Ultrasound Fusion Imaging Research Articles

Ultrasonographic technique and appearance of the coelomic organs in crocodilians

IntroductionCrocodilians have significant ecological, conservational, and economic roles. They are also commonly raised for commercial purposes and kept as zoological specimens. Although ultrasonography has been used in zoological contexts for health assessments of crocodilians, published studies on a detailed ultrasonography protocol and ultrasonographic anatomy are lacking. This study aimed to establish a standardized ultrasonography protocol and pictorial reference of the ultrasonographic appearances of the coelomic organs of crocodilians.MethodsA total of 7 crocodilians comprising 4 different species were included in this study. The crocodilians were manually restrained and underwent a non-contrasted and contrasted computed tomography (CT) scan, followed by an ultrasonography (USG) examination. Ultrasound fusion imaging technique enabled greater confidence in establishing a clear organ localization and correlation between modalities by visualizing the same anatomy from the same view angle.ResultsThe heart, caudal vena cava, liver, fat body (steatotheca), spleen, stomach, duodenal loops, pancreas, kidneys, testes, ovaries and cloaca were visualized in all species. Longitudinal and transverse images of the coelomic structures were acquired when possible. The ultrasonographic characteristics of the coelomic organs, including transducer positioning, acoustic window and approach, shape, size, marginations, and echo pattern were documented.DiscussionThe findings of this study provided a useful ultrasonographic protocol and anatomical reference of the coelomic organs in crocodilians. Invaluable insights into the practicality and adequacy of ultrasonography in evaluating the coelomic structures of crocodilians as part of health assessment and disease diagnosis were also discussed.

Precise liver tumor ablation: the clinical potential of US-US overlay fusion guidance.

Image-guided thermal ablation is a minimally invasive option for patients with early-stage hepatocellular carcinoma (HCC). However, the risk of local recurrence remains substantial because ultrasound (US) artifacts have a negative impact on the assessment of ablative margins during and immediately after ablation. Precise, real-time assessment of the ablation zone is key to reducing the risk of local tumor progression. With the advent of US image fusion technology, ablative margins can now be assessed three-dimensionally with greater accuracy. Therefore, US-US overlay fusion guidance has the potential to improve the local controllability of ablation in patients with HCC. This review discusses the US-US fusion guidance technique and its current clinical applications for hepatic interventions, with descriptions of its concept, methodology, and efficacy.

Three-dimensional trans-rectal and trans-abdominal ultrasound image fusion for the guidance of gynecologic brachytherapy procedures: a proof of concept study

High dose-rate brachytherapy is a treatment technique for gynecologic cancers where intracavitary applicators are placed within the patient’s pelvic cavity. To ensure accurate radiation delivery, localization of the applicator at the time of insertion is vital. This study proposes a novel method for acquiring, registering, and fusing three-dimensional (3D) trans-abdominal and 3D trans-rectal ultrasound (US) images for visualization of the pelvic anatomy and applicators during gynecologic brachytherapy. The workflow was validated using custom multi-modal pelvic phantoms and demonstrated during two patient procedures. Experiments were performed for three types of intracavitary applicators: ring-and-tandem, ring-and-tandem with interstitial needles, and tandem-and-ovoids. Fused 3D US images were registered to magnetic resonance (MR) and computed tomography (CT) images for validation. The target registration error (TRE) and fiducial localization error (FLE) were calculated to quantify the accuracy of our fusion technique. For both phantom and patient images, TRE and FLE across all modality registrations (3D US versus MR or CT) resulted in mean ± standard deviation of 4.01 ± 1.01 mm and 0.43 ± 0.24 mm, respectively. This work indicates proof of concept for conducting further clinical studies leveraging 3D US imaging as an accurate, accessible alternative to advanced modalities for localizing brachytherapy applicators.

Microwave ablation for colorectal liver metastases with ultrasound fusion imaging assistance: a stratified analysis study based on tumor size and location.

