1
|
Liu J, Guo Y, Sun Y, Liu M, Zhang X, Zheng R, Cong L, Liu B, Xie X, Huang G. Three-dimensional ultrasound fusion imaging in precise needle placement for thermal ablation of hepatocellular carcinoma. Int J Hyperthermia 2024; 41:2316097. [PMID: 38360570 DOI: 10.1080/02656736.2024.2316097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/03/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To investigate the value of three-dimensional ultrasound fusion imaging (3DUS FI) technique for guiding needle placement in hepatocellular carcinoma (HCC) thermal ablation. METHODS A total of 57 patients with 60 HCCs with 3DUS FI-guided thermal ablation were retrospectively included in the study. 3DUS volume data of liver were acquired preoperatively by freehand scanning with the tumor and predetermined 5 mm ablative margin automatically segmented. Plan of needle placement was made through a predetermined simulated ablation zone to ensure a 5 mm ablative margin with the coverage rate toward tumor and ablative margin. With real-time ultrasound and 3DUS fusion imaging, ablation needles were placed according to the plan. After ablation, the ablative margin was immediately evaluated by contrast-enhanced ultrasound and 3DUS fusion imaging. The rate of adequate ablative margin, complete response (CR), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) was evaluated. RESULTS According to postoperative contrast-enhanced CT or MR imaging, the complete response rate was 100% (60/60), and 83% of tumors (30/36) achieved adequate ablative margin (>5 mm) three-dimensionally. During the follow-up period of 6.0-42.6 months, LTP occurred in 5 lesions, with 1- and 2-year LTP rates being 7.0% and 9.4%. The 1- and 2-year DFS rates were 76.1% and 65.6%, and 1- and 2-year OS rates were 98.1% and 94.0%. No major complications or ablation-related deaths were observed in any patients. CONCLUSIONS Three-dimensional ultrasound fusion imaging technique may improve the needle placement of thermal ablation for HCC and reduce the rate of LTP.
Collapse
Affiliation(s)
- Jiaming Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuqing Guo
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yueting Sun
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruiying Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Longfei Cong
- Medical Imaging System Division, Shenzhen Mindray Bio-Medical Electronics Co., Ltd, Shenzhen, China
| | - Baoxian Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guangliang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Medical Ultrasonics, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Nanning, China
| |
Collapse
|
2
|
Meershoek P, van den Berg NS, Lutjeboer J, Burgmans MC, van der Meer RW, van Rijswijk CSP, van Oosterom MN, van Erkel AR, van Leeuwen FWB. Assessing the value of volume navigation during ultrasound-guided radiofrequency- and microwave-ablations of liver lesions. Eur J Radiol Open 2021; 8:100367. [PMID: 34286051 PMCID: PMC8273361 DOI: 10.1016/j.ejro.2021.100367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The goal of our study was to determine the influence of ultrasound (US)-coupled volume navigation on the use of computed tomography (CT) during minimally-invasive radiofrequency and microwave ablation procedures of liver lesions. Method Twenty-five patients with 40 liver lesions of different histological origin were retrospectively analysed. Lesions were ablated following standard protocol, using 1) conventional US-guidance, 2) manual registered volume navigation (mVNav), 3) automatic registered (aVNav) or 4) CT-guidance. In case of ultrasonographically inconspicuous lesions, conventional US-guidance was abandoned and mVNav was used. If mVNav was also unsuccessful, the procedure was either continued with aVNav or CT-guidance. The number, size and location of the lesions targeted using the different approaches were documented. Results Of the 40 lesions, sixteen (40.0 %) could be targeted with conventional US-guidance only, sixteen (40.0 %) with mVNav, three (7.5 %) with aVNav and five (12.5 %) only through the use of CT-guidance. Of the three alternatives (mVNav, aVNav and CT only) the mean size of the lesions targeted using mVNav (9.1 ± 4.6 mm) was significantly smaller from those targeted using US-guidance only (20.4 ± 9.4 mm; p < 0.001). The location of the lesions did not influence the selection of the modality used to guide the ablation. Conclusions In our cohort, mVNav allowed the ablation procedure to become less dependent on the use of CT. mVNav supported the ablation of lesions smaller than those that could be ablated with US only and doubled the application of minimally-invasive US-guided ablations.
