Ablation of hepatocellular carcinoma assisted by ultrasound-CT or MRI navigation and planning system

Abstract

Objective To evaluate the feasibility, accuracy and efficacy of ultrasound-computed tomography(CT) or magnetic resonance imaging(MRI) navigation and planning system in radiofrequency ablation (RFA) of hepatocellular carcinoma(HCC). Methods In this prospective study, 18 patients with 20 HCC lesions diagnosed pathologically or clinically in the Third Affiliated Hospital of Sun Yat-sen University from June to December 2011, were enrolled. The diameter of these lesions was between 10-20 mm. All patients were planned to undergo RFA. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. The patients included 17 males and 1 female and were 41-70 years old with an average age of 58 years old. Before RFA, puncture ablation plan of each lesion was made in planning system, and during RFA the lesion and the 5 mm ablative margin (AM) around were ablated according to the puncture ablation plan. Time spend in puncture planning, the planned puncture times, the actual puncture times, time spend in image fusion and image fusing success rate were recorded. Complications such as hemorrhage, ascites and pleural effusion, as well as patient death, were observed. All the patients received enhanced CT or MRI and alpha-fetoprotein(AFP) check-up 1 month after ablation to observe whether the HCC had been completely ablated. Results Time spend in puncture planning was 13-22 min (18 min mean time) and the planned puncture times were 2-4 with the mean of 3 times. The image fusion was successfully applied in all the 20 HCC patients, and an average of 5-15 min (8 min mean time) was spent in image fusion. The actual puncture times were 2-4 with the mean of 3 times and no statistic difference was found between the planned and actual puncture times (Z=-0.311, P=0.820). No severe complications and death occurred in all 18 patients. Complete ablation of 20 lesions were observed through CT or MRI scan one month after RFA showed that all the 20 lesions had been completely ablated. Conclusions Ultrasound-CT or MRI navigation and planning system was safe, feasible and accurate in assisting ablation of HCC lesions with satisfactory clinical efficacy. Key words: Hepatocellular carcinoma; Navigation and planning system; Catheter ablation; Radiofrequency ablation; Computed tomography; Magnetic resonance imaging