To investigate the efficacy of ultrasound fusion imaging-assisted microwave ablation (MWA) for patients with colorectal liver metastases (CRLM) based on stratified analysis of tumor size and location. Patients with CRLM who underwent ultrasound fusion imaging-assisted MWA in our hospital between February 2020 and February 2023 were enrolled into this retrospective study. Ultrasound fusion imaging was used for detection, guidance, monitoring and immediate evaluation throughout the MWA procedures. Technical success, technique efficacy, local tumor progression (LTP), intrahepatic progression and overall survival (OS) were recorded and analyzed. The subgroup analysis of intrahepatic progression of MWA for CRLM was performed according to tumor size and location. A total of 51 patients with 122 nodules were enrolled. Both technical success and technique efficacy were acquired in all nodules. In a median follow-up period of 19months, 2.5% of the nodules (3/122) were observed LTP. The 1-year and 2-year cumulative intrahepatic progression rates were 38.7% and 52.1% respectively. Patients were divided into subgroups according to tumor size (≥ 30mm, n = 13; < 30mm, n = 38) and tumor location (perivascular, n = 20; non-perivascular, n = 31 and subcapsular, n = 36; non-subcapsular, n = 15). The cumulative intrahepatic progression rates were similar between the subgroups regarding tumor size and perivascular location, while significantly higher in the subcapsular group than in the non-subcapsular group (p = 0.021). Ultrasound fusion imaging-assisted MWA exhibited satisfactory local efficacy for CRLM, especially for non-subcapsular tumors.

Transperineal 3-Core Magnetic Resonance Imaging Ultrasound Fusion Targeted Plus Laterally 6-Core Systematic Biopsy in Prostate Cancer Diagnosis

IntroductionIt is important to explore strategies reducing the number of SB cores taken to minimize biopsy-related morbidity and patient's discomfort during biopsy. This study aims to optimize prostate biopsy procedures by reducing the number of systematic biopsy (SB) cores while preserving cancer detection rates in the era of combined biopsy. Patients and MethodsWe prospectively recruited patients with ≥1 magnetic resonance imaging (MRI) lesions and they underwent transperineal combined 12-core SB+3-core targeted prostate biopsy (TB, reference standard). New strategy was defined as a laterally 6-core SB+3-core TB. Patients were served as their own control. Detection rates for overall prostate cancer (PCa) and clinically significant PCa (csPCa) were compared among the standard SB, MRI-TB, 6-core SB +3-core TB, and reference standard. Pathology consistency was assessed using the Kappa test. ResultsA total of 204 men were included, of which 111 (54.41%) and 92 (45.10%) harbored overall PCa and csPCa. Referenced combined biopsy detected significantly 6.86% (P = .0005) or 4.90% (P = .0044) more csPCa than performing only SB or 3-core TB, but was comparable to the new biopsy strategy. (45.10% vs. 43.14%, P = .1336) Similar results persisted when limiting patients in biopsy-naïve men or stratified by Prostate Imaging Reporting and Data System scores, PSAD, and index lesion parameters. Additionally, performing 6-core SB+3-core TB demonstrated high consistency with reference standard in grade group distribution (Kappa coefficient: 0.952 for all, 0.961 for biopsy-naïve men) and achieved superior sensitivity of 95.7% (All: 95% CI: 89.2%-99.8%) and 96.9% (Biopsy-naïve: 95% CI: 91.1%-99.7%), respectively. ConclusionsThe 6-core SB+3-core TB approach maintains expected detection rates while reducing the total core count, offering a promising alternative to the reference standard, which may help to tailor transperineal combined biopsy procedures.

Initial investigation on ultrasound-guided percutaneous biopsy of lesions in the first hepatic hilum with fusion of ultrasound and multimodal imaging cognitive guidance.

