3D-CEUS/MRI-CEUS fusion imaging vs 2D-CEUS after locoregional therapies for hepatocellular carcinoma: a multicenter prospective study of therapeutic response evaluation

OBJECTIVES

To compare the diagnostic accuracy of 3D contrast-enhanced ultrasound (CEUS)/MRI-CEUS fusion imaging with 2D-CEUS in assessing the response of hepatocellular carcinoma (HCC) to locoregional therapies in a multicenter prospective study.

MATERIALS AND METHODS

A consecutive series of patients with HCC scheduled for locoregional treatment were enrolled between April 2021 and March 2023. Patients were randomly divided into 3D-CEUS/MRI-CEUS fusion imaging group (3D/fusion group) or 2D-CEUS group (2D group). CEUS was performed 1 week before and 4-6 weeks after locoregional treatment. Contrast-enhanced MRI (CE-MRI) 4-6 weeks after treatment was set as the reference standard. CEUS images were evaluated for the presence or absence of viable tumors. Diagnostic performance criteria, including sensitivity, specificity, accuracy, and area under the curve (AUC), were determined for each modality.

RESULTS

A total of 140 patients were included, 70 patients in the 2D group (mean age, 60.2 ± 10.4 years) and 70 patients in the 3D/fusion group (mean age, 59.8 ± 10.6 years). The sensitivity of the 3D/fusion group was 100.0% (95% CI: 75.9, 100.0), higher than that of the 2D group (55.6%, 95% CI: 22.7, 84.7; p = 0.019). The specificity of the 3D/fusion group was 96.3% (95% CI: 86.2, 99.4), which was comparable to that of the 2D group (98.4%, 95% CI: 90.0, 99.9; p = 0.915). The AUC of the 3D/fusion group was 0.98 (95% CI: 0.95, 1.00), higher than that of the 2D group (0.77, 95% CI: 0.56, 0.98; p = 0.020).

CONCLUSION

3D-CEUS/MRI-CEUS fusion imaging exhibits superior diagnostic accuracy in evaluating the treatment response to locoregional therapies for HCC.

CLINICAL RELEVANCE STATEMENT

3D-CEUS/MRI-CEUS fusion imaging can be applied for post-treatment assessment of residual tumors in HCC undergoing locoregional treatment, offering potential benefits in terms of accurate diagnosis and clinical management.

KEY POINTS

Evaluating for HCC recurrence following locoregional therapy is important. 3D-CEUS/MRI-CEUS fusion imaging achieved a higher sensitivity than 2D-CEUS in assessing residual tumors after locoregional therapies. 3D-CEUS/MRI-CEUS fusion imaging can help clinicians intervene early in residual HCC lesions after locoregional treatment.

Comparison of Respiratory Effects between Dexmedetomidine and Propofol Sedation for Ultrasound-Guided Radiofrequency Ablation of Hepatic Neoplasm: A Randomized Controlled Trial

Patient’s cooperation and respiration is necessary in percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). We compared the respiratory patterns of dexmedetomidine and propofol sedation during this procedure. Participants were randomly allocated into two groups: the continuous infusions of dexmedetomidine-remifentanil (DR group) or the propofol-remifentanil (PR group). We measured the tidal volume for each patient’s respiration during one-minute intervals at five points and compared the standard deviation of the tidal volumes (SDvt) between the groups. Sixty-two patients completed the study. SDvt at 10 min was not different between the groups (DR group, 108.58 vs. PR group, 149.06, p = 0.451). However, SDvt and end-tidal carbon dioxide (EtCO₂) level of PR group were significantly increased over time compared to DR group (p = 0.004, p = 0.021; ß = 0.14, ß = −0.91, respectively). Heart rate was significantly decreased during sedation in DR group (p < 0.001, ß = −2.32). Radiologist satisfaction was significantly higher, and the incidence of apnea was lower in DR group (p = 0.010, p = 0.009, respectively). Compared with propofol-remifentanil, sedation using dexmedetomidine-remifentanil provided a lower increase of the standard deviation of tidal volume and EtCO₂, and also showed less apnea during RFA of HCC.

Diagnosis of Chronic Kidney Disease by Three-Dimensional Contrast-Enhanced Ultrasound Combined with Augmented Reality Medical Technology

Chronic kidney disease is a worldwide clinical and public health problem. As a risk factor for cardiovascular and cerebrovascular diseases, the disease has gradually become one of the causes of morbidity and death. As a routine method of screening for kidney disease, ultrasound is very important in improving the rate of early detection and accuracy of chronic kidney disease. This article explores the value of applying 3D ultrasound in conjunction with augmented reality medical technology in chronic kidney disease, observing changes in kidney tumor at different stages with percutaneous 3D ultrasound in patients with chronic kidney disease. Volunteers with chronic kidney disease were selected for this experiment. Among them, 160 males and 140 females were diagnosed as chronic kidney disease by clinical or renal pathological biopsy, and they all met the K/DOQI diagnostic criteria for chronic kidney disease. The selected subjects met the criteria and were divided into 5 groups, each with 60 patients, to explore the correlation of properties such as three-dimensional ultrasound kidney volume in different stages of chronic kidney disease. Experiments have shown that, with the increase in the stages of chronic kidney disease, the elasticity and volume of the renal parenchyma decrease, and the resistance index of the renal artery becomes larger, P < 0.05; the difference is statistically significant, indicating that the elasticity of the renal parenchyma is associated with chronic kidney disease. The stage is negatively correlated, and the resistance index of the renal artery is positively correlated with the stage of chronic kidney disease. That is, as the stage of chronic kidney disease increases, the three-dimensional volume of the kidney shows a decreasing trend and the resistance index of the renal artery shows an increasing trend. Speed shows a declining trend and there is some correlation between the three.

