Real-Time Three-Dimensional Ultrasound Guided Tumour Ablation

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Live 3D ultrasound guided tumour ablation
Live 3D ultrasound guided tumour ablation. Click on the image to see the "bubbles" in a 4D movie showing the heat this hepatic tumour is undergoing.

Three-Dimensional Visualisation & Quantification of Tumour Vascularity with Contrast-Enhanced Ultrasound & CT

Lesion vascularity and permeability are of value in assessment of tumour angiogenesis and anti-angiogenesis response. Although transpulmonary contrast agents can enhance the vascularity, the distribution patterns are not always ready for mental 3D comprehension from individual 2D images. 3D reconstruction is used to make assessment of these patterns more direct and objective. Permeability is defined as the amount of substance(s) crossing an interface per unit time and per unit surface area (VSA). But current CT and MRI assessments can only calculate the amount of substance(s) over time because their contrast agents leak out through the vascular walls, making the interface unmeasurable. US contrast agents are intravascular-only agents. Therefore, US VSA measurement may be used with MRI or CT for permeability quantification.
 
A gastrinoma metastasis to the liver
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Pre-contrast agent injection: Power Doppler blood flow signals (red branches) around and within the lesion (blue mass) were only partially visualised [AVI 439 KB]. Post-contrast agent injection: Blood flow signals around and within the lesion were significantly enhanced and the spatial distribution was clearly visualised [AVI 548 KB].
tumour vessel without tumour tissue
3D CT image of hepatic metastasis of gastrinoma
The threshold is set to display the vasculature only [AVI 507 KB]. CT images show less striking enhancement with a homogeneous distribution (red-dotted area) [AVI 652 KB]..
A colonic metastasis to the liver
3D US of a colonic metastasis to the liver
3D CT of a colonic metastasis to the liver
3D US enhancement [AVI 506 KB]. 3D CT enhancement showing the same distribution pattern [AVI 484 KB].
A lung squamous cell metastasis to the liver 
3D US of a lung squamous cell metastasis to the liver
3D measurement of a tumour vascularity
Left: tumour and vessels displayed together; right: only vessels displayed. As the vessel surface area (VSA), vessel volume (VV) and lesion volume (LV) are measurable on these 3D images, we introduced the following three parameters for quantifying tumour vascularity: VSA / VV, VSA / LV and VSA / ( LV - VV ) (click here for reference to this).