This study aims to evaluate the efficacy and safety of ultrasound-guided percutaneous biopsy of the first hepatic hilum lesion, and examine its clinical value of diagnosis and treatment. We conducted a retrospective study on patients diagnosed with the first hepatic hilum lesions at Fujian Provincial Hospital between February 2015 and October 2022. We selected patients who had lesions in the first hepatic hilum(including a 2cm surrounding area of the left/right hepatic ducts and upper-middle segment of the common bile duct) and the liver periphery(in the peripheral area of the liver, outside of the above-mentioned first hepatic porta region). These patients underwent percutaneous ultrasound-guided core needle biopsy (PUS-CNB) with cognitive fusion guidance using CT, MRI, or PET-CT. We compared the safety and efficacy of PUS-CNB in the first hepatic hilum and the liver periphery to explore the value of PUS-CNB in optimizing the clinical treatment of the first hepatic hilum lesions. The studied includes 38 cases of the first hepatic hilum cases (18 females; 20 males), 23 presented with mass-forming tumors while the remaining 15 exhibited diffuse infiltrative tumors, with an average diameter of 4.65± 2.51 cm. The percutaneous biopsy procedure, conducted under ultrasound guidance, had an average operation time of 14.55 ± 2.73 minutes, and resulted in a postoperative bleeding volume of approximately 10.79 ± 2.79 ml. The diagnostic success rate was noted to be as high as 92.11% among the participants who underwent percutaneous biopsy of the first hepatic hilum. Procedural complications, such as bleeding, bile leakage, intestinal perforation, infection or needle tract seeding, did not occur during or after the biopsy procedure. Affected by biopsy results, 5 altered their clinical treatment plans accordingly, 24patients received non-surgical treatment, 9 underwent surgical treatment, 5 underwent radiofrequency ablation for the lesions. The study comprised a total of 112 cases for percutaneous biopsy of the liver periphery. The safety and effectiveness of the two biopsy techniques were comparable, with diagnostic success rates of 92.11% VS. 94.34%, respectively (p = 0.61). Cognitive fusion of ultrasound and multi-modal imaging for the first hepatic hilum lesion puncture biopsy is a safe and effective diagnostic procedure, with better diagnostic rate, may improve clinical value of diagnosis and treatment of various diseases.

The learning curve and experience of a novel multi-modal image fusion targeted transperineal prostate biopsy technique using electromagnetic needle tracking under local anesthesia.

Prostate cancer is the most common malignant tumor of male genitourinary system, and the gold standard for its diagnosis is prostate biopsy. Focusing on the methods and skills of prostate biopsy, we explored the learning curve and experience of a novel magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) image fusion transperineal biopsy (TPB) technique using electromagnetic needle tracking under local anesthesia. The clinical and pathological data of 92 patients who underwent targeted TPB from January 2023 to July 2023 in our center were prospectively collected. The cumulative sum (CUSUM) analysis method and the best fitting curve were used to analyze the learning curve of this novel technique, and the clinical characteristics, perioperative data and tumor positive rate of prostate biopsy of patients at different stages of the learning curve were compared. With the increase of the number of surgical cases, the overall operative time showed a downward trend. The best fitting curve of CUSUM reached its peak at the twelfth case, which is the minimum cumulative number of surgical cases needed to cross the learning curve of the operation. Taking this as the boundary, the learning curve is divided into two stages: learning improvement stage (group A, 12 cases) and proficiency stage (group B, 80 cases). The surgical time and visual analog scale score during prostate biopsy in group A were significantly higher than those in group B. The visual numerical scale score during prostate biopsy in group A was significantly lower than that in group B. There was no statistically significant difference between group A and group B in the detection rate of csPCa and the incidence of perioperative complications. The novel targeted TPB technique is divided into learning improvement stage and proficiency stage, and 12 cases may be the least cumulative number.

Three-dimensional ultrasound fusion imaging in precise needle placement for thermal ablation of hepatocellular carcinoma

