Abstract
BackgroundTo assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation.MethodsNinety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.ResultsThe success rate of image fusion was 96.2 % (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3–13) min. The CEUS image quality was good in 36.1 % (53/147) and medium in 63.9 % (94/147) of the cases. By supplementary ablation, 21.8 % (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95 % confidence interval, 1.070–78.571; p = 0.043).ConclusionCEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.
Highlights
To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation
The aim of this study was to assess whether CEUS-CT/MR image fusion could be applied intraoperatively to evaluate the AM and guide supplementary ablation to facilitate the achievement of adequate AMs and, reduce the rate of local tumor progression (LTP)
Future studies are needed to assess whether the AM should be covered in all lesion types to decrease LTP, such as lesions with a complete pseudocapsule. In conclusion, these present findings demonstrated the feasibility of intraoperative evaluation of the AM using CEUS-CT/MR image fusion after HCC ablation
Summary
To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation. Percutaneous ablation is one of the most frequently used methods for hepatocellular carcinomas (HCCs) that are not suitable for resection or liver transplantation. Percutaneous radiofrequency ablation (RFA) has a higher rate of local tumor progression (LTP) [1,2,3], and the LTP rate contributes to long-term survival [4]. Ultrasound has the advantages of real-time guidance, accessibility and non-invasiveness, and contrast-enhanced ultrasound (CEUS) has greatly improved the accuracy of ultrasound in liver tumor diagnosis and the evaluation of local ablation treatment [14]. The sensitivity of CEUS within 1 h after ablation has been variable in many different studies [15,16,17] and can be as low as
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