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Zimmermann C, Michelmann A, Daniel Y, Enderle MD, Salkic N, Linzenbold W. Application of Deep Learning for Real-Time Ablation Zone Measurement in Ultrasound Imaging. Cancers (Basel) 2024; 16:1700. [PMID: 38730652 PMCID: PMC11083655 DOI: 10.3390/cancers16091700] [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: 04/03/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The accurate delineation of ablation zones (AZs) is crucial for assessing radiofrequency ablation (RFA) therapy's efficacy. Manual measurement, the current standard, is subject to variability and potential inaccuracies. AIM This study aims to assess the effectiveness of Artificial Intelligence (AI) in automating AZ measurements in ultrasound images and compare its accuracy with manual measurements in ultrasound images. METHODS An in vitro study was conducted using chicken breast and liver samples subjected to bipolar RFA. Ultrasound images were captured every 15 s, with the AI model Mask2Former trained for AZ segmentation. The measurements were compared across all methods, focusing on short-axis (SA) metrics. RESULTS We performed 308 RFA procedures, generating 7275 ultrasound images across liver and chicken breast tissues. Manual and AI measurement comparisons for ablation zone diameters revealed no significant differences, with correlation coefficients exceeding 0.96 in both tissues (p < 0.001). Bland-Altman plots and a Deming regression analysis demonstrated a very close alignment between AI predictions and manual measurements, with the average difference between the two methods being -0.259 and -0.243 mm, for bovine liver and chicken breast tissue, respectively. CONCLUSION The study validates the Mask2Former model as a promising tool for automating AZ measurement in RFA research, offering a significant step towards reducing manual measurement variability.
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Affiliation(s)
| | | | | | | | - Nermin Salkic
- Erbe Elektromedizin GmbH, 72072 Tübingen, Germany
- Faculty of Medicine, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
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Lesser T, Wolfram F, Braun C, Gottschall R. Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding. World J Exp Med 2024; 14:87256. [PMID: 38590298 PMCID: PMC10999063 DOI: 10.5493/wjem.v14.i1.87256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/30/2023] [Accepted: 12/29/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Superimposed high-frequency jet ventilation (SHFJV) is suitable for respiratory motion reduction and essential for effective lung tumor ablation. Fluid filling of the target lung wing one-lung flooding (OLF) is necessary for therapeutic ultrasound applications. However, whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear. AIM To compared SHFJV with pressure-controlled ventilation (PCV) during OLF by assessing hemodynamics and gas exchange in different animal positions. METHODS SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF. The animal positions were changed from left lateral position to supine position (SP) to right lateral position (RLP) every 30 min. In each position, ventilation was maintained for 15 min in both modalities. Hemodynamic variables and arterial blood gas levels were repeatedly measured. RESULTS Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels. SHFJV slightly decreased oxygenation in SP and RLP compared with PCV; the lowest values of PaO2 and PaO2/FiO2 ratio were found in SP [13.0; interquartile range (IQR): 12.6-5.6 and 32.5 (IQR: 31.5-38.9) kPa]. Conversely, during SHFJV, the shunt fraction was higher in all animal positions (highest in the RLP: 0.30). CONCLUSION In porcine model, unilateral SHFJV may provide adequate ventilation in different animal positions during OLF. Lower oxygenation and CO2 removal rates compared to PCV did not lead to hypoxia or hypercapnia. SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.
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Affiliation(s)
- Thomas Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, Gera D-07548, Germany
| | - Frank Wolfram
- Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, Gera D-07548, Germany
| | - Conny Braun
- Central Experimental Animal Facility, Jena University Hospital, Jena 07743, Germany
| | - Reiner Gottschall
- Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena 07747, Germany
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Wu H, Zhang B, Huang CC, Peng C, Zhou Q, Jiang X. Ultrasound-Guided Intravascular Sonothrombolysis With a Dual Mode Ultrasound Catheter: In Vitro Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1917-1925. [PMID: 35201986 PMCID: PMC9702596 DOI: 10.1109/tuffc.2022.3153929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Thromboembolism in vessels often leads to stroke or heart attack and even sudden death unless brought under control. Sonothrombolysis based on ultrasound contrast agents has shown promising outcome in effective treatment of thromboembolism. Intravascular sonothrombolysis transducer was reported recently for unprecedented sonothrombolysis in vitro. However, it is necessary to provide an imaging guide during thrombolysis in clinical applications for optimal treatment efficiency. In this article, a dual mode ultrasound catheter was developed by combining a 16-MHz high-frequency element (imaging transducer) and a 220-kHz low-frequency element (treatment transducer) for sonothrombolysis in vitro. The treatment transducer was designed with a 20-layer PZT-5A stack with the aperture size of 1.2×1.2 mm2, and the imaging transducer with the aperture size of 1.2×1.2 mm2 was attached in front of the treatment transducer. Both transducers were assembled into a customized 2-lm 10-Fr catheter. In vitro experiment was carried out using a bovine blood clot. Imaging tests were conducted, showing that the backscattering signals can be obtained with a high signal-to-noise ratio (SNR) for the 16-MHz imaging transducer. Sonothrombolysis was performed successfully that the volume of clot was reduced significantly after the 30-min treatment. The size changes of clot were observed clearly using the 16-MHz M-mode imaging during the thrombolysis. The findings suggest that the proposed ultrasound-guided intravascular sonothrombolysis can be enhanced since the position of treatment transducer can be adjusted with the target at the clot due to the imaging guide.
