Fusion imaging techniques and contrast-enhanced ultrasound for thermal ablation of hepatocellular carcinoma – A prospective randomized controlled trial

Abstract

Objectives: This randomized controlled trial (RCT) aims to compare the clinical application values of contrast-enhanced ultrasound (CEUS), computed tomography/magnetic resonance-CEUS (CT/MR-CEUS), and three-dimensional ultrasound-CEUS (3DUS-CEUS) Fusion imaging (FI) techniques in the assistance of thermal ablation for hepatocellular carcinoma (HCC). Methods: A RCT was conducted on 374 patients with 456 HCCs between January 2016 and September 2017. CEUS, CT/MR-CEUS, and 3DUS-CEUS FI techniques were randomly used to assist HCC ablation. All lesions were ablated according to a previously determined plan, and FI groups required a 5-mm ablative margin. The primary endpoints were technical efficacy of thermal ablation and local tumor progression (LTP). Results: According to randomization, 153 (18.8 ± 8.0 cm), 153 (18.3 ± 6.6 cm) and 150 (19.1 ± 6.9 cm) HCCs were assigned to CT/MR-CEUS, 3DUS-CEUS and CEUS groups respectively. Technical efficacy rates (99.3% vs. 100% vs. 100%) were achieved in the three groups, showing no statistical differences (p ¼ 1.000). The median follow-up time was 24 (1-37) months. LTP rates at 1 and 2 years were 3.4%, 12.2% for CT/MR-CEUS FI, 4.8%, 9.0% for 3DUS-CEUS FI, and 8.6%, 19.9% for CEUS, respectively (p ¼ .105). The results of subgroup analysis for LTP were statistically significant when patients with albumin-bilirubin (ALBI) grade 2 and 3 (p ¼ .000), and tumor located at risky positions (p ¼ .042). In addition, the p value in group of multiple tumors was close to .05 (p ¼ .052). Conclusions: All the three techniques are feasible for intraoperative HCC thermal ablation. Compared with CEUS, FI techniques are more suitable in patients with ALBI grade 2 and 3, multiple tumors, and in tumors at risky locations.

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

“…Sato is based on acoustic radiation force pulse imaging, and by using the working mechanism of acoustic pulse radiation force imaging and shear wave propagation, without manual pressure application, it provides the possibility of analyzing deep tissue compliance [ 8 ]. George proposed that contrast-enhanced ultrasound technology can dynamically observe the whole process of tumor blood perfusion, has a high ability to display small blood vessels, and has a high accuracy rate for kidney tumors [ 9 ].…”

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

“…Some studies considered that saline can conduct electrical current due to its ionic composition, which may lead to non-target tissue heating while using RFA. However, based on our previous experience [30,31], we did not have any complications associated with the choice of normal saline as arti cial ascites. In addition, we did not nd any articles about the complications of using normal saline as arti cial ascites in human beings.…”

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

“…Some studies considered that saline can conduct electrical current due to its ionic composition, which may lead to non-target tissue heating while using RFA. However, based on our previous experience [28,29], we did not have any complications associated with the choice of normal saline as arti cial ascites. In addition, we did not nd any articles about the complications of using normal saline as arti cial ascites in human beings.…”