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. 2016 Aug 11:4:e2277.
doi: 10.7717/peerj.2277. eCollection 2016.

Stereotactically-navigated percutaneous Irreversible Electroporation (IRE) compared to conventional IRE: a prospective trial

Lukas P Beyer  1 , Benedikt Pregler  1 , Christoph Nießen  1 , Andreas Schicho  1 , Michael Haimerl  1 , Ernst Michael Jung  1 , Christian Stroszczynski  1 , Philipp Wiggermann  1
Affiliations

Stereotactically-navigated percutaneous Irreversible Electroporation (IRE) compared to conventional IRE: a prospective trial

Lukas P Beyer et al. PeerJ. .

Abstract

Purpose. The purpose of this study was to compare CT-navigated stereotactic IRE (SIRE) needle placement to non-navigated conventional IRE (CIRE) for percutaneous ablation of liver malignancies. Materials and Methods. A prospective trial including a total of 20 patients was conducted with 10 patients in each arm of the study. IRE procedures were guided using either CT fluoroscopy (CIRE) or a stereotactic planning and navigation system (SIRE). Primary endpoint was procedure time. Secondary endpoints were accuracy of needle placement, technical success rate, complication rate and dose-length product (DLP). Results. A total of 20 IRE procedures were performed to ablate hepatic malignancies (16 HCC, 4 liver metastases), 10 procedures in each arm. Mean time for placement of IRE electrodes in SIRE was significantly shorter with 27 ± 8 min compared to 87 ± 30 min for CIRE (p < 0.001). Accuracy of needle placement for SIRE was higher than CIRE (2.2 mm vs. 3.3 mm mean deviation, p < 0.001). The total DLP and the fluoroscopy DLP were significantly lower in SIRE compared to CIRE. Technical success rate and complication rates were equal in both arms. Conclusion. SIRE demonstrated a significant reduction of procedure length and higher accuracy compared to CIRE. Stereotactic navigation has the potential to reduce radiation dose for the patient and the radiologist without increasing the risk of complications or impaired technical success compared to CIRE.

Keywords: CT-guided; Interventional radiology; Irreversible electroporation; Liver tumor; Robotic assistance; Stereotactic navigation.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Flow of participants through each stage of the study.
Figure 2
Figure 2. Planning the path of access on the navigation system.
A virtual entry point on the skin and tumor center is defined. Then the trajectories of the individual electrodes are calculated, but can still be adjusted individually.
Figure 3
Figure 3. Positioning the needle guidance device for inserting the IRE electrodes.
Figure 4
Figure 4. Evaluation of the lateral deviation of the IRE electrodes.
(A) Orthogonal plane (thickness 0.7 mm) at the tip of the reference electrode. (B) Orthogonal plane at a distance of 3 cm from the tip of the reference electrode. (C) Fusion of (A) and (B) with determination of lateral probe deviations.
Figure 5
Figure 5. Colorectal liver metastasis in close relationship to the right portal vein.
(A) Late phase MRI shows complete ablation (B) after stereotactic placement of 3 IRE electrodes above and 2 below the portal vein (C).
See this image and copyright information in PMC

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