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J Hepatol. 2017 Feb;66(2):347-354. doi: 10.1016/j.jhep.2016.09.003. Epub 2016 Sep 17.

Real-time US-CT/MR fusion imaging for percutaneous radiofrequency ablation of hepatocellular carcinoma.

Author information

1
Department of Radiology, Seoul National University Hospital, Seoul, South Korea.
2
Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Institute of Radiation Medicine, Department of Internal, Seoul National University Hospital, Seoul, South Korea. Electronic address: jmsh@snu.ac.kr.
3
Department of internal medicine, Seoul National University Hospital, Seoul, South Korea.
4
Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Institute of Radiation Medicine, Department of Internal, Seoul National University Hospital, Seoul, South Korea.

Abstract

BACKGROUND & AIMS:

Although ultrasonography (US) guided radiofrequency ablation (RFA) is a commonly used treatment option for early hepatocellular carcinoma (HCC), inconspicuous tumors on US limits its feasibility. Thus, we prospectively determined whether real-time US-CT/MR fusion imaging can improve the technical feasibility of RFA compared with B-mode US, and help predict local tumor progression after RFA in patients with HCC.

METHODS:

A total of 216 patients with 243 HCCs ⩽5cm referred for RFA were prospectively enrolled. Prior to RFA, the operators scored the visibility of tumors, and technical feasibility on a 4-point scale at both B-mode US and fusion imaging. RFA was performed with a switching monopolar system using a separable cluster electrode under fusion imaging guidance. Technique effectiveness, local tumor progression and intrahepatic remote recurrences were evaluated.

RESULTS:

Tumor visibility and technical feasibility were significantly improved with fusion imaging compared with B-mode US (p<0.001). Under fusion imaging guidance, the technique effectiveness of RFA for invisible tumors on B-mode US was similar to those for visible tumors (96.1% vs. 97.6%, p=0.295). Estimated cumulative incidence of local tumor progression at 24months was 4.7%, and previous treatment for other hepatic tumors (p=0.01), higher expected number of electrode insertions needed and lower technical feasibility scores (p<0.01) on fusion imaging were significant negative predictive factors for local tumor progression.

CONCLUSION:

Real-time fusion imaging guidance significantly improved the tumor visibility and technical feasibility of RFA in patients with HCCs compared with B-mode US, and low feasibility scores on fusion imaging was a significant negative predictive factor for local tumor progression.

LAY SUMMARY:

US/CT-MR fusion imaging guidance improved the tumor visibility and technical feasibility of RFA in patients with HCCs. In addition, fusion imaging guided RFA using multiple electrodes demonstrated a high technique effectiveness rate and a low local tumor progression rate during mid-term follow-up. Clinical trial number: ClinicalTrials.gov number, NCT02687113.

KEYWORDS:

Hepatocellular carcinoma; Imaging guidance; Local tumor progression; Radiofrequency ablation; Real-time fusion imaging; Risk of recurrence

PMID:
27650284
DOI:
10.1016/j.jhep.2016.09.003
[Indexed for MEDLINE]

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