Electromagnetic navigation system combined with High-Frequency-Jet-Ventilation for CT-guided hepatic ablation of small US-Undetectable and difficult to access lesions

• Published in: International journal of hyperthermia Vol. 36; no. 1; pp. 1050 - 1056
• Main Authors: Volpi, Stephanie, Tsoumakidou, Georgia, Loriaud, Amélie, Hocquelet, Arnaud, Duran, Rafael, Denys, Alban
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-01-2019; Taylor & Francis Group
• Subjects: ablation techniques; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - surgery; electromagnetic navigation; Electromagnetic Phenomena; Female; high-frequency jet ventilation; High-Frequency Jet Ventilation - methods; Humans; image guidance; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - surgery; Liver tumors; Male; Middle Aged; Prospective Studies; Tomography, X-Ray Computed - methods; Liver tumors; ablation techniques; electromagnetic navigation; high-frequency jet ventilation; image guidance
• ISSN: 0265-6736; 1464-5157
• DOI: 10.1080/02656736.2019.1671612

Objectives: To report the feasibility and efficacy of percutaneous ablation of small hepatic malignant tumors that are invisible on ultrasound and inaccessible using in-plane CT guidance, using a combination of high-frequency jet-ventilation (HFJV) and electromagnetic (EM) needle tracking.
Methods: This study reviewed 27 percutaneous ablations of small hepatic tumors (<2 cm) performed using EM navigation-based probe placement and HFJV. All lesions were invisible on ultrasound and difficult to reach on CT requiring a double-oblique approach. The primary outcome was technical efficacy, defined as complete lesion coverage, and evaluated on contrast enhanced MRI after 3 and 6 months. Needle placement accuracy, the number of control CT acquisitions, procedure time, complications and radiation doses were assessed.
Results: Twenty-one patients with 27 treated lesions (14 hepatocellular carcinomas and 13 metastases) were included in this study. Mean tumor size was 12 ± 5.7 mm. Thirty-three percent of the lesions were located on the hepatic dome. Complete ablation was obtained in 100% at the 3- and 6-month MRI follow-up. The ablation probe was correctly placed on the first pass in 96%, with a mean path-to-tumor angle of 7 ± 4 degrees and a mean tip-to-tumor distance of 22 ± 19mm. A readjustment for additional overlapping application resulted in complete treatment in 4 patients. Needle placement took a mean 23 ± 12 min with mean radiation doses of 558 mGy*cm. No major complications were reported.
Conclusion: Percutaneous liver ablation of lesions that cannot be seen on US and requiring out-of-plane CT access can be successfully and safely treated using electromagnetic-based navigation and jet-ventilation.