Use of High-Frequency Jet Ventilation for Percutaneous Tumor Ablation

Denys, Alban; Lachenal, Yann; Durán, Rafael; Chollet-Rivier, Madeleine; Bize, Pierre

doi:10.1007/s00270-013-0620-4

Cited by 59 publications

(41 citation statements)

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“…Indeed, the variations in diaphragm position should be about 3 mm, quite similar with high-frequency ventilation under anesthesia. 37 Conversely, variations of about 2 cm are expected in FB. ) is increased, as well as the sharpness of bronchial walls with the UTE-HF-NIV sequence.…”

Section: Discussionmentioning

confidence: 97%

“…Also, additional image quality improvements could be expected in UTE‐HF‐NIV images if retrospective gating or motion‐resolved reconstructions were used to remove residual motion artifacts linked to the ventilation procedure. Indeed, the variations in diaphragm position should be about 3 mm, quite similar with high‐frequency ventilation under anesthesia . Conversely, variations of about 2 cm are expected in FB.…”

Section: Discussionmentioning

confidence: 99%

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Ultrashort echo time imaging of the lungs under high‐frequency noninvasive ventilation: A new approach to lung imaging

Delacoste

Dournes

Dunet

et al. 2019

Magnetic Resonance Imaging

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BackgroundAlthough ultrashort echo time (UTE) sequences allow excellent assessment of lung parenchyma, image quality remains lower than that of computed tomography (CT).PurposeTo investigate a high‐frequency noninvasive ventilation (HF‐NIV) technique allowing a stabilized inspiration and to compare image quality with current dedicated MR sequences.Study TypeProspective.PopulationTen healthy volunteers.Field Strength/Sequence3D radial UTE sequence at 1.5T.AssessmentUTE‐HF‐NIV sequence was compared with UTE‐free‐breathing (UTE‐FB), reconstructed at end expiration (UTE‐Exp) and average (UTE‐Avg), and breath‐hold VIBE sequences. The distance from lung apex to the dome of the right hemidiaphragm was measured. Visual assessment of the visibility and sharpness of normal anatomical structures was carried out. Dedicated software also quantitatively evaluated vessel–lung and right lung–liver interface sharpness. Apparent signal ratio (Sr) and contrast ratios (Cr) were quantitatively evaluated.Statistical TestsWilcoxon signed rank test for visual scores, paired t‐test for continuous variables, significance at P < 0.05.ResultsThe distance between apex and the right hemidiaphragmatic dome was significantly larger (P < 0.001) with UTE‐HF‐NIV compared with UTE‐FB and VIBE acquisitions. Vessel and airway visibility had identical median visual scores with all UTE methods. Median visual scores for sharpness of vessels and airways were significantly higher (P < 0.001) with HF‐NIV (vessels = 3; airways = 2) than in UTE‐FB (vessels = 2; airways = 1) and VIBE (vessels = 1; airways = 1). Software‐based vessel sharpness evaluation resulted in larger values in 8/10 volunteers with UTE‐HF‐NIV (67.3 ± 9.8) compared with UTE‐Avg (62.3 ± 12.6) but the average difference was not significant (P = 0.28). The sharpness of the lung–liver interface was significantly higher (P < 0.001) with HF‐NIV (17.3 ± 5.3) compared with UTE‐Avg (14.1 ± 3.9). Significantly higher values (P < 0.01) of Sr and Cr were observed with UTE‐HF‐NIV compared with UTE‐FB and VIBE.Data ConclusionHF‐NIV allowing acquisition at full inspiration significantly improves image quality for lung imaging. This could offer the option to alternate some follow‐up CT studies by using this technique. Level of Evidence: 2 Technical Efficacy: Stage 1J. Magn. Reson. Imaging 2019;50:1789–1797.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Ultrashort echo time imaging of the lungs under high‐frequency noninvasive ventilation: A new approach to lung imaging

Delacoste

Dournes

Dunet

et al. 2019

Magnetic Resonance Imaging

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“…However, careful evaluation of the publications quoted in their paper did not show a study with a prospective organ movement measurement in humans using this technique. We have recently published a prospective trial on HFJV for percutaneous tumor ablation in 50 patients [3]. In this series, we could demonstrate two important points that are of interest for readers.…”

