Intra-Procedural CT/MR-Ultrasound Fusion Imaging Helps to Improve Outcomes of Thermal Ablation for Hepatocellular Carcinoma: Results in 502 Nodules

Abstract

Purpose The aim was to assess the value of intra-procedural CT/MR-ultrasound (CT/MR-US) fusion imaging in the management of thermal ablation for hepatocellular carcinoma (HCC). Materials and Methods This retrospective study was approved by the institutional review board. From May 2010 to October 2016, 543 HCC nodules in 440 patients (387 men and 53 women; age range: 25–84 years) that met the Milan Criteria were treated by percutaneous thermal ablation using intra-procedural CT/MR-US fusion imaging. The HCC nodules were divided into subgroups and compared (≤ 3 cm and > 3 cm, or high-risk and low-risk location, or inconspicuous and conspicuous, respectively). Technique efficacy and major complication were calculated. Cumulative local tumor progression (LTP), tumor-free and overall survival rates were estimated with the Kaplan-Meier method. Results CT/MR-US fusion imaging was successfully registered in 419 patients with 502 nodules. The technique efficacy rate of thermal ablation was 99.4 %. The major complication rate was 1.9 %. The cumulative LTP rates were 3.2 %, 5.6 % and 7.2 % at 1, 3, and 5 years, respectively. There were no significant differences for the comparisons of cumulative LTP rates between different subgroups (P = 0.541, 0.314, 0.329). The cumulative tumor-free survival rates were 74.8 %, 54.0 % and 37.5 % at 1, 3, and 5 years, respectively. The cumulative overall survival rates were 97.8 %, 87.1 % and 81.7 % at 1, 3, and 5 years, respectively. Conclusion Intra-procedural CT/MR-ultrasound fusion imaging is a useful technique for percutaneous liver thermal ablation. It could help to achieve satisfying survival outcomes for HCC patients who meet the Milan Criteria.

Improving Ablation Safety for Hepatocellular Carcinoma Proximal to the Hilar Bile Ducts by Ultrasound-MR Fusion Imaging: A Preliminary Comparative Study

“…Ultrasound (US)-computed tomography (CT)/magnetic resonance (MR) fusion imaging is a navigation technique that is increasing in popularity that simultaneously combines the real-time capacity of US imaging and the high spatial resolution of CT/MR imaging (16). US-CT/MR fusion imaging has been widely used during US-guided RFA procedures for HCC detection, guidance, and evaluation (17)(18)(19)(20)(21)(22)(23)(24). A few studies have integrated the use of a three-dimensional ablation planning system for the ablation procedure for liver tumors to enhance the complete ablation rate and reduce operators' experience dependence (25)(26)(27).…”

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

“…Some studies considered that saline can conduct electrical current due to its ionic composition, which may lead to non-target tissue heating while using RFA. However, based on our previous experience [30,31], we did not have any complications associated with the choice of normal saline as arti cial ascites. In addition, we did not nd any articles about the complications of using normal saline as arti cial ascites in human beings.…”

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

“…Some studies considered that saline can conduct electrical current due to its ionic composition, which may lead to non-target tissue heating while using RFA. However, based on our previous experience [28,29], we did not have any complications associated with the choice of normal saline as arti cial ascites. In addition, we did not nd any articles about the complications of using normal saline as arti cial ascites in human beings.…”