Feasibility of Navigated Resection of Liver Tumors Using Multiplanar Visualization of Intraoperative 3-dimensional Ultrasound Data

Beller, S.; Hünerbein, M.; Eulenstein, Sebastian; Lange, Thomas; Schlag, Peter M.

doi:10.1097/01.sla.0000264233.48306.99

Cited by 88 publications

(48 citation statements)

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“…But only general applicability [23,24] or algorithmic solutions [25,26] could be demonstrated so far. Reliable, precise, and applicable soft tissue registration procedures are not available yet, but some experimental approaches are described that still lack clinical application and validation [27].…”

Section: Discussionmentioning

confidence: 98%

How to operate a liver tumor you cannot see

Oldhafer¹,

Stavrou²,

Prause

et al. 2009

Langenbecks Arch Surg

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Section: Discussionmentioning

confidence: 98%

How to operate a liver tumor you cannot see

Oldhafer¹,

Stavrou²,

Prause

et al. 2009

Langenbecks Arch Surg

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“…This system was validated [26] and employed [27] for accurate ultrasound-based navigation of liver-tumor resections.…”

Section: Discussionmentioning

confidence: 99%

Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US, spiral CT, and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)

Giangregorio

Comparato

Marinone

et al. 2009

Journal of Ultrasound

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Introduction: The commercially available Navigator system ª (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator ª ). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC). Materials and methods: From November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue ª (Bracco, Milan, Italy) as a contrast agent and Technos MPX ª scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15). Results: Definitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1e3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (þ9 multinodularN and 6 LR), 3 falsenegatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9). Conclusions: 3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.Sommario Introduzione: Il sistema ''Navigator ª '' di Esaote consente di ottenere ricostruzioni 3-D di tutto il fegato (corrette volumetricamente da un sistema di guida) mediante singola acquisizione con CEUS (mediante scansione perpendicolare all'asse lungo del fegato, per una completa acquisizione 2-D del suo asse corto) e sovrappone tali ricostruzioni 3-D con quelle ottenute con la TC. Scopo: valutare la capacità di tale sistema di diagnosticare nuovi HCC rispetto all'US e alla TC in una popolazione di HCC su cirrosi precedentemente trattati con varie metodiche. Materiali e metodi: Settantadue cirrotici con pregressi HCC (M/F: 38/34; tutti HCV þvi, Child A/B: 58/14, con detection di 49 nuovi noduli (N) in 34...

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“…Especially in difficult cases with complex tumor localization, intraoperative visualization of liver vessels and tumor margins is essential for an adequate resection and reduction of surgery-associated risks [1][2][3]. Various groups have worked on navigation techniques for open liver resection.…”

mentioning

confidence: 99%