Abstract
Purpose
To prospectively evaluate the technical success rate of real-time computed tomography/magnetic resonance imaging and ultrasound (CT/MRI-US) automatic fusion system and the long-term therapeutic efficacy of radiofrequency ablation (RFA) guided by automatic fusion in hepatocellular carcinoma (HCC) patients.
Materials and Methods
139 patients with 151 HCCs were prospectively enrolled for RFA guided by an automatic CT/MRI-US fusion system (PercuNav system, Philips, the Netherlands). Automatic fusion imaging, based on vascular segmentation and registration, was performed by sonographic sweeping at the intercostal plane. The fusion quality, tumor localization confidence and technical feasibility were recorded before and after fusion using a scoring system. Technical success rate of the RFA procedure and local tumor progression (LTP) were assessed during follow-up. Analysis of technical success and LTP was performed using generalized estimating equations and Cox proportional hazard regression analysis.
Results
The success rate of the fusion system was 82.7% (115/139) per patient. The mean sonographic scan time for fusion was 154.4 ± 108.4 s. In patients with successful fusion, the score indicating tumor localization confidence (2.2 ± 0.8 vs. 2.7 ± 0.9) and technical feasibility (2.6 ± 0.8 vs. 3.4 ± 0.7) increased after fusion (p < 0.001). The technical success rate of the RFA procedure was 96.8% (120/124) per tumor in patients with successful fusion, including poorly localized tumors. LTP rates were 8.6%, 12.2% and 15.2% at 1, 2 and 3 years.
Conclusion
The CT/MRI-US automatic fusion system showed a high success rate for image registration and facilitated better feasibility and a high technical success rate of RFA in HCCs, even with poor localization on US.
Level of Evidence
Level 3b, Nonrandomized prospective study
Similar content being viewed by others
References
Ahn SJ, Lee JM, Lee DH, Lee SM, Yoon JH, Kim YJ, et al. Real-time US-CT/MR fusion imaging for percutaneous radiofrequency ablation of hepatocellular carcinoma. J Hepatol. 2017;66(2):347–54. https://doi.org/10.1016/j.jhep.2016.09.003.
Kang J, Ryu JK, Son JH, Lee JW, Choi JH, Lee SH, et al. Association between pathologic grade and multiphase computed tomography enhancement in pancreatic neuroendocrine neoplasm. J Gastroenterol Hepatol. 2018. https://doi.org/10.1111/jgh.14139.
Mauri G, Cova L, De Beni S, Ierace T, Tondolo T, Cerri A, et al. Real-time US-CT/MRI image fusion for guidance of thermal ablation of liver tumors undetectable with US: results in 295 cases. Cardiovasc Intervent Radiol. 2015;38(1):143–51. https://doi.org/10.1007/s00270-014-0897-y.
Calandri M, Mauri G, Yevich S, Gazzera C, Basile D, Gatti M, et al. Fusion imaging and virtual navigation to guide percutaneous thermal ablation of hepatocellular carcinoma: a review of the literature. Cardiovasc Intervent Radiol. 2019;42(5):639–47. https://doi.org/10.1007/s00270-019-02167-z.
Lee MW, Rhim H, Cha DI, Kim YJ, Choi D, Kim YS, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma: fusion imaging guidance for management of lesions with poor conspicuity at conventional sonography. AJR Am J Roentgenol. 2012;198(6):1438–44. https://doi.org/10.2214/AJR.11.7568.
Song KD, Lee MW, Rhim H, Kang TW, Cha DI, Sinn DH, et al. Percutaneous US/MRI fusion-guided radiofrequency ablation for recurrent subcentimeter hepatocellular carcinoma: technical feasibility and therapeutic outcomes. Radiology. 2018;288(3):878–86. https://doi.org/10.1148/radiol.2018172743.
Xu ZF, Xie XY, Kuang M, Liu GJ, Chen LD, Zheng YL, et al. Percutaneous radiofrequency ablation of malignant liver tumors with ultrasound and CT fusion imaging guidance. J Clin Ultrasound. 2014;42(6):321–30. https://doi.org/10.1002/jcu.22141.
Kim AY, Lee MW, Cha DI, Lim HK, Oh YT, Jeong JY, et al. Automatic registration between real-time ultrasonography and pre-procedural magnetic resonance images: a prospective comparison between two registration methods by liver surface and vessel and by liver surface only. Ultrasound Med Biol. 2016;42(7):1627–36. https://doi.org/10.1016/j.ultrasmedbio.2016.02.008.
Lee MW, Park HJ, Kang TW, Ryu J, Bang WC, Lee B, et al. Image fusion of real-time ultrasonography with computed tomography: factors affecting the registration error and motion of focal hepatic lesions. Ultrasound Med Biol. 2017;43(9):2024–32. https://doi.org/10.1016/j.ultrasmedbio.2017.01.027.
Ewertsen C, Saftoiu A, Gruionu LG, Karstrup S, Nielsen MB. Real-time image fusion involving diagnostic ultrasound. AJR Am J Roentgenol. 2013;200(3):W249-55. https://doi.org/10.2214/AJR.12.8904.
