Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US

Min, Ji Hye; Lim, Hyo Keun; Lim, Sanghyeok; Kang, Tae Wook; Song, Kyoung Doo; Choi, Sung Yong; Rhim, Hyunchul; Lee, Min Woo

doi:10.3350/cmh.2014.20.1.61

Cited by 54 publications

(45 citation statements)

References 24 publications

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“…Therefore, fusion imaging is also useful for the detection of HCC and safe RFA therapy of HCC [29,30,31,32,33,34,35,36]. Occasionally, however, there are HCC cases which are more difficult to be detected even when using CEUS or fusion imaging [37]. …”

Section: Introductionmentioning

confidence: 99%

Combination Guidance of Contrast-Enhanced US and Fusion Imaging in Radiofrequency Ablation for Hepatocellular Carcinoma with Poor Conspicuity on Contrast-Enhanced US/Fusion Imaging

Minami

Minami²,

Chishina³

et al. 2014

Oncology

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Purpose: The purpose of this study was to evaluate the usefulness of the combination guidance of contrast-enhanced US (CEUS) and fusion imaging in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) with poor conspicuity on B-mode US and CEUS/fusion imaging. Materials and Methods: We conducted a retrospective cohort study, which included 356 patients with 556 HCCs that were inconspicuous on B-mode US. A total of 192 patients with 344 HCCs, 123 patients with 155 HCCs, and 37 patients with 57 HCCs underwent RFA under CEUS guidance, fusion imaging guidance, and the combination of CEUS and fusion imaging guidance. Results: The average number of treatment sessions was 1.1 (range: 1-2) in the CEUS guidance group, 1.1 (range: 1-2) in the fusion imaging guidance group, and 1.1 (range: 1-3) in the combination of CEUS and fusion imaging guidance group. Treatment analysis did not reveal significantly more RFA treatment sessions in the combination guidance group than in the other groups (p = 0.97, Student's t test). During the follow-up period (1.1-85.3 months, mean ± SD, 43.2 ± 59.5), the 3-year local tumor progression rates were 4.9, 7.2, and 5.9% in the CEUS guidance group, the fusion imaging guidance group, and the combination guidance group, respectively (p = 0.84, log-rank test). Conclusion: In spite of selection bias, session frequency and local tumor progression were not different under the combination guidance with CEUS and fusion imaging in RFA. The combination of fusion imaging and CEUS guidance in RFA therapy is an effective treatment for HCC with poor conspicuity on B-mode US and CEUS/fusion imaging.

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Section: Introductionmentioning

confidence: 99%

Combination Guidance of Contrast-Enhanced US and Fusion Imaging in Radiofrequency Ablation for Hepatocellular Carcinoma with Poor Conspicuity on Contrast-Enhanced US/Fusion Imaging

Minami

Minami²,

Chishina³

et al. 2014

Oncology

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“…Mauri et al 20 showed that 95.6% (282/295) of tumours were correctly targeted and 90.2% (266/285) of tumours were successfully ablated with no perioperative deaths and 0.9% major complications using real-time ultrasound-CT/MRI guided. Min et al 39 and Minami et al 40 also reported that combination of CEUS and fusion imaging was highly effective in percutaneous RFA for HCC with poor conspicuity on conventional ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Wang