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confidence: 94%

High-Frequency Jet Ventilation for HIFU

Courbon¹,

Bize

Rivier³

et al. 2014

Cardiovasc Intervent Radiol

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We read the review by Muller et al.[1] about the management of respiratory motion in high-intensity focused ultrasound with great interest. As acknowledged by the authors, the motion of abdominal organs due to ventilation is sometimes a main obstacle for interventional radiology [2]. This is a critical issue for HIFU treatment where energy deposits in tissue are small and where precise overlap of each deposit is mandatory. The authors present many solutions more or less adapted to the HIFU technique.For one solution, the authors use high-frequency jet ventilation as a potentially useful tool. However, careful evaluation of the publications quoted in their paper did not show a study with a prospective organ movement measurement in humans using this technique. We have recently published a prospective trial on HFJV for percutaneous tumor ablation in 50 patients [3]. In this series, we could demonstrate two important points that are of interest for readers. First, we demonstrated that during HFJV for hepatic and pulmonary radiofrequency ablation (RFA), the mean movement of target close to the diaphragm was 0.3 ± 0.12, 0.3 ± 0.13, and less than 3.75 mm in x, y, and z directions respectively (mean ± SD). The movement in the z direction is probably lower than 3.75 mm, but due to the slice thickness used in our protocol we were not able to give more precise measure in the z direction. Interestingly in our study, some patients could not be treated using HFJV. They were patients with small tumors highly located in the liver dome area. These lesions could not be reached, because HFJV ventilates the patient in a position near of end expiration. The lesions were then nonvisible under US guidance and a transthoracic approach would have been necessary for needle positioning under CT guidance. This also might be an issue for HIFU, because an ultrasonographic window is necessary for energy deposition in the tissue. This problem was easily solved, because we could switch from HFJV to conventional positive pressure ventilation easily. HFJV, which was claimed by some authors [4] to be a ventilation method that could not be used for long period of time due to a risk of atelectasia and hypercapnia, was actually used for long period of time in our study (mean 2 h) without treatment discontinuation due to ventilation problem.HFJV has the ability to solve all the anesthetic and ventilation issues related to HIFU: a nearly immobile organ even close to the diaphragm, a ventilation method for long procedure. The only remaining problem could be deeply located lesion close to the liver dome that may be obscured by the lung when using this ventilation method.

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“…We aim here to evaluate, comprehensively and concisely, what we believe to be essential issues concerning the use of HFJV as a motion suppression technique for abdominal ablation during extracorporeal HIFU.At the time we made the final submission of our review article [1], Denys et al article [2] had not yet been publicly released. Moreover, no clinical experience describing the association of HIFU and HFJV techniques had been published and to the best of our knowledge, this continues to be the situation today.…”

mentioning

confidence: 99%

“…At the time we made the final submission of our review article [1], Denys et al article [2] had not yet been publicly released. Moreover, no clinical experience describing the association of HIFU and HFJV techniques had been published and to the best of our knowledge, this continues to be the situation today.…”

mentioning

confidence: 99%

Reply to: High-Frequency Jet Ventilation for HIFU

Muller

Petrusca

Auboiroux

et al. 2014

Cardiovasc Intervent Radiol

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We would like to thank Dr. Denys for his insightful comments and to the Editorial Board of this Journal for offering us the opportunity to communicate a reply letter. We aim here to evaluate, comprehensively and concisely, what we believe to be essential issues concerning the use of HFJV as a motion suppression technique for abdominal ablation during extracorporeal HIFU.At the time we made the final submission of our review article [1], Denys et al. article [2] had not yet been publicly released. Moreover, no clinical experience describing the association of HIFU and HFJV techniques had been published and to the best of our knowledge, this continues to be the situation today. The reports we have cited consider the application of HFJV to radiation therapy, percutaneous thermal ablation, or extracorporeal shock wave lithotripsy. To summarize, Fritz et al. [3], working with radiotherapy, showed that HFJV enabled liver motion to be minimized to 3 mm, in agreement with Denys et al. experience. In the field of percutaneous ablation, the only series we found in literature was a retrospective observational study published in 2011 in which nine patients with hepatic or renal lesions were treated under HFJV [4]. We have also acknowledged several reports associating high frequency jet ventilation with extracorporeal shock wave lithotripsy [5-7], a technique similar to some extent to HIFU. It was shown that HFJV reduced urinary stone movement, which increased lithotripsy efficiency with better utilization of shockwave energy and less patient exposure to tissue trauma.Denys et al. study is the first prospective study for percutaneous thermal ablation with the inclusion of a large subset of patients with an intention to treat with HFJV. A real estimation of the proportion of patients noneligible for HFJV therefore can be calculated and details of the exclusion criteria are provided. Overall, their report provides detailed informations on HFJV applied to thermotherapy while we have only summarized some principles in our referenced article whose aim was to review broader topics.We agree with the observation that some lesions located in the upper part of the liver may not be treatable with extracorporeal HIFU under HFJV due to patient being ventilated in a position near of end expiration. This is a problem we have already been confronted with during conventional mechanical ventilation, since we performed sonication during the expiration phase (in sheep and pig animal studies), as it is the longest and most stable phase. Interestingly, intercostal sonication was demonstrated to be feasible [8]; however, the interposition of the right lung's inferior lobe in the HIFU beam may be a complicated problem for this configuration.Dr. Denys and his team mentioned the possibility of using HFJV for a long period of time. In the specific

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Use of High-Frequency Jet Ventilation for Percutaneous Tumor Ablation

Abstract: HFJV is feasible in 80 % of patients allowing for near immobility of internal organs during liver, kidney, and lung tumor ablation.

Cited by 59 publications

References 19 publications

Ultrashort echo time imaging of the lungs under high‐frequency noninvasive ventilation: A new approach to lung imaging

Ultrashort echo time imaging of the lungs under high‐frequency noninvasive ventilation: A new approach to lung imaging

High-Frequency Jet Ventilation for HIFU

Reply to: High-Frequency Jet Ventilation for HIFU

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