Clinical value of CT/MRI-CEUS image fusion in ablation of primary liver cancer

Abstract

Objective To investigate the clinical value of CT/MRI-CEUS image fusion in ablation of primary liver cancer (PLC). Methods A total of 171 PLC patients undergoing radical thermal ablation in the Third Affiliated Hospital of Sun Yat-sen University between April 2010 and February 2014 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 171 patients, 151 were males and 20 were females with the average age of (53±11) years old. Patients underwent radiofrequency ablation (RFA) or microwave ablation (MWA). CT/MRI-CEUS image fusion was used to immediately evaluate and guide the supplementary ablation during the operation. The success rate of CT/MRI-CEUS image fusion operation, the rate of intraoperative immediate supplementary ablation and incidence of postoperative complication were recorded. The complete ablation rate was assessed according to the enhanced CT/MRI results 1 month after ablation. According to intraoperative ablation conditions, the patients were divided into the satisfied ablation margin group and the unsatisfied ablation margin group after the ablation. The patients of two groups were followed up for 12 months to monitor the progression of local tumors. The local tumor progression rate of two groups was compared using Kaplan-Meier method and Log-rank test. Results For the total 200 lesions, the success rate of CT/MRI-CEUS image fusion operation was 86.0% (172/200) and the immediate supplementary ablation rate was 16.9% (29/172). There were 108 lesions with satisfied ablation margin and 64 lesions with unsatisfied ablation margin. No treatment-related death was observed and the incidence of complication was 1.2% (2/171). The complete ablation rate was 100.0% (172/172), which was confirmed by the enhanced CT/MRI after operation. The 1-year cumulative local tumor progression rate in the satisfied ablation margin group and the unsatisfied ablation margin group was respectively 1.9% and 6.5%, and no significant difference was observed (χ2=2.16, P>0.05). Conclusion CT/MRI-CEUS image fusion technique can evaluate and guide the ablation for PLC immediately, and thus can enhance the complete ablation rate. Key words: Liver neoplasms; Tomography, spiral computed; Magnetic resonance imaging; Contrast-enhanced ultrasound; Catheter ablation