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CardioVascular and Interventional Radiology

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01-01-2019 | Clinical Investigation

Real-Time US-¹⁸FDG-PET/CT Image Fusion for Guidance of Thermal Ablation of ¹⁸FDG-PET-Positive Liver Metastases: The Added Value of Contrast Enhancement

Authors: Giovanni Mauri, Nicolò Gennaro, Stefano De Beni, Tiziana Ierace, S. Nahum Goldberg, Marcello Rodari, Luigi Alessandro Solbiati

Published in: CardioVascular and Interventional Radiology | Issue 1/2019

Abstract

Purpose

To assess the feasibility of US-¹⁸FDG-PET/CT fusion-guided microwave ablation of liver metastases either poorly visible or totally undetectable with US, CEUS and CT, but visualized by PET imaging.

Materials and Methods

Twenty-three patients with 58 liver metastases underwent microwave ablation guided by image fusion system that combines US with ¹⁸FDG-PET/CT images. In 28/58 tumors, ¹⁸FDG-PET/CT with contrast medium (PET/CECT) was used. The registration technical feasibility, registration time, rates of correct targeting, technical success at 24 h, final result at 1 year and complications were analyzed and compared between the PET/CT and PET/CECT groups.

Results

Registration was successfully performed in all cases with a mean time of 7.8 + 1.7 min (mean + standard deviation), (4.6 + 1.5 min for PET/CECT group versus 10.9 + 1.8 min for PET/CT group, P < 0.01). In total, 46/58 (79.3%) tumors were correctly targeted, while 3/28 (10.7%) and 9/30 (30%) were incorrectly targeted in PET/CT and PET/CECT group, respectively (P < 0.05). Complete ablation was obtained at 24 h in 70.0% of cases (n = 40 tumors), 23/28 (82.1%) in the PET/CECT group and 17/30 (56.7%) in the PET/CT group (P < 0.037). Fourteen tumors underwent local retreatment (11 ablations, 2 with resection and 1 with stereotactic body radiation therapy), while 4 tumors could not be retreated because of distant disease progression and underwent systemic therapy. Finally, 54/58 (93.1%) tumors were completely treated at 1 year. One major complication occurred, a gastrointestinal hemorrhage which required surgical repair.

Conclusions

Percutaneous ablation of ¹⁸FDG-PET-positive liver metastases using fusion imaging of real-time US and pre-acquired ¹⁸FDG-PET/CT images is feasible, safe and effective. Contrast-enhanced PET/CT improves overall ablation accuracy and shortens procedural duration time.

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Title: Real-Time US-18FDG-PET/CT Image Fusion for Guidance of Thermal Ablation of 18FDG-PET-Positive Liver Metastases: The Added Value of Contrast Enhancement
Authors: Giovanni Mauri
Nicolò Gennaro
Stefano De Beni
Tiziana Ierace
S. Nahum Goldberg
Marcello Rodari
Luigi Alessandro Solbiati
Publication date: 01-01-2019
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 1/2019
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-018-2082-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Real-Time US-¹⁸FDG-PET/CT Image Fusion for Guidance of Thermal Ablation of ¹⁸FDG-PET-Positive Liver Metastases: The Added Value of Contrast Enhancement

Abstract

Purpose

Materials and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusions

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