title: Synchronized real-time ultrasonography and three-dimensional computed tomography scan navigation during percutaneous renal cryoablation in a porcine model.
abstract: OBJECTIVE
  To investigate the accuracy of percutaneous cryoablation for kidney tumors performed under combined real-time ultrasonography (US) and three-dimensional (3D) CT scan navigation in a porcine model.
  
  
  METHODS
  After percutaneously injecting 2 to 6 tumor mimic lesions in 11 pigs, a CT scan was performed and digital data were saved into a navigation system (Real-Time Virtual Sonography [RVS]) that allows 3D reconstruction and synchronization with real-time US images. The cryoprobe was guided percutaneously into the kidney tumor mimic, and ice ball formation was monitored continuously during cryoablation using the RVS system. Kidneys were harvested and sent for gross pathologic and histopathologic analysis at days 0, 15, and 30 postoperatively.
  
  
  RESULTS
  Thirty-five renal tumor mimics were created and treated by percutaneous cryotherapy; tumor mimic locations were as follows: 16 tumors (46%) in the lower pole, 14 (40%) in the central region, and 5 (14%) in the upper pole. Eleven tumor mimics (31%) were intraparenchymal, and 24 (69%) subcapsular. The synchronization between the CT scan 3D reconstructed images and real-time US was successful in all cases. The mean tumor size was 2 cm (range, 1.2-4 cm). Mean cryonecrosis size was 3.3, 3.7, and 2.8 cm at days 0, 15, and 30, respectively. Three (8.5%) positive margins were found on the macroscopic and microscopic analysis.
  
  
  CONCLUSIONS
  RVS imaging system synchronizing real-time US with preoperative CT scan is a feasible and safe technique for percutaneous probe ablation of kidney tumors.
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Jose Roberto
authors.initials: JR
authors.lastname: Colombo
authors.forename: Eric
authors.initials: E
authors.lastname: Remer
authors.forename: Charles
authors.initials: C
authors.lastname: O'Malley
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
authors.forename: Cristina
authors.initials: C
authors.lastname: Magi-Galluzzi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Spaliviero
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
mesh_terms: D000818:Animals; D003452:Cryosurgery / Q000379:methods*; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology; D007858:Learning; D023421:Models, Animal; D009336:Necrosis; D034421:Sus scrofa / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography