title: Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions: first results.
abstract: OBJECTIVE
  Assessing the feasibility and efficiency of interventions using ultrasound (US) volume navigation (V Nav) with real time needle tracking and image fusion with contrast enhanced (ce) CT, MRI or US.
  
  
  METHODS
  First an in vitro study on a liver phantom with CT data image fusion was performed, involving the puncture of a 10 mm lesion in a depth of 5 cm performed by 15 examiners with US guided freehand technique vs. V Nav for the purpose of time optimization. Then 23 patients underwent ultrasound-navigated biopsies or interventions using V Nav image fusion of live ultrasound with ceCT, ceMRI or CEUS, which were acquired before the intervention. A CEUS data set was acquired in all patients. Image fusion was established for CEUS and CT or CEUS and MRI using anatomical landmarks in the area of the targeted lesion. The definition of a virtual biopsy line with navigational axes targeting the lesion was achieved by the usage of sterile trocar with a magnetic sensor embedded in its distal tip employing a dedicated navigation software for real time needle tracking.
  
  
  RESULTS
  The in vitro study showed significantly less time needed for the simulated interventions in all examiners when V Nav was used (p<0.05). In the study involving patients, in all 10 biopsies of suspect lesions of the liver a histological confirmation was achieved. We also used V Nav for a breast biopsy (intraductal carcinoma), for a biopsy of the abdominal wall (metastasis of ovarial carcinoma) and for radiofrequency ablations (4 ablations). In 8 cases of inflammatory abdominal lesions 9 percutaneous drainages were successfully inserted.
  
  
  CONCLUSIONS
  Percutaneous biopsies and drainages, even of small lesions involving complex access pathways, can be accomplished with a high success rate by using 3D real time image fusion together with real time needle tracking.
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Ernst Michael
authors.initials: EM
authors.lastname: Jung
authors.forename: Chris
authors.initials: C
authors.lastname: Friedrich
authors.forename: Patrick
authors.initials: P
authors.lastname: Hoffstetter
authors.forename: Lena Marie
authors.initials: LM
authors.lastname: Dendl
authors.forename: Frank
authors.initials: F
authors.lastname: Klebl
authors.forename: Ayman
authors.initials: A
authors.lastname: Agha
authors.forename: Phillipp
authors.initials: P
authors.lastname: Wiggermann
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszcynski
authors.forename: Andreas Georg
authors.initials: AG
authors.lastname: Schreyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001707:Biopsy, Needle; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation; D003199:Computer Systems; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D014057:Tomography, X-Ray Computed; D014465:Ultrasonics; D014463:Ultrasonography
chemical_list: D003287:Contrast Media