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Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy

Nina Boc
Nina Boc
, 
Ibrahim Edhemovic
Ibrahim Edhemovic
, 
Bor Kos
Bor Kos
, 
Maja M. Music
Maja M. Music
, 
Erik Brecelj
Erik Brecelj
, 
Blaz Trotovsek
Blaz Trotovsek
, 
Masa Bosnjak
Masa Bosnjak
, 
Mihajlo Djokic
Mihajlo Djokic
, 
Damijan Miklavcic
Damijan Miklavcic
, 
Maja Cemazar
Maja Cemazar
 and 
Gregor Sersa
Gregor Sersa
   | Oct 18, 2018
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Article Category: Research Article
Published Online: Oct 18, 2018
Page range: 383 - 391
Received: Sep 03, 2018
Accepted: Oct 04, 2018
DOI: https://doi.org/10.2478/raon-2018-0041
Keywords
© 2018 Nina Boc, Ibrahim Edhemovic, Bor Kos, Maja M. Music, Erik Brecelj, Blaz Trotovsek, Masa Bosnjak, Mihajlo Djokic, Damijan Miklavcic, Maja Cemazar, Gregor Sersa, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Colorectal liver metastases in difficult-to-treat locations. Locations of metastases to be treated with electrochemotherapy are indicated by white arrows (A) subdiafragmally in the liver remnant after right hepatectomy; (B) segment VII near the right hepatic vein.
Colorectal liver metastases in difficult-to-treat locations. Locations of metastases to be treated with electrochemotherapy are indicated by white arrows (A) subdiafragmally in the liver remnant after right hepatectomy; (B) segment VII near the right hepatic vein.

Figure 2

Effects of electrochemotherapy as is visible in the ultrasound imaging. (A) Immediate effect of microbubbles formation in the electrode track (5 min). Location of the metastasis is indicated by the dashed white curve. Overlaid is a contour plot showing iso-contours of the electric field of 400 and 800 V/cm, yellow and green solid curves, respectively. Electrode locations for one array location are indicated by blue dashed lines (B) Illustration of the ultrasound imaging plane in the reconstructed 3-D geometry of the liver. The tumor is shown in yellow, blood vessels are shown in blue, and the liver surface is shown in transparent red. The imaging plane is shown in black. One location of the electrode array is also shown. (C) Microbubbles are resorbed, the hypoechoic area represents the electroporated area, and the hyperechoic tumor is well demarcated within the ablation zone (5-15 min). Location of the metastasis is indicated by dashed white curve. Overlaid are the electric field iso-contours after delivery of all pulses as in (A). (D) Illustration of the imaging plane and location. Colors as in (C). Anatomic directions in (C) and (F) are indicated as follows: A – anterior, P– posterior, L– left, R– right, S – superior, I – inferior.
Effects of electrochemotherapy as is visible in the ultrasound imaging. (A) Immediate effect of microbubbles formation in the electrode track (5 min). Location of the metastasis is indicated by the dashed white curve. Overlaid is a contour plot showing iso-contours of the electric field of 400 and 800 V/cm, yellow and green solid curves, respectively. Electrode locations for one array location are indicated by blue dashed lines (B) Illustration of the ultrasound imaging plane in the reconstructed 3-D geometry of the liver. The tumor is shown in yellow, blood vessels are shown in blue, and the liver surface is shown in transparent red. The imaging plane is shown in black. One location of the electrode array is also shown. (C) Microbubbles are resorbed, the hypoechoic area represents the electroporated area, and the hyperechoic tumor is well demarcated within the ablation zone (5-15 min). Location of the metastasis is indicated by dashed white curve. Overlaid are the electric field iso-contours after delivery of all pulses as in (A). (D) Illustration of the imaging plane and location. Colors as in (C). Anatomic directions in (C) and (F) are indicated as follows: A – anterior, P– posterior, L– left, R– right, S – superior, I – inferior.

Figure 3

Effects of electrochemotherapy (ECT) as visible in the US imaging. (A) Immediate effect of microbubble formation in the electrode track immediately after electroporation (5 min). Location of the metastasis is indicated by the dashed white curve. Overlaid is a contour plot showing iso-contours of the electric field of 400 and 800 V/cm, yellow and green solid curves, respectively. Electrode locations are indicated by dashed blue lines (B) Illustration of the US imaging plane in the reconstructed 3-D geometry of the liver. The tumor is shown in yellow, blood vessels in blue, and the liver surface in transparent red. The imaging plane is shown in black. (C) First hyperechoic changes and microbubbles after treatment (5-15 minutes). Location of the metastasis is indicated by dashed curve. Overlaid are the electric field iso-contours. Colors as in (A). (D) Illustration of the imaging plane and location. Colors as in (B). (E) Hyperechoic tumor in the hypoechoic ablation zone 1.5 h after ECT. Location of the metastasis is indicated by dashed white curve. Electric field and electrodes are shown as above. (F) Illustration of the imaging plane and location. Colors as in (B). Anatomic directions in (B), (D), and (F) are indicated as follows: A – anterior, P– posterior, L– left, R – right, S – superior, I – inferior.
Effects of electrochemotherapy (ECT) as visible in the US imaging. (A) Immediate effect of microbubble formation in the electrode track immediately after electroporation (5 min). Location of the metastasis is indicated by the dashed white curve. Overlaid is a contour plot showing iso-contours of the electric field of 400 and 800 V/cm, yellow and green solid curves, respectively. Electrode locations are indicated by dashed blue lines (B) Illustration of the US imaging plane in the reconstructed 3-D geometry of the liver. The tumor is shown in yellow, blood vessels in blue, and the liver surface in transparent red. The imaging plane is shown in black. (C) First hyperechoic changes and microbubbles after treatment (5-15 minutes). Location of the metastasis is indicated by dashed curve. Overlaid are the electric field iso-contours. Colors as in (A). (D) Illustration of the imaging plane and location. Colors as in (B). (E) Hyperechoic tumor in the hypoechoic ablation zone 1.5 h after ECT. Location of the metastasis is indicated by dashed white curve. Electric field and electrodes are shown as above. (F) Illustration of the imaging plane and location. Colors as in (B). Anatomic directions in (B), (D), and (F) are indicated as follows: A – anterior, P– posterior, L– left, R – right, S – superior, I – inferior.

Figure 4

Transabdominal US of liver metastasis 4 days after electrochemotherapy. The metastasis was well demarcated and hyperechoic (indicated by the white arrow) in the hypoechoic ablation zone.
Transabdominal US of liver metastasis 4 days after electrochemotherapy. The metastasis was well demarcated and hyperechoic (indicated by the white arrow) in the hypoechoic ablation zone.

Figure 5

Late effects of electrochemotherapy (ECT). (A) US image 5 months after ECT in patient #1. (B) MRI 5 months after ECT in patient #1. Metastasis of reduced size presented as a fibrotic residuum without the edematous rim. (C) MRI 3 months after ECT in patient #2. The metastasis of reduced size presented as a fibrotic residuum without the edematous rim. All lesions are indicated by white arrows.
Late effects of electrochemotherapy (ECT). (A) US image 5 months after ECT in patient #1. (B) MRI 5 months after ECT in patient #1. Metastasis of reduced size presented as a fibrotic residuum without the edematous rim. (C) MRI 3 months after ECT in patient #2. The metastasis of reduced size presented as a fibrotic residuum without the edematous rim. All lesions are indicated by white arrows.

Figure 6

Schematic representation of the timeline of ultrasonographic changes after the delivery of electrochemotherapy treatment.
Schematic representation of the timeline of ultrasonographic changes after the delivery of electrochemotherapy treatment.
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