Purpose To investigate the value of three-dimensional ultrasound fusion imaging (3DUS FI) technique for guiding needle placement in hepatocellular carcinoma (HCC) thermal ablation. Methods A total of 57 patients with 60 HCCs with 3DUS FI-guided thermal ablation were retrospectively included in the study. 3DUS volume data of liver were acquired preoperatively by freehand scanning with the tumor and predetermined 5 mm ablative margin automatically segmented. Plan of needle placement was made through a predetermined simulated ablation zone to ensure a 5 mm ablative margin with the coverage rate toward tumor and ablative margin. With real-time ultrasound and 3DUS fusion imaging, ablation needles were placed according to the plan. After ablation, the ablative margin was immediately evaluated by contrast-enhanced ultrasound and 3DUS fusion imaging. The rate of adequate ablative margin, complete response (CR), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) was evaluated. Results According to postoperative contrast-enhanced CT or MR imaging, the complete response rate was 100% (60/60), and 83% of tumors (30/36) achieved adequate ablative margin (>5 mm) three-dimensionally. During the follow-up period of 6.0-42.6 months, LTP occurred in 5 lesions, with 1- and 2-year LTP rates being 7.0% and 9.4%. The 1- and 2-year DFS rates were 76.1% and 65.6%, and 1- and 2-year OS rates were 98.1% and 94.0%. No major complications or ablation-related deaths were observed in any patients. Conclusions Three-dimensional ultrasound fusion imaging technique may improve the needle placement of thermal ablation for HCC and reduce the rate of LTP.

FAMF-Net: Feature Alignment Mutual Attention Fusion with Region Awareness for Breast Cancer Diagnosis via Imbalanced Data.

Automatic and accurate classification of breast cancer in multimodal ultrasound images is crucial to improve patients' diagnosis and treatment effect and save medical resources. Methodologically, the fusion of multimodal ultrasound images often encounters challenges such as misalignment, limited utilization of complementary information, poor interpretability in feature fusion, and imbalances in sample categories. To solve these problems, we propose a feature alignment mutual attention fusion method (FAMF-Net), which consists of a region awareness alignment (RAA) block, a mutual attention fusion (MAF) block, and a reinforcement learning-based dynamic optimization strategy(RDO). Specifically, RAA achieves region awareness through class activation mapping and performs translation transformation to achieve feature alignment. When MAF utilizes a mutual attention mechanism for feature interaction fusion, it mines edge and color features separately in B-mode and shear wave elastography images, enhancing the complementarity of features and improving interpretability. Finally, RDO uses the distribution of samples and prediction probabilities during training as the state of reinforcement learning to dynamically optimize the weights of the loss function, thereby solving the problem of class imbalance. The experimental results based on our clinically obtained dataset demonstrate the effectiveness of the proposed method. Our code will be available at: https://github.com/Magnety/Multi_modal_Image.

Cancer Detection Rate of MRI Ultrasound Fusion Prostate Biopsy in 1,039 Patients and Number Needed to Biopsy in Targeted Lesion

Objective: To determine the cancer detection rate (CDR) of magnetic resonance imaging ultrasound fusion prostate biopsy (MRI/US fusion prostate biopsy) in Thailand. The secondary aim was to estimate the number needed to biopsy (NNB) for each prostate lesion in a targeted biopsy, classified by Prostate Imaging-Reporting and Data System (PI-RADS). Materials and Methods: The data of 1,039 consecutive patients who underwent a MRI/US fusion prostate biopsy at Siriraj Hospital between September 2017 and February 2021 was included and retrospectively reviewed. Those included had previous negative biopsies and were biopsy naïve. The data was analyzed to find the detection rate and NNB. Results: The overall detection rate of MRI/US fusion prostate biopsy was 58.71%, whereas that of systematic biopsy was 45.72%. Clinically significant prostate cancer (csPCa) (Gleason score ≥ 3+4) detection rate of MRI/US fusion prostate biopsy was 51.01%. When categorized by PI-RADS category 3, 4, and 5 were 12.16%, 44.98%, 85.71% respectively. NNB in targeted biopsy of PI-RADS 3, 4, and 5 were 8, 7, and 3 times sequentially. Positive predictive factors for prostate cancer (PCa) detection were age, prostate-specific antigen density (PSAD) and PI-RADS, whereas prostate volume was a negative predictive factor. Conclusion: This study supports the role of MRI/US fusion prostate biopsy in PCa detection and should not avoid systematic biopsies. The higher the PI-RADS was, the greater the csPCa detection rate. NNB is helpful in guiding the least amount of biopsied cores for each lesion.

Efficacy and Safety of Microwave Ablation Assisted by Ultrasound Fusion Imaging for Primary and Secondary Liver Cancers with a Diameter of 3-7 Cm.

