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Lim HG, Kim H, Kim K, Park J, Kim Y, Yoo J, Heo D, Baik J, Park SM, Kim HH. Thermal Ablation and High-Resolution Imaging Using a Back-to-Back (BTB) Dual-Mode Ultrasonic Transducer: In Vivo Results. Sensors (Basel) 2021; 21:1580. [PMID: 33668260 PMCID: PMC7956793 DOI: 10.3390/s21051580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/13/2021] [Accepted: 02/20/2021] [Indexed: 02/06/2023]
Abstract
We present a back-to-back (BTB) structured, dual-mode ultrasonic device that incorporates a single-element 5.3 MHz transducer for high-intensity focused ultrasound (HIFU) treatment and a single-element 20.0 MHz transducer for high-resolution ultrasound imaging. Ultrasound image-guided surgical systems have been developed for lesion monitoring to ensure that ultrasonic treatment is correctly administered at the right locations. In this study, we developed a dual-element transducer composed of two elements that share the same housing but work independently with a BTB structure, enabling a mode change between therapy and imaging via 180-degree mechanical rotation. The optic fibers were embedded in the HIFU focal region of ex vivo chicken breasts and the temperature change was measured. Images were obtained in vivo mice before and after treatment and compared to identify the treated region. We successfully acquired B-mode and C-scan images that display the hyperechoic region indicating coagulation necrosis in the HIFU-treated volume up to a depth of 10 mm. The compact BTB dual-mode ultrasonic transducer may be used for subcutaneous thermal ablation and monitoring, minimally invasive surgery, and other clinical applications, all with ultrasound only.
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Affiliation(s)
- Hae Gyun Lim
- Department of Biomedical Engineering, Pukyong National University, Busan 48513, Korea;
| | - Hyunhee Kim
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
| | - Kyungmin Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Jeongwoo Park
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
| | - Yeonggeun Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Jinhee Yoo
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
| | - Dasom Heo
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
| | - Jinhwan Baik
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Hyung Ham Kim
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
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Zhang Z, Li JZ, Li HM. Hepatic Hemangioma Treatment Using Microwave Coagulation Therapy—a Systematic Review. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Felli E, Cherkaoui Z, Pessaux P. Clinical efficacy of liver resection combined with adjuvant microwave coagulation for patients with hepatocellular carcinoma: a promising approach to minimize recurrence? Ann Transl Med 2020; 8:1123. [PMID: 33240972 PMCID: PMC7576037 DOI: 10.21037/atm-2020-114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emanuele Felli
- Digestive and Endocrine Surgery, HPB Unit, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France.,IHU Strasbourg - Institut de Chirurgie Guidée par l'image, Strasbourg, France.,Institut of Viral and Liver Disease, Inserm U1110, Strasbourg, France
| | - Zineb Cherkaoui
- Digestive and Endocrine Surgery, HPB Unit, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France.,IHU Strasbourg - Institut de Chirurgie Guidée par l'image, Strasbourg, France
| | - Patrick Pessaux
- Digestive and Endocrine Surgery, HPB Unit, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France.,IHU Strasbourg - Institut de Chirurgie Guidée par l'image, Strasbourg, France.,Institut of Viral and Liver Disease, Inserm U1110, Strasbourg, France
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Baimas-George M, Watson M, Salibi P, Murphy KJ, Vrochides D, Martinie JB, Baker EH, Iannitti DA. A pre-operative platelet transfusion algorithm for patients with cirrhosis and hepatocellular carcinoma undergoing laparoscopic microwave ablation. Surg Endosc 2021; 35:3811-7. [PMID: 32632482 DOI: 10.1007/s00464-020-07760-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thrombocytopenia is a common finding in patients with chronic liver disease. It is associated with poor clinical outcomes due to increased risk of bleeding after even minor procedures. We sought to determine an algorithm for pre-operative platelet transfusion in patients with cirrhosis and hepatocellular carcinoma (HCC) undergoing laparoscopic microwave ablation (MIS-MWA). METHODS A retrospective review identified all patients with cirrhosis and HCC who underwent MIS-MWA at a single tertiary institution between 2007 and 2019. Demographics, pre-operative and post-operative laboratory values, transfusion requirements, and bleeding events were collected. The analyzed outcome of bleeding risk included any transfusion received intra-operatively or a transfusion or surgical intervention post-operatively. Logistic regression models were created to predict bleeding risk and identify patients who would benefit from pre-operative transfusion. RESULTS There were 433 patients with cirrhosis and HCC who underwent MIS-MWA identified; of these, 353 patients had complete laboratory values and were included. Bleeding risk was evaluated through bivariate analysis of statistically and clinically significant variables. The accuracy of both models was substantiated through bootstrap validation for 500 iterations (model 1: ROC 0.8684, Brier score 0.0238; model 2: ROC 0.8363, Brier score 0.0252). The first model captured patients with both thrombocytopenia and anemia: platelet count < 60 × 109 / L (OR 7.75, p 0.012, CI 1.58-38.06) and hemoglobin < 10 gm/dL (OR 5.76, p 0.032, CI 1.16-28.63). The second model captured patients with thrombocytopenia without anemia: platelet count < 30 × 109/L (OR 8.41, p 0.05, CI 0.96-73.50) and hemoglobin > 10 gm/dL (OR 0.16, p 0.026, CI 0.031-0.80). CONCLUSION The prediction of patients with cirrhosis and HCC requiring pre-operative platelet transfusions may help to avoid bleeding complications after invasive procedures. This study needs to be prospectively validated and ultimately may be beneficial in assessment of novel therapies for platelet-based clinical treatment in liver disease.
