V470 VIDEO: HYBRID REAL-TIME US SYSTEM FUSED WITH VIRTUAL 3D CT/MRI FOR IMAGE-GUIDED SURGERY

Abstract

You have accessJournal of UrologyProstate Oncology1 Apr 2010V470 VIDEO: HYBRID REAL-TIME US SYSTEM FUSED WITH VIRTUAL 3D CT/MRI FOR IMAGE-GUIDED SURGERY Naoki Hirahara, Osamu Ukimura, Atsuko Fujihara, Tsuyoshi Iwata, Koji Okihara, Satoru Ishikawa, and Tsuneharu Miki Naoki HiraharaNaoki Hirahara Kyoto, Japan More articles by this author , Osamu UkimuraOsamu Ukimura Kyoto, Japan More articles by this author , Atsuko FujiharaAtsuko Fujihara Kyoto, Japan More articles by this author , Tsuyoshi IwataTsuyoshi Iwata Kyoto, Japan More articles by this author , Koji OkiharaKoji Okihara Kyoto, Japan More articles by this author , Satoru IshikawaSatoru Ishikawa Hitachi, Japan More articles by this author , and Tsuneharu MikiTsuneharu Miki Kyoto, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.544AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In percutaneous interventional surgery for the renal and prostatic pathology, reliable intra-operative needle guidance is under investigation to increase the precision and safety of the targeting. This video demonstrates the clinical technique and usefulness of the hybrid navigation system (Real-time Virtual Sonography, RVS, Hitachi Medical Co., Kashiwa, Japan) as guidance for renal intervention and lesion-targeted prostate biopsy. METHODS During percutaneous intervention in renal radiofrequency ablation (RFA) for renal tumor, percutaneous nephrostomy for renal lithotripsy (PCNL), as well as MRI-detected lesion-targeted prostatic biopsy, we applied the hybrid system of real-time US with preoperative CT/MRI, which have been first introduced by us for renal intervention (BJU Int. 101:707. 2008). After the registration between pre-operative CT/MRI volume data and real surgical space, the workstation reconstructs and displays new tomograms of the virtual CT/MRI to be synchronized with real-time US image. RESULTS In 10 cases for RFA, 3 cases for PCNL, and 52 cases with MRI-suspicious cancerous lesions in the prostate, the hybrid system allowed real-time US visualization of the area of the surgical targets, that corresponded with the lesions to be detected by pre-operative CT/MRI, which were synchronized and displayed in parallel in the same screen of the US. Synchronized CT image increase the safety of renal intervention because of enhanced anatomical understanding of the vital anatomies surrounding the kidney. Using TRUS-MRI fusion guidance, cancer was revealed in 26 of the 52 patients, which improve up to 50% positive rate. The hybrid system guided biopsy enhanced identifying of cancer in 14 of the 26 cancer patients, which implicated 61% increase of positive rate compared to systematic biopsy technique alone. These data suggested that this system improve prostate cancer detection, especially on the lesions which can be identified by MRI alone. CONCLUSIONS The hybrid US-guidance system with CT for the kidney and with MRI for the prostate intervention allowed excellent anatomical visualization and precise navigation, in which anatomical understanding of the targets and surrounding organs can be enhanced by the synchronized CT or MRI. This system provides potentially effective guidance for the focal targeted therapy. This system involves only minimal additional time and costs, to use clinically available equipments of US, CT and MRI machines. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e185-e186 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naoki Hirahara Kyoto, Japan More articles by this author Osamu Ukimura Kyoto, Japan More articles by this author Atsuko Fujihara Kyoto, Japan More articles by this author Tsuyoshi Iwata Kyoto, Japan More articles by this author Koji Okihara Kyoto, Japan More articles by this author Satoru Ishikawa Hitachi, Japan More articles by this author Tsuneharu Miki Kyoto, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...