Ahn, Su Joa; Lee, Jeong Min; Lee, Dong Ho; Lee, Sang Min; Yoon, Jung-Hwan; Kim, Yoon Jun; Lee, Jeong-Hoon; Yu, Su Jong; Han, Joon Koo
Journal of hepatology
2017Feb ; 66 ( 2 ) :347-354.
PMID : 27650284
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Ahn, Su Joa -
Lee, Jeong Min -
Lee, Dong Ho -
Lee, Sang Min -
Yoon, Jung-Hwan -
Kim, Yoon Jun -
Lee, Jeong-Hoon -
Yu, Su Jong -
Han, Joon Koo -
ABSTRACT
BACKGROUND & AIMS: Although ultrasonography (US) guided radiofrequency ablation (RFA) is a commonly used treatment option for early hepatocellular carcinoma (HCC), inconspicuous tumors on US limits its feasibility. Thus, we prospectively determined whether real-time US-CT/MR fusion imaging can improve the technical feasibility of RFA compared with B-mode US, and help predict local tumor progression after RFA in patients with HCC.
METHODS: A total of 216 patients with 243 HCCs ?5cm referred for RFA were prospectively enrolled. Prior to RFA, the operators scored the visibility of tumors, and technical feasibility on a 4-point scale at both B-mode US and fusion imaging. RFA was performed with a switching monopolar system using a separable cluster electrode under fusion imaging guidance. Technique effectiveness, local tumor progression and intrahepatic remote recurrences were evaluated.
RESULTS: Tumor visibility and technical feasibility were significantly improved with fusion imaging compared with B-mode US (p<0.001). Under fusion imaging guidance, the technique effectiveness of RFA for invisible tumors on B-mode US was similar to those for visible tumors (96.1% vs. 97.6%, p=0.295). Estimated cumulative incidence of local tumor progression at 24months was 4.7%, and previous treatment for other hepatic tumors (p=0.01), higher expected number of electrode insertions needed and lower technical feasibility scores (p<0.01) on fusion imaging were significant negative predictive factors for local tumor progression. CONCLUSION: Real-time fusion imaging guidance significantly improved the tumor visibility and technical feasibility of RFA in patients with HCCs compared with B-mode US, and low feasibility scores on fusion imaging was a significant negative predictive factor for local tumor progression. LAY SUMMARY: US/CT-MR fusion imaging guidance improved the tumor visibility and technical feasibility of RFA in patients with HCCs. In addition, fusion imaging guided RFA using multiple electrodes demonstrated a high technique effectiveness rate and a low local tumor progression rate during mid-term follow-up. Clinical trial number: ClinicalTrials.gov number, NCT02687113. CI - Copyright ??2016. Published by Elsevier B.V.
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