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Naki T, Aderibigbe BA. Efficacy of Polymer-Based Nanomedicine for the Treatment of Brain Cancer. Pharmaceutics 2022; 14:pharmaceutics14051048. [PMID: 35631634 PMCID: PMC9145018 DOI: 10.3390/pharmaceutics14051048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 12/11/2022] Open
Abstract
Malignant brain tumor is a life-threatening disease with a low survival rate. The therapies available for the treatment of brain tumor is limited by poor uptake via the blood–brain barrier. The challenges with the chemotherapeutics used for the treatment of brain tumors are poor distribution, drug toxicity, and their inability to pass via the blood–brain barrier, etc. Several researchers have investigated the potential of nanomedicines for the treatment of brain cancer. Nanomedicines are designed with nanosize particle sizes with a large surface area and are loaded with bioactive agents via encapsulation, immersion, conjugation, etc. Some nanomedicines have been approved for clinical use. The most crucial part of nanomedicine is that they promote drug delivery across the blood–brain barrier, display excellent specificity, reduce drug toxicity, enhance drug bioavailability, and promote targeted drug release mechanisms. The aforementioned features make them promising therapeutics for brain targeting. This review reports the in vitro and in vivo results of nanomedicines designed for the treatment of brain cancers.
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Wu H, Goel LD, Kim H, Zhang B, Kim J, Dayton PA, Xu Z, Jiang X. Dual-Frequency Intravascular Sonothrombolysis: An In Vitro Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:3599-3607. [PMID: 34370663 PMCID: PMC8645157 DOI: 10.1109/tuffc.2021.3103409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Thrombo-occlusive disease is one of the leading causes of death worldwide. There has been active research on safe and effective thrombolysis in preclinical and clinical studies. Recently, the dual-frequency transcutaneous sonothrombolysis with contrast agents [microbubbles (MBs)] has been reported to be more efficient in trigging the acoustic cavitation, which leads to a higher lysis rate. Therefore, there is increasing interest in applying dual-frequency technique for more significant efficacy improvement in intravascular sonothrombolysis since a miniaturized intravascular ultrasound transducer typically has a limited power output to fully harness cavitation effects. In this work, we demonstrated this efficacy enhancement by developing a new broadband intravascular transducer and testing dual-frequency sonothromblysis in vitro. A broadband intravascular transducer with a center frequency of 750 kHz and a footprint size of 1.4 mm was designed, fabricated, and characterized. The measured -6-dB fractional bandwidth is 68.1%, and the peak negative pressure is 1.5 MPa under the driving voltage of 80 Vpp. By keeping one frequency component at 750 kHz, the second frequency component was selected from 450 to 650 kHz with an interval of 50 kHz. The in vitro sonothrombolysis tests were conducted with a flow model and the results indicated that the MB-mediated, dual-frequency (750+500 kHz) sonothrombolysis yields an 85% higher lysis rate compared with the single-frequency treatment, and the lysis rate of dual-frequency sonothrombolysis increases with the difference between the two frequency components. These findings suggest a dual-frequency excitation technique for more efficient intravascular sonothrombolysis than conventional single-frequency excitation.