Collapse
Affiliation(s)
- Philippa Meershoek
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Nynke S van den Berg
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Jacob Lutjeboer
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Mark C Burgmans
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Rutger W van der Meer
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Catharina S P van Rijswijk
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Arian R van Erkel
- Interventional Radiology Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| |
Collapse
|
3
|
Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Westerlund P, Henninger B, Bale R. Thermal ablation of CT 'invisible' liver tumors using MRI fusion: a case control study. Int J Hyperthermia 2020; 37:564-572. [PMID: 32484004 DOI: 10.1080/02656736.2020.1766705] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: To evaluate whether 'invisible' liver tumors on CT can be treated by stereotactic radiofrequency ablation (SRFA) using fusion of pre-ablation MRI.Methods: In this retrospective case-control study, 60 patients (14 with Hepatocellular carcinoma (HCC) and 46 with metastatic liver tumors) with CT 'invisible' lesions underwent SRFA using MRI-fusion between June 2005 and June 2018 ('fusion group'). For comparison, 60 patients who underwent SRFA without image fusion were selected using nearest neighbor propensity score matching ('control group'). Endpoints consisted of local tumor control, safety, overall and disease-free survival.Results: Major complications occurred in 6/69 ablations (8.7%) in the fusion group and in 6/89 ablations (6.7%) in the control group (p = 0.434). Primary technical efficacy rate (i.e., successful initial ablation) was 96.6% (28/29) for HCC and 97.9% (166/170) for metastatic disease in the fusion group and 100% (33/33) and 93.3% (184/194) in the control group, respectively (p = 0.468 and 0.064). Local recurrence (LR) was observed in 1/29 (3.5%) HCCs and in 6/170 metastases (4.0%) in the fusion group and 1/33 (3.0%) and 21/196 (10.7%) in the control group, respectively. The LR rate of metastasis in the control group was significantly higher (p = 0.007), although differences in OS and DFS did not reach statistical significance.Conclusions: Image fusion using pre-procedural MRI allows for ablation of CT-'invisible' liver tumors that are otherwise untreatable. Moreover, local oncological control was higher in metastatic liver tumors versus matched controls which suggests it could be useful tool for all stereotactic radiofrequency ablation procedures.
Collapse
Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Westerlund
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
4
|
Ma QP, Xu EJ, Zeng QJ, Su ZZ, Tan L, Chen JX, Zheng RQ, Li K. Intraprocedural computed tomography/magnetic resonance-contrast-enhanced ultrasound fusion imaging improved thermal ablation effect of hepatocellular carcinoma: Comparison with conventional ultrasound. Hepatol Res 2019; 49:799-809. [PMID: 30907477 DOI: 10.1111/hepr.13336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/24/2019] [Accepted: 03/16/2019] [Indexed: 12/13/2022]
Abstract
AIM To retrospectively compare the treatment effect of intraprocedural computed tomography/magnetic resonance-contrast-enhanced ultrasound (CT/MR-CEUS) fusion imaging (FI) with that of conventional ultrasound (US) in the guidance and assessment of thermal ablation of hepatocellular carcinoma (HCC). METHODS The FI group (112 patients with 129 HCC) was treated between April 2010 and December 2012, whereas the US group (83 patients with 90 HCC) was treated between January 2008 and March 2010. Either CT/MR-CEUS FI or US was used to guide puncture, provide immediate assessment, and guide supplementary ablation. Technical efficacy, cumulative local tumor progression rate (LTP), recurrence-free survival (RFS), and overall survival (OS) were evaluated and compared during follow-up. Technical success rate of CT/MR-CEUS FI was also recorded. RESULTS Technical efficacy was significantly higher in the FI group than in the US group (100% vs. 86.7%, P < 0.001). The 1-, 2-, 3-, 4-, 5-, and 6-year cumulative LTP rates in the FI group were significantly lower than in the US group (3.8%, 4.9%, 6.0%, 6.0%, 7.2%, and 7.2% vs. 16.9%, 20.1%, 25%, 25%, 25%, and 25%, respectively; P < 0.001); RFS and OS were significantly higher in the FI group than in the US group (P = 0.027 and P = 0.049, respectively). The technical success rate of FI was 85.3%. CONCLUSIONS Intraprocedural CT/MR-CEUS FI improved the treatment effect of thermal ablation of HCC by immediately assessing treatment response and guiding supplementary ablation relative to those resulting from the use of conventional US.