et al. 2016

BJR

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Objective: To investigate the usefulness of fusion imaging of contrast-enhanced ultrasound (CEUS) and CECT/ CEMRI before percutaneous ultrasound-guided radiofrequency ablation (RFA) for liver cancers. Methods: 45 consecutive patients with 70 liver lesions were included between March 2013 and October 2015, and all the lesions were identified on CEMRI/CECT prior to inclusion in the study. Planning ultrasound for percutaneous RFA was performed using conventional ultrasound, ultrasound-CECT/CEMRI and CEUS and CECT/CEMRI fusion imaging during the same session. The numbers of the conspicuous lesions on ultrasound and fusion imaging were recorded. RFA was performed according to the results of fusion imaging. Complete response (CR) rate was calculated and the complications were recorded. Results: On conventional ultrasound, 25 (35.7%) of the 70 lesions were conspicuous, whereas 45 (64.3%) were inconspicuous. Ultrasound-CECT/CEMRI fusion imaging detected additional 24 lesions thus increased the number of the conspicuous lesions to 49 (70.0%) (70.0% vs 35.7%; p , 0.001 in comparison with conventional ultrasound). With the use of CEUS and CECT/CEMRI fusion imaging, the number of the conspicuous lesions further increased to 67 (95.7%, 67/70) (95.7% vs 70.0%, 95.7% vs 35.7%; both p , 0.001 in comparison with ultrasound and ultrasound-CECT/CEMRI fusion imaging, respectively). With the assistance of CEUS and CECT/CEMRI fusion imaging, the confidence level of the operator for performing RFA improved significantly with regard to visualization of the target lesions (p 5 0.001). The CR rate for RFA was 97.0% (64/66) in accordance to the CECT/CEMRI results 1 month later. No procedure-related deaths and major complications occurred during and after RFA. Conclusion: Fusion of CEUS and CECT/CEMRI improves the visualization of those inconspicuous lesions on conventional ultrasound. It also facilitates improvement in the RFA operators' confidence and CR of RFA. Advances in knowledge: CEUS and CECT/CEMRI fusion imaging is better than both conventional ultrasound and ultrasound-CECT/CEMRI fusion imaging for lesion visualization and improves the operator confidence, thus it should be recommended to be used as a routine in ultrasound-guided percutaneous RFA procedures for liver cancer.

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“…Sonazoid was administered at a dose of 0.015 mL/kg by manual bolus injection, followed by a 10 mL normal saline flush via a peripheral venous line. CEUS was performed with fusion imaging (one side of screen: contrast mode; the other side: fused CT/MR images), rather than with conventional B-mode US (13). …”

Section: Methodsmentioning

confidence: 99%

“…For example, the detection rate of HCC < 2 cm in diameter on fusion imaging was 86.7% (11), and mistargeting of index tumor can occur during RFA despite the use of fusion imaging (12). To overcome these problems, CEUS and fusion imaging can be used simultaneously for guidance of RFA of HCCs (131415). …”

Section: Introductionmentioning

confidence: 99%

Added Value of Contrast-Enhanced Ultrasound on Biopsies of Focal Hepatic Lesions Invisible on Fusion Imaging Guidance

et al. 2017

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ObjectiveTo assess whether contrast-enhanced ultrasonography (CEUS) with Sonazoid can improve the lesion conspicuity and feasibility of percutaneous biopsies for focal hepatic lesions invisible on fusion imaging of real-time ultrasonography (US) with computed tomography/magnetic resonance images, and evaluate its impact on clinical decision making.Materials and MethodsThe Institutional Review Board approved this retrospective study. Between June 2013 and January 2015, 711 US-guided percutaneous biopsies were performed for focal hepatic lesions. Biopsies were performed using CEUS for guidance if lesions were invisible on fusion imaging. We retrospectively evaluated the number of target lesions initially invisible on fusion imaging that became visible after applying CEUS, using a 4-point scale. Technical success rates of biopsies were evaluated based on histopathological results. In addition, the occurrence of changes in clinical decision making was assessed.ResultsAmong 711 patients, 16 patients (2.3%) were included in the study. The median size of target lesions was 1.1 cm (range, 0.5–1.9 cm) in pre-procedural imaging. After CEUS, 15 of 16 (93.8%) focal hepatic lesions were visualized. The conspicuity score was significantly increased after adding CEUS, as compared to that on fusion imaging (p < 0.001). The technical success rate of biopsy was 87.6% (14/16). After biopsy, there were changes in clinical decision making for 11 of 16 patients (68.8%).ConclusionThe addition of CEUS could improve the conspicuity of focal hepatic lesions invisible on fusion imaging. This dual guidance using CEUS and fusion imaging may affect patient management via changes in clinical decision-making.

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Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US

Cited by 54 publications

References 24 publications

Combination Guidance of Contrast-Enhanced US and Fusion Imaging in Radiofrequency Ablation for Hepatocellular Carcinoma with Poor Conspicuity on Contrast-Enhanced US/Fusion Imaging

Combination Guidance of Contrast-Enhanced US and Fusion Imaging in Radiofrequency Ablation for Hepatocellular Carcinoma with Poor Conspicuity on Contrast-Enhanced US/Fusion Imaging

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Added Value of Contrast-Enhanced Ultrasound on Biopsies of Focal Hepatic Lesions Invisible on Fusion Imaging Guidance

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