Characterization by Biopsy or CEUS of Liver Lesions Guided by Image Fusion between Ultrasonography and CT, PET/CT or MRI

Zusammenfassung

Ziel: Ziel der Studie war es, die Anzahl der Fälle aufzuzeigen, in denen der Einsatz fusionsgestützten Ultraschalls zu einer konklusiven Diagnose von Läsionen führte, die sich im CT, MRT oder PET/CT darstellten. Als Läsion wurde eine durch Verletzung oder Erkrankung geschädigte Region definiert. Material und Methoden: 40 Patienten mit Leberläsionen entsprechend CT (n = 35), MRI (n = 2) oder PET/CT (n = 3), von denen 34 eine bekannte neoplastische Grunderkrankung hatten, wurden zur US-Untersuchung oder US-gestützten Biopsie prospektiv in die Studie eingeschlossen. Zur Untersuchung wurde ein LOGIQ-Prototypensystem mit geräteinhärenter Software zur Fusionsbildgebung mit einem 4 MHz-Konvexschallkopf (GE Healthcare, Chalfont St. Giles, UK) verwandt. Alle Patienten wurden zunächst mit B-Mode-US, dann mit fusionsgestütztem US und einige zusätzlich mit CEUS untersucht. Alle Patienten erhielten eine Follow-up-Untersuchung nach wenigstens einem Jahr. Ergebnisse: 26 Läsionen waren im US initial nicht darstellbar. Von diesen konnten 9 mithilfe des fusionsgestützten Ultraschalls und weitere 4 mithilfe von CEUS dargestellt werden, was die endgültige Diagnose bei 11 dieser 13 Patienten erleichterte. Die mittlere Läsionsgröße aller in die Studie eingeschlossenen Raumforderungen lag bei 1,5 cm (Interquartilsabstand: 1,0 – 2,4 cm). Zwischen den Gruppen bestand kein signifikanter Unterschied in der Größe der Läsionen. Schlussfolgerung: Wir konnten erfolgreich zeigen, dass, verglichen zum konventionellen B-Mode-US, der fusionsgestützte Ultraschall eine verbesserte Charakterisierung von Leberläsionen erlaubt.

Abstract

Purpose: The aim of this study was to show the number of cases in which the use of fusion-guided ultrasonography (US) provided conclusive diagnosis of lesions in the liver seen on CT or MRI or PET/CT. A lesion is defined as a region that has suffered damage due to injury or disease. Materials and Methods: Forty patients of whom 34 had confirmed neoplastic disease, referred to US evaluation or US-guided biopsy of liver lesions seen on CT (n = 35), MRI (n = 2) or PET/CT (n = 3), were prospectively included in the study. We used a LOGIQ prototype system with incorporated software for fusion imaging, and a convex-array 4 MHz transducer (GE Healthcare, Chalfont St. Giles, UK). All patients were initially examined with B-mode US, then by fusion-guided US and for some patients also with CEUS. All patients received follow-up after at least one year. Results: Twenty-six lesions were initially indistinguishable with US. Of these, 9 became visible with fusion-guided US and another 4 became visible with CEUS, which facilitated a final diagnosis in 11 of these 13 patients. The median tumor size for all lesions included in the study was 1.5 cm (interquartile range: 1.0 – 2.4). There was no statistically significant difference in tumor size between the groups. Conclusion: We have successfully demonstrated an increase in the characterization of liver lesions by using fusion-guided US compared with conventional B-mode US.