Collapse
Affiliation(s)
- Qiu-Ping Ma
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Er-Jiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Jing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhong-Zhen Su
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Xin Chen
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rong-Qin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
5
|
Fusion Imaging and Virtual Navigation to Guide Percutaneous Thermal Ablation of Hepatocellular Carcinoma: A Review of the Literature. Cardiovasc Intervent Radiol 2019; 42:639-647. [PMID: 30809699 DOI: 10.1007/s00270-019-02167-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
|
6
|
Ren H, An C, Liang P, Yu J, Cheng Z, Han Z, Liu F, Dong L, Li D. Ultrasound-guided percutaneous microwave ablation assisted by athree-dimensional visualization treatment platform combined with transcatheter arterial chemoembolization for a single large hepatocellular carcinoma 5 cm or larger: a preliminary clinical application. Int J Hyperthermia 2018; 36:44-54. [PMID: 30354847 DOI: 10.1080/02656736.2018.1530459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To assess the clinical efficiency and feasibility of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by a three-dimensional (3D) visualization platform for treating a single large hepatocellular carcinoma (HCC) (diameter ≥5 cm).Methods: We included 40 patients with a single large HCC from May 2015 to August 2017. Nineteen patients who underwent US-PMWA assisted by a 3D visualization platform formed the 3D group; 21 patients without 3D visualization assistance formed the control group. Preoperative planning and post-procedural evaluation were performed successfully with the 3D visualization treatment platform. Thermal ablative parameters, survival and recurrence were compared between groups.Results: The primary efficacy rate and recurrence-free survival (RFS) rate in the 3D group were higher than those in the control group (p = .007 and p = .014, respectively). The number of inserted probes in the 3D group was higher than that in the control group (p = .016). The overall survival (OS) rate in the 3D group was comparable to that of controls (p = .745). Estimated 3-year OS and RFS rates were 38.5% and 64.6% in the 3D group and 34.4% and 18.8% in the control group, respectively. Treatment effects were evaluated using a tumor map and confirmed by traditional contrast-enhanced ultrasound in the 3D group. After the first treatment, nine patients (47.4%) achieved complete ablation with a 5-mm safety margin. No major complications related to ablation occurred.Conclusions: US-PMWA assisted by a 3D visualization treatment platform can improve treatment efficiency and appears to be a safe, effective and innovative technique to manage a single large HCC.
