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Ultrasound-ultrasound image overlay fusion improves real-time control of radiofrequency ablation margin in the treatment of hepatocellular carcinoma

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the clinical feasibility of US-US image overlay fusion with evaluation of the ablative margin in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).

Methods

Fifty-three patients with 68 HCCs measuring 0.9–4.0 cm who underwent RFA guided by US-US overlay image fusion were included in this retrospective study. By an overlay of pre-/postoperative US, the tumor image could be projected onto the ablative hyperechoic zone. Therefore, the ablative margin three-dimensionally could be shown during the RFA procedure. US-US image overlay was compared to dynamic CT a few days after RFA for assessment of early treatment response. Accuracy of graded response was calculated, and the performance of US-US image overlay fusion was compared with that of CT using a Kappa agreement test.

Results

Technically effective ablation was achieved in a single session, and 59 HCCs (86.8 %) succeeded in obtaining a 5-mm margin on CT. The response with US-US image overlay correctly predicted early CT evaluation with an accuracy of 92.6 % (63/68) (k = 0.67; 95 % CI: 0.39–0.95).

Conclusion

US-US image overlay fusion can be proposed as a feasible guidance in RFA with a safety margin and predicts early response of treatment assessment with high accuracy.

Key points

• US-US image overlay fusion visualizes the ablative margin during RFA procedure.

• Visualizing the margin during the procedure can prompt immediate complementary treatment.

• US image fusion correlates with the results of early evaluation CT.

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Abbreviations

3D:

Three-dimensional

BCLC:

Barcelona clinic liver cancer

CEUS:

Contrast-enhanced ultrasonography

HCC:

Hepatocellular carcinoma

MDCT:

Multidetector CT

MPR:

Multiplanar reconstruction

RFA:

Radiofrequency ablation

ROI:

Region of interest

SD:

Standard deviation

US:

Ultrasound

References

  1. Chen MS, Li JQ, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328

    Article  PubMed  PubMed Central  Google Scholar 

  2. Takayama T, Makuuchi M, Hasegawa K (2010) Single HCC smaller than 2 cm: surgery or ablation? a surgeon's perspective. J Hepatobiliary Pancreat Sci 17(4):422–424

    Article  PubMed  Google Scholar 

  3. Wang JH, Wang CC, Hung CH, Chen CL, Lu SN (2012) Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. J Hepatol 56(2):412–418

    Article  PubMed  Google Scholar 

  4. Peng ZW, Lin XJ, Zhang YJ et al (2012) Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study. Radiology 262(3):1022–1033

    Article  PubMed  Google Scholar 

  5. Huang J, Yan L, Cheng Z et al (2010) A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 252(6):903–912

    Article  PubMed  Google Scholar 

  6. Feng K, Yan J, Li X et al (2012) A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 57(4):794–802

    Article  PubMed  Google Scholar 

  7. Imai K, Beppu T, Chikamoto A et al (2013) Comparison between hepatic resection and radiofrequency ablation as first-line treatment for solitary small-sized hepatocellular carcinoma of 3 cm or less. Hepatol Res 43(8):853–864

    Article  PubMed  Google Scholar 

  8. Liu PH, Hsu CY, Hsia CY et al (2016) Surgical Resection Versus Radiofrequency Ablation for Single Hepatocellular Carcinoma ≤ 2  cm in a Propensity Score Model. Ann Surg 263(3):538–545

    Article  PubMed  Google Scholar 

  9. Liu CH, Arellano RS, Uppot RN, Samir AE, Gervais DA, Mueller PR (2010) Radiofrequency ablation of hepatic tumours: effect of post-ablation margin on local tumour progression. Eur Radiol 20(4):877–885

    Article  PubMed  Google Scholar 

  10. Minami Y, Kudo M (2010) Radiofrequency ablation of hepatocellular carcinoma: Current status. World J Radiol 2(11):417–424

    Article  PubMed  PubMed Central  Google Scholar 

  11. Minami Y, Nishida N, Kudo M (2014) Therapeutic response assessment of RFA for HCC: contrast-enhanced US, CT and MRI. World J Gastroenterol 20(15):4160–4166

    Article  PubMed  PubMed Central  Google Scholar 

  12. Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 16:765–778

    Article  PubMed  Google Scholar 

  13. Nishikawa H, Inuzuka T, Takeda H et al (2011) Percutaneous radiofrequency ablation therapy for hepatocellular carcinoma: a proposed new grading system for the ablative margin and prediction of local tumor progression and its validation. J Gastroenterol 46(12):1418–1426

    Article  PubMed  Google Scholar 

  14. Nishikawa H, Osaki Y, Iguchi E et al (2013) Radiofrequency ablation for hepatocellular carcinoma: the relationship between a new grading system for the ablative margin and clinical outcomes. J Gastroenterol 48(8):951–965

    Article  PubMed  Google Scholar 

  15. Leyendecker JR, Dodd GD 3rd, Halff GA et al (2002) Sonographically observed echogenic response during intraoperative radiofrequency ablation of cirrhotic livers: pathologic correlation. AJR Am J Roentgenol 178(5):1147–1151

