Abstract
Purpose: To assess the feasibility of fusion imaging between intraprocedural ultrasound (US) and contrast-enhanced cone-beam CT (CBCT) for small (< 2 cm) hepatocellular carcinoma (HCC).Materials and methods: Six patients (five males, one female, age range 58–80, mean 69 years), with small (mean diameter 16.8 mm) HCC poorly visible at US underwent percutaneous microwave ablation under US/CBCT fusion guidance. During general anesthesia with apnea control, a contrast- enhanced CBCT was acquired with an active tracker. Subsequently, real time US images were fused with CBCT images, and treatment performed under fusion imaging guidance. Feasibility of fusion imaging and percutaneous ablation were assessed, correct targeting (distance from center of tumor and center of ablation area <5 mm) and one-month primary technical efficacy were evaluated. Major and minor complications as well as overall procedural time were recorded.Results: US/CBCT fusion was feasible in all cases, allowing for completion of the treatment as previously planned (technical success 100%). Correct targeting was achieved in 4/6 cases (66%), while in two cases, center of tumor and center of ablated area were respectively 7 and 8 mm distant. At 1 month CT scan, all tumors were completely ablated (primary technical efficacy 100%). No major or minor complications occurred. Mean overall procedure time was 127 min.Conclusions: US/CBCT fusion is a feasible technique for liver ablation, and might represent a useful tool to increase the correct targeting of poorly US-visible HCC nodules in the angio suite.
Highlights
Image-guided ablations are currently proposed as first treatment choice for small hepatocellular carcinoma (HCC) [1]
The aim of the present study is to describe the technique for US/cone beam computed tomography (CT) (CBCT) fusion imaging, and to report the preliminary data on its technical feasibility and primary technical efficacy as guidance in the percutaneous treatment of small HCC poorly visible at US
Our preliminary results demonstrate that US/CBCT fusion is a feasible technique for precisely guiding percutaneous thermal ablations
Summary
Image-guided ablations are currently proposed as first treatment choice for small HCC [1]. Ultrasound (US) is the most commonly-used image guidance option for percutaneous ablations in consideration of its broad distribution, real time capability and good general visualization of liver tumors and normal structures. The technical feasibility of USguided ablations is often limited by poor lesion visualization, due to lack of echogenicity difference or difficult localization in the liver [2]. In these cases, other imaging modalities such as computed tomography (CT), magnetic resonance (MR), or cone beam CT (CBCT) can be used to perform liver ablations [3]. US/CBCT fusion imaging has never previously been reported for the guidance of percutaneous ablation of small HCC poorly visible at US. Application of US/CBCT fusion would allow to perform ablations in the angio room without the use of the CT machine
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