Collapse
Affiliation(s)
- He Ren
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Linan Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Dongrui Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
7
|
Xu EJ, Lv SM, Li K, Long YL, Zeng QJ, Su ZZ, Zheng RQ. Immediate evaluation and guidance of liver cancer thermal ablation by three-dimensional ultrasound/contrast-enhanced ultrasound fusion imaging. Int J Hyperthermia 2017; 34:870-876. [PMID: 28847188 DOI: 10.1080/02656736.2017.1373306] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Er-Jiao Xu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, PR China
| | - Shu-Min Lv
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, PR China
| | - Kai Li
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, PR China
| | - Ying-Lin Long
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, PR China
| | - Qing-Jing Zeng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, PR China
| | - Zhong-Zhen Su
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, PR China
| | - Rong-Qin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, PR China
| |
Collapse
|
8
|
Ishikawa T, Imai M, Ko M, Sato H, Nozawa Y, Sano T, Iwanaga A, Seki K, Honma T, Yoshida T. Effect of treatment support on preventing local recurrence of hepatocellular carcinoma directly adjacent to the diaphragm. Mol Clin Oncol 2017; 7:61-66. [PMID: 28685077 DOI: 10.3892/mco.2017.1257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/20/2017] [Indexed: 02/07/2023] Open
Abstract
Treatment support is anticipated to improve the results of radiofrequency ablation (RFA) treatment in cases in which visualization of tumors using the conventional B-mode is unclear. In the present study, the effectiveness of treatment support for RFA reducing the local recurrence rate of hepatocellular carcinoma (HCC) that are located directly adjacent to the diaphragm, and which are difficult to visualize with B-mode ultrasound imaging, was investigated. A total of 103 HCC tumors measuring <5 cm, which were located abutting the diaphragm, and which were difficult to visualize using the B-mode, were treated using RFA. Thirty-three of those HCC tumors were treated using RFA without treatment support, whereas the remaining 70 HCC tumors were treated using RFA with treatment support, including artificial pleural effusion, contrast-enhanced ultrasonography (CEUS) with the contrasting agent, Sonazoid™, and fusion imaging, either alone or in combination to improve the visualization of the tumors. The rate of local recurrence, and factors affecting local recurrence, were analyzed. Local recurrences were confirmed in 17 of the 103 nodules (16.50%). The overall rate of local recurrence was 13.1% at 6 months, and 20.2% at 12 months. The rate of local recurrence using RFA with artificial pleural effusion was significantly lower compared with those cases of HCC tumors treated without artificial pleural effusion (P=0.008). Similarly, the rate of local recurrence for CEUS RFA with Sonazoid™ was significantly lower compared with those cases of HCC tumors treated without Sonazoid™ (P=0.00081). In a multivariate analysis, CEUS RFA with Sonazoid™ and artificial pleural effusion contributed to the decrease in the rate of local recurrence (hazard ratios, 0.075 and 0.143, respectively). Based on these results, it is possible to conclude that CEUS with Sonazoid™ as a treatment support was the most effective method for reducing the rate of local recurrences abutting the diaphragm that are difficult to visualize using B-mode ultrasonography.
Collapse
Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Masayoshi Ko
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Hiroki Sato
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Keiichi Seki
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| |
Collapse
|
9
|
Makino Y, Imai Y, Igura T, Kogita S, Sawai Y, Fukuda K, Iwamoto T, Okabe J, Takamura M, Fujita N, Hori M, Takehara T, Kudo M, Murakami T. Feasibility of Extracted-Overlay Fusion Imaging for Intraoperative Treatment Evaluation of Radiofrequency Ablation for Hepatocellular Carcinoma. Liver Cancer 2016; 5:269-279. [PMID: 27781199 PMCID: PMC5075812 DOI: 10.1159/000449338] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Extracted-overlay fusion imaging is a novel computed tomography/magnetic resonance-ultrasonography (CT/MR-US) imaging technique in which a target tumor with a virtual ablative margin is extracted from CT/MR volume data and synchronously overlaid on US images. We investigated the applicability of the technique to intraoperative evaluation of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). METHODS This retrospective study analyzed 85 HCCs treated with RFA using extracted-overlay fusion imaging for guidance and evaluation. To perform RFA, an electrode was inserted targeting the tumor and a virtual 5-mm ablative margin overlaid on the US image. Following ablation, contrast-enhanced US (CEUS) was performed to assess the ablative margin, and the minimal ablative margins were categorized into three groups: (I) margin <0 mm (protrusion), (II) margin 0 to <5 mm, and (III) margin ≥5 mm. Margin assessment was based on the positional relationship between the overlaid tumor plus margin and the perfusion defect of the ablation zone. Tumors in group I underwent repeat ablation until they were in groups II or III. The final classifications were compared with those obtained by retrospectively created fusion images of pre- and post-RFA CT or MR imaging (CT-CT/MR-MR fusion imaging). RESULTS Treatment evaluation was impossible using CEUS in six HCCs because the tumors were located far below the body surface. Of the remaining 79 HCCs, the categorizations of minimal ablative margins between CEUS extracted-overlay fusion imaging and CT-CT/MR-MR fusion imaging were in agreement for 72 tumors (91.1%) (Cohen's quadratic-weighted kappa coefficient 0.66, good agreement, p<0.01). CONCLUSIONS Extracted-overlay fusion imaging combined with CEUS is feasible for the evaluation of RFA and enables intraoperative treatment evaluation without the need to perform contrast-enhanced CT.