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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Zhou Y, Cunitz BW, Dunmire B, Wang YN, Karl SG, Warren C, Mitchell S, Hwang JH. Characterization and Ex Vivo evaluation of an extracorporeal high-intensity focused ultrasound (HIFU) system. J Appl Clin Med Phys 2021; 22:345-359. [PMID: 34346559 PMCID: PMC8425942 DOI: 10.1002/acm2.13074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/15/2020] [Accepted: 02/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background High‐intensity focused ultrasound (HIFU) has been in clinical use for a variety of solid tumors and cancers. Accurate and reliable calibration is in a great need for clinical applications. An extracorporeal clinical HIFU system applied for the investigational device exemption (IDE) to the Food and Drug Administration (FDA) so that evaluation of its characteristics, performance, and safety was required. Methods The acoustic pressure and power output was characterized by a fiber optic probe and a radiation force balance, respectively, with the electrical power up to 2000 W. An in situ acoustic energy was established as the clinical protocol at the electrical power up to 500 W. Temperature elevation inside the tissue sample was measured by a thermocouple array. Generated lesion volume at different in situ acoustic energies and pathological examination of the lesions was evaluated ex vivo. Results Acoustic pressure mapping showed the insignificant presence of side/grating lobes and pre‐ or post‐focal peaks (≤−12 dB). Although distorted acoustic pressure waveform was found in the free field, the nonlinearity was reduced significantly after the beam propagating through tissue samples (i.e., the second harmonic of −11.8 dB at 500 W). Temperature elevation was <10°C at a distance of 10 mm away from a 20‐mm target, which suggests the well‐controlled HIFU energy deposition and no damage to the surrounding tissue. An acoustic energy in the range of 750–1250 J resulted in discrete lesions with an interval space of 5 mm between the treatment spots. Histology confirmed that the lesions represented a region of permanently damaged cells by heat fixation, without causing cell lysis by either cavitation or boiling. Conclusions Our characterization and ex vivo evaluation protocol met the IDE requirement. The in‐situ acoustic energy model will be used in clinical trials to deliver almost consistent energy to the various targets.
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Affiliation(s)
- Yufeng Zhou
- School of Mechanical Engineering, Northwestern Ploytechnical University, Xi'an, China
| | - Bryan W Cunitz
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Barbrina Dunmire
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Yak-Nam Wang
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Steven G Karl
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Cinderella Warren
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Stuart Mitchell
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Joo Ha Hwang
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA.,Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
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Zhang X, Landgraf L, Bailis N, Unger M, Jochimsen TH, Melzer A. Image-Guided High-Intensity Focused Ultrasound, A Novel Application for Interventional Nuclear Medicine? J Nucl Med 2021; 62:1181-1188. [PMID: 34088775 DOI: 10.2967/jnumed.120.256230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/05/2021] [Indexed: 12/25/2022] Open
Abstract
Image-guided high-intensity focused ultrasound (HIFU) has been increasingly used in medicine over the past few decades, and several systems for such have become commercially available. HIFU has passed regulatory approval around the world for the ablation of various solid tumors, the treatment of neurologic diseases, and the palliative management of bone metastases. The mechanical and thermal effects of focused ultrasound provide a possibility for histotripsy, supportive radiation therapy, and targeted drug delivery. The integration of imaging modalities into HIFU systems allows for precise temperature monitoring and accurate treatment planning, increasing the safety and efficiency of treatment. Preclinical and clinical results have demonstrated the potential of image-guided HIFU to reduce adverse effects and increase the quality of life postoperatively. Interventional nuclear image-guided HIFU is an attractive noninvasive option for the future.
