Real-time ultrasound and freehand-SPECT

M. Freesmeyer; T. Winkens; T. Opfermann; P. Elsner; I. Runnebaum; A. Darr

doi:10.3413/Nukmed-0680-14-06

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2014; 53(06): 259-264
DOI: 10.3413/Nukmed-0680-14-06

Original article

Schattauer GmbH

Real-time ultrasound and freehand-SPECT

Experiences with sentinel lymph node mappingUltraschall und Freihand-SPECT/UltraschallErfahrungen mit dem Lymphknoten-Mapping

M. Freesmeyer

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

,

T. Winkens

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

,

T. Opfermann

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

,

P. Elsner

²Department of Dermatology, Jena University Hospital Jena, Germany

,

I. Runnebaum

³Department of Gynecology and Obstetrics, Jena University Hospital, Jena, Germany

,

A. Darr

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

› Author Affiliations

Abstract

Summary

Aim of this work is to report first experiences of the feasibility and applicability of a hybrid freehandSPECT/ultrasound (fh-SPECT/US) imaging concept, with regard to SLN imaging, in patients with breast cancer and malignant melanoma. Patients, methods: 18 patients with breast cancer or malignant melanoma received standard SLN scintigraphy. Following this, fh-SPECT using declipse®SPECT (SurgicEye, Munich, Germany) was performed, a handheld-gamma camera-based method to visualize activity distribution within a region of interest as a cross-sectional data set. These data were transferred to an ultrasound device and sensor-navigated ultrasound was performed combining fhSPECT data with ultrasound images, displaying superimposed images. Quality of fh- SPECT and co-registration accuracy was assigned to one of four categories and occurrence of artefacts was assessed. Results: In 4/18 examinations, there was a no deviation regarding co-registration of both data sets. For 9/18 patients, there was a deviation of <1 cm (mean 0.7±0.3 cm, range 0.3–1.0 cm). For 3/18 patients, a deviation >1 cm was present (mean 1.7±0.3 cm, range 1.5–2.0 cm). In 2/18 examinations no lymph node was found in the region of highest activity. Fh-SPECT reconstruction artifacts occurred in 6/18 examinations. Conclusion: The fusion imaging concept combining SLN information with ultrasound images presented here proves to be feasible and technically successful. However, significant technical limitations were shown in fh-SPECT quality and fusion precision. Subject to technical optimisation of SPECT quality and co-registration, a meaningful contribution to the preoperative planning of lymph node therapy is imaginable. Thus, fundamentally a preoperative histological examination by fh-SPECT/US-guided biopsy is possible.

Zusammenfassung

Ziel dieser Arbeit ist es, über erste Anwendungserfahrungen eines hybriden Freihand- SPECT/Ultraschallkonzeptes (fh-SPECT/US) bei der Sentinel-Lymphknoten-(SLN)-Szintigraphie an Patienten mit Mammakarzinom und malignem Melanom zu berichten. Patienten, Methoden: Zunächst wurde bei 18 Patienten mit Brustkrebs oder malignem Melanom eine leitliniengerechte SLN-Szintigraphie durchgeführt. Anschließend wurde mit einer mobilen Hand-Gammasonde und einem Ortungssystem (declipse®SPECT, SurgicEye, München, Deutschland) die dreidimensionale Aktivitätsverteilung (fh-SPECT) der Lymphabflussregion aufgezeichnet und dieser Datensatz auf ein Ultraschallgerät transferiert. Es folgte eine Ultraschalluntersuchung der Lymphabflussregion. Dabei wurden fh-SPECT-Daten- satz und Ultraschallbilder mittels sensornavi-gierter Sonographie in Echtzeit überlagert und auf dem Ultraschallbildschirm angezeigt. Qualität des fh-SPECT und Genauigkeit der Überlagerung wurden in Kategorien eingeteilt und das Auftreten von Artefakten wurde untersucht. Ergebnisse: In 4/18 Untersuchungen trat keine räumliche Abweichung zwischen beiden Datensätzen auf. Bei 9/18 Patienten war eine geringe Abweichung <1 cm feststellbar (Mittelwert: 0,7±0,3 cm, Intervall 0,3-1,0 cm). 3/18 Untersuchungen zeigten ein Offset von >1 cm (Mittelwert: 1,7±0,3 cm, Intervall 1,5-2,0 cm). In 2/18 Untersuchungen konnte an der Stelle der höchsten Aktivität sonographisch kein Lymphknoten gefunden werden. Rekonstruktionsartefakte des fh-SPECT traten in 6/18 Untersuchungen auf. Schlussfolgerung: Das Fusionskonzept der SLN-Szintigraphie und der Sonographie hat sich in dieser Studie als technisch erfolgreich und praktikabel erwiesen. Allerdings sind deutliche technische Limitationen bezüglich der fh-SPECT-Qualität und der Fusionsgenauigkeit vorhanden. Unter der Voraussetzung, dass diese Limitationen optimiert werden, kann die fh-SPECT/US-Fusion einen sinnvollen Beitrag zur präoperativen Planung leisten, indem zum Beispiel eine fh-SPECT/ US-gestützte Biopsie des SLN erfolgt und somit eine valide histologische SLN-Analyse der eigentlichen Operation vorgeschaltet wird.

