Abstract
Objectives: Thermal ablation is an increasingly accepted treatment of liver tumors and metastases as an alternative to liver resection or as part of a multi-modality treatment concept. While stereotactic navigation technology optimizes needle guidance and precision in targeting, it can also visualize lesions not detectable on computertomography (CT) by fusion with magnetresonance (MR) images. We aimed to access technical feasibility and success of patients treated with stereotactic microwave ablation (SMWA) using MR/CT fusion. Methods: Retrospective analysis of radiological reports and clinical data of patients treated with SMWA at the University Department of Visceral Surgery and Medicine in Berne from January 2015 to December 2018. Results: A total of 236 patients received 312 SMWAs for 496 lesions. In 22 (7.1%) interventions, 43 (8.7%) hepatic lesions were invisible on the pre-interventional CT. Sixteen patients had hepatocellular carcinoma, 6 metastases. Following image fusion, 40 (8.5%) lesions were sufficiently visible to perform SMWA. In one case, previous CT images were fused to a non-contrast CT which was performed due to renal failure. Thirty (75%) lesions were located in the right liver (14 in segment 8, 6 in segment 7, 6 in segment 7 and 3 in segment 5). Mean tumor size was 12 (3 - 28) mm. One patient developed fever, no other complications occurred. The mean follow-up of the lesions was 321 (81-779) days. So far, 5 (23.8%) patients underwent transplantation, 1 was transplanted before follow-up. Four patients have not yet received follow-up imaging. Radiologically, 2 (5%) lesions showed an incomplete ablation at the first follow-up after 1-3 months and were successfully re-ablated. Three (7.5%) lesions showed local reccurence and were also successfully re-ablated. Conclusion: SMWA with CT/MR fusion offers an efficient and safe treatment option for patients with small, but suspicious liver lesions invisible on CT and not amenable to surgery.
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