Fusion Imaging–Guided Radiofrequency Ablation for Hepatocellular Carcinomas Not Visible on Conventional Ultrasound

Song, Kyoung Doo; Lee, Min Woo; Rhim, Hyunchul; Ik, Dong; Chong, Yonuk; Lim, Hyo Keun

doi:10.2214/ajr.13.10532

Cited by 100 publications

(92 citation statements)

References 26 publications

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“…After the two images match well, the target lesion on ultrasound image can be located according to the CT/MRI image. Previous studies [21][22][23] reported that ultrasound-CECT/CEMRI image fusion technique could detect more tumours than conventional ultrasound (53.3-98% vs 38.8-66%), and it facilitates RFA for liver tumours with poor conspicuity on conventional ultrasound. 17,[24][25][26] However, even with the help of ultrasound-CECT/CEMRI fusion, some lesions still show suboptimal conspicuity on the images of conventional ultrasound, and CEUS is often necessary to confirm the exact location and configuration of the target lesion.…”

Section: Introductionmentioning

confidence: 99%

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Wang

et al. 2016

BJR

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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 5 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.

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Section: Introductionmentioning

confidence: 99%

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Wang

et al. 2016

BJR

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“…There are some new techniques to overcome the limitation of B-mode US-guided RFA (22)(23)(24)(25)(26)(27)(28)(29). One of the new techniques is fusion imaging-guided RFA.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound-guided radiofrequency ablation in inconspicuous hepatocellular carcinoma on B-mode ultrasound

Kim¹,

Kim²,

Shin³

et al. 2017

Turk J Gastroenterol

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Recently, novel contrast agents for ultrasound have been developed to improve the diagnostic yield. SonoVue (Bracco, Milan, Italy) and Sonazoid (Daiichi-SanTurk J Gastroenterol 2017; 28: 446-52 Contrast-enhanced ultrasound-guided radiofrequency ablation in inconspicuous hepatocellular carcinoma on B-mode ultrasound Eui Joo Kim , Yun Soo Kim , Seung Kak Shin , Oh Sang Kwon , Duck Joo Choi , Ju LiverOriginal Article

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“…Applying this technique to tumor ablation enhances the identification of target lesions and the feasibility of the intervention [36,37]. In addition, fusion imaging is more useful for RFA in patients with small HCCs because the detectability of HCCs in planning US for RFA depends on the index tumor size [38].…”

Section: Fusing Imaging System For Interventionmentioning

confidence: 99%

Recent Advances in Tumor Ablation for Hepatocellular Carcinoma

2015

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Image-guided tumor ablation for early stage hepatocellular carcinoma (HCC) is an accepted non-surgical treatment that provides excellent local tumor control and favorable survival benefit. This review summarizes the recent advances in tumor ablation for HCC. Diagnostic imaging and molecular biology of HCC has recently undergone marked improvements. Second-generation ultrasonography (US) contrast agents, new computed tomography (CT) techniques, and liver-specific contrast agents for magnetic resonance imaging (MRI) have enabled the early detection of smaller and inconspicuous HCC lesions. Various imaging-guidance tools that incorporate imaging-fusion between real-time US and CT/MRI, that are now common for percutaneous tumor ablation, have increased operator confidence in the accurate targeting of technically difficult tumors. In addition to radiofrequency ablation (RFA), various therapeutic modalities including microwave ablation, irreversible electroporation, and high-intensity focused ultrasound ablation have attracted attention as alternative energy sources for effective locoregional treatment of HCC. In addition, combined treatment with RFA and chemoembolization or molecular agents may be able to overcome the limitation of advanced or large tumors. Finally, understanding of the biological mechanisms and advances in therapy associated with tumor ablation will be important for successful tumor control. All these advances in tumor ablation for HCC will result in significant improvement in the prognosis of HCC patients. In this review, we primarily focus on recent advances in molecular tumor biology, diagnosis, imaging-guidance tools, and therapeutic modalities, and refer to the current status and future perspectives for tumor ablation for HCC.

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Fusion Imaging–Guided Radiofrequency Ablation for Hepatocellular Carcinomas Not Visible on Conventional Ultrasound

Abstract: Fusion imaging can improve the conspicuity of HCCs and the feasibility of percutaneous RFA of HCCs not visible on conventional ultrasound. Peritumoral anatomic landmarks can be used for electrode placement in HCCs that are still not visible even after image fusion.

Cited by 100 publications

References 26 publications

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Contrast-enhanced ultrasound-guided radiofrequency ablation in inconspicuous hepatocellular carcinoma on B-mode ultrasound

Recent Advances in Tumor Ablation for Hepatocellular Carcinoma

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