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Safety margin of radiofrequency ablation for hepatocellular carcinoma: a prospective study using magnetic resonance imaging with superparamagnetic iron oxide

  • Kuniaki FukudaEmail author
  • Kensaku Mori
  • Naoyuki Hasegawa
  • Katsuhiro Nasu
  • Kazunori Ishige
  • Yoshikazu Okamoto
  • Masanari Shiigai
  • Masato Abei
  • Manabu Minami
  • Ichinosuke Hyodo
Original Article

Abstract

Purpose

In radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), it is difficult to assess the ablative margin (AM) precisely by comparing pre- and post-RFA CT images. We prospectively studied the AMs using magnetic resonance imaging (MRI) with pre-administered superparamagnetic iron oxide (SPIO). SPIO is safe for kidney disease patients.

Materials and methods

Hepatocellular carcinoma patients were treated with RFA within 8 h of SPIO administration. On T2*-weighted MRI performed 4–7 days later, AM was visualized as a hypointense rim. The ablation status was classified as AM(+) if the rim completely surrounded the tumor, AM(0) if the rim was partly discontinuous without tumor protrusion, and AM(−) if the rim was partly discontinuous with tumor protrusion. The minimal thickness of AM was measured. AM(−) tumors were re-treated consecutively.

Results

In total, 85 HCCs ablated in 76 patients were evaluated. The local recurrence rate at 3 years was 2% for AM(+) tumors and 34% for AM(0) tumors (p < 0.01). In addition, no local recurrence was seen in the tumors with an AM of ≥ 2 mm.

Conclusion

MRI with pre-administered SPIO is useful for determining the AM precisely, and an AM of ≥ 2 mm is recommended for curative RFA.

Trial registration number

This study was registered with UMIN Clinical Trials Registry (UMIN 000025406).

Keywords

Hepatocellular carcinoma Radiofrequency ablation Superparamagnetic iron oxide Ablative margin 

Notes

Author contribution

KM and KF contributed equally. Study concepts, data analysis and manuscript drafting: KF and KM; acquisition of data and clinical studies: all authors; statistical analysis: NH; critical revision of the manuscript for important intellectual content: MA, MM, and IH; manuscript editing and final approval: all authors.

Funding

This study was not supported by any grants.

Compliance with ethical standards

Conflict of interest

All authors declare no potential conflict of interest.

Ethical statement

This study was approved by the institutional ethics committee (H19-208) and was conducted in accordance with the ethical standards of the Declaration of Helsinki.

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Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  • Kuniaki Fukuda
    • 1
    Email author
  • Kensaku Mori
    • 2
  • Naoyuki Hasegawa
    • 1
  • Katsuhiro Nasu
    • 2
  • Kazunori Ishige
    • 1
  • Yoshikazu Okamoto
    • 2
  • Masanari Shiigai
    • 3
  • Masato Abei
    • 1
  • Manabu Minami
    • 2
  • Ichinosuke Hyodo
    • 1
  1. 1.Department of Gastroenterology, Institute of Clinical Medicine, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  2. 2.Department of Radiology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
  3. 3.Department of RadiologyTsukuba Medical Center HospitalIbarakiJapan

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