To investigate the efficacy and safety of microwave ablation (MWA) assisted by ultrasound fusion imaging (FI) for primary and secondary liver cancers with a diameter of 3-7 cm. A retrospective analysis was conducted on patients with primary and secondary liver cancers (3-7 cm) who underwent MWA with ultrasound FI assistance in our hospital from April 2020 to May 2022. Technical success, technique efficacy, local tumor progression (LTP), major complication, intrahepatic distant recurrence (IDR), and overall survival (OS) were assessed during the follow-up period. In addition, the ablation results of tumors between the medium-sized group (3.1-5.0 cm) and large-sized group (5.1-7.0 cm) were compared. 31 patients with 35 primary and secondary liver cancers were treated with MWA assisted by ultrasound FI. Complete ablation was achieved in 34 lesions with a technical success rate of 97.1%. Major complications occurred in 6.5% of patients (2/31), while no ablation-related deaths were reported. The median follow-up time of this study was 24 months (range:10 to 35 months). The technique efficacy rate was 97.1% (34/35), with LTP occurring in three lesions at a rate of 8.8% (3/34). The incidence of IDR was 38.7% (12/31) and the 2-year cumulative OS rate reached 96.7%. Moreover, there were no statistical differences in technique efficacy rate (p=0.286), LTP rate (p=0.328), major complication rate (p=0.503), IDR (p=0.857), and OS (p=0.118) between medium-sized group and large-sized group. Ultrasound FI-assisted MWA has the potential to be an effective and safe therapeutic strategy for primary and secondary liver cancers ranging from 3-7 cm in size.

Multimodal classification of breast cancer using feature level fusion of mammogram and ultrasound images in machine learning paradigm

Multimodal classification of breast cancer using feature level fusion of mammogram and ultrasound images in machine learning paradigm

Percutaneous Microwave Ablation of Hepatocellular Carcinoma with "Double Fusion" Technique: Technical Note and Single-Center Preliminary Experience.

Percutaneous image-guided thermal ablation is included in most society guidelines for treatment of hepatocellular carcinoma (HCC). The results of this treatment in terms of efficacy depend on the ability to precisely place the device into the target tumor. Ultrasound (US) is a commonly used imaging guidance modality for its real-time feedback. However, an accurate device deployment remains challenging in some clinical scenarios, including cases of tumors that are undetectable or not clearly visible by US. To overcome this problem, fusion imaging techniques have been developed, which combine images from different modalities. The most widely known technique combines pre-procedural contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) with real-time US scans. Cone beam CT (CBCT) is a technology that can provide intra-procedural cross-sectional images, which can be registered to images from other modalities, including preprocedural CT/MR scans. The aim of our study is to report the preliminary experience on percutaneous microwave ablation (MWA) of patients with HCC that were treated using the "double fusion" technique, which combines the use of US fusion imaging and CBCT fusion imaging. We describe the technical details, feasibility, safety and short-term efficacy of this technique in a small series of eight patients with 11 HCCs.

A new local structural similarity fusion-based thresholding method for homomorphic ultrasound image despeckling in NSCT domain

Ultrasound is a diagnostic imaging technique to detect various illnesses related to the body's internal organs. It is a non-invasive, safe, cost-effective, and simple imaging modality that uses high-frequency sound waves and their reflection from internal organs. However, a key drawback of using ultrasound imaging tools is that they are often contaminated by multiplicative speckle noise, which can reduce the image resolution and contrast and complicates the diagnosis of the tiny structure of lesions. Extensive studies have shown that eliminating speckle noise is a necessary pre-processing task for computer-assisted ultrasound image systems. This paper proposes a novel method for denoising, weighted thresholding, and fusion of ultrasound images in the Non-Subsampled Contourlet Transformation (NSCT) domain. The method utilizes (a) The Bayesian and Bivariate shrinkage rule in the NSCT domain, (b) A new local structural similarity-fusion-based homomorphic ultrasound image despeckling method in the NSCT domain, and (c) A weights estimation approach based on a bilateral method that helps improve noise suppression and edge preservation results. The performance of the proposed algorithm is evaluated in terms of mean squared error (MSE), peak signal-to-noise ratio, structural similarity index (SSIM), speckle suppression index, signal-to-MSE ratio, and speckle signal-to-noise ratio. Extensive computer simulation results show that the presented method performs better in subjective visual inspection than existing state-of-the-art despeckling techniques.

