Virtual Sonographic Radiofrequency Ablation of Hepatocellular Carcinoma Visualized on CT but Not on Conventional Sonography

Hirooka, Masashi; Iuchi, Hidehito; Kumagi, Teru; Shigematsu, Shuichiro; Hiraoka, Atsushi; Uehara, Takeki; Kurose, Kiyotaka; Horiike, Norio; Onji, Morikazu

doi:10.2214/ajr.04.1252

Cited by 74 publications

(61 citation statements)

References 22 publications

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“…CEUS with Sonazoid ® makes it possible to diagnose small HCCs (<2 cm) and make continuous images for target lesions in Kupffer phase (14), and is useful as an indicator and guide for RFA (12). Furthermore, artificial pleural effusion and/or artificial ascites have been shown to be helpful for performing percutaneous RFA (15), while guidance provided by VUS (6) and RVUS (7) have been reported as useful for increasing the reliability of RFA in cases with invisible tumors. Although the use of VUS increases the ability for detecting the invisible tumors, development of an effective method to determine therapeutic response for detectable target lesions during the RFA procedure is necessary, which would make it possible to obtain an adequate ablated margin and thus reduce the number of more additional RFA sessions and increase the safety of the re-puncturing.…”

Section: Discussionmentioning

confidence: 99%

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Modified technique for determining therapeutic response to radiofrequency ablation therapy for hepatocellular carcinoma using US-volume system

Hiraoka

Hirooka²,

Hidaka³

et al. 2009

Oncol Rep

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Abstract. In radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), microbubbles appearing during the procedure make it difficult to determine effectiveness with ultrasonography (US) imaging. We developed a modified US-volume system and evaluated its efficacy for demonstrating response to therapeutic RFA. Our US-volume system displays multiplanar reconstruction (MPR) images providing a synchronized view with a US image along with past USvolume data in real-time side-by-side on a personal computer. Seventy-eight patients (94 nodules) were enrolled, of whom 35 (47 nodules) were evaluated using this system (US-volume group) and compared to the other 43 (47 nodules) examined before development of our system (control group). All nodules were clearly depicted by US. If the shortage of margin was predicted with US-volume system, we performed additional needle insertion. Tumor necrosis following RFA was graded by dynamic computed tomography as follows: Grade A, necrotic area surrounded in all directions with an adequate margin (≥5 mm); Grade B, necrotic area surrounded in all directions, though some margin areas <5 mm; and Grade C, residual tumor or necrotic area smaller than the target tumor. In the US-volume group, the average tumor size was not smaller than that in the control (15.9±4.9 vs. 16.0±4.3 mm) and adequate margins were obtained (Grade A, B, C, 45/1/1 vs. 35/8/4; P<0.01). Further, there was a significant reduction in numbers of RFA sessions as compared to the control (1.03±0.17 vs. 1.12±0.32; P<0.01). In HCC patients undergoing RFA, our modified US-volume system accurately demonstrated therapeutic response, which led to a reduced number of RFA sessions.

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Section: Discussionmentioning

confidence: 99%

“…Recently, new therapeutic methods used to assist RFA have been developed that utilize multiplanar reconstruction (MPR) images obtained from volume data provided by multidetector row computed tomography (CT), which is also known as virtual US (VUS) (6). Furthermore, real-time VUS (RVUS) results have been reported (7,8).…”

Section: Introductionmentioning

confidence: 99%

Modified technique for determining therapeutic response to radiofrequency ablation therapy for hepatocellular carcinoma using US-volume system

Hiraoka

Hirooka²,

Hidaka³

et al. 2009

Oncol Rep

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“…Virtual US was also a useful tool for US-guided treatment of HCC. The same author confirmed this experience in vitro and in vivo [23]. The same group combined CEUS with VUS to assess the responses of HCCs to RFA, and this approach reduced the need for spiral CT [24].…”

Section: Discussionmentioning

confidence: 68%

Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US, spiral CT, and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)

Giangregorio

Comparato

Marinone

et al. 2009

Journal of Ultrasound

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Introduction: The commercially available Navigator system ª (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator ª ). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC). Materials and methods: From November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue ª (Bracco, Milan, Italy) as a contrast agent and Technos MPX ª scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15). Results: Definitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1e3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (þ9 multinodularN and 6 LR), 3 falsenegatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9). Conclusions: 3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.Sommario Introduzione: Il sistema ''Navigator ª '' di Esaote consente di ottenere ricostruzioni 3-D di tutto il fegato (corrette volumetricamente da un sistema di guida) mediante singola acquisizione con CEUS (mediante scansione perpendicolare all'asse lungo del fegato, per una completa acquisizione 2-D del suo asse corto) e sovrappone tali ricostruzioni 3-D con quelle ottenute con la TC. Scopo: valutare la capacità di tale sistema di diagnosticare nuovi HCC rispetto all'US e alla TC in una popolazione di HCC su cirrosi precedentemente trattati con varie metodiche. Materiali e metodi: Settantadue cirrotici con pregressi HCC (M/F: 38/34; tutti HCV þvi, Child A/B: 58/14, con detection di 49 nuovi noduli (N) in 34...

