Intraprocedurally EOB-MRI/US fusion imaging focusing on hepatobiliary phase findings can help to reduce the recurrence of hepatocellular carcinoma after radiofrequency ablation

Abstract

Background & aims: To explore the ability of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (EOB-MRI)/ultrasound (US) fusion imaging (FI) to improve the prognosis of radiofrequency ablation (RFA) by ablating the characteristic findings of hepatocellular carcinoma (HCC) in hepatobiliary phase (HBP) imaging. Methods: We retrospectively recruited 115 solitary HCC lesions with size of (15.9 ± 4.6) mm. They were all treated by RFA and preoperative EOB-MRI. According to the modalities guiding RFA performance, the lesions were grouped into contrast enhanced US (CEUS)/US guidance group and EOB-MRI/US FI guidance group. For the latter group, the ablation scope was set to cover the HBP findings (peritumoral hypointensity and irregular protruding margin). The presence of HBP findings, the modalities guided RFA, the recurrence rate were observed. Results: After an average follow-up of 377 days, local tumor progression (LTP) and intrahepatic distant recurrence (IDR) were 14.8% and 38.4%, respectively. The lesions having HBP findings exhibited a higher recurrence rate (73.7%) than the lesions without HBP findings (42.9%) (p ¼ 0.002) and a low overall recurrence-free curve using the Kaplan-Meier method (p ¼ 0.038). Using EOB-MRI/US FI as guidance, there was no difference in the recurrence rate between the groups with and without HBP findings (p ¼ 0.799). In lesions with HBP findings, RFA guided by EOB-MRI/US FI (53.8%) produced a lower recurrence rate than CEUS/US (84.0%) (p ¼ 0.045). Conclusions: The intraprocedurally application of EOB-MRI/US FI to determine ablation scope according to HBP findings is feasible and beneficial for prognosis of RFA.

Fusion imaging versus ultrasound-guided percutaneous thermal ablation of liver cancer: a meta-analysis

“…This meta-analysis included only six relevant studies published before April 2021, with a total of 1168 patients with HCC. Although this study showed a similar TER for FI and ultrasound-guided thermal ablation for HCC, it failed to indicate a superiority of FI-guided ablation to ultrasound-guided ablation (16–30). Compared to this previous meta-analysis, our study has several strengths in methodology.…”

“…Pooled results of 15 comparisons from 14 studies (16–21,23–30) indicated that compared to conventional HCC ablation guided by ultrasound, FI-guided procedure showed similar TER (RR = 1.01, 95% CI = 1.00–1.02, P = 0.25) (Fig. 2a) with mild heterogeneity (p for Cochrane's Q test = 0.13, I 2 = 30%).…”

“…Table 1 summarizes the characteristics of the studies included in the meta-analysis. Overall, one RCT (18), three prospective cohort studies (17,19,27), and 11 retrospective cohort studies (16,20–26,28–30) were available. Since one study included two comparisons of different FI techniques with ultrasound (CT/MR-CEUS vs. CEUS and 3DUS-CEUS vs. CEUS) (18), these datasets were included independently in the meta-analysis.…”

Optimal application of stereotactic body radiotherapy and radiofrequency ablation treatment for different multifocal hepatocellular carcinoma lesions in patients with Barcelona Clinic Liver Cancer stage A4–B1: a pilot study

“…As described by Wang et al [ 26 ] and Hao et al [ 27 ], a 480 kHz generator (VIVA RF generator; STARmed, Gyeonggi, Korea) capable of producing a maximum power of 200 W and a specifically sized 17-gauge internally cooled, adjustable RF electrode (Proteus; STARmed, Gyeonggi, Korea) were applied. RFA was performed with the guidance of real-time CT/MRI and US fusion imaging carried out by one of the three senior hepatologists (K.N., K.O., and H.F.), each having more than 20 years of experience in interventional techniques.…”

Safety and efficacy study: Short-term application of radiofrequency ablation and stereotactic body radiotherapy for Barcelona Clinical Liver Cancer stage 0–B1 hepatocellular carcinoma

“…RFA procedure. As Wang F's study described [10], RFA was performed using a 480 kHz generator (VIVA RF generator; STARmed, Gyeonggi, Korea) and a 17-gauge, internally cooled, adjustable RF electrode (Proteus; STARmed, Gyeonggi, Korea). The lengths of the active tips of the electrodes were selected mainly according to the location and size of the lesion.…”