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Clinical impact of cone beam computed tomography on iterative treatment planning during ultrasound-guided percutaneous ablation of liver malignancies

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Abstract

A standardized cone beam computed tomography (CBCT) protocol may impact optimal ablation probe(s) positioning during ultrasound-guided microwave ablation (MWA). To evaluate this hypothesis, 15 patients underwent ultrasound-guided percutaneous MWA of 15 liver lesions (10 hepatocellular carcinomas, 5 metastasis ranging 11–41 mm) with the ultrasound guidance assisted by a dedicated CBCT protocol. Pre-procedural enhanced CBCT (ceCBCT) was performed after intravenous contrast administration to visualize the lesion and determine the optimal approach using CBCT-based ablation planning software. MW antennas were positioned under ultrasound guidance, and non-enhanced CBCT was performed after deployment and fused with pre-procedural ceCBCT to assess tumor targeting and modify subsequent steps of the procedure. CBCT lesion detection accuracy and number of needle repositioning on the basis of CBCT information were recorded. Clinical success was measured on 1-month follow-up contrast-enhanced CT. The target lesion was detected on ceCBCT in 13 out of 15 patients (87%). The undetected lesions were only visible on diagnostic contrast-enhanced magnetic resonance imaging, which was then fused to the CBCT and fluoroscopy to facilitate targeting. MW antennas were repositioned on the basis of CBCT in 11 lesions (73%). Clinical success was achieved in 14/15 ablations (93%) with a mean follow-up of X months. The only case of local recurrence was expected, as the intent was tumor debulking. CBCT imaging during ultrasound-guided liver ablation is feasible and leads to ablation device repositioning in the majority of cases.

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Authors and Affiliations

  1. Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy

    Chiara Floridi

  2. Image-Guided Therapy Systems, Philips Healthcare, Best, The Netherlands

    Alessandro Radaelli

  3. Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy

    Filippo Pesapane, Enrico Maria Fumarola & Gianpaolo Carrafiello

  4. Health Physics, San Paolo Hospital, University of Milan, Milan, Italy

    Michela Lecchi

  5. Department of Radiology, School of Radiology, Università Politecnica delle Marche, Ancona, Italy

    Andrea Agostini & Andrea Giovagnoni

  6. Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA

    Bradford Wood

Authors
  1. Chiara Floridi
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  2. Alessandro Radaelli
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  3. Filippo Pesapane
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  4. Enrico Maria Fumarola
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  5. Michela Lecchi
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  6. Andrea Agostini
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  7. Andrea Giovagnoni
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  8. Gianpaolo Carrafiello
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  9. Bradford Wood
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Correspondence to Chiara Floridi.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Floridi, C., Radaelli, A., Pesapane, F. et al. Clinical impact of cone beam computed tomography on iterative treatment planning during ultrasound-guided percutaneous ablation of liver malignancies. Med Oncol 34, 113 (2017). https://doi.org/10.1007/s12032-017-0954-x

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  • DOI: https://doi.org/10.1007/s12032-017-0954-x

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