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Real-Time US-CT/MRI Image Fusion for Guidance of Thermal Ablation of Liver Tumors Undetectable with US: Results in 295 Cases

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Abstract

Purpose

This study was designed to assess feasibility of US-CT/MRI fusion-guided ablation in liver tumors undetectable with US.

Methods

From 2002 to 2012, 295 tumors (162 HCCs and 133 metastases; mean diameter 1.3 ± 0.6 cm, range 0.5–2.5 cm) detectable on contrast-enhanced CT/MRI, but completely undetectable with unenhanced US and either totally undetectable or incompletely conspicuous with contrast-enhanced US (CEUS), were treated in 215 sessions using either internally cooled radiofrequency or microwave with standard ablation protocols, guided by an image fusion system (Virtual Navigation System, Esaote S.p.A., Genova, Italy) that combines US with CT/ MRI images. Correct targeting and successful ablation of tumor were verified after 24 hours with CT or MRI.

Results

A total of 282 of 295 (95.6 %) tumors were correctly targeted with successful ablation achieved in 266 of 295 (90.2 %). Sixteen of 295 (5.4 %) tumors were correctly targeted, but unsuccessfully ablated, and 13 of 295 (4.4 %) tumors were unsuccessfully ablated due to inaccurate targeting. There were no perioperative deaths. Major complications were observed in 2 of the 215 treatments sessions (0.9 %).

Conclusions

Real-time virtual navigation system with US-CT/MRI fusion imaging is precise for targeting and achieving successful ablation of target tumors undetectable with US alone. Therefore, a larger population could benefit from ultrasound guided ablation procedures.

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Conflict of interest

Giovanni Mauri, Luca Cova, Stefano De Beni, Tiziana Ierace, Tania Tondolo, Anna Cerri, and Luigi Solbiati have nothing to disclose. S. Nahum Goldberg has sponsored research and consulting for AngioDynamics, Marlborough, MA, and Cosman Company, Burlington, MA, USA.

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Authors and Affiliations

  1. Unit of Interventional Oncologic Radiology, Department of Diagnostic Imaging, Azienda Ospedaliera Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Varese, Italy

    Giovanni Mauri, Luca Cova, Tiziana Ierace, Tania Tondolo, Anna Cerri & Luigi Solbiati

  2. Unit of Radiology, Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097, Milano, Italy

    Giovanni Mauri

  3. Esaote SpA, Genova, Italy

    Stefano De Beni

  4. Image-guided Therapy and Interventional Oncology Unit, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    S. Nahum Goldberg

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  1. Giovanni Mauri
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  2. Luca Cova
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  3. Stefano De Beni
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Correspondence to Giovanni Mauri.

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Mauri, G., Cova, L., De Beni, S. et al. Real-Time US-CT/MRI Image Fusion for Guidance of Thermal Ablation of Liver Tumors Undetectable with US: Results in 295 Cases. Cardiovasc Intervent Radiol 38, 143–151 (2015). https://doi.org/10.1007/s00270-014-0897-y

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  • DOI: https://doi.org/10.1007/s00270-014-0897-y

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