Skip to main content
SpringerLink
Log in

Advanced CT techniques for hepatic microwave ablation zone monitoring and follow-up

  • Special Section: Cross sectional interventions
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate utility of advanced CT techniques including HighlY constrained back-projection and dual-energy CT for intra- and post-procedure hepatic microwave ablation zone monitoring.

Methods

8 hepatic microwave ablations were performed in 4 adult swine (5 min/65 W). Low-dose routine CECT and dual-energy CT images were obtained every 1 min during ablation. Images were reconstructed ± HYPR. Image quality and dose metrics were collected.

21 MWA were performed in 4 adult swine. Immediate post-procedure CECT was performed in the arterial, portal venous, and delayed phases using both routine and DECT imaging with full-dose weight-based IV contrast dosing. An additional 16 MWA were subsequently performed in 2 adult swine. Immediate post-procedure CT was performed with half-dose IV contrast using routine and DECT.

12 patients (10 M/2F, mean age 62.4 yrs) with 14 hepatic tumors (4 HCC, 10 metastatic lesions) treated with MWA were prospectively imaged with DECT 1 month post-procedure. 120 kV equivalent images were compared to DECT [51 keV, iodine material density]. Image quality and dose metrics were collected.

Results

Gas created during MWA led to high CNR in all intraprocedural CT datasets. Optimal CNRs were noted at 4 min with CNR 6.7, 15.5,15.9, and 21.5 on LD-CECT, LD-CECT + HYPR, DECT, and DECT + HYPR, respectively (p < 0.001). Image quality scores at 4 min were 1.8, 2.8, 2.4, and 3, respectively (p < 0.001). Mean radiation dose (CTDIvol) was eightfold higher for the DECT series.

For swine, post-procedural DECT images (IMD/51 keV) showed improved CNR compared to routine CT at all time points with full and with reduced dose contrast (CNR 4.6, 3.2, and 1.5, respectively, at half-contrast dose, p < 0.001). For human subjects, the 51 keV and IMD images showed higher CNRs (5.8, 4.8 vs 4.0, p < 0.001) and SNRs (3.7, 5.9 vs 2.8). Ablation zone sharpness was improved with DECT (routine 3.0 ± 0.7, DECT 3.5 ± 0.5). Diagnostic confidence was higher with DECT (routine 2.3 ± 0.9, DECT 2.6 ± 0.8). Mean DLP for DECT was 905.7 ± 606 mGy-cm, CTDIvol 37.5 ± 21.2 mGy, and effective dose 13.6 ± 9.1 mSv, slightly higher than conventional CT series.

Conclusion

Advanced CT techniques can improve CT image quality in peri-procedural hepatic microwave ablation zone evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Peng ZW, Lin XJ, Zhang YJ, et al. Radiofrequency Ablation versus Hepatic Resection for the Treatment of Hepatocellular Carcinomas 2 cm or Smaller: A Retrospective Comparative Study. Radiology 2012; 262:1022-1033

    Article  Google Scholar 

  2. Potretzke TA, Ziemlewicz TJ, Hinshaw JL, et al. Microwave versus Radiofrequency Ablation Treatment for Hepatocellular Carcinoma: A Comparison of Efficacy at a Single Center. J Vasc Interv Radiol 2016; 27:631-638

    Article  Google Scholar 

  3. Ziemlewicz TJ, Hinshaw JL, Lubner MG, et al. Percutaneous microwave ablation of hepatocellular carcinoma with a gas-cooled system: initial clinical results with 107 tumors. J Vasc Interv Radiol 2015; 26:62-68

    Article  Google Scholar 

  4. Lu DS, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the “heat sink” effect. AJR Am J Roentgenol 2002; 178:47-51

    Article  Google Scholar 

  5. Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DS. Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol 2008; 19:1087-1092

    Article  Google Scholar 

  6. Lubner MG, Brace CL, Hinshaw JL, Lee FT, Jr. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21:S192-203

    Article  Google Scholar 

  7. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Jr., Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics 2014; 34:1344-1362

    Article  Google Scholar 

  8. Mistretta CA, Wieben O, Velikina J, et al. Highly constrained backprojection for time-resolved MRI. Magn Reson Med 2006; 55:30-40

    Article  CAS  Google Scholar 

  9. Wu PH, Borden Z, Brace CL. Ablation zone visualization enhancement by periodic contrast-enhancement computed tomography during microwave ablation. Med Phys 2017; 44:2132-2140

