Cone Beam Computed Tomography Image Fusion with Cross Sectional Images for Percutaneous Renal Tumor Ablation - Preliminary Data

Sep 28, 2026

Percutaneous ablative kidney treatments are standard for local cancer therapy, yet procedural imaging and targeting may benefit from multimodality fusion. This study evaluates intraprocedural cone beam computed tomography (CBCT) guidance using magnetic resonance (MR) or CT image fusion for percutaneous microwave ablation (MWA) of renal neoplasms. Fifteen patients underwent CBCT-based fusion planning in a dedicated angiography room, with technical success, time, complications, and recurrences assessed.

LanguageEnglish

CategoryHealthcare

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Cone Beam Computed Tomography Image Fusion with Cross Sectional Images for Percutaneous Renal Tumor Ablation: Preliminary Data Anna Maria Ierardi, MD 1, Aldo Carnevale, MD2 , Elvira Stellato, MD3, Elisa De Lorenzis, MD4, Licia Uccelli, PhD2, Gianlorenzo Dionigi, MD5, Melchiore Giganti, MD2, Emanuele Montanari, MD4,6, and Gianpaolo Carraﬁello, MD1,7 Technology in Cancer Research & Treatment Volume 22: 1-8 © The Author(s) 2023 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/15330338231154994](DOI: 10.1177/15330338231154994)[ ](DOI: 10.1177/15330338231154994)[journals.sagepub.com/home/tct](journals.sagepub.com/home/tct) Abstract Purpose: Percutaneous ablative treatments in the kidney are now standard options for local cancer therapy. Multimodality image guidance, combining two 3D image sets, may improve procedural images and interventional strategies. We aimed to assess the value of intraprocedural cone beam computed tomography(CBCT)with magnetic resonance (MR)or CT imaging fusion technique in the guidance of percutaneous microwave ablation (MWA) of renal neoplasms. Materials and methods: Fifteen patients (eight males, seven females, median age65years, median lesion size20 mm)underwent percutaneous MWAfor15renal tumors. All the procedures were performed ina dedicated angiography room setting; CBCTablation planning capabilities included multimodality image fusion. Preoperative contrastenhanced CTwas available in12patients, whereas magnetic resonance imaging in the remaining. All patients were considered inoperable due to comorbidities, advanced age, and/or refusal to undergo surgery. Exclusion criteriawere: tumors visible at unenhanced CBCT, metastatic disease, and uncorrected coagulopathy. Technical success and technical effectiveness were calculated. Procedural time, complicationsand recurrences were registered. Results: MWA under CBCT-guidance withfusiontechnique was technically successful in14out of 15 cases (93%). The median procedural time was 45 min. No procedure-related complications were reported. No enhancing tissue was visualized inthe area ofablation at1-month follow-up. All15cases were recurrence-free at lastfollow-up assessment(median follow-up of 12months);no cancer-speciﬁc deaths were registered. Conclusion: CBCT-CT/MR image fusion is technically feasible and safe inachieving correct targeting and complete ablation of renal lesions. This approach bears the potential to overcome most of the limitations ofunenhanced CBCT guidance alone; larger series are needed to validate this technique. Keywords renal tumor, ablation, microwave, fusion, cone beam, computed tomography, magnetic resonance imaging Received: June 26, 2022; Revised: November 12, 2018; Accepted: January 18, 2023. Introduction Percutaneous ablative treatments, including radiofrequency ablation, microwave ablation (MWA), and cryoablation, are now performed as standard nephron-sparing options for local cancer therapy. Such procedures are currently considered viable alternatives in patients with small peripheral renal nodules (less than 3 cm in diameter), particularly for those patients who are not eligible for surgery due to multiple comorbidities, those with a solitary kidney, limited renal function, hereditary or multiple lesions. 1,2 In general, MWA offers some theoretical advantages over the other available 1 Radiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 2 Radiology Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy 3 Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy 4 Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 5 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy 6 Department of Clinical Sciences and Community Health, University of Milan, Milan

FAQs

What clinical problem does the study address for renal tumor ablation?

It addresses the need for improved multimodality image guidance during percutaneous microwave ablation of kidney tumors, using intraprocedural CBCT with CT/MR fusion to enhance targeting and procedural strategy.

How was the study conducted and what was the patient sample?

Fifteen patients (eight males, seven females) with renal tumors underwent percutaneous MWA. All procedures were performed in a dedicated angiography room with CBCT ablation planning that included multimodality image fusion.

What were the main outcomes of CBCT-CT/MR fusion guidance?

MWA was technically successful in 14 of 15 cases (93%), no procedure-related complications were reported, enhancing tissue was not visualized at one month, and all 15 cases were recurrence-free at median follow-up of 12 months.

Sep 28, 2026

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