dual-phase-cone-beam-computed-tomography-to-see-reach-treat

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

Philips Healthcare

In the Fontan circulation, pulmonary and systemic vascular resistances are in series. The influence of various inferior vena cava to pulmonary artery connections in this unique circulatory arrangement was evaluated using computation fluid dynamics methods.

Computational fluid dynamic study of flow optimization in realistic models of the total cavopulmonary connections.

Intracranial stents are medical devices that are becoming increasingly popular in the treatment of intracranial aneurysms. A methodology that predicts the released stent configuration prior to intervention has the potential to support the physician in the selection of the optimal approach for a specific patient. This paper proposes a fast virtual stenting technique based on constrained simplex deformable models that is able to virtually release stents in arbitrarily shaped vessel and aneurysm models. The technique effectively embeds the geometrical properties of the stent (cell design, strut size and shape and angles between struts) and achieves favorable execution times of the order of one minute.

Fast virtual stenting with deformable meshes: application to intracranial aneurysms.

The objective of this study was to investigate the relationship between hemodynamics patterns and aneurysmal rupture in cerebral aneurysms of the same morphology regardless their location. Particularly, terminal aneurysms in both the anterior and posterior circulation were studied.

Hemodynamics and rupture of terminal cerebral aneurysms.

Modeling of flow in intracranial aneurysms (IAs) requires flow information at the model boundaries. In absence of patient-specific measurements, typical or modeled boundary conditions (BCs) are often used. This study investigates the effects of modeled versus patient-specific BCs on modeled hemodynamics within IAs. Computational fluid dynamics (CFD) models of five IAs were reconstructed from three-dimensional rotational angiography (3DRA). BCs were applied using in turn patient-specific phase-contrast-MR (pc-MR) measurements, a 1D-circulation model, and a physiologically coherent method based on local WSS at inlets. The Navier-Stokes equations were solved using the Ansys®-CFX™ software. Wall shear stress (WSS), oscillatory shear index (OSI), and other hemodynamic indices were computed. Differences in the values obtained with the three methods were analyzed using boxplot diagrams. Qualitative similarities were observed in the flow fields obtained with the three approaches. The quantitative comparison showed smaller discrepancies between pc-MR and 1D-model data, than those observed between pc-MR and WSS-scaled data. Discrepancies were reduced when indices were normalized to mean hemodynamic aneurysmal data. The strong similarities observed for the three BCs models suggest that vessel and aneurysm geometry have the strongest influence on aneurysmal hemodynamics. In absence of patient-specific BCs, a distributed circulation model may represent the best option when CFD is used for large cohort studies.

Computational hemodynamics in cerebral aneurysms: the effects of modeled versus measured boundary conditions.

C-arm cone-beam computed tomography (CBCT) can be used to visualize tumor-feeding vessels and parenchymal staining during transcatheter arterial chemoembolization (TACE). To capture these two phases, all current commercially available CBCT systems necessitate two separate contrast-enhanced scans. In this feasibility study, we report initial results of novel software that enhanced our current CBCT system to capture these two phases using only one contrast injection. Novelty of this work is the addition of software that enabled the acquisition of two sequential, back-to-back CBCT scans (dual-phase CBCT, DPCBCT) so both tumor feeding vessels and parenchyma are captured using only one contrast injection. To illustrate our initial experience, DPCBCT was used for TACE treatments involving lipiodol, drug-eluting beads, and Yttrium-90 radioembolizing microspheres. For each case, the DPCBCT images were compared to pre-intervention contrast-enhanced MR/CT. DPCBCT is feasible for TACE treatments and the preliminary results show positive correlation with pre-intervention conventional CT and MR. In addition, the degree of embolization can be monitored. DPCBCT is a promising technology that provides comprehensive visualization of tumor-feeding vessels and parenchymal staining using a single injection of contrast. DPCBCT could potentially be used during TACE to verify catheter position and monitor the embolization effect.

Evaluating tumors in transcatheter arterial chemoembolization (TACE) using dual-phase cone-beam CT.

To evaluate the sensitivity of dual-phase cone-beam computed tomography during hepatic arteriography (CBCTHA) for the detection of hepatocellular carcinoma (HCC) by comparing it with the diagnostic imaging "gold standard": contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.

Comparing the detectability of hepatocellular carcinoma by C-arm dual-phase cone-beam computed tomography during hepatic arteriography with conventional contrast-enhanced magnetic resonance imaging.

To describe a novel technique for multimodality positron emission tomography (PET) fusion-guided interventions that combines cone-beam computed tomography (CT) with PET/CT before the procedure.

Cone-beam computed tomography fusion and navigation for real-time positron emission tomography-guided biopsies and ablations: a feasibility study.

To investigate whether C-arm dual-phase cone-beam computed tomography (CT) performed during transcatheter arterial chemoembolization (TACE) with doxorubicin-eluting beads can help predict tumor response at 1-month follow-up in patients with hepatocellular carcinoma (HCC).

Intraprocedural C-arm dual-phase cone-beam CT: can it be used to predict short-term response to TACE with drug-eluting beads in patients with hepatocellular carcinoma?

C-Arm CT (CACT) is a new imaging modality in liver oncology therapy that allows for the acquisition of 3D images intra-procedurally. CACT has been used to enhance intra-arterial therapies for the liver by improving lesion detection, avoiding non-target embolization, and allowing for more selective delivery of agents. However, one of the limitations of this technology is image artifacts created by respiratory motion. Purpose: To determine in this preliminary study improvements in image acquisition, motion compensation, and high resolution 3D reconstruction that can improve CACT image quality (IQ).

Article	Year
Computational fluid dynamic study of flow optimization in realistic models of the total cavopulmonary connections. The Journal of surgical research\| PubMed ID: 15013370	2004
Fast virtual stenting with deformable meshes: application to intracranial aneurysms. Medical image computing and computer-assisted intervention : MICCAI ... International Conference on Medical Image Computing and Computer-Assisted Intervention\| PubMed ID: 18982677	2008
Hemodynamics and rupture of terminal cerebral aneurysms. Academic radiology\| PubMed ID: 19553143	2009
Computational hemodynamics in cerebral aneurysms: the effects of modeled versus measured boundary conditions. Annals of biomedical engineering\| PubMed ID: 20972626	2011
Evaluating tumors in transcatheter arterial chemoembolization (TACE) using dual-phase cone-beam CT. Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy\| PubMed ID: 21082901	2011
Comparing the detectability of hepatocellular carcinoma by C-arm dual-phase cone-beam computed tomography during hepatic arteriography with conventional contrast-enhanced magnetic resonance ... Cardiovascular and interventional radiology\| PubMed ID: 21328023	2012
Cone-beam computed tomography fusion and navigation for real-time positron emission tomography-guided biopsies and ablations: a feasibility study. Journal of vascular and interventional radiology : JVIR\| PubMed ID: 22494658	2012
Intraprocedural C-arm dual-phase cone-beam CT: can it be used to predict short-term response to TACE with drug-eluting beads in patients with hepatocellular carcinoma? Radiology\| PubMed ID: 23143027	2013
Image quality improvements in C-Arm CT (CACT) for liver oncology applications: preliminary study in rabbits. Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy\| PubMed ID: 23837536	2013

Alessandro Radaelli

Biography

JoVE Journal Publications

Other Publications