Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, 10 Center Dr, Bldg 10, Room 1C369, MSC 1182, Bethesda, MD 20892, USA.
Radiology. 2011 Sep;260(3):848-56. doi: 10.1148/radiol.11101985. Epub 2011 Jul 6.
To assess the feasibility of combined electromagnetic device tracking and computed tomography (CT)/ultrasonography (US)/fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) fusion for real-time feedback during percutaneous and intraoperative biopsies and hepatic radiofrequency (RF) ablation.
In this HIPAA-compliant, institutional review board-approved prospective study with written informed consent, 25 patients (17 men, eight women) underwent 33 percutaneous and three intraoperative biopsies of 36 FDG-avid targets between November 2007 and August 2010. One patient underwent biopsy and RF ablation of an FDG-avid hepatic focus. Targets demonstrated heterogeneous FDG uptake or were not well seen or were totally inapparent at conventional imaging. Preprocedural FDG PET scans were rigidly registered through a semiautomatic method to intraprocedural CT scans. Coaxial biopsy needle introducer tips and RF ablation electrode guider needle tips containing electromagnetic sensor coils were spatially tracked through an electromagnetic field generator. Real-time US scans were registered through a fiducial-based method, allowing US scans to be fused with intraprocedural CT and preacquired FDG PET scans. A visual display of US/CT image fusion with overlaid coregistered FDG PET targets was used for guidance; navigation software enabled real-time biopsy needle and needle electrode navigation and feedback.
Successful fusion of real-time US to coregistered CT and FDG PET scans was achieved in all patients. Thirty-one of 36 biopsies were diagnostic (malignancy in 18 cases, benign processes in 13 cases). RF ablation resulted in resolution of targeted FDG avidity, with no local treatment failure during short follow-up (56 days).
Combined electromagnetic device tracking and image fusion with real-time feedback may facilitate biopsies and ablations of focal FDG PET abnormalities that would be challenging with conventional image guidance.
评估联合电磁设备跟踪和计算机断层扫描（CT）/超声（US）/氟 18 氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）融合在经皮和术中活检及肝脏射频（RF）消融术中实时反馈的可行性。
在这项符合 HIPAA 规定、机构审查委员会批准的前瞻性研究中，患者签署了书面知情同意书，共有 25 名患者（17 名男性，8 名女性）接受了 33 次 FDG 阳性靶目标的经皮和 3 次术中活检，时间为 2007 年 11 月至 2010 年 8 月。1 名患者接受了 FDG 阳性肝病灶的活检和 RF 消融。目标表现为 FDG 摄取不均匀或在常规影像上显示不佳或完全不显影。术前 FDG PET 扫描通过半自动方法与术中 CT 扫描严格配准。包含电磁传感器线圈的同轴活检针导入器尖端和 RF 消融电极引导针尖端通过电磁场发生器进行空间跟踪。实时 US 扫描通过基于基准的方法进行配准，允许将 US 扫描与术中 CT 和预获取的 FDG PET 扫描融合。使用 US/CT 图像融合的叠加显示和核心注册 FDG PET 目标的视觉显示来进行引导；导航软件使实时活检针和针电极导航和反馈成为可能。
所有患者均成功实现了实时 US 与核心配准 CT 和 FDG PET 扫描的融合。36 次活检中有 31 次具有诊断意义（18 例为恶性肿瘤，13 例为良性病变）。RF 消融导致靶向 FDG 摄取的消除，在短期随访（56 天）期间无局部治疗失败。
联合电磁设备跟踪和实时反馈的图像融合可能有助于对常规图像引导具有挑战性的 FDG PET 异常的焦点进行活检和消融。