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Affiliation(s)
- Xinrui Zhang
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Lisa Landgraf
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Nikolaos Bailis
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Michael Unger
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Thies H Jochimsen
- Department of Nuclear Medicine, Leipzig University Hospital, Leipzig, Germany; and
| | - Andreas Melzer
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany; .,Institute of Medical Science and Technology (IMSaT), University of Dundee, Dundee, Scotland
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9
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Li X, Young AS, Raman SS, Lu DS, Lee YH, Tsao TC, Wu HH. Automatic needle tracking using Mask R-CNN for MRI-guided percutaneous interventions. Int J Comput Assist Radiol Surg 2020; 15:1673-1684. [PMID: 32676870 DOI: 10.1007/s11548-020-02226-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/03/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Accurate needle tracking provides essential information for MRI-guided percutaneous interventions. Passive needle tracking using MR images is challenged by variations of the needle-induced signal void feature in different situations. This work aimed to develop an automatic needle tracking algorithm for MRI-guided interventions based on the Mask Region Proposal-Based Convolutional Neural Network (R-CNN). METHODS Mask R-CNN was adapted and trained to segment the needle feature using 250 intra-procedural images from 85 MRI-guided prostate biopsy cases and 180 real-time images from MRI-guided needle insertion in ex vivo tissue. The segmentation masks were passed into the needle feature localization algorithm to extract the needle feature tip location and axis orientation. The proposed algorithm was tested using 208 intra-procedural images from 40 MRI-guided prostate biopsy cases, and 3 real-time MRI datasets in ex vivo tissue. The algorithm results were compared with human-annotated references. RESULTS In prostate datasets, the proposed algorithm achieved needle feature tip localization error with median Euclidean distance (dxy) of 0.71 mm and median difference in axis orientation angle (dθ) of 1.28°, respectively. In 3 real-time MRI datasets, the proposed algorithm achieved consistent dynamic needle feature tracking performance with processing time of 75 ms/image: (a) median dxy = 0.90 mm, median dθ = 1.53°; (b) median dxy = 1.31 mm, median dθ = 1.9°; (c) median dxy = 1.09 mm, median dθ = 0.91°. CONCLUSIONS The proposed algorithm using Mask R-CNN can accurately track the needle feature tip and axis on MR images from in vivo intra-procedural prostate biopsy cases and ex vivo real-time MRI experiments with a range of different conditions. The algorithm achieved pixel-level tracking accuracy in real time and has potential to assist MRI-guided percutaneous interventions.
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Affiliation(s)
- 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
| | - Adam S Young
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA
| | - David S Lu
- Department of Radiological Sciences, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA, 90095, USA
| | - Yu-Hsiu Lee
- Department of Mechanical and Aerospace Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Tsu-Chin Tsao
- Department of Mechanical and Aerospace Engineering, University of California Los Angeles, Los Angeles, CA, 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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Ma Y, Hsu G, Zhang F. The applicability and efficacy of magnetic resonance-guided high intensity focused ultrasound system in the treatment of primary trigeminal neuralgia. Med Hypotheses 2020; 139:109688. [PMID: 32240878 DOI: 10.1016/j.mehy.2020.109688] [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: 02/04/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022]
Abstract
Primary trigeminal neuralgia is a common clinical refractory neuralgia characterized by an onset of excruciating pain that can severely affect patients' quality of life. Long-term suffering from this pain may lead to depression, anxiety, and suicide. Current treatments, however, are associated with high recurrent rates and severe complications. We hypothesize that both the applicability and efficacy of magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) treatment in primary trigeminal neuralgia can be achieved under the following conditions: a specific target focus and incident channel, a temperature measurement system that does not incur damage to surrounding tissues, and an optimal radiation dose. Successful non-invasive treatment of primary trigeminal neuralgia by MR-HIFU systems could represent a breakthrough of this technology applied to the oral and maxillofacial region.
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Affiliation(s)
- Yaping Ma
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China; Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Grace Hsu
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Fugui Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
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Harvey J, Windsor MN, Steinke K. Delayed complications following microwave ablation of lung tumours. J Med Imaging Radiat Oncol 2019; 63:770-778. [DOI: 10.1111/1754-9485.12946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- James Harvey
- Department of Medical Imaging Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- University of Queensland School of Medicine Brisbane Queensland Australia
| | - Morgan N Windsor
- Department of Thoracic Surgery Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Karin Steinke
- Department of Medical Imaging Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- University of Queensland School of Medicine Brisbane Queensland Australia
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12
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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Elhelf IS, Albahar H, Shah U, Oto A, Cressman E, Almekkawy M. High intensity focused ultrasound: The fundamentals, clinical applications and research trends. Diagn Interv Imaging 2018; 99:349-359. [DOI: 10.1016/j.diii.2018.03.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
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Lundt JE, Allen SP, Shi J, Hall TL, Cain CA, Xu Z. Non-invasive, Rapid Ablation of Tissue Volume Using Histotripsy. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2834-2847. [PMID: 28935135 PMCID: PMC5693635 DOI: 10.1016/j.ultrasmedbio.2017.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/22/2017] [Accepted: 08/08/2017] [Indexed: 05/09/2023]
Abstract
Histotripsy is a non-invasive, non-thermal ablation technique that uses high-amplitude, focused ultrasound pulses to fractionate tissue via acoustic cavitation. The goal of this study was to illustrate the potential of histotripsy with electronic focal steering to achieve rapid ablation of a tissue volume at a rate matching or exceeding those of current clinical techniques (∼1-2 mL/min). Treatment parameters were established in tissue-mimicking phantoms and applied to ex vivo tissue. Six-microsecond pulses were delivered by a 250-kHz array. The focus was electrically steered to 1000 locations at a pulse repetition frequency of 200 Hz (0.12% duty cycle). Magnetic resonance imaging and histology of the treated tissue revealed a distinct region of necrosis in all samples. Mean lesion volume was 35.6 ± 4.3 mL, generated at 0.9-3.3 mL/min, a speed faster than that of any current ablation method for a large volume. These results suggest that histotripsy has the potential to achieve non-invasive, rapid, homogeneous ablation of a tissue volume.
