Treatment of hepatocellular carcinoma using the Smart Fusion needle navigation system: conversion from real-time 4D-echo data

Treatment of hepatocellular carcinoma using the Smart Fusion needle navigation system: conversion from real-time 4D-echo data

Naoki Hotta

Department of Internal medicime,division of Hepatology,Msusko Memorial Hospital, 35-28 takebashi nakamuraku-,Nagoya,aichi,Japan 453-8566

Advances in ultrasound systems have improved the accuracy of hepatocellular carcinoma (HCC) diagnosis and treatment.

We have been treating HCC using real-time 4D and Live 3D-echo technologies. However, these treatment methods have drawbacks such as vibrations during puncture and a limited angle of needle insertion.

To overcome these problems, systems that can display ultrasound images simultaneously with computed tomography (CT) and magnetic resonance images in a real-time manner for reference purposes have been reported. These systems have recently been equipped with a needle tip navigation system, making it possible to reliably visualize tumors and determine the needle tip position in a tumor. These developments have enabled the safe treatment of HCC.

Treatment using needle navigation is performed as follows: A Canon APLIO800 ultrasound system is used with a conventional convex probe (PVT-375BT) and a micro-convex probe (PVT-382BT).

The system function is known as Smart Fusion. Ultrasound images can be displayed with volume data from other modalities, such as CT and magnetic resonance imaging (MRI), in relation to the positional information using a magnetic sensor. This enables the use of CT/MRI data as reference for accurate puncture and treatment of lesions that are difficult to identify by ultrasound alone. Axis alignment is also completed by displaying the xiphoid process on a CT image and having the system learn the orientation of the probe placed perpendicular to the body axis. Then, landmark alignment is performed and fine-adjusted by aligning a target point near the lesion with the same point as displayed on CT (Fig. 1).

Case presentation

A 7x-year-old woman was found to have elevated tumor markers and a liver tumor identified by regular blood testing and CT performed in August 20xx and was admitted to our hospital for treatment.

Abdominal ultrasonography showed a hypoechoic lesion measuring approximately 3 cm in diameter in liver S6, which led to a diagnosis of HCC. For treatment, microwave therapy was selected at the patient’s request. Microwaves were delivered using a Medtronic Emprint ablation system with a 3.0-cm needle for ablation. During treatment, the needle position was confirmed by needle navigation before ablation (Fig. 2) because the tumor needed to be ablated in an overlapping manner (Fig. 3).

Keywords: hepatocellular carcinoma, radiofrequency ablation, virtualsonography navigationsystem, four-dimensional ultrasonography

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How to cite this article:
Naoki Hotta. Treatment of hepatocellular carcinoma using the Smart Fusion needle navigation system: conversion from real-time 4D-echo data. Open Journal of Gastroenterology and Hepatology, 2021; 4:46. DOI: 10.28933/ojgh-2021-02-1005


1. Hotta N,Ayada M,Okumura A et al:Usefulness of live 3D echocardiography during radiofrequency ablation in a case of hepa tocellular carcinoma.Clin imaging 31:283-286.2007
2. Sugimoto K.Moriyasu F.Shiraishi J etat:A Phantom study Comparring Ultrasound-guided liver umor Puncture Using New Real-Time 3D Ultrasound and Conventional 2D Ultrasound AJR W753-757 2011
3. Hotta N,Maeno T,ayada M etal;Four-dimensional ultrasongraphy for therapeutic radiofrequency ablation for hepatocellular carcinoma.Hepatogastroenterology.53(70)521-5 2006
4. Hotta N,Yamada S,Murase K etal:Usefulness of real-time 4D ultrasonography during radiofrequency ablation ina case of hepa- tocellular carcinoma.Case Rep Gastroenterol 5(1)82-7 2011
5. Kusakabe A,Nojiri S,Iio E et al:Case-control study of RFA therapeutic effect of newly developed 4D and conventional 2D Us:J med Ultrasonics 40:39-46 2013
6. Rose Sc,Hassnein Ti,easter Dw et al;Value of tree-dimensional Us for optimizing guidance for abating focal liver tumors.J vas inrv Rabiol 12(4)507-15 2001
7. Won HJ,Han JK,Do KH et al:value of four-dimensional ultrasonography in ultrasonpgraphyically guided biopsy hepatic mass.J ultrasound med 22:215-220 2003 8. Nmata K,Lou W,Morimoto m et al:Contrast enhanced ultrasound of hepatocellular carcinoma:WJR 28(2)68-82 2010
9. Iwasaki T.Mikami E,Shimosegawa T et al:Realtime virtual sonography (RVS) :a novel navigation tool in percutaneous radiofr- 124 quency ablation of hepatoceller carcinoma.into Rad 9103 DS1-RSNA2004
10. AJ Lawence,Kla Naveen,Bhatia A etal:Fusion Imaging-Guided and Ultrasound -Guided Fine Neddle Aspiration in Patients with suspected hepatic Metastases.J of Clinical and experimental Hepatology.VOL9 547-553 2019
11. Kuzuya T,Isshizu Y,NinomiT etal:Clinical trial percutaneous radiofrequency ablation therapy by tow-step insertion metod us- ing VirtuTrax instrument navigator.JSH 54(12)850-853 2013

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