title: Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation.
abstract: OBJECTIVE
  To assess the feasibility of combined electromagnetic device tracking and computed tomography (CT)/ultrasonography (US)/fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) fusion for real-time feedback during percutaneous and intraoperative biopsies and hepatic radiofrequency (RF) ablation.
  
  
  METHODS
  In this HIPAA-compliant, institutional review board-approved prospective study with written informed consent, 25 patients (17 men, eight women) underwent 33 percutaneous and three intraoperative biopsies of 36 FDG-avid targets between November 2007 and August 2010. One patient underwent biopsy and RF ablation of an FDG-avid hepatic focus. Targets demonstrated heterogeneous FDG uptake or were not well seen or were totally inapparent at conventional imaging. Preprocedural FDG PET scans were rigidly registered through a semiautomatic method to intraprocedural CT scans. Coaxial biopsy needle introducer tips and RF ablation electrode guider needle tips containing electromagnetic sensor coils were spatially tracked through an electromagnetic field generator. Real-time US scans were registered through a fiducial-based method, allowing US scans to be fused with intraprocedural CT and preacquired FDG PET scans. A visual display of US/CT image fusion with overlaid coregistered FDG PET targets was used for guidance; navigation software enabled real-time biopsy needle and needle electrode navigation and feedback.
  
  
  RESULTS
  Successful fusion of real-time US to coregistered CT and FDG PET scans was achieved in all patients. Thirty-one of 36 biopsies were diagnostic (malignancy in 18 cases, benign processes in 13 cases). RF ablation resulted in resolution of targeted FDG avidity, with no local treatment failure during short follow-up (56 days).
  
  
  CONCLUSIONS
  Combined electromagnetic device tracking and image fusion with real-time feedback may facilitate biopsies and ablations of focal FDG PET abnormalities that would be challenging with conventional image guidance.
authors: Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, 10 Center Dr, Bldg 10, Room 1C369, MSC 1182, Bethesda, MD 20892, USA. VenkatesanA@cc.nih.gov
authors: Aradhana M
authors: AM
authors: Venkatesan
authors: Samuel
authors: S
authors: Kadoury
authors: Nadine
authors: N
authors: Abi-Jaoudeh
authors: Elliot B
authors: EB
authors: Levy
authors: Roberto
authors: R
authors: Maass-Moreno
authors: Jochen
authors: J
authors: Krücker
authors: Sandeep
authors: S
authors: Dalal
authors: Sheng
authors: S
authors: Xu
authors: Neil
authors: N
authors: Glossop
authors: Bradford J
authors: BJ
authors: Wood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D003199:Computer Systems; D004574:Electromagnetic Fields; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D013382:Subtraction Technique; D025321:Surgery, Computer-Assisted / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18