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Affiliation(s)
- Jonathan E Lundt
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
| | - Steven P Allen
- Department Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Jiaqi Shi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles A Cain
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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D'Onofrio M, Barbi E, Girelli R, Tinazzi Martini P, De Robertis R, Ciaravino V, Salvia R, Butturini G, Frigerio I, Milazzo T, Crosara S, Paiella S, Pederzoli P, Bassi C. Variation of tumoral marker after radiofrequency ablation of pancreatic adenocarcinoma. J Gastrointest Oncol 2016; 7:213-20. [PMID: 27034788 DOI: 10.3978/j.issn.2078-6891.2015.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To evaluate the correlation between variations of CA 19.9 blood levels and the entity of necrosis at CT after radiofrequency ablation (RFA) of unresectable pancreatic adenocarcinoma. METHODS In this study, from June 2010 to February 2014, patients with diagnosis of unresectable and not metastatic pancreatic ductal adenocarcinoma, expressing tumor marker CA 19.9, treated with RFA procedure were included. All these patients underwent RFA. CT study was performed 1 week after RFA. The dosage of CA 19.9 levels was performed 1 month after RFA. Features of necrosis at CT, as mean entity, density and necrosis percentages compared to the original lesion, were evaluated and compared by using t-test with CA 19.9 blood levels variations after RFA procedure. RESULTS In this study were included 51 patients with diagnosis of unresectable and not metastatic pancreatic ductal adenocarcinoma, expressing tumor marker CA 19.9, treated with RFA procedure and with CT study and CA 19.9 available for analysis. After the procedure, CA 19.9 blood levels reduced in 24/51 (47%), remained stable in 10/51 (20%) and increased in 17/51 (33%). In patients with CA 19.9 levels reduced, the tumor marker were reduced less than 20% in 4/24 (17%) and more than 20% in 20/24 (83%); instead the tumor marker were reduced less than 30% in 8/24 (33%) and more than 30% in 16/24 (67%). At CT scan necrotic area density difference was not statistically significant. Also there was no statistically significant difference among the mean area, the mean volume and the mean ablation volume in percentage related to the treated tumor among the three different groups of patients divided depending on the CA 19.9 blood levels. But a tendency to a statistically significant difference was found in comparing the mean percentage of ablation volume between two subgroups of patients with a decrease of CA 19.9 levels with less or more than 20% reduction of tumor markers and between two subgroups with less or more than 30% reduction of CA 19.9 levels. CONCLUSIONS RFA of unresectable pancreatic adenocarcinoma induces reduction of CA 19.9 blood levels in about half of the cases.
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Affiliation(s)
- Mirko D'Onofrio
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Emilio Barbi
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Roberto Girelli
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Paolo Tinazzi Martini
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Riccardo De Robertis
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Valentina Ciaravino
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Roberto Salvia
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giovanni Butturini
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Isabella Frigerio
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Teresa Milazzo
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Stefano Crosara
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Salvatore Paiella
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Paolo Pederzoli
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Claudio Bassi
- 1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy
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Drug-Loaded Perfluorocarbon Nanodroplets for Ultrasound-Mediated Drug Delivery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:221-41. [DOI: 10.1007/978-3-319-22536-4_13] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Kim KR, Thomas S. Complications of image-guided thermal ablation of liver and kidney neoplasms. Semin Intervent Radiol 2014; 31:138-48. [PMID: 25049443 DOI: 10.1055/s-0034-1373789] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Image-guided thermal ablation is a widely accepted tool in the treatment of a variety of solid organ neoplasms. Among the different techniques of ablation, radiofrequency ablation, cryoablation, and microwave ablation have been most commonly used and investigated in the treatment of liver and kidney neoplasms. This article will review complications following thermal ablation of tumors in the liver and kidney, and discuss the risks and clinical presentation of each complication as well as how to treat and potentially avoid complications.