    Article  CAS  Google Scholar 

  10. Brace CL, Mistretta CA, Hinshaw JL, Lee FT, Jr. Periodic contrast-enhanced computed tomography for thermal ablation monitoring: a feasibility study. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2009:4299-4302

    PubMed  Google Scholar 

  11. Johnson TRC, Krauss B, Sedlmair M, et al. Material differentiation by dual energy CT: initial experience. Eur Radiol 2007; 17:1510-1517

    Article  Google Scholar 

  12. Lin YM, Chiou YY, Wu MH, Huang SS, Shen SH. Postablation assessment of hepatocellular carcinoma using dual-energy CT: Comparison of half versus standard iodine contrast medium. PLoS One 2019; 14:e0219577

    Article  CAS  Google Scholar 

  13. Lee SH, Lee JM, Kim KW, et al. Dual-energy computed tomography to assess tumor response to hepatic radiofrequency ablation: potential diagnostic value of virtual noncontrast images and iodine maps. Invest Radiol 2011; 46:77-84

    Article  Google Scholar 

  14. Li Y, Shi G, Wang S, Wang S, Wu R. Iodine quantification with dual-energy CT: phantom study and preliminary experience with VX2 residual tumour in rabbits after radiofrequency ablation. Br J Radiol 2013; 86:20130143

    Article  CAS  Google Scholar 

  15. Morris J, Michalak G, Leng S, et al. Dual-Energy CT Monitoring of Cryoablation Zone Growth in the Spinal Column and Bony Pelvis: A Laboratory Study. J Vasc Interv Radiol 2019; 30:1496-1503

    Article  Google Scholar 

  16. Park SY, Kim CK, Park BK. Dual-energy CT in assessing therapeutic response to radiofrequency ablation of renal cell carcinomas. Eur J Radiol 2014; 83:e73-79

    Article  Google Scholar 

  17. Zhang L, Wang N, Mao J, et al. Dual-Energy CT-Derived Volumetric Iodine Concentration for the Assessment of Therapeutic Response after Microwave Ablation in a Rabbit Model with Intrahepatic VX2 Tumor. J Vasc Interv Radiol 2018; 29:1455-1461

    Article  Google Scholar 

  18. Brace CL, Hinshaw JL, Laeseke PF, Sampson LA, Lee FT, Jr. Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology 2009; 251:705-711

    Article  Google Scholar 

  19. Durick NA, Laeseke PF, Broderick LS, et al. Microwave ablation with triaxial antennas tuned for lung: results in an in vivo porcine model. Radiology 2008; 247:80-87

    Article  Google Scholar 

  20. Brace CL, Sampson LA, Hinshaw JL, Sandhu N, Lee FT, Jr. Radiofrequency ablation: simultaneous application of multiple electrodes via switching creates larger, more confluent ablations than sequential application in a large animal model. J Vasc Interv Radiol 2009; 20:118-124

    Article  Google Scholar 

  21. Flicek KT, Hara AK, Silva AC, Wu Q, Peter MB, Johnson CD. Reducing the radiation dose for CT colonography using adaptive statistical iterative reconstruction: A pilot study. AJR Am J Roentgenol 2010; 195:126-131

    Article  Google Scholar 

  22. Burgess AE. The Rose model, revisited. J Opt Soc Am A Opt Image Sci Vis 1999; 16:633-646

    Article  CAS  Google Scholar 

  23. Rose A. The sensitivity performance of the human eye on an absolute scale. J Opt Soc Am 1948; 38:196-208

    Article  CAS  Google Scholar 

  24. Vollmar SV, Kalender WA. Reduction of dose to the female breast as a result of spectral optimisation for high-contrast thoracic CT imaging: a phantom study. Br J Radiol 2009; 82:920-929

    Article  CAS  Google Scholar 

  25. Ziemlewicz TJ, Hinshaw JL, Lubner MG, et al. Radiofrequency and microwave ablation in a porcine liver model: non-contrast CT and ultrasound radiologic-pathologic correlation. Int J Hyperthermia 2020; 37:799-807

    Article  Google Scholar 

  26. Team RDC. R: a language and environment for statistical computing. . In: Computing RFfS, ed. Vienna, Austria, 2015

  27. Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat 2007; 17:571-582

    Article  Google Scholar 

  28. Cao L, Liu X, Li J, et al. A study of using a deep learning image reconstruction to improve the image quality of extremely low-dose contrast-enhanced abdominal CT for patients with hepatic lesions. Br J Radiol 2021; 94:20201086

