Abstract
ObjectiveAssessing the feasibility and efficiency of interventions using ultrasound (US) volume navigation (V Nav) with real time needle tracking and image fusion with contrast enhanced (ce) CT, MRI or US.MethodsFirst an in vitro study on a liver phantom with CT data image fusion was performed, involving the puncture of a 10 mm lesion in a depth of 5 cm performed by 15 examiners with US guided freehand technique vs. V Nav for the purpose of time optimization. Then 23 patients underwent ultrasound-navigated biopsies or interventions using V Nav image fusion of live ultrasound with ceCT, ceMRI or CEUS, which were acquired before the intervention. A CEUS data set was acquired in all patients. Image fusion was established for CEUS and CT or CEUS and MRI using anatomical landmarks in the area of the targeted lesion. The definition of a virtual biopsy line with navigational axes targeting the lesion was achieved by the usage of sterile trocar with a magnetic sensor embedded in its distal tip employing a dedicated navigation software for real time needle tracking.ResultsThe in vitro study showed significantly less time needed for the simulated interventions in all examiners when V Nav was used (p<0.05). In the study involving patients, in all 10 biopsies of suspect lesions of the liver a histological confirmation was achieved. We also used V Nav for a breast biopsy (intraductal carcinoma), for a biopsy of the abdominal wall (metastasis of ovarial carcinoma) and for radiofrequency ablations (4 ablations). In 8 cases of inflammatory abdominal lesions 9 percutaneous drainages were successfully inserted.ConclusionPercutaneous biopsies and drainages, even of small lesions involving complex access pathways, can be accomplished with a high success rate by using 3D real time image fusion together with real time needle tracking.
Highlights
Real time image guided biopsy is performed either based on fundamental B-scan ultrasound (US) or CT fluoroscopy [1,2]
In vitro study For the preclinical study on a liver phantom applying CT image fusion with the Volume Navigation (V Nav) needle tracking system 15 examiners with different ultrasound experience performed the puncture of the simulated lesion successfully
The average time needed for successful puncture of the simulated lesion in conventional ultrasound guided freehand technique without V Nav was 116 seconds
Summary
Real time image guided biopsy is performed either based on fundamental B-scan ultrasound (US) or CT fluoroscopy [1,2]. The advantage of the MRI and CT based method is the excellent visualization of lesions after intravenous (iv) contrast application, which improves the perceptibility of most lesions dramatically. The disadvantage using these methods is the lack of real time image data on the needle position, which reduces the safety and pace of the procedure. CT fluoroscopy offers a real time image data update but still lacks contrast based image information because of the contrast media’s dynamic. It exposes the patient as well as the physician to ionizing radiation
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