CardioVascular and Interventional Radiology

, Volume 38, Issue 1, pp 143–151 | Cite as

Real-Time US-CT/MRI Image Fusion for Guidance of Thermal Ablation of Liver Tumors Undetectable with US: Results in 295 Cases

  • Giovanni MauriEmail author
  • Luca Cova
  • Stefano De Beni
  • Tiziana Ierace
  • Tania Tondolo
  • Anna Cerri
  • S. Nahum Goldberg
  • Luigi Solbiati
Clinical Investigation



This study was designed to assess feasibility of US-CT/MRI fusion-guided ablation in liver tumors undetectable with US.


From 2002 to 2012, 295 tumors (162 HCCs and 133 metastases; mean diameter 1.3 ± 0.6 cm, range 0.5–2.5 cm) detectable on contrast-enhanced CT/MRI, but completely undetectable with unenhanced US and either totally undetectable or incompletely conspicuous with contrast-enhanced US (CEUS), were treated in 215 sessions using either internally cooled radiofrequency or microwave with standard ablation protocols, guided by an image fusion system (Virtual Navigation System, Esaote S.p.A., Genova, Italy) that combines US with CT/ MRI images. Correct targeting and successful ablation of tumor were verified after 24 hours with CT or MRI.


A total of 282 of 295 (95.6 %) tumors were correctly targeted with successful ablation achieved in 266 of 295 (90.2 %). Sixteen of 295 (5.4 %) tumors were correctly targeted, but unsuccessfully ablated, and 13 of 295 (4.4 %) tumors were unsuccessfully ablated due to inaccurate targeting. There were no perioperative deaths. Major complications were observed in 2 of the 215 treatments sessions (0.9 %).


Real-time virtual navigation system with US-CT/MRI fusion imaging is precise for targeting and achieving successful ablation of target tumors undetectable with US alone. Therefore, a larger population could benefit from ultrasound guided ablation procedures.


Real-time virtual navigation Liver malignancies Percutaneous thermal ablation Ultrasonography Image fusion 


Conflict of interest

Giovanni Mauri, Luca Cova, Stefano De Beni, Tiziana Ierace, Tania Tondolo, Anna Cerri, and Luigi Solbiati have nothing to disclose. S. Nahum Goldberg has sponsored research and consulting for AngioDynamics, Marlborough, MA, and Cosman Company, Burlington, MA, USA.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Giovanni Mauri
    • 1
    • 2
    Email author
  • Luca Cova
    • 1
  • Stefano De Beni
    • 3
  • Tiziana Ierace
    • 1
  • Tania Tondolo
    • 1
  • Anna Cerri
    • 1
  • S. Nahum Goldberg
    • 4
  • Luigi Solbiati
    • 1
  1. 1.Unit of Interventional Oncologic Radiology, Department of Diagnostic ImagingAzienda Ospedaliera Ospedale di Circolo di Busto ArsizioBusto ArsizioItaly
  2. 2.Unit of RadiologyServizio di Radiologia, IRCCS Policlinico San DonatoMilanoItaly
  3. 3.Esaote SpAGenovaItaly
  4. 4.Image-guided Therapy and Interventional Oncology Unit, Department of RadiologyHadassah Hebrew University Medical CenterJerusalemIsrael

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