The Application Comparison of Contrast-Enhanced Ultrasound and Contrast-Enhanced Computed Tomography in Radiofrequency Ablation Treatment for Hepatocellular Carcinoma

Objective: To compare the application value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) in radiofrequency ablation (RFA) for treatment of hepatocellular carcinoma (HCC). Methods: A total of 112 patients with primary HCC were enrolled for the treatment of RFA and they were randomly equally divided into the CEUS group and CECT group. The gender, age, and number and maximum diameter of tumors between the two groups were compared. The median duration of follow-up was 27.0 months and the clinical outcomes were compared. Results: The average examination time period before ablation, of guiding needle insertion and of ablation in the CEUS group were significantly shorter than those in the CECT group (p < 0.05). The complete ablation rate of the CEUS group was significantly higher than that of the CECT group (86.36% vs. 73.17%, χ² = 4.618, p = 0.032). There was no comparative difference in the incidence of complications (including fever, infection, pain, and liver injury) between the two groups (p > 0.05). The relapse rate of the CEUS group was lower and the survival rate was higher than that in the CECT group (p < 0.05). Conclusions: Compared with the CECT, the RFA for treatment of HCC guided by the CEUS shorten the time of examination and treatment. The immediate postoperative assessment can improve the overall complete ablation rate, reduce the relapse rate, and increase the survival rate, which provides insights for the clinical application.

Radiofrequency ablation with four electrodes as a building block for matrix radiofrequency ablation: Ex vivo liver experiments and finite element method modelling. Influence of electric and activation mode on coagulation size and geometry

PURPOSE

Radiofrequency ablation (RFA) is increasingly being used to treat unresectable liver tumors. Complete ablation of the tumor and a safety margin is necessary to prevent local recurrence. With current electrodes, size and shape of the ablation zone are highly variable leading to unsatisfactory local recurrence rates, especially for tumors >3 cm. In order to improve predictability, we recently developed a system with four simple electrodes with complete ablation in between the electrodes. This rather small but reliable ablation zone is considered as a building block for matrix radiofrequency ablation (MRFA). In the current study we explored the influence of the electric mode (monopolar or bipolar) and the activation mode (consecutive, simultaneous or switching) on the size and geometry of the ablation zone.

MATERIALS AND METHODS

The four electrode system was applied in ex vivo bovine liver. The electric and the activation mode were changed one by one, using constant power of 50 W in all experiments. Size and geometry of the ablation zone were measured. Finite element method (FEM) modelling of the experiment was performed.

RESULTS

In ex vivo liver, a complete and predictable coagulation zone of a 3 × 2 × 2 cm block was obtained most efficiently in the bipolar simultaneous mode due to the combination of the higher heating efficacy of the bipolar mode and the lower impedance by the simultaneous activation of four electrodes, as supported by the FEM simulation.

CONCLUSIONS

In ex vivo liver, the four electrode system used in a bipolar simultaneous mode offers the best perspectives as building block for MRFA. These results should be confirmed by in vivo experiments.

Safety margin after radiofrequency ablation of hepatocellular carcinoma: precise assessment with a three-dimensional reconstruction technique using CT imaging

PURPOSE

To analyse the precise ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and the correlation between AM and local tumour progression (LTP) with a three-dimension (3D) reconstruction technique.

METHODS

From March 2011 to May 2013, 134 patients who underwent RFA for 159 primary or recurrent HCCs within Milan criteria were enrolled. Contrast-enhanced computed tomography (CECT) scans were performed 1 week before and 1 month after treatment. The AM was measured in various directions using a 3D reconstruction technique that shows the index tumour and ablated zone on the same image. The average of all obtained AMs (average AM) and the smallest AM (min-AM) were calculated.

RESULTS

The min-AM after RFA ranged from 1 to 9.3 mm (median ± standard deviation, 4.8 ± 1.8 mm). LTP was observed in 19 tumours from 19 patients. The median min-AM was 3.1 ± 1.6 mm for patients with LTP, while the median min-AM of patients without LTP was 5.1 ± 1.8 mm (p = 0.023). After RFA, the 1-, 2- and 3-year LTP rates were 10.9, 25.9 and 35.1%, respectively, for patients with min-AM <5 mm, and 4.1, 4.1 and 4.1%, respectively, for patients with min-AM ≥5 mm (p = 0.016). Multivariate analysis showed that only min-AM <5 mm was an independent risk factor for LTP after RFA (p = 0.044, hazard ratio =4.587, 95% confidence interval, 1.045-22.296).

CONCLUSIONS

The 3D reconstruction technique is a precise method for evaluating the post-ablation margin. Patients with min-AM less than 5 mm had a higher probability of developing LTP.