Keywords

Hybrid imaging - fh-SPECT/US fusion - free-hand-SPECT - SPECT/US fusion - SPECT/ultra-sound

Schlüsselwörter

Hybridbildgebung - fh-SPECT/US-Fusion - Frei- hand-SPECT - SPECT/US-Fusion - SPECT/Ultra- schall

Full Text

References

References
1 Abe H, Schmidt RA, Sennett CA. et al. US-guided core needle biopsy of axillary lymph nodes in patients with breast cancer: why and how to do it. Radiographics 2007; 27 (Suppl. 01) S91-99.
2 Bisplinghoff S, Hänisch C, Becker M. et al. Fusion of coronary angiography and stress echocardiography for myocardial viability evaluation. Int J Comput Assist Radiol Surg. 2014
3 Bricou A, Duval MA, Charon Y. et al. Mobile gamma cameras in breast cancer care – a review. Eur J Surg Oncol 2013; 39: 409-416.
4 Bucki M, Chassat F, Galdames F. et al. Real-Time SPECT and 2D Ultrasound Image Registration. Ayache N, Ourselin S, Maeder A. Medical Image Computing and Computer-Assisted Intervention – MICCAI 2007. Vol 4792:. Springer Berlin; Heidelberg: 2007: 219-226.
5 Coffey JP, Hill JC. Breast sentinel node imaging with low-dose SPECT/CT. Nucl Med Commun 2010; 31: 107-111.
6 Cools-Lartigue J, Meterissian S. Accuracy of axillary ultrasound in the diagnosis of nodal metastasis in invasive breast cancer: a review. World J Surg 2012; 36: 46-54.
7 Curiel L, Chopra R, Hynynen K. Progress in multimodality imaging: truly simultaneous ultrasound and magnetic resonance imaging. IEEE Trans Med Imaging 2007; 26: 1740-1746.
8 Dalus K, Reitsamer R, Holzmannhofer J. et al. Lymphoscintigraphy in breast cancer patients after neoadjuvant chemotherapy. Diagnostic value and the work-up of sentinel node negative patients. Nuklearmedizin 2011; 50: 33-38.
9 Drescher R, Müller A, Lesser T. et al. PET/ultrasound fusion for differentiation of Vox implant silicone particles from recurrent cancer. Nuklearmedizin 2013; 52: N29-N30.
10 Dummer R, Hauschild A, Guggenheim M. et al. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 (Suppl. 07) vii86-91.
11 Ewertsen C. Image fusion between ultrasonography and CT, MRI or PET/CT for image guidance and intervention – a theoretical and clinical study. Dan Med Bull 2010; 57: B4172.
12 Freesmeyer M, Opfermann T, Winkens T. Hybrid integration of real-time US and freehand SPECT: Proof of concept in patients with thyroid diseases. Radiology 2014; 271: 856-861.
13 Hassanzade M, Attaran M, Treglia G. et al. Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature. Gynecol Oncol 2013; 130: 237-245.
14 Holl G, Dorn R, Wengenmair H. et al. Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients. Eur J Nucl Med Mol Imaging 2009; 36: 1377-1382.
15 Janni W, Kühn T, Schwentner L. et al. Sentinel-Node-Biopsie und Axilladissektion beim Mam-makarzinom: Evidenz und ihre Grenzen. Dtsch Arztebl International 2014; 111: 244-249.
16 Kavallaris A, Camara O, Runnebaum IB. subareolar blue dye only injection sentinel lymph node biopsy could reduce the numbers of standard axillary lymph node dissection in environments without access to nuclear medicine. J Cancer Res Clin Oncol 2008; 134: 667-672.
17 Kotzerke J, Luster M, Freesmeyer M. Give me a fixed point in space, and I will lift the world upside down. Nuklearmedizin 2012; 51: 65-66.
18 Krohn T, Verburg FA, Brockmann H. et al. A phantom assessment of portable imaging and radio-guided surgery systems with technetium-99m and fluorine-18. Nucl Med Commun 2012; 33: 452-458.
19 Lee B, Lim AK, Krell J. et al. The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer. Am J Roentgenol 2013; 200: W314-320.