Nam WH, Kang DG, Lee D, Lee JY, Ra JB. Automatic registration between 3D intra-operative ultrasound and pre-operative CT images of the liver based on robust edge matching. Phys Med Biol. 2012;57(1):69–91. https://doi.org/10.1088/0031-9155/57/1/69.
Penney GP, Blackall JM, Hamady MS, Sabharwal T, Adam A, Hawkes DJ. Registration of freehand 3D ultrasound and magnetic resonance liver images. Med Image Anal. 2004;8(1):81–91. https://doi.org/10.1016/j.media.2003.07.003.
Wein W, Brunke S, Khamene A, Callstrom MR, Navab N. Automatic CT-ultrasound registration for diagnostic imaging and image-guided intervention. Med Image Anal. 2008;12(5):577–85. https://doi.org/10.1016/j.media.2008.06.006.
Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update. J Vasc Interv Radiol. 2014;25(11):1691-705.e4. https://doi.org/10.1016/j.jvir.2014.08.027.
Ahn SJ, Lee JM, Chang W, Lee SM, Kang HJ, Yang HK, et al. Clinical utility of real-time ultrasound-multimodality fusion guidance for percutaneous biopsy of focal liver lesions. Eur J Radiol. 2018;103:76–83. https://doi.org/10.1016/j.ejrad.2018.04.002.
Appelbaum L, Solbiati L, Sosna J, Nissenbaum Y, Greenbaum N, Goldberg SN. Evaluation of an electromagnetic image-fusion navigation system for biopsy of small lesions: assessment of accuracy in an in vivo swine model. Acad Radiol. 2013;20(2):209–17. https://doi.org/10.1016/j.acra.2012.09.020.
Krucker J, Xu S, Glossop N, Viswanathan A, Borgert J, Schulz H, et al. Electromagnetic tracking for thermal ablation and biopsy guidance: clinical evaluation of spatial accuracy. J Vasc Interv Radiol. 2007;18(9):1141–50. https://doi.org/10.1016/j.jvir.2007.06.014.
Cha DI, Lee MW, Kim AY, Kang TW, Oh YT, Jeong JY, et al. Automatic image fusion of real-time ultrasound with computed tomography images: a prospective comparison between two auto-registration methods. Acta Radiol. 2017;58(11):1349–57. https://doi.org/10.1177/0284185117693459.
Yoon JH, Lee JM, Klotz E, Woo H, Yu MH, Joo I, et al. Prediction of local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma by assessment of ablative margin using Pre-RFA MRI and Post-RFA CT registration. Korean J Radiol. 2018;19(6):1053–65. https://doi.org/10.3348/kjr.2018.19.6.1053.
Au KP, Chiang CL, Chan ACY, Cheung TT, Lo CM, Chok KSH. Initial experience with stereotactic body radiotherapy for intrahepatic hepatocellular carcinoma recurrence after liver transplantation. World J Clin Cases. 2020;8(13):2758–68. https://doi.org/10.12998/wjcc.v8.i13.2758.
Baek MY, Yoo JJ, Jeong SW, Jang JY, Kim YK, Jeong SO, et al. Clinical outcomes of patients with a single hepatocellular carcinoma less than 5 cm treated with transarterial chemoembolization. Korean J Intern Med. 2019;34(6):1223–32. https://doi.org/10.3904/kjim.2018.058.
Iwazawa J, Ohue S, Hashimoto N, Mitani T. Local tumor progression following lipiodol-based targeted chemoembolization of hepatocellular carcinoma: a retrospective comparison of miriplatin and epirubicin. Cancer Manag Res. 2012;4:113–9. https://doi.org/10.2147/cmar.S30431.
Zheng L, Li HL, Guo CY, Luo SX. Comparison of the efficacy and prognostic factors of transarterial chemoembolization plus microwave ablation versus transarterial chemoembolization alone in patients with a large solitary or multinodular hepatocellular carcinomas. Korean J Radiol. 2018;19(2):237–46. https://doi.org/10.3348/kjr.2018.19.2.237.
Wigg AJ, Narayana SK, Le H, Iankov I, Chinnaratha MA, Tse E, et al. Stereotactic body radiation therapy for early hepatocellular carcinoma: a retrospective analysis of the South Australian experience. ANZ J Surg. 2019;89(9):1138–43. https://doi.org/10.1111/ans.15130.
Kong WT, Zhang WW, Qiu YD, Zhou T, Qiu JL, Zhang W, et al. Major complications after radiofrequency ablation for liver tumors: analysis of 255 patients. World J Gastroenterol. 2009;15(21):2651–6. https://doi.org/10.3748/wjg.15.2651.
Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Amann A, et al. Frequency and risk factors for major complications after stereotactic radiofrequency ablation of liver tumors in 1235 ablation sessions: a 15-year experience. Eur Radiol. 2020. https://doi.org/10.1007/s00330-020-07409-0.
Acknowledgements
This study was conducted under technical support from Philips (Best, the Netherlands) and statistical support from Medical Research Collaborating Center (MRCC) of Seoul National University Hospital
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Han, S., Lee, J.M., Lee, D.H. et al. Utility of Real-time CT/MRI-US Automatic Fusion System Based on Vascular Matching in Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: A Prospective Study. Cardiovasc Intervent Radiol 44, 1579–1596 (2021). https://doi.org/10.1007/s00270-021-02896-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-021-02896-0