C-Arm Cone Beam Computed Tomography Guidance for Radiofrequency Ablation in Hepatocellular Carcinoma

Abstract

Objective: To assess the usefulness of C-arm cone beam computed tomography (CBCT) combined with ultrasound for the treatment of hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA). Methods: Patients underwent RFA following transcatheter arterial chemoembolization (TACE) or RFA alone under ultrasound or CBCT guidance combined with ultrasound-based techniques. They were divided into 2 groups based on the use (C group) and nonuse (NC group) of CBCT guidance. The technical success of RFA and local tumor progression after the first RFA session were evaluated by dynamic contrast-enhanced imaging methods. Between-group differences were assessed retrospectively. Results: We enrolled 198 patients with 260 HCC nodules. The complete ablation rates were 63.0 and 89.4% in the NC and C groups, respectively. In log-rank testing, local tumor progression occurred significantly more often in the NC group when RFA was used without TACE, in males when des-gamma-carboxy prothrombin was ≥29 mAU/mL, and when the diameter of a nodule was ≥18 mm. On Cox proportional-hazards regression analysis, the NC group, RFA alone without TACE, and male gender were significant independent variables. Conclusion: TACE followed by RFA under CBCT and ultrasound guidance improves the reliability of ablation of target HCC nodules, reduces the need for additional treatment sessions, and prevents local tumor progression.

Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma

“…And with the technique, TACE and MWA can be performed on the same working bed sequentially during one intervention. Following TACE, we now use DynaCT to scan the tumor and reconstruct 3D images for the puncture site and the route planning [28]. Wang needle can accurately penetrate the target lesions of 46 patients and achieve favorable clinical results [29].…”

Radiofrequency ablation guided by cone beam computed tomography for hepatocellular carcinoma: a comparative study of clinical results with the conventional spiral computed tomography-guided procedure

“…During RFA, the puncture process can be monitored in real time under fluoroscopy and needle deployment can be accurately adjusted according to the location of the lesion, which more effectively creates a sufficient ablation zone as a safety margin. 13,20 In order to further understand role of CBCT in image-guided RFA, this current study retrospectively reviewed and compared the clinical data from patients that had undergone CBCT-guided RFA with those that had undergone conventional s-CT-guided procedures.…”

“…In recent years, RFA guided by CBCT has received increasing attention and application, showing unique technical advantages compared with s-CT guidance, but few published studies have reported on the difference between the two image-guiding modalities, especially in liver cancer. 13–15…”

Expert consensus on image‐guided radiofrequency ablation of pulmonary tumors: 2018 edition

“…Other new techniques include magnetic resonance, C‐arm CT positron emission tomography‐CT (PET‐CT), CT‐fiber bronchoscope, and electromagnetic navigation bronchoscopy (ENB) …”