    Article  Google Scholar 

  29. Jensen CT, Liu X, Tamm EP, et al. Image Quality Assessment of Abdominal CT by Use of New Deep Learning Image Reconstruction: Initial Experience. AJR Am J Roentgenol 2020; 215:50-57

    Article  Google Scholar 

  30. Szczykutowicz TP, Nett B, Cherkezyan L, et al. Protocol Optimization Considerations for Implementing Deep Learning CT Reconstruction. AJR Am J Roentgenol 2021; 216:1668-1677

    Article  Google Scholar 

  31. Wu PH, Bedoya M, White J, Brace CL. Feature-based automated segmentation of ablation zones by fuzzy c-mean clustering during low-dose computed tomography. Med Phys 2021; 48:703-714

    Article  Google Scholar 

  32. Kaza RK, Platt JF, Cohan RH, Caoili EM, Al-Hawary MM, Wasnik A. Dual-energy CT with single- and dual-source scanners: current applications in evaluating the genitourinary tract. Radiographics 2012; 32:353-369

    Article  Google Scholar 

  33. De Cecco CN, Boll DT, Bolus DN, et al. White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 4: Abdominal and Pelvic Applications. J Comput Assist Tomogr 2017; 41:8-14

    Article  Google Scholar 

  34. Morgan DE. Dual-energy CT of the abdomen. Abdom Imaging 2014; 39:108-134

    Article  Google Scholar 

  35. Izaaryene J, Vidal V, Bartoli JM, Loundou A, Gaubert JY. Role of dual-energy computed tomography in detecting early recurrences of lung tumours treated with radiofrequency ablation. Int J Hyperthermia 2017; 33:653-658

    Article  Google Scholar 

  36. Lubner MG, Hinshaw JL, Andreano A, Sampson L, Lee FT, Jr., Brace CL. High-powered microwave ablation with a small-gauge, gas-cooled antenna: initial ex vivo and in vivo results. J Vasc Interv Radiol 2012; 23:405-411

    Article  Google Scholar 

  37. Clark ZE, Bolus DN, Little MD, Morgan DE. Abdominal rapid-kVp-switching dual-energy MDCT with reduced IV contrast compared to conventional MDCT with standard weight-based IV contrast: an intra-patient comparison. Abdom Imaging 2015; 40:852-858

    Article  Google Scholar 

  38. Foley WD, Shuman WP, Siegel MJ, et al. White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 2: Radiation Dose and Iodine Sensitivity. J Comput Assist Tomogr 2016; 40:846-850

    Article  Google Scholar 

  39. Patel BN, Alexander L, Allen B, et al. Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols. Abdom Radiol (NY) 2017; 42:676-687

    Article  Google Scholar 

Download references

Funding

The work was supported by the Wylie J. Dodds Research Award through the Society of Abdominal Radiology. This work was presented at the Society of Abdominal Radiology, 2015.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA

    Meghan G. Lubner, Timothy J. Ziemlewicz, Shane A. Wells, Ke Li, Po-Hung Wu, J. Louis Hinshaw, Fred T. Lee Jr & Chris L. Brace

  2. Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Ke Li & Chris L. Brace

  3. Department of Biomedical and Electrical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Po-Hung Wu & Chris L. Brace

  4. Department of Electrical and Computer Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Po-Hung Wu

Authors
  1. Meghan G. Lubner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy J. Ziemlewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shane A. Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ke Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Po-Hung Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Louis Hinshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fred T. Lee Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chris L. Brace
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meghan G. Lubner.

Ethics declarations

Conflict of interest

MGL Prior grant funding Philips, Ethicon. TJZ Advisor, Shareholder, HistoSonics, Inc; Consultant, Ethicon, Inc. SAW Consultant, Ethicon, Inc. JLH Consultant, Neuwave Medical; Shareholder, Elucent; Shareholder, Accure; Shareholder, HistoSonics, Inc.; Shareholder, Cellectar. FTL Consultant, Ethicon, Inc.; Patents, Royalties Medtronic, Inc; Board of directors, stockholder, research support, Histosonics Inc. CLB: Consultant for J&J and NeuroOne; Shareholder in Symple Surgical, Elucent Medical, and Hepta Medical.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lubner, M.G., Ziemlewicz, T.J., Wells, S.A. et al. Advanced CT techniques for hepatic microwave ablation zone monitoring and follow-up. Abdom Radiol 47, 2658–2668 (2022). https://doi.org/10.1007/s00261-021-03333-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03333-z

Keywords

Search

Navigation