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Zhang T, Wang M, Zhang X, Hu J, Dou W, Fan Q, Feng D, Liu L. Analysis of the clinical efficacy of liver resection combined with adjuvant microwave coagulation for patients with hepatocellular carcinoma. Ann Transl Med 2020; 8:585. [PMID: 32566612 PMCID: PMC7290546 DOI: 10.21037/atm.2020.02.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Liver resection has been widely applied as a curative measure in the treatment of hepatocellular carcinoma (HCC) patients. However, the high rate of postoperative recurrence observed following liver resection proposes a problem, the solution for which is yet to be well established. Microwave coagulation is a therapy that was recently proposed as an adjuvant tool. In this study, we intended to evaluate the effectiveness of microwave coagulation as an auxiliary therapeutic method for patients undergoing liver resection. Methods A total of 236 consecutive patients classified as Barcelona Clinic Liver Cancer (BCLC) stage A who had only one tumor were enrolled in this retrospective study, regardless of tumor size. Survival analyses were performed using the Kaplan-Meier method, and the statistical differences between patients who underwent liver resection with and without adjuvant microwave coagulation were examined by the log-rank test. To investigate the prognostic factors for OS, we carried out univariate and multivariate Cox regression analyses. Results Based on the Kaplan-Meier curves, patients who underwent surgical resection with intraoperative adjuvant microwave coagulator had prolonged recurrence-free survival time and showed better overall survival (OS) than those who underwent surgical resection alone, with OS at 1, 3, and 5 years of 77.8%, 33.2%, 12.6% vs. 58.2%, 15.5%, 9.7%, respectively (log-rank P<0.001). The univariate and multivariate analyses demonstrated that tumor size, albumin, bilirubin, Child-Pugh score, and treatment method had significant prognostic power for both PFS and OS. According to the subgroup analyses based on the tumor size, there were significant differences in PFS and OS among overall subsets between the liver resection with adjuvant microwave coagulator and liver resection only groups. Conclusions Liver resection combined with intraoperative adjuvant microwave coagulation had a better prognostic performance than treatment with liver resection alone. Adjuvant microwave coagulation should be suggested as an alternative treatment modality for BCLC stage A patients with a single tumor, regardless of its size.
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Affiliation(s)
- Ting Zhang
- Department of Nuclear Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Mengmeng Wang
- Department of Drug and Equipment, Aeromedicine Identification and Training Centre of Air Force, Xi'an 710069, China
| | - Xiangnan Zhang
- Division of Scientific Research, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Jie Hu
- Department of Clinical laboratory, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Weijia Dou
- Department of Nuclear Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Qingling Fan
- Department of Nuclear Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Dayun Feng
- Department of Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Lei Liu
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
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Gao F, Wang GB, Xiang ZW, Yang B, Xue JB, Mo ZQ, Zhong ZH, Zhang T, Zhang FJ, Fan WJ. A preoperative mathematic model for computed tomographic guided microwave ablation treatment of hepatic dome tumors. Oncotarget 2017; 7:25949-59. [PMID: 27028994 PMCID: PMC5041956 DOI: 10.18632/oncotarget.8299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/06/2016] [Indexed: 12/14/2022] Open
Abstract
Purpose This study sought to prospectively evaluate the feasibility and safety of a preoperative mathematic model for computed tomographic(CT) guided microwave(MW) ablation treatment of hepatic dome tumors. Methods This mathematic model was a regular cylinder quantifying appropriate puncture routes from the bottom up. A total of 103 patients with hepatic dome tumors were enrolled and randomly divided into 2 groups based on whether this model was used or not: Group A (using the model; n = 43) versus Group B (not using the model; n = 60). All tumors were treated by CT-guided MW ablation and follow-up contrast CT were reviewed. Results The average number of times for successful puncture, average ablation time, and incidence of right shoulder pain were less in Group A than Group B (1.4 vs. 2.5, P = 0.001; 8.8 vs. 11.1 minutes, P = 0.003; and 4.7% vs. 20%, P = 0.039). The technical success rate was higher in Group A than Group B (97.7% vs. 85.0%, P = 0.032). There were no significant differences between the two groups in primary and secondary technique efficacy rates (97.7% vs. 88.3%, P = 0.081; 90.0% vs. 72.7%, P = 0.314). No major complications occurred in both groups. Conclusion The mathematic model of regular cylinder is feasible and safe for CT-guided MW ablation in treating hepatic dome tumors.
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Affiliation(s)
- Fei Gao
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Guo-Bao Wang
- State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Zhan-Wang Xiang
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Bin Yang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, PR China
| | - Jing-Bing Xue
- Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Zhi-Qiang Mo
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Zhi-Hui Zhong
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Tao Zhang
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Fu-Jun Zhang
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Wei-Jun Fan
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
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Abstract
Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.
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Chen X, Liu HP, Li M, Qiao L. Advances in non-surgical management of primary liver cancer. World J Gastroenterol 2014; 20:16630-16638. [PMID: 25469032 PMCID: PMC4248207 DOI: 10.3748/wjg.v20.i44.16630] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/17/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide. There have been great improvements in the diagnosis and treatment of HCC in recent years, but the problems, including difficult diagnosis at early stage, quick progression, and poor prognosis remain unsolved. Surgical resection is the mainstay of the treatment for HCC. However, 70%-80% of HCC patients are diagnosed at an advanced stage when most are ineligible for potentially curative therapies such as surgical resection and liver transplantation. In recent years, non-surgical management for unrespectable HCC, such as percutaneous ethanol injection, percutaneous microwave coagulation therapy, percutaneous radiofrequency ablation, transcatheter arterial chemoembolization, radiotherapy, chemotherapy, biotherapy, and hormonal therapy have been developed. These therapeutic options, either alone or in combination, have been shown to control tumor growth, prolong survival time, and improve quality of life to some extent. This review covers the current status and progress of non-surgical management for HCC.
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