Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma: Fusion Imaging Guidance for Management of Lesions With Poor Conspicuity at Conventional Sonography

Lee, Min Woo; Rhim, Hyunchul; Ik, Dong; Kim, Young Jun; Choi, Dongil; Kim, Youngsun; Lim, Hyo Keun

doi:10.2214/ajr.11.7568

Cited by 107 publications

(97 citation statements)

References 25 publications

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“…Both the transmitter and sensors are connected to a fully integrated position sensor unit embedded in the ultrasound machine. 2 The first image fusion step was to upload the CT or MRI data to the ultrasound machine. First, the radiologist who performed the liver biopsy reviewed the CT or MR images and decided which image would be better for image fusion.…”

Section: Fusion Imagingmentioning

confidence: 99%

“…[1][2][3][4] Fusion imaging can facilitate accurate localization of the target lesion and eventually allow lesions to be targeted with a higher degree of confidence during interventional procedures. 2,3,5,6 Although previous studies of fusion imagingguided biopsy showed promising results, they had vague inclusion criteria and lacked homogeneity of the patient population. 7,8 Hence, a well-organized study focusing on the advantages of fusion imaging-guided percutaneous liver biopsy is still required.…”

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confidence: 99%

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Fusion Imaging–Guided Percutaneous Biopsy of Focal Hepatic Lesions With Poor Conspicuity on Conventional Sonography

Park

Lee

et al. 2013

J of Ultrasound Medicine

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iver biopsy and radiofrequency ablation of focal hepatic lesions is widely performed under sonographic guidance, mainly because sonography is convenient, safe, and easily accessible, and it offers real-time guidance for interventional procedures. However, we quite frequently encounter focal hepatic lesions that have poor sonographic conspicuity; thus, it is difficult to accurately localize and target the index lesion. When the biopsy specimen is not adequate for pathologic examination, another biopsy is Hyun Jeong Park, MD, Min Woo Lee, MD, Mi Hee Lee, MD, Jiyoung Hwang, MD, Tae Wook Kang, MD, Sanghyeok Lim, MD, Hyunchul Rhim, MD, Hyo K. Lim, MD Received October 12, 2012, ORIGINAL RESEARCHObjectives-The purpose of this study was to evaluate the effectiveness of real-time fusion imaging (sonography combined with computed tomography or magnetic resonance imaging) for percutaneous sonographically guided biopsy of focal hepatic lesions with poor sonographic conspicuity.Methods-This study was conducted as a retrospective analysis of a prospective database and was approved by the Institutional Review Board. Patients who had target lesions with poor conspicuity on B-mode sonography for percutaneous biopsy were enrolled in the study. Lesion conspicuity was assessed by conventional B-mode sonography first and then by fusion imaging later in the same session. We compared lesion conspicuity and detection rates between B-mode sonography and fusion imaging and evaluated how many cases of initially invisible lesions on B-mode sonography became visible on fusion imaging. The technical success rate was evaluated on the basis of the final diagnoses, which were established by pathologic examination of the biopsy specimens as well as follow-up clinical and radiologic examinations.Results-A total of 22 patients were enrolled in the study. On fusion imaging, lesion conspicuity was increased in 63.6% of focal hepatic lesions (14 of 22). Moreover, 66.7% of lesions (6 of 9) that were invisible on B-mode sonography became visible on fusion imaging. The true-positive detection rate was significantly different between B-mode sonography and fusion imaging (9 of 22 versus 19 of 22; P = .0044). Percutaneous biopsy was performed for all lesions, including 3 target lesions that were invisible even on fusion imaging. The technical success rate was 95.5% (21 of 22).Conclusions-Fusion imaging is effective for percutaneous biopsy of focal hepatic lesions with poor sonographic conspicuity.

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Section: Fusion Imagingmentioning

confidence: 99%

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confidence: 99%

Fusion Imaging–Guided Percutaneous Biopsy of Focal Hepatic Lesions With Poor Conspicuity on Conventional Sonography

Park

Lee

et al. 2013

J of Ultrasound Medicine

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“…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. The fusion of CEUS and CECT/CEMRI before RFA might further enhance the lesion conspicuity and operator confidence in that the inconspicuous lesions would show arterial hyperenhancement in both modalities, thus the lesions are easily detectable.…”

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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“…80 Two cohort studies showed an excellent technical success rate, safety and effectiveness for RFA using fusion imaging. 81,82 Reduced energy diffusion is a complication observed in RFA using conventional electrodes. Utilizing internally cold (IC) electrodes and saline-enhanced RFA are two techniques to overcome this drawback.…”

Section: Rfamentioning

confidence: 99%

New modalities of treatment for hepatocellular carcinoma

Behnagh

Rezaei

Jahannia

et al. 2017

J. contemp. med. sci.

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Hepatocellular carcinoma (HCC) is the second most common cause of death from cancer worldwide. Managing HCC is difficult. However, there are many treatment options available such as liver transplantation, radiotherapy, different ablative techniques, surgery, trans-arterial chemoembolization (TACE) and systemic therapy. These treatments did not show the promising responses and the recurrence rate is still high. On the other hand, there are some new treatments such as immunotherapy, gene therapy, combination of different therapies, Chinese traditional therapies and new targeted therapies. The aim of this study is to review both the recent changes in the common therapies and newly developed therapies of HCC.

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Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma: Fusion Imaging Guidance for Management of Lesions With Poor Conspicuity at Conventional Sonography

Abstract: Fusion imaging-guided percutaneous RFA is effective in the management of HCC that has poor ultrasound conspicuity.

Cited by 107 publications

References 25 publications

Fusion Imaging–Guided Percutaneous Biopsy of Focal Hepatic Lesions With Poor Conspicuity on Conventional Sonography

Fusion Imaging–Guided Percutaneous Biopsy of Focal Hepatic Lesions With Poor Conspicuity on Conventional Sonography

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

New modalities of treatment for hepatocellular carcinoma

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