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Affiliation(s)
- Kyung Rae Kim
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Thomas
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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18
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Ge HY, Miao LY, Xiong LL, Yan F, Zheng CS, Wang JR, Jia JW, Cui LG, Chen W. High-intensity focused ultrasound treatment of late-stage pancreatic body carcinoma: optimal tumor depth for safe ablation. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:947-55. [PMID: 24462161 DOI: 10.1016/j.ultrasmedbio.2013.11.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/12/2013] [Accepted: 11/16/2013] [Indexed: 06/03/2023]
Abstract
Objective criteria are currently not available for assessing the extent of ablation by high-intensity focused ultrasound (HIFU). A retrospective review was conducted in Chinese patients with late-stage pancreatic body carcinoma treated with 1 h/d intermittent HIFU at a single center. Clinical and procedure-related characteristics were examined in relation to tumor posterior depth. Clinically, tumor ablation was negatively correlated with posterior tumor depth, with a 1-cm increase in depth decreasing ablation by 30.7%. At a computed tomography (CT)-determined 7-cm posterior tumor depth (considered the critical value for the procedure), ablation sensitivity and specificity were 77.8% and 72.7%, respectively. Tumor ablation >30% in patients with a CT-determined posterior tumor depth ≤7 cm was 9.333 times better than that in patients with a CT-determined posterior tumor depth >7 cm. Adverse effects did not affect the efficacy of HIFU. Tumors with posterior depths <7 cm may effectively be treated with HIFU-induced ablation with minimal adverse events.
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Affiliation(s)
- Hui-Yu Ge
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Li-Ying Miao
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China.
| | - Liu-Lin Xiong
- Department of Urology, Peking University People's Hospital, Xicheng District, Beijing, China.
| | - Fang Yan
- Clinic Epidemiology Research Group, Beijing Anding Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Cui-Shan Zheng
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jin-Rui Wang
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jian-Wen Jia
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
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Wang J, Liang P, Yu J, Yu MA, Liu F, Cheng Z, Yu X. Clinical outcome of ultrasound-guided percutaneous microwave ablation on colorectal liver metastases. Oncol Lett 2014; 8:323-326. [PMID: 24959270 PMCID: PMC4063642 DOI: 10.3892/ol.2014.2106] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/27/2014] [Indexed: 12/22/2022] Open
Abstract
The present study aimed to assess the feasibility, safety and efficiency of ultrasound-guided percutaneous microwave ablation (MWA) on liver metastases from colon or rectal cancer. Patients who received MWA therapy for liver metastases from colon or rectal cancer between June 2009 and May 2012 were enrolled in the study. Follow-up data was collected from the patients in order to statistically analyze the adverse effects, concurrent disease and survival status. Of the total 115 patients, 62 presented with colon cancer and 53 with rectal cancer. A total of 78 patients were male and 37 were female. The patient age ranged between 30 and 86 years [mean ± standard deviation (SD), 59.46±11.79 years]. The number of overall ablation lesions was 165, and the diameter of the lesions ranged between 1.3 and 5.0 cm (mean ± SD, 3.10±1.05 cm). Subsequent to treatment, the mean (± SD) hospitalization time was 4.69±2.08 days (range, 2-10 days). The median follow-up time was 28 months (range, 12-48 months) and 5 patients were lost to follow-up. The pain grade was recorded between the 4th and 6th degree following treatment in 23 patients. The body temperatures of 35 patients reached >38°C, with the longest time at this temperature recorded as 5 days. Following treatment, 5 patients presented with pleural effusion and required thoracocentesis and drainage. Following ablation, the rate of local progression was 11.82%. The recurrence rates were 27.8, 48.4 and 59.3% and the cumulative survival rates were 98.1, 87.1 and 78.7% in years 1, 2 and 3 post-treatment, respectively. A total of 14 patients succumbed. No significant differences were observed in the liver metastases of colorectal cancer with regard to gender, age, number of lesions, lesion size and pathological differentiation (P>0.05). Also, no significant difference was observed in the recurrence or cumulative survival rates for years 1, 2 and 3 years post-treatment (P>0.05). In conclusion, ultrasound-guided percutaneous MWA is a safe and competent way to treat inoperable colorectal liver metastases.
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Affiliation(s)
- Jianbin Wang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Ming-An Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Prefumo F, Cabassa P, Fichera A, Frusca T. Preliminary experience with microwave ablation for selective feticide in monochorionic twin pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:470-471. [PMID: 22903562 DOI: 10.1002/uog.12286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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