Intraprocedural computed tomography/magnetic resonance–contrast‐enhanced ultrasound fusion imaging improved thermal ablation effect of hepatocellular carcinoma: Comparison with conventional ultrasound

Abstract

Aim To retrospectively compare the treatment effect of intraprocedural computed tomography/magnetic resonance–contrast‐enhanced ultrasound (CT/MR‐CEUS) fusion imaging (FI) with that of conventional ultrasound (US) in the guidance and assessment of thermal ablation of hepatocellular carcinoma (HCC). Methods The FI group (112 patients with 129 HCC) was treated between April 2010 and December 2012, whereas the US group (83 patients with 90 HCC) was treated between January 2008 and March 2010. Either CT/MR‐CEUS FI or US was used to guide puncture, provide immediate assessment, and guide supplementary ablation. Technical efficacy, cumulative local tumor progression rate (LTP), recurrence‐free survival (RFS), and overall survival (OS) were evaluated and compared during follow‐up. Technical success rate of CT/MR‐CEUS FI was also recorded. Results Technical efficacy was significantly higher in the FI group than in the US group (100% vs. 86.7%, P < 0.001). The 1‐, 2‐, 3‐, 4‐, 5‐, and 6‐year cumulative LTP rates in the FI group were significantly lower than in the US group (3.8%, 4.9%, 6.0%, 6.0%, 7.2%, and 7.2% vs. 16.9%, 20.1%, 25%, 25%, 25%, and 25%, respectively; P < 0.001); RFS and OS were significantly higher in the FI group than in the US group (P = 0.027 and P = 0.049, respectively). The technical success rate of FI was 85.3%. Conclusions Intraprocedural CT/MR‐CEUS FI improved the treatment effect of thermal ablation of HCC by immediately assessing treatment response and guiding supplementary ablation relative to those resulting from the use of conventional US.

Efficacy and Safety of Fusion Imaging in Radiofrequency Ablation of Hepatocellular Carcinoma Compared to Ultrasound: A Meta-Analysis

“…Moreover, subgroup analysis, based on mean diameter (<15 mm) revealed no heterogeneity (I 2 = 0.0%, p = 0.77). Results of sensitivity analysis, used to examine the effect of each study on pooled effect diameter, revealed that exclusion of Ma's study (21) from the analysis altered the overall effect diameter (RR, RE:1; 95% CI: 0.99, 1.02, p = 0.84). Moreover, no evidence of significant publication bias was found across the included studies with regards to technical efficiency (p = 0.81, Begg's test and p = 0.65, Egger's test).…”

“…However, published studies have yielded conflicting results with regards to efficacy and safety of FI relative to that of ultrasound. While some studies have shown that FI is more superior than ultrasound (20,21), others have found no significant differences in the two technologies (22,23). Therefore, the present metaanalysis was designed to systematically evaluate efficacy and safety of FI relative to ultrasound in radiofrequency surgery for the treatment of hepatocellular carcinoma.…”

Feasibility and Efficacy of Fusion Imaging Systems for Immediate Post Ablation Assessment of Liver Neoplasms: Protocol for a Rapid Systematic Review

“…This would allow the clinicians to immediately assess the treatment response post-procedure and perform immediate supplementary ablation if needed. This potentially avoids the need for secondary treatment as well as reducing the economic burden to the patients [ 10 ].…”

Use of intra-procedural fusion imaging combining contrast-enhanced ultrasound using a perflubutane-based contrast agent and auto sweep three-dimensional ultrasound for guiding radiofrequency ablation and evaluating its efficacy in patients with hepatocellular carcinoma

“…Fusion imaging combining CEUS and hepatobiliary-phase CEMRI also appears to be useful for evaluating the therapeutic efficacy of RFA for HCCs identified as having isoechoic or unclear margins by conventional US [12]. The usefulness of fusion imaging combining CEUS and CECT/CEMRI for evaluating the therapeutic efficacy of RFA has been reported by several investigators [13,14]. The reported concordance rate for the results of the RFA efficacy evaluation between intraprocedural CEUS and CECT/CEMRI fusion imaging and CECT/CEMRI performed within 30 days after RFA was 91.1% (72/79) [13].…”