Key words

abdomen - interventional procedures - ultrasound - technology assessment

References

• 1 Ewertsen C, Grossjohann H S, Nielsen M B. Image fusion involving ultrasound.  Ultraschall in Med. 2006;  27 128-129
• 2 Maintz J B, Viergever M A. A survey of medical image registration.  Med Image Anal. 1998;  2 1-36
• 3 Blomley M, Claudon M, Cosgrove D. WFUMB Safety Symposium on Ultrasound Contrast Agents: clinical applications and safety concerns.  Ultrasound Med Biol. 2007;  33 180-186
• 4 Claudon M, Cosgrove D, Albrecht T et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008.  Ultraschall in Med. 2008;  29 28-44
• 5 Cosgrove D. Ultrasound contrast agents: an overview.  Eur J Radiol. 2006;  60 324-330
• 6 Giesel F L, Delorme S, Sibbel R et al. Contrast-enhanced ultrasound for the characterization of incidental liver lesions – an economical evaluation in comparison with multi-phase computed tomography.  Ultraschall in Med. 2009;  30 259-268
• 7 Lencioni R. Impact of European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on the use of contrast agents in liver ultrasound.  Eur Radiol. 2006;  16 1610-1613
• 8 Solbiati L, Martegani A, Leen E et al. Contrast-Enhanced Ultrasound of Liver Diseases. Milano: Springer-Verlag; 2003
• 9 Strobel D, Seitz K, Blank W et al. Contrast-enhanced ultrasound for the characterization of focal liver lesions – diagnostic accuracy in clinical practice (DEGUM multicenter trial) 1.  Ultraschall in Med. 2008;  29 499-505
• 10 Laghi F, Catalano O, Maresca M et al. Indeterminate, subcentimetric focal liver lesions in cancer patients: additional role of contrast-enhanced ultrasound 1.  Ultraschall in Med. 2010;  31 283-288
• 11 Piscaglia F, Venturi A, Mancini M et al. Diagnostic features of real-time contrast-enhanced ultrasound in focal nodular hyperplasia of the liver 1.  Ultraschall in Med. 2010;  31 276-282
• 12 Seitz K, Bernatik T, Strobel D et al. Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI – a prospective comparison in 269 patients.  Ultraschall in Med. 2010;  31 492-499
• 13 Strobel D, Seitz K, Blank W et al. Tumor-specific vascularization pattern of liver metastasis, hepatocellular carcinoma, hemangioma and focal nodular hyperplasia in the differential diagnosis of 1,349 liver lesions in contrast-enhanced ultrasound (CEUS) 4.  Ultraschall in Med. 2009;  30 376-382
• 14 Crocetti L, Lencioni R, Debeni S et al. Targeting liver lesions for radiofrequency ablation: an experimental feasibility study using a CT-US fusion imaging system.  Invest Radiol. 2008;  43 33-39
• 15 Ewertsen C, Grossjohann H S, Nielsen K R et al. Biopsy guided by real-time sonography fused with MRI: a phantom study.  Am J Roentgenol. 2008;  190 1671-1674
• 16 Krucker J, Xu S, Glossop N et al. Electromagnetic tracking for thermal ablation and biopsy guidance: clinical evaluation of spatial accuracy.  J Vasc Interv Radiol. 2007;  18 1141-1150
• 17 Minami Y, Kudo M, Chung H et al. Percutaneous radiofrequency ablation of sonographically unidentifiable liver tumors. Feasibility and usefulness of a novel guiding technique with an integrated system of computed tomography and sonographic images.  Oncology. 2007;  72 111-116
• 18 Minami Y, Chung H, Kudo M et al. Radiofrequency ablation of hepatocellular carcinoma: value of virtual CT sonography with magnetic navigation.  Am J Roentgenol. 2008;  190 W335-W341
• 19 Penney G P, Blackall J M, Hamady M S et al. Registration of freehand 3D ultrasound and magnetic resonance liver images.  Med Image Anal. 2004;  8 81-91
• 20 Wein W, Khamene A, Clevert D A et al. Simulation and fully automatic multimodal registration of medical ultrasound.  Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv. 2007;  10 136-143
• 21 Wein W, Brunke S, Khamene A et al. Automatic CT-ultrasound registration for diagnostic imaging and image-guided intervention.  Med Image Anal. 2008;  12 577-585
• 22 Singh A K, Kruecker J, Xu S et al. Initial clinical experience with real-time transrectal ultrasonography-magnetic resonance imaging fusion-guided prostate biopsy.  BJU Int. 2008;  101 841-845
• 23 Xu S, Kruecker J, Guion P et al. Closed-loop control in fused MR-TRUS image-guided prostate biopsy.  Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv. 2007;  10 128-135
• 24 Schlaier J R, Warnat J, Dorenbeck U et al. Image fusion of MR images and real-time ultrasonography: evaluation of fusion accuracy combining two commercial instruments, a neuronavigation system and a ultrasound system.  Acta Neurochir. 2004;  146 271-276
• 25 Mork H, Ignee A, Schuessler G et al. Analysis of neuroendocrine tumour metastases in the liver using contrast enhanced ultrasonography.  Scand J Gastroenterol. 2007;  42 652-662
• 26 Dorffel Y, Wermke W. Neuroendocrine tumors: characterization with contrast-enhanced ultrasonography.  Ultraschall in Med. 2008;  29 506-514