Electromagnetic Navigation System Combined With High-Frequency-Jet-Ventilation For Ct-Guided Hepatic Ablation Of Small Us-Undetectable And Difficult To Access Lesions

Objectives: To report the feasibility and efficacy of percutaneous ablation of small hepatic malignant tumors that are invisible on ultrasound and inaccessible using in-plane CT guidance, using a combination of high-frequency jet-ventilation (HFJV) and electromagnetic (EM) needle tracking. Methods: This study reviewed 27 percutaneous ablations of small hepatic tumors (<2?cm) performed using EM navigation-based probe placement and HFJV. All lesions were invisible on ultrasound and difficult to reach on CT requiring a double-oblique approach. The primary outcome was technical efficacy, defined as complete lesion coverage, and evaluated on contrast enhanced MRI after 3 and 6?months. Needle placement accuracy, the number of control CT acquisitions, procedure time, complications and radiation doses were assessed. Results: Twenty-one patients with 27 treated lesions (14 hepatocellular carcinomas and 13 metastases) were included in this study. Mean tumor size was 12???5.7?mm. Thirty-three percent of the lesions were located on the hepatic dome. Complete ablation was obtained in 100% at the 3- and 6-month MRI follow-up. The ablation probe was correctly placed on the first pass in 96%, with a mean path-to-tumor angle of 7???4 degrees and a mean tip-to-tumor distance of 22???19mm. A readjustment for additional overlapping application resulted in complete treatment in 4 patients. Needle placement took a mean 23???12?min with mean radiation doses of 558?mGy*cm. No major complications were reported. Conclusion: Percutaneous liver ablation of lesions that cannot be seen on US and requiring out-of-plane CT access can be successfully and safely treated using electromagnetic-based navigation and jet-ventilation.