20 Lee C, Collichio F, Ollila D. et al. Historical review of melanoma treatment and outcomes. Clin Dermatol 2013; 31: 141-147.
21 Lyman GH, Temin S, Edge SB. et al. Sentinel lymph node biopsy for patients with early-stage breast cancer. J Clin Oncol 2014; 32: 1365-1383.
22 Martinez A, Zerdoud S, Mery E. et al. Hybrid imaging by SPECT/CT for sentinel lymph node detection in patients with cancer of the uterine cervix. Gynecol Oncol 2010; 119: 431-435.
23 Navab N, Blum T, Wang LJ. et al. First deployments of augmented reality in operating rooms. Computer 2012; 45: 48-55.
24 Niccoli Asabella A, Antonica F, Renna MA. et al. Radio-guided sentinel lymph node identification by lymphoscintigraphy fused with an anatomical vector profile: clinical applications. Ann Nucl Med 2013; 27: 942-950.
25 Rahbar H, Partridge SC, Javid SH. et al. Imaging axillary lymph nodes in patients with newly diagnosed breast cancer. Curr Probl Diagn Radiol 2012; 41: 149-158.
26 Rao R, Lilley L, Andrews V. et al. Axillary staging by percutaneous biopsy: sensitivity of fine-needle aspiration versus core needle biopsy. Ann Surg Oncol 2009; 16: 1170-1175.
27 Rennert J, Georgieva M, Schreyer AG. et al. Image fusion of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) using volume navigation for detection, characterization and planning of therapeutic interventions of liver tumors. Clin Hemorheol Microcirc 2011; 49: 67-81.
28 Sever AR, Mills P, Jones SE. et al. Preoperative sentinel node identification with ultrasound using microbubbles in patients with breast cancer. Am J Roentgenol 2011; 196: 251-256.
29 Stachs A, Gode K, Hartmann S. et al. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer – size of metastases as limiting factor. SpringerPlus 2013; 2: 350.
30 Tang AM, Kacher DF, Lam EY. et al. Multi-modal imaging: simultaneous MRI and ultrasound imaging for carotid arteries visualization. Conf Proc IEEE Eng Med Biol Soc 2007; 2007: 2603-2606.
31 Van den Berg NS, Valdes-Olmos RA, van der Poel HG. et al. Sentinel lymph node biopsy for prostate cancer: a hybrid approach. J Nucl Med 2013; 54: 493-496.
32 Vermeeren L, van der Ploeg IM, Olmos RA. et al. SPECT/CT for preoperative sentinel node localization. J Surg Oncol 2010; 101: 184-190.
33 Vogt H, Schmidt M, Bares R. et al. Procedure guideline for sentinel lymph node diagnosis. Nuklearmedizin 2010; 49: 167-172.
34 Wagner T, Buscombe J, Gnanasegaran G. et al. SPECT/CT in sentinel node imaging. Nucl Med Commun 2013; 34: 191-202.
35 Wei S, Bleiweiss IJ, Nagi C. et al. Characteristics of breast carcinoma cases with false-negative sentinel lymph nodes. Clin Breast Cancer. 2014
36 Weiss M, Meyer M, Siegert S. et al. Metastases in patients with breast cancer despite of negative sentinel lymph node. Has the concept to be changed?. Nuklearmedizin 2013; 52: 14-20.
37 Wendler T, Hartl A, Lasser T. et al. Towards intraoperative 3D nuclear imaging: reconstruction of 3D radioactive distributions using tracked gamma probes. Med Image Comput Comput Assist Interv 2007; 10: 909-917.
38 Wendler T, Herrmann K, Schnelzer A. et al. First demonstration of 3-D lymphatic mapping in breast cancer using freehand SPECT. Eur J Nucl Med Mol Imaging 2009; 37: 1452-1461.
39 Xiong L, Gazyakana E, Yang W. et al. Indocyanine green fluorescence-guided sentinel node biopsy: A meta-analysis on detection rate and diagnostic performance. Eur J Surg Oncol 2014; 40: 843-849.
40 Yamamoto S, Maeda N, Tamesa M. et al. Sentinel lymph node detection in breast cancer patients by real-time virtual sonography constructed with three-dimensional computed tomography-lymphography. Breast J 2010; 16: 4-8.