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“…Other newer tools include C-arm cone-beam CT [18] and real-time virtual sonography [19]. The former is an advanced three-dimensional imaging technology that incorporates a flat-panel detector angiography system; this technology enables real-time three-dimensional fluoroscopic guidance for needle insertion.…”

Section: Discussionmentioning

confidence: 99%

Effect of CT fluoroscopy-guided transpulmonary radiofrequency ablation of liver tumours on the lung

Iguchi¹,

Inoue²,

Yabushita³

et al. 2012

The British Journal of Radiology

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Objective: We retrospectively evaluated the effect of transpulmonary radiofrequency ablation (RFA) of liver tumours on the lung. Methods: 16 patients (10 males and 6 females; mean age, 65.2 years) with 16 liver tumours (mean diameter 1.5 cm) underwent transpulmonary RFA under CT fluoroscopic guidance. The tumours were either hepatocellular carcinoma (n514) or liver metastasis (n512). All 16 liver tumours were undetectable with ultrasonography. The pulmonary function values at 3 months after transpulmonary RFA were compared with baseline (i.e. values before RFA). Results: In 8 of 16 sessions, minor pulmonary complications occurred, including small pneumothorax (n58) and small pleural effusion (n51). In two sessions, major pulmonary complications occurred, including pneumothorax requiring a chest tube (n52). These chest tubes were removed at 4 and 6 days, and these patients were discharged 7 and 10 days after RFA, respectively, without any sequelae. The pulmonary function values we evaluated were forced expiratory volume in 1 s (FEV1.0) and vital capacity (VC). The mean values of FEV1.0 before and 3 months after RFA were 2.55 l and 2.59 l, respectively; the mean values of VC before and 3 months after RFA were 3.20 l and 3.27 l, respectively. These pulmonary values did not show any significant worsening (p50.393 and 0.255 for FEV1.0 and VC, respectively). Conclusion: There was no significant lung injury causing a fatal or intractable complication after transpulmonary RFA of liver tumours. Percutaneous radiofrequency ablation (RFA) has been established as a local therapy for liver cancers, including both hepatocellular carcinoma (HCC) and liver metastasis [1]; meta-analysis that included a total of 5224 treated liver tumours showed a local progression rate of 12% (647/5224) after one or more RFA sessions [2]. In this procedure, a radiofrequency (RF) electrode is generally inserted using the transabdominal and/or transhepatic route under ultrasonographic guidance. However, depending upon the tumour location, it is often difficult to detect these by ultrasonography (e.g. tumours located in the hepatic dome). In such tumours, certain modified approaches, such as artificial pleural effusion [3], artificial ascites [4], artificial pneumothorax [5] or thoracoscopic guidance [6], are often used.The transpulmonary approach under CT guidance is another method that can be used for needle insertion into such liver tumours. Some investigators have reported the feasibility, effectiveness and safety of transpulmonary RFA of liver tumours [7][8][9][10][11][12]. Further, certain pulmonary complications-such as pneumothorax and pleural effusion caused by puncture of the pleura, lung and/or diaphragm-have been reported too, along with these being common complications of RFA of liver tumours. To our knowledge, however, although there are no reports of fatal or intractable pulmonary complications of this procedure, there are also no reports that evaluate its effect on the lung.The purpose of this study is to retrospectively evaluate th...

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Virtual Sonographic Radiofrequency Ablation of Hepatocellular Carcinoma Visualized on CT but Not on Conventional Sonography

Abstract: In the treatment of nodules not depicted on sonography, radiofrequency ablation assisted by virtual sonography is an efficacious alternative.

Cited by 74 publications

References 22 publications

Modified technique for determining therapeutic response to radiofrequency ablation therapy for hepatocellular carcinoma using US-volume system

Modified technique for determining therapeutic response to radiofrequency ablation therapy for hepatocellular carcinoma using US-volume system

Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US, spiral CT, and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)

Effect of CT fluoroscopy-guided transpulmonary radiofrequency ablation of liver tumours on the lung

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