Collapse
Affiliation(s)
- Yuki Makino
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan,*Yasuharu Imai, MD, PhD, Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18 Johnan, Ikeda, Osaka 563-8510 (Japan), Tel. +81 72 751 2881, E-Mail
| | - Takumi Igura
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Sachiyo Kogita
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Yoshiyuki Sawai
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Kazuto Fukuda
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Takayuki Iwamoto
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Junya Okabe
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Manabu Takamura
- Department of Radiology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Norihiko Fujita
- Department of Radiology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Masatoshi Hori
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takamichi Murakami
- Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| |
Collapse
|
10
|
Bo XW, Xu HX, Wang D, Guo LH, Sun LP, Li XL, Zhao CK, He YP, Liu BJ, Li DD, Zhang K. Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers. Br J Radiol 2016; 89:20160379. [PMID: 27626506 DOI: 10.1259/bjr.20160379] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the usefulness of fusion imaging of contrast-enhanced ultrasound (CEUS) and CECT/CEMRI before percutaneous ultrasound-guided radiofrequency ablation (RFA) for liver cancers. METHODS 45 consecutive patients with 70 liver lesions were included between March 2013 and October 2015, and all the lesions were identified on CEMRI/CECT prior to inclusion in the study. Planning ultrasound for percutaneous RFA was performed using conventional ultrasound, ultrasound-CECT/CEMRI and CEUS and CECT/CEMRI fusion imaging during the same session. The numbers of the conspicuous lesions on ultrasound and fusion imaging were recorded. RFA was performed according to the results of fusion imaging. Complete response (CR) rate was calculated and the complications were recorded. RESULTS On conventional ultrasound, 25 (35.7%) of the 70 lesions were conspicuous, whereas 45 (64.3%) were inconspicuous. Ultrasound-CECT/CEMRI fusion imaging detected additional 24 lesions thus increased the number of the conspicuous lesions to 49 (70.0%) (70.0% vs 35.7%; p < 0.001 in comparison with conventional ultrasound). With the use of CEUS and CECT/CEMRI fusion imaging, the number of the conspicuous lesions further increased to 67 (95.7%, 67/70) (95.7% vs 70.0%, 95.7% vs 35.7%; both p < 0.001 in comparison with ultrasound and ultrasound-CECT/CEMRI fusion imaging, respectively). With the assistance of CEUS and CECT/CEMRI fusion imaging, the confidence level of the operator for performing RFA improved significantly with regard to visualization of the target lesions (p = 0.001). The CR rate for RFA was 97.0% (64/66) in accordance to the CECT/CEMRI results 1 month later. No procedure-related deaths and major complications occurred during and after RFA. CONCLUSION Fusion of CEUS and CECT/CEMRI improves the visualization of those inconspicuous lesions on conventional ultrasound. It also facilitates improvement in the RFA operators' confidence and CR of RFA. Advances in knowledge: CEUS and CECT/CEMRI fusion imaging is better than both conventional ultrasound and ultrasound-CECT/CEMRI fusion imaging for lesion visualization and improves the operator confidence, thus it should be recommended to be used as a routine in ultrasound-guided percutaneous RFA procedures for liver cancer.
Collapse
Affiliation(s)
- Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Kun Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
|