Thermal ablation of CT ‘invisible’ liver tumors using MRI fusion: a case control study

Abstract

Purpose: To evaluate whether 'invisible' liver tumors on CT can be treated by stereotactic radiofrequency ablation (SRFA) using fusion of pre-ablation MRI. Methods: In this retrospective case-control study, 60 patients (14 with Hepatocellular carcinoma (HCC) and 46 with metastatic liver tumors) with CT 'invisible' lesions underwent SRFA using MRI-fusion between June 2005 and June 2018 ('fusion group'). For comparison, 60 patients who underwent SRFA without image fusion were selected using nearest neighbor propensity score matching ('control group'). Endpoints consisted of local tumor control, safety, overall and disease-free survival. Results: Major complications occurred in 6/69 ablations (8.7%) in the fusion group and in 6/89 ablations (6.7%) in the control group (p ¼ 0.434). Primary technical efficacy rate (i.e., successful initial ablation) was 96.6% (28/29) for HCC and 97.9% (166/170) for metastatic disease in the fusion group and 100% (33/33) and 93.3% (184/194) in the control group, respectively (p ¼ 0.468 and 0.064). Local recurrence (LR) was observed in 1/29 (3.5%) HCCs and in 6/170 metastases (4.0%) in the fusion group and 1/33 (3.0%) and 21/196 (10.7%) in the control group, respectively. The LR rate of metastasis in the control group was significantly higher (p ¼ 0.007), although differences in OS and DFS did not reach statistical significance. Conclusions: Image fusion using pre-procedural MRI allows for ablation of CT-'invisible' liver tumors that are otherwise untreatable. Moreover, local oncological control was higher in metastatic liver tumors versus matched controls which suggests it could be useful tool for all stereotactic radiofrequency ablation procedures.

Fusion imaging-guided radiofrequency ablation for residual hepatocellular carcinoma invisible on ultrasound after transcatheter arterial chemoembolization

“…Moreover, no significant difference was observed in the local recurrence rate between the two groups 1 month after RFA. Similarly, other studies have shown that the difference in recurrence is small during early follow-up, but it tends to be significant in late followups [25].…”

Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review

“…Multiple trajectories are planned with the 3D navigation system software on multiplanar reformatted images to cover the entire tumor volume with an appropriate peritumoral safety margin. If required, especially for non-visible lesions in the planning CT, it is possible to fuse pre-interventional CT/MRI/PET/SPECT data with the intraprocedural CT dataset [26]. Following registration, accuracy check, and sterile draping, the ATLAS aiming device (Interventional Systems Inc., Kitzbühel, Austria) is adjusted using the 3D navigation system.…”

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumours - A Systematic Review and Meta-Analysis

“…All of the 34 included works were single-centre studies, of which 26 were retrospective studies (29,30,(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)31,(49)(50)(51)(52)(53)(54)(32)(33)(34)(35)(36)(37)(38), 3 prospective case series(55-57), 3 prospective cohort studies(58-60) and 2 randomised controlled trials (61,62). Two studies reported results using a laparoscopic treatment access (44,55), the other 32 reporting on thermal ablations using a percutaneous approach.…”

“…Four propensity score matched analyses compared stereotactic thermal ablation for different subtypes of patients or lesions. Stereotactic RFA yielded similar safety and treatment e cacy outcomes when comparing CT 'invisible' tumours ablated with MR image fusion to CT visible tumours (30), octogenarians to a younger study population (36), lesions in a subphrenic location to non-dome locations (39) and HCC in a subcardiac position to a non-subcardiac location (40).…”