
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Affiliation(s)
| | | | | | - Anil N Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN
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Clinical utility of virtual noncalcium dual-energy CT in imaging of the pelvis and hip. Skeletal Radiol 2019; 48:1833-1842. [PMID: 31147733 DOI: 10.1007/s00256-019-03243-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/22/2019] [Accepted: 05/12/2019] [Indexed: 02/02/2023]
Abstract
Dual-energy virtual noncalcium images are increasingly used to identify marrow edema which accompanies bony pelvic injuries and marrow pathology obscured by cancellous bone. We present a clinical perspective of our experience using virtual noncalcium images in the work up of pelvic osseous pathology.
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