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3D fusion is superior to 2D point-to-point contrast-enhanced US to evaluate the ablative margin after RFA for hepatocellular carcinoma

  • Hepatobiliary-Pancreas
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Abstract

Purpose

To compare the efficiency of three-dimensional (3D) and two-dimensional (2D) contrast-enhanced ultrasound (CEUS)–derived techniques in evaluating the ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).

Methods

In total, 98 patients with 98 HCCs were enrolled. The 2D CEUS point-to-point imaging (2D CEUS-PI) was conducted by comparing the pre- and post-RFA 2D CEUS images manually, and the 3D CEUS fusion imaging (3D CEUS-FI) was conducted by fusing the pre- and post-RFA 3D CEUS images automatically. These two techniques were compared in distinguishing an adequate AM ≥ 5 mm. Risk factors for local tumor progression (LTP) after RFA were analyzed by the Kaplan–Meier method with log-rank test.

Results

The mean registration time of 3D CEUS-FI and 2D CEUS-PI was 5.0 and 9.3 min, respectively (p < 0.0001). The kappa coefficient was 0.680 for agreement between 2D CEUS-PI and 3D CEUS-FI in the evaluation of AM (p < 0.0001). Tumors with AM < 5 mm by 2D CEUS-PI were all identified as AM < 5 mm by 3D CEUS-FI. Nonetheless, 16 (26%) tumors identified as AM ≥ 5 mm by 2D CEUS-PI were re-classified as AM < 5 mm by 3D CEUS-FI. During a median follow-up time of 31.2 months (range, 3.2–66.0 months), LTP was identified in 8 tumors. The estimated 1-/2-/3-year cumulative incidence of LTP was 4.4%, 8.1%, and 10.3%, respectively. Higher estimated cumulative incidence of LTP was identified in tumors with AM < 5 mm by 2D CEUS-PI (at 3-year, 27.2% vs 0%; p < 0.001), and by 3D CEUS-FI (at 3-year, 20.7% vs 0%; p = 0.004).

Conclusion

3D CEUS-FI excelled in the evaluation of AM when compared with 2D CEUS-PI. With equivalent efficacy in the prediction of LTP, 3D CEUS-FI was superior to 2D CEUS-PI for its automatic and time-saving procedure.

Clinical relevance statement

3D CEUS fusion imaging may serve as an effective tool in evaluating ablative margin and predicting local tumor progression after RFA in HCC.

Key Points

• Both 2D and 3D CEUS–derived techniques could evaluate ablative margin (AM) after RFA for hepatocellular carcinoma.

• 3D CEUS fusion imaging was more precise in the evaluation of AM compared to 2D CEUS point-to-point imaging, with advantages of its automatic and time-saving procedure.

• An inadequate AM < 5 mm evaluated by CEUS-derived techniques was the only risk factor of LTP after RFA for hepatocellular carcinoma (p < 0.001 for 2D CEUS point-to-point imaging, and p = 0.004 for 3D CEUS fusion imaging).

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Abbreviations

2D CEUS-PI:

Two-dimensional contrast-enhanced ultrasound point-to-point imaging

3D CEUS-FI:

Three-dimensional contrast-enhanced ultrasound fusion imaging

AM:

Ablative margin

HCC:

Hepatocellular carcinoma

LTP:

Local tumor progression

RFA:

Radiofrequency ablation

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Funding

This research was supported by the National Natural Science Foundation of China [Grants No. 92059201, No. 81530055, and No. 81501493].

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Authors and Affiliations

  1. Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China

    Haiyi Long, Xiaoer Zhang, Tongyi Huang, Xiaoyan Xie & Guangliang Huang

  2. Department of Ultrasound, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China

    Xiaoyu Zhou

  3. Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First People’s Hospital, 81 Lingnan North Road, Foshan, 528000, Guangdong, China

    Jieyi Ye

  4. Medical Imaging System Division, Shenzhen Mindray Bio-Medical Electronics Co. Ltd, Shenzhen, China

    Longfei Cong

  5. Department of Medical Ultrasonics, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Guangxi, China

    Guangliang Huang

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  1. Haiyi Long
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Correspondence to Xiaoyan Xie or Guangliang Huang.

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The scientific guarantor of this publication is Prof. Guangliang Huang.

Conflicts 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. All authors declare they have no conflicts of interest to disclose.

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Prof. Huang Guangliang is the scientific guarantor of statistics in this manuscript.

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

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Institutional Review Board approval was obtained.

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• performed at one institution

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Haiyi Long and Xiaoyu Zhou share the first authorship.

Guangliang Huang and Xiaoyan Xie share the last authorship.

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Long, H., Zhou, X., Zhang, X. et al. 3D fusion is superior to 2D point-to-point contrast-enhanced US to evaluate the ablative margin after RFA for hepatocellular carcinoma. Eur Radiol 34, 1247–1257 (2024). https://doi.org/10.1007/s00330-023-10023-5

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