Optical and electromagnetic tracking guidance for hepatic interventions

摘要 经皮肝局灶性病变取材是肝病患者治疗的基石 病理学。先进成像技术的出现提高了病变检测的灵敏度； 病变往往缺乏特定的特征，无法进行可靠的非侵入性表征，导致 在过去十年中，此类肝脏病变的活检数量。局灶性肝活检的准确性是 这是必要的，因为假阴性的活检可能会对患者的治疗产生毁灭性的影响。在回顾中 研究发现，高达45%的小肝脏病变在活检针到位时显示不够清晰 假阴性率，定义为良性活检患者的数量，这些患者随后被发现 在试图活检的部位有恶性病变，37%为肝细胞癌。因此，有一个 对准确采集肝脏病变样本的方法进行改进是非常必要的。最近，人们发现， 吲哚青绿(ICG)是一种临床批准的近红外荧光色素，在肝脏病灶中蓄积，如 肝细胞癌和肝脏结直肠癌转移，导致高目标与背景比 当使用近红外光进行可视化时。这项提议的PI在麻省理工学院领导了第一次人类体验， ICG光学成像与介入放射学经皮肝穿取材相结合。 独立地，这项提议的内部PI开创了 电磁(EM)导航技术在介入放射学引导下经皮穿刺术的应用 NIH临床中心-介入肿瘤学中心(CIO)。我们建议在长期合作的基础上 壁外和壁内PI之间的协作，并结合这两个内在的协同作用， 介入放射学领域的最新进展。EM引导设备导航活检针 接近成像的损伤，可以被认为是远场优化的；光学成像设备提供真正的 时间反馈以评估针芯是否适当地位于小的肝脏肿瘤内，以及是否可以 被认为是近场设备。这是对新的、拟议的壁内-壁外的第一次亲身评估 联合开发的设备将在NIH CC-CIO进行。这款共同创建并反复优化的设备 将有助于通过提高诊断准确性来改善患者护理。

Abstract Percutaneous sampling of focal hepatic lesions is a cornerstone in the management of patients with hepatic pathology. The advent of advanced imaging has improved the sensitivity for lesion detection; however small lesions often lack specific features to allow for reliable non-invasive characterization, resulting in an increase in the number of biopsies for such hepatic lesions over the past decade. Accuracy of a focal hepatic biopsy is essential, as a false negative biopsy can have a devastating impact on a patient's treatment. In a retrospective study, up to 45% of small hepatic lesions were insufficiently visualized with the biopsy needle in place and had a false negative rate, defined as the number of patients with benign biopsies who were subsequently found to have malignant lesions at the attempted site of biopsy, of 37% for hepatocellular carcinomas. Thus, there is a significant need for improved methods for accurately sampling hepatic lesions. Recently, it was discovered that indocyanine green (ICG), a clinically approved near infrared fluorochrome, accumulates in hepatic foci such as hepatocellular carcinomas and hepatic colorectal metastases, resulting in a high target to background ratio when visualized using near infrared light. The PI of this proposal has led the first human experience, at MGH, combining optical imaging using ICG with interventional radiology percutaneous hepatic sampling. Independently, the intramural PI of this proposal has pioneered the development and clinical trials of electromagnetic (EM) navigation techniques for interventional radiology guided percutaneous sampling at the NIH Clinical Center – Center for Interventional Oncology (CIO). We propose to build upon a longstanding collaboration between the extramural and intramural PIs, and combine these two intrinsically synergistic, recent advances in the field of interventional radiology. The EM guided devices navigate the biopsy needle close to imaged lesions and can be thought of as far-field optimized; the optical imaging devices provide real- time feedback to assess if needle cores are appropriately located within small hepatic tumors and can be thought of as near-field devices. This first-in-man assessment of the new, proposed intramural-extramural jointly developed device will take place at the NIH CC-CIO. This jointly created and iteratively optimized device will help to improve patient care through improved diagnostic accuracy.