    Article  PubMed  Google Scholar 

  16. Zytoon AA, Ishii H, Murakami K et al (2007) Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome. Jpn J Clin Oncol 37(9):658–672

    Article  PubMed  Google Scholar 

  17. Minami Y, Chung H, Kudo M, at al. (2008) Radiofrequency ablation of hepatocellular carcinoma: value of virtual CT sonography with magnetic navigation. AJR Am J Roentgenol 190(6):W335–W341

    Article  PubMed  Google Scholar 

  18. Kitada T, Murakami T, Kuzushita N et al (2008) Effectiveness of real-time virtual sonography-guided radiofrequency ablation treatment for patients with hepatocellular carcinomas. Hepatol Res 38(6):565–571

    Article  PubMed  Google Scholar 

  19. Song KD, Lee MW, Rhim H, Cha DI, Chong Y, Lim HK (2013) Fusion imaging-guided radiofrequency ablation for hepatocellular carcinomas not visible on conventional ultrasound. AJR Am J Roentgenol 201(5):1141–1147

    Article  PubMed  Google Scholar 

  20. Makino Y, Imai Y, Igura T et al (2016) Feasibility of Extracted-Overlay Fusion Imaging for Intraoperative Treatment Evaluation of Radiofrequency Ablation for Hepatocellular Carcinoma. Liver Cancer 5(4):269–279

    Article  PubMed  PubMed Central  Google Scholar 

  21. Minami Y, Minami T, Chishina H et al (2016) US-US Fusion Imaging in Radiofrequency Ablation for Liver Metastases. Dig Dis 34(6):687–691

    Article  PubMed  Google Scholar 

  22. Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases (2005) Management of hepatocellular carcinoma. Hepatology 42(5):1208–1236

    Article  PubMed  Google Scholar 

  23. Kim YS, Rhim H, Lim HK, Choi D, Lee MW, Park MJ (2011) Coagulation necrosis induced by radiofrequency ablation in the liver: histopathologic and radiologic review of usual to extremely rare changes. Radiographics 31(2):377–390

    Article  PubMed  Google Scholar 

  24. Orth RC, Guillerman RP, Zhang W, Masand P, Bisset GS 3rd (2014) Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology 272(1):233–240

    Article  PubMed  Google Scholar 

  25. Martin ML, Tay KH, Flak B et al (2003) Multidetector CT angiography of the aortoiliac system and lower extremities: a prospective comparison with digital subtraction angiography. AJR Am J Roentgenol 180(4):1085–1091

    Article  PubMed  Google Scholar 

  26. Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363

    PubMed  Google Scholar 

  27. Costa AF, Kajal D, Pereira A, Atri M (2017) Should fat in the radiofrequency ablation zone of hepatocellular adenomas raise suspicion for residual tumour? Eur Radiol 27(4):1704–1712

    Article  PubMed  Google Scholar 

  28. Germani G, Pleguezuelo M, Gurusamy K et al (2010) Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma: a meta-analysis. J Hepatol 52(3):380–388

    Article  CAS  PubMed  Google Scholar 

  29. Tanis E, Nordlinger B, Mauer M et al (2014) Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 50(5):912–919

    Article  CAS  PubMed  Google Scholar 

  30. Donadon M, Solbiati L, Dawson L et al (2016) Hepatocellular Carcinoma: The Role of Interventional Oncology. Liver Cancer 6(1):34–43

    Article  PubMed  PubMed Central  Google Scholar 

  31. Granata V, Petrillo M, Fusco R et al (2013) Surveillance of HCC Patients after Liver RFA: Role of MRI with Hepatospecific Contrast versus Three-Phase CT Scan-Experience of High Volume Oncologic Institute. Gastroenterol Res Pract 2013:469097. https://doi.org/10.1155/2013/469097

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kang TW, Rhim H, Lee J et al (2016) Magnetic resonance imaging with gadoxetic acid for local tumour progression after radiofrequency ablation in patients with hepatocellular carcinoma. Eur Radiol 26(10):3437–3446

    Article  PubMed  Google Scholar 

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi Osaka-Sayama, Osaka, 589-8511, Japan

    Yasunori Minami, Tomohiro Minami, Satoru Hagiwara, Hiroshi Ida, Kazuomi Ueshima, Naoshi Nishida & Masatoshi Kudo

  2. Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi Osaka-Sayama, Osaka, 589-8511, Japan

    Takamichi Murakami

Authors
  1. Yasunori Minami
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  2. Tomohiro Minami
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  3. Satoru Hagiwara
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  4. Hiroshi Ida
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  5. Kazuomi Ueshima
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  6. Naoshi Nishida
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  7. Takamichi Murakami
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  8. Masatoshi Kudo
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Corresponding author

Correspondence to Yasunori Minami.

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Guarantor

The scientific guarantor of this publication is Prof. Masatoshi Kudo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Cite this article

Minami, Y., Minami, T., Hagiwara, S. et al. Ultrasound-ultrasound image overlay fusion improves real-time control of radiofrequency ablation margin in the treatment of hepatocellular carcinoma. Eur Radiol 28, 1986–1993 (2018). https://doi.org/10.1007/s00330-017-5162-8

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  • DOI: https://doi.org/10.1007/s00330-017-5162-8

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