Offline ultrasound-ultrasound fusion imaging for assessment of normal fetal brain development: the way forward?

Offline ultrasound-ultrasound fusion imaging for assessment of normal fetal brain development: the way forward?

Ultrasound fusion imaging for improving diagnostic and therapeutic strategies of focal liver lesions: A preliminary study.

To assess the effect of ultrasound (US) fusion imaging on the clinical diagnostic and therapeutic strategies of focal liver lesions, which are difficult to detect or diagnose by conventional US. From November 2019 to June 2022, 71 patients with invisible or undiagnosed focal liver lesions who underwent fusion imaging combining US with CT or MR were included in this retrospective study. The reasons for US fusion imaging were as follows: (1) lesions that were undetectable or inconspicuous on B-mode US; (2) post-ablation lesions that could not be assessed accurately by B-mode US; (3) to evaluate whether the lesions detected by B-mode US that were consistent with those presented on MRI/CT images. Of the 71 cases, 43 cases were single lesions, and 28 cases were multiple lesions. Among the 46 cases which were invisible on conventional US, the display rate of lesions using US-CT/MRI fusion imaging was 30.8%, and that combined with CEUS was 76.9%. US-guided biopsy was performed in 30 patients after the detection and localization determined by fusion imaging, with a positive rate of 73.3%. Six patients with recurrence after ablation therapy were all detected and located accurately after fusion imaging, and 4 of them successfully underwent ablation therapy again. Fusion imaging contributes to the understanding of the anatomical relationship between lesion location and blood vessels. Additionally, fusion imaging can improve the diagnostic confidence, be helpful to guide interventional operations, and hence be conducive to clinical therapeutic strategies.

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion

Prostate cancer is among the most frequently diagnosed cancers and a leading cause of cancer-related death in men. Currently, the most reliable and widely used imaging test for prostate cancer diagnosis is multiparametric pelvic magnetic resonance imaging (mpMRI). Modern biopsy techniques are based on the computerised merging of ultrasound and MRI images to provide better vision during the biopsy procedure (Fusion Biopsy). However, the method is expensive due to high equipment cost. Cognitive fusion of ultrasound and MRI images has recently emerged as a cheaper and easier alternative to computerised fusion. The aim of this prospective study is to perform an in-patient comparison of the systematic prostate biopsy procedure (SB) vs. cognitive fusion (CF) guided prostate biopsy method in terms of safety, ease of use, cancer detection rate and clinically significant cancer detection. We enrolled 103 patients with suspected prostate cancer that were biopsy naive, with PSA > 4 ng/dL and PIRADS score of 3, 4 or 5. All patients received a transperineal standard 12-18 cores systematic biopsy (SB) and a four-cores targeted cognitive fusion (CF) biopsy. Following the prostate biopsy, 68% of the patients were diagnosed with prostate cancer (70/103 patients). SB diagnosis rate was 62% while CF biopsy was slightly better with a 66% rate. There was a significant 20% increase in clinically significant prostate cancer detection rate for the CF compared to SB (p < 0.05) and a significant prostate cancer risk upgrade from the low to the intermediate risk category (13%, p = 0.041). Transperineal cognitive fusion targeted prostate biopsy is a straightforward biopsy method that is easy to perform and is a safe alternative to standard systematic biopsy with improved significant cancer detection accuracy. A combined targeted and systematic approach should be used for the best diagnostic results.

