Evaluation of the ablation margin of hepatocellular carcinoma using CEUS-CT/MR image fusion in a phantom model and in patients

Kai Li,Qiannan Huang,Erjiao Xu,Rongqin Zheng,Qingjing Zeng,Zhongzhen Su

doi:10.1186/s12885-017-3061-7

Kai Li, Qiannan Huang + Show 4 more

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https://doi.org/10.1186/s12885-017-3061-7

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Abstract

BackgroundTo assess the accuracy of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion in evaluating the radiofrequency ablative margin (AM) of hepatocellular carcinoma (HCC) based on a custom-made phantom model and in HCC patients.MethodsTwenty-four phantoms were randomly divided into a complete ablation group (n = 6) and an incomplete ablation group (n = 18). After radiofrequency ablation (RFA), the AM was evaluated using ultrasound (US)-CT image fusion, and the results were compared with the AM results that were directly measured in a gross specimen. CEUS-CT/MR image fusion and CT-CT / MR-MR image fusion were used to evaluate the AM in 37 tumors from 33 HCC patients who underwent RFA.ResultsThe sensitivity, specificity, and accuracy of US-CT image fusion for evaluating AM in the phantom model were 93.8, 85.7 and 91.3%, respectively. The maximal thicknesses of the residual AM were 3.5 ± 2.0 mm and 3.2 ± 2.0 mm in the US-CT image fusion and gross specimen, respectively. No significant difference was observed between the US-CT image fusion and direct measurements of the AM of HCC. In the clinical study, the success rate of the AM evaluation was 100% for both CEUS-CT/MR and CT-CT/MR-MR, and the duration was 8.5 ± 2.8 min (range: 4–12 min) and 13.5 ± 4.5 min (range: 8–16 min) for CEUS-CT/MR and CT-CT/MR-MR, respectively. The sensitivity, specificity, and accuracy of CEUS-CT/MR imaging for evaluating the AM were 100.0, 80.0, and 90.0%, respectively.ConclusionsA phantom model composed of carrageenan gel and additives was suitable for the evaluation of HCC AM. CEUS-CT/MR image fusion can be used to evaluate HCC AM with high accuracy.

Highlights

To assess the accuracy of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion in evaluating the radiofrequency ablative margin (AM) of hepatocellular carcinoma (HCC) based on a custom-made phantom model and in HCC patients
US-CT image fusion detected residual AM with high sensitivity, specificity, and accuracy in the phantom models Of the 24 phantom models, one phantom was accidentally damaged, and 23 phantoms were used in all followup experiments
The US-CT image fusion showed that AM was completely encompassed by the ablative area, but a 1-mm residual AM was still observed in the gross specimen

Summary

Introduction

To assess the accuracy of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion in evaluating the radiofrequency ablative margin (AM) of hepatocellular carcinoma (HCC) based on a custom-made phantom model and in HCC patients. Novel medical imaging methods have been explored to assess AM in HCC patients after ablation, including CT-CT image fusion [21, 22], MR-MR image fusion [23, 24], contrast-enhanced ultrasound (CEUS)-CT/MR image fusion [18, 25], MR with impaired clearance of ferucarbotran [26, 27], and MR with gadolinium ethoxybenzyl diethylene triamine pentaacetic acid [28]. Our group has reported that CEUS-CT/MR image fusion, which can be applied intraoperatively, is useful for assessing AM in HCC patients receiving ablation [25]. The accuracy of CEUS-CT/MR image fusion in assessing AM should be further evaluated

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