الفهرس 
Blood supply of the liverOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fourth leading cause of cancer-related death worldwide.
To overcome the limitations of US guidance and monitoring during percutaneous hepatic procedures, a CT/ MR-US fusion imaging system has been developed and introduced to clinical practice for use with the percutaneous management of HCC.
Percutaneous image-guided interventions are performed for a variety of clinical indications: to obtain tissue biopsies, to alleviate pain, and to treat diseases including a variety of malignancies
Imaging-based navigation is a new technology that allows the fusion of real-time US and preoperative CT or MRI data. Image fusion navigation technique has been introduced as a promising method in the procedure of RF ablation in liver tumors
In 2018, the guidelines of the European Association for the Study of the Liver confirmed the value of CT/MR-US fusion imaging in percutaneous management of HCC.
The present study aimed to evaluate the efficacy and feasibility of real time virtual electromagnetic navigation system, in percutaneous interventional procedures of hepatocellular carcinoma. To achieve this aim, we compared the results of such technique on loco-regional interventional management on HCC treatment.
For this purpose, 93 HCC lesions of 89 patients were enrolled & classified into 2 groups:
1.group I: in whom the correct targeted of 74 lesions of 71 patients.
2.group II: in whom the inaccurate targeted of 19 lesions of 18 patients.
The study included 89 patients with 93 hepatic focal lesions, 71 males (79.78%) and 18 females (20.22%) with age distribution from 23 years to 76 years old, Underwent percutaneous interventional procedures (Biopsy, MWA, RFA & EI) under guidance with fusion imaging, to evaluate the efficacy and feasibility of real time virtual electromagnetic navigation system.
Multidisplinary team (MDT) in national liver institute recruit all the included patients were scheduled to undergo percutaneous loco regional therapeutic (LRT) interventions managment.
the patient’s weight in between both groups of study, showed 18 patient (20.22% of all patients) with ranged patient’s weight Min-Max 78.00 – 113.00 Kg with Mean± Std. Deviation = 94.78 ± 10.95. 95% CI for mean 89.33 – 100.22 in the inaccurate target group , while the correct target group shows 71 patent (79.78% of all patients) with ranged patient’s weight Min-Max 67.00 – 114.00 Kg with Mean± Std. Deviation = 89.46 ± 9.38. 95% CI for mean 87.24 – 91.68.
The time used in the fusion process showed in the inaccurate target group shows 19 lesions (20.43% of all lesions) with ranged registration time Min-Max 4.40 – 13.00 minute with Mean± Std. Deviation = 8.76 ± 2.56. 95% CI for mean 7.52 – 9.99, while the correct target group shows 74 lesions (79.56% of all lesions) with ranged registration time Min-Max 3.00 – 14.00 minute with Mean± Std. Deviation = 6.96 ± 2.21. 95% CI for mean 6.44 – 7.46.
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The fusion of ultrasound with different images modalities In the inaccurate target group shows 19 lesions (20.43 % of all lesions) which 16 lesions were imaged fusion by CT (84.21 % of target accuracy), 3 lesions were image fusion by MRI (15.79 % of target accuracy).while In the correct target group shows 74 lesions (79.57 % of all lesions) which shows 70 lesions were imaged fusion by CT (94.60 % within target accuracy), 3 lesions were imaged fusion by MRI (4.05 % within target accuracy) & one lesion was imaged fusion by PET/CT (1.35 % of target accuracy).
The interventional procedure in between both groups of study showed, the inaccurate target group shows 19 lesions (20.43 % of all lesions) which shows 7 lesions managed by RFA (36.84 % of target accuracy), 3 lesions managed by MWA (15.79 % of target accuracy) & 9 lesions managed by ethanol injections (47.37 % of target accuracy). While the correct target group shows 74 lesions (79.57 % of all lesions) which shows 2 biopsied lesion (2.70 % within target accuracy), 30 lesions managed by RFA (40.54 % within target accuracy), 4 lesions managed by MWA (5.41 % of target accuracy) & 39 lesions managed by ethanol injections (51.35 % of target accuracy).
The follow up triphasic CT study after 1 month shows that the inaccurate target group shows 19 lesions (20.88 % of all lesions) which shows 12 lesions were shows no residual on Triphasic CT follow up (14.81 % of target accuracy) & 7 lesions show residual noted on Triphasic CT (70.00 % of target accuracy). While the correct target group shows 72 lesions (79.12 % of all lesions) which shows 69 lesions were shows no residual on Triphasic CT follow up (85.19 % of target accuracy) & 3 lesions show residual noted on Triphasic CT (30.00 % of target accuracy).
In summary, we concluded that Real Time Virtual Electromagnetic Navigation System was feasible & efficient for Percutaneous Interventional Procedures of Hepatocellular Carcinoma.