V07-10 PROSTATE SPECIFIC MEMBRANE ANTIGEN (PSMA)-TARGETED PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023V07-10 PROSTATE SPECIFIC MEMBRANE ANTIGEN (PSMA)-TARGETED PROSTATE BIOPSY David Kuppermann, Jeremie Calais, and Leonard Marks David KuppermannDavid Kuppermann More articles by this author , Jeremie CalaisJeremie Calais More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI-guided biopsy (MRGB) has emerged as the de facto standard for the best accuracy in diagnosis of prostate cancer (PCa). However, MRI is imperfect, and both falsely positive and falsely negative results have been observed. A new method has been developed for diagnosis of PCa by using a new way to image PCa anywhere in the body. In the present video we illustrate how PSMA-targeted prostate biopsy can complement conventional MRGB. METHODS: PSMA PET scanning employs a radiotracer labeled with gallium 68 (Ga68) or fluor 18 (F18). When injected the radiotracer binds to the extracellular part of the PSMA molecule which sits on the surface of PCa cells. The bound molecule then becomes internalized into the cytoplasm of PCa cells, where it accumulates allowing visualization by PET scanning. A CT scan is then performed and overlayed for anatomic localization. The result is a visual representation of PCa, wherever it may be in the body including within the prostate. RESULTS: PSMA PET/CT detects lesions suspicious for clinically significant PCa (csPCa). The degree of suspicion is based on the pattern of the PSMA PET signal. When focal, the level of suspicion increases. When diffuse and faint, the level of suspicion decreases. The PSMA PET signal intensity is also quantified using a metric called Standardized Uptake Value (SUV). The suspicious lesions identified on PSMA PET/CT can be contoured, transferred onto an ultrasound (US) image fusion device, and used as targets for biopsy. At our institution the Artemis device is used, but the procedure is also applicable to other fusion devices. The prostate is imaged using US, anesthetized, scanned, and a 3D representation of the prostate is created for targeting and tracking of biopsy data. Next the PET/CT image, with a contoured region of interest, is fused with real-time US images of the prostate. Biopsy samples targeted to the PSMA avid spot are obtained in and around the lesion. If not obtained previously, systematic samples may also be obtained at this time. The tissue cores are submitted individually for pathologic review. The workflow is identical to that used in MRI-US fusion procedures. At this time PSMA guided biopsies are limited to cases where MRI is suspected of being falsely negative or where MRI is contraindicated. At our institution we have performed 21 PSMA-targeted biopsies in men whose MRGBs were negative, but PSA density remained elevated, of which 14 (66.67%) showed csPCa (≥ GG2). CONCLUSIONS: PSMA scanning and PSMA-targeted biopsy have brought on a disruptive innovation in the world of prostate cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e599 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Kuppermann More articles by this author Jeremie Calais More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

PD45-09 APPLICATION RESEARCH OF ARTIFICIAL INTELLIGENCE FULL QUANTITATIVE MIXED REALITY TECHNOLOGY IN FUSION PUNCTURE NAVIGATION OF PCNL

You have accessJournal of UrologyCME1 Apr 2023PD45-09 APPLICATION RESEARCH OF ARTIFICIAL INTELLIGENCE FULL QUANTITATIVE MIXED REALITY TECHNOLOGY IN FUSION PUNCTURE NAVIGATION OF PCNL Yubao Liu and Jianxing Li Yubao LiuYubao Liu More articles by this author and Jianxing LiJianxing Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the application value of artificial intelligence full quantitative mixed reality technology in real-time puncture guided by holographic image fused with ultrasound image during staghorn renal stones PCNL. METHODS: The clinical data of 16 patients with staghorn renal stones who underwent PCNL in our hospital from May 2021 to June 2022 were retrospectively analyzed. Before operation, two calibration patches were fixed on the skin area of bilateral iliopsoas muscle, and CTU examination was performed under prone position. DICOM data were exported and 3D imaging reconstruction was performed. Combined with AI-QMR, holographic three-dimensional images of body were projected in real space. The surgeon wore a mixed reality head-mounted display (HoloLens 2). Based on the calibration patches, combined with the position of the twelfth rib and lumbar vertebrae, the holographic model was visually matched with the real human body. Then, the ultrasound images were fused under the guidance of the virtual puncture path, and the needle was punctured into the collection system. When significant deviation occurred, the puncture direction was mainly adjusted under ultrasound. A questionnaire was designed to evaluate the satisfaction of surgeons with fusion puncture. The consistency rate of intraoperative fusion-guided puncture, puncture location time, postoperative complications, one-stage stone free rate and satisfaction were analyzed. RESULTS: Holograms were obtained in all 16 patients using QMR, and fusion puncture and one-stage operation were completed during the operation. In 6 patients, two standard channels were established and fusion puncture was performed 22 times. Among them, 4 fusion punctures showed significant deviation and were adjusted or re-punctured by ultrasound guidance. The consensus rate of fusion-guided puncture was 81.8%, the average puncture location time was 45.1s, and the first stage stone free rate was 91%. The subjective questionnaire showed that holography was helpful to improve the surgeon's cognition of puncture location and shorten the puncture location time. The satisfaction rate of matching and fusion-guided puncture was 82% and 90%, respectively. There were no Clavien-Dindo grade ≥Ⅱcomplications such as blood transfusion, organ injury and urosepsis. CONCLUSIONS: PCNL for staghorn renal stones has a long learning curve and high requirements for ultrasound-guided puncture. This technique can achieve the prediction and design of puncture path under the effect of 3D holographic image, and it can also be used to guide puncture by real-time fusion of ultrasound images. It shortens the learning curve of PCNL, effectively reduces the risk of complications, so as to achieve visual, quantifiable and controllable precision surgery, and improve the one-stage stone free rate. Source of Funding: The General Program of National Natural Science Foundation of China, 52175028 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1166 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yubao Liu More articles by this author Jianxing Li More articles by this author Expand All Advertisement PDF downloadLoading ...

Ultrasound-guided breast biopsy using an adapted automated cone-based ultrasound scanner: a feasibility study.

Among available breast biopsy techniques, ultrasound (US)-guided biopsy is preferable because it is relatively inexpensive and provides live imaging feedback. The availability of magnetic resonance imaging (MRI)-3D US image fusion would facilitate US-guided biopsy even for US occult lesions to reduce the need for expensive and time-consuming MRI-guided biopsy. In this paper, we propose a novel Automated Cone-based Breast Ultrasound Scanning and Biopsy System (ACBUS-BS) to scan and biopsy breasts of women in prone position. It is based on a previously developed system, called ACBUS, that facilitates MRI-3D US image fusion imaging of the breast employing a conical container filled with a coupling medium. The purpose of this study was to introduce the ABCUS-BS system and demonstrate its feasibility for biopsy of US occult lesions. The biopsy procedure with the ACBUS-BS comprises four steps: target localization, positioning, preparation, and biopsy. The biopsy outcome can be impacted by 5 types of errors: due to lesion segmentation, MRI-3D US registration, navigation, lesion tracking during repositioning, and US inaccuracy (due to sound speed difference between the sample and the one used for image reconstruction). For the quantification, we use a soft custom-made polyvinyl alcohol phantom (PVA) containing 8 lesions (3 US-occult and 5 US-visible lesions of 10 mm in diameter) and a commercial breast mimicking phantom with a median stiffness of 7.6 kPa and 28 kPa, respectively. Errors of all types were quantified using the custom-made phantom. The error due to lesion tracking was also quantified with the commercial phantom. Finally, the technology was validated by biopsying the custom-made phantom and comparing the size of the biopsied material to the original lesion size. The average size of the 10-mm-sized lesions in the biopsy specimen was 7.00 ± 0.92 mm (6.33 ± 1.16 mm for US occult lesions, and 7.40 ± 0.55 mm for US-visible lesions). For the PVA phantom, the errors due to registration, navigation, lesion tracking during repositioning, and US inaccuracy were 1.33 mm, 0.30 mm, 2.12 mm, and 0.55 mm. The total error was 4.01 mm. For the commercial phantom, the error due to lesion tracking was estimated at 1.10 mm, and the total error was 4.11 mm. Given these results, the system is expected to successfully biopsy lesions larger than 8.22 mm in diameter. Patient studies will have to be carried out to confirm this in vivo. The ACBUS-BS facilitates US-guided biopsy of lesions detected in pre-MRI and therefore might offer a low-cost alternative to MRI-guided biopsy. We demonstrated the feasibility of the approach by successfully taking biopsies of 5 US-visible and 3 US-occult lesions embedded in a soft breast-shaped phantom. This article is protected by copyright. All rights reserved.