Real-Time US-CT/MRI Image Fusion for Guidance of Thermal Ablation of Liver Tumors Undetectable with US: Results in 295 Cases
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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.
KeywordsReal-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.
- 3.Hung HH, Chiou YY, Hsia CY, Su CW, Chou YH, Chiang JH, Kao WY, Huo TI, Huang YH, Su YH, Lin HC, Lee SD, Wu JC (2011) Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. Clin Gastroenterol Hepatol 9(1):79–86 Epub 2010 Sep 8PubMedCrossRefGoogle Scholar
- 4.Livraghi T, Mäkisalo H, Line PD (2011) Treatment options in hepatocellular carcinoma today. Scand J Surg. Scand J Surg 100(1):22–29Google Scholar
- 5.Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, Rossi S (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology 47(1):82–89PubMedCrossRefGoogle Scholar
- 7.Ikeda K, Kobayashi M, Saitoh S, Someya T, Hosaka T, Sezaki H, Suzuki Y, Suzuki F, Akuta N, Arase Y, Kumada H, Matsuda M, Hashimoto M, Watanabe G (2005) Cost-effectiveness of radiofrequency ablation and surgical therapy for small hepatocellular carcinoma of 3 cm or less in diameter. Hepatol Res 33(3):241–249 Epub 2005 Nov 2PubMedCrossRefGoogle Scholar
- 8.Van Tilborg AA, Meijerink MR, Sietses C, Van Waesberghe JH, Mackintosh MO, Meijer S, Van Kuijk C, Van Den Tol P (2011) Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention. Br J Radiol 84(1002):556–565 Epub 2010 Dec 15PubMedCentralPubMedCrossRefGoogle Scholar
- 13.Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD III, Dupuy DE, Gervais DA, Gillams AR, Kane RA, Lee FT Jr, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG, Solbiati L, Vogl TJ, Wood BJ, Vedantham S, Sacks D (2009) Society of Interventional Radiology Technology Assessment Committee and the International Working Group on image-guided tumor ablation. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 20(7 Suppl):S377–s390PubMedCrossRefGoogle Scholar
- 17.Kim JE, Kim YS, Rhim H, Lim HK, Lee MW, Choi D, Shin SW, Cho SK (2011) Outcomes of patients with hepatocellular carcinoma referred for percutaneous radiofrequency ablation at a tertiary center: analysis focused on the feasibility with the use of ultrasonography guidance. Eur J Radiol 79:e80–e84PubMedCrossRefGoogle Scholar
- 19.Kim PN, Choi D, Rhim H, Rha SE, Hong HP, Lee J, Choi JI, Kim JW, Seo JW, Lee EJ, Lim HK (2012) Planning ultrasound for percutaneous radiofrequency ablation to treat small (≤3 cm) hepatocellular carcinomas detected on computed tomography or magnetic resonance imaging: a multicenter prospective study to assess factors affecting ultrasound visibility. J Vasc Interv Radiol 23:627–634PubMedCrossRefGoogle Scholar
- 20.Lee MW, Lim HK, Kim YJ, Choi D, Kim YS, Lee WJ, Cha DI, Park MJ, Rhim H (2011) Percutaneous sonographically guided radio frequency ablation of hepatocellular carcinoma: causes of mistargeting and factors affecting the feasibility of a second ablation session. J Ultrasound Med 30:607–615PubMedGoogle Scholar
- 22.Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, Chaubal NG, Chen MH, Clevert DA, Correas JM, Ding H, Forsberg F, Fowlkes JB, Gibson RN, Goldberg BB, Lassau N, Leen EL, Mattrey RF, Moriyasu F, Solbiati L, Weskott HP, Xu HX (2013) Guidelines and good clinical practice recommendations for contrast enhaced ultrasound (CEUS) in the liver—update 2012. Ultraschall Med 34(1):11–29 Epub 2012 Nov 5PubMedGoogle Scholar
- 23.Kim AY, Lee MW, Rhim H, Cha DI, Choi D, Kim YS, Lim HK, Cho SW (2013) Pretreatment evaluation with contrast-enhanced ultrasonography for percutaneous radiofrequency ablation of hepatocellular carcinomas with poor conspicuity on conventional ultrasonography. Korean J Radiol 14(5):754–763PubMedCentralPubMedCrossRefGoogle Scholar
- 26.Venkatesan AM, Kadoury S, Abi-Jaoudeh N, Levy EB, Maass-Moreno R, Krücker J, Dalal S, Xu S, Glossop N, Wood BJ (2011) Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation. Radiology 260(3):848–856 Epub 2011 Jul 6PubMedCentralPubMedCrossRefGoogle Scholar
- 28.Hakime A, Deschamps F, De Carvalho EG, Teriitehau C, Auperin A, De Baere T (2011) Clinical evaluation of spatial accuracy of a fusion imaging technique combining previously acquired computed tomography and real-time ultrasound for imaging of liver metastases. Cardiovasc Interv Radiol 34(2):338–344 Epub 2010 Sep 16CrossRefGoogle Scholar
- 30.Stang A, Keles H, Hentschke S, Seydewitz C, Keuchel M, Pohland C, Dahlke J, Weilert H, Wessling J, Malzfeldt E (2010) Real-time ultrasonography-computed tomography fusion imaging for staging of hepatic metastatic involvement in patients with colorectal cancer: initial results from comparison to US seeing separate CT images and to multidetector-row CT alone. Invest Radiol 45(8):491–501PubMedCrossRefGoogle Scholar
- 31.Wood BJ, Zhang H, Durrani A, Glossop N, Ranjan S, Lindisch D, Levy E, Banovac F, Borgert J, Krueger S, Kruecker J, Viswanathan A, Cleary K (2005) Navigation with electromagnetic tracking for interventional radiology procedures: a feasibility study. J Vasc Interv Radiol 16(4):493–505PubMedCentralPubMedCrossRefGoogle Scholar
- 32.Wood BJ, Locklin JK, Viswanathan A, Kruecker J, Haemmerich D, Cebral J, Sofer A, Cheng R, McCreedy E, Cleary K, McAuliffe MJ, Glossop N, Yanof J (2007) Technologies for guidance of radiofrequency ablation in the multimodality interventional suite of the future. J Vasc Interv Radiol 18(1 Pt 1):9–24PubMedCentralPubMedCrossRefGoogle Scholar
- 34.Kawasoe H, Eguchi Y, Mizuta T, Yasutake T, Ozaki I, Shimonishi T, Miyazaki K, Tamai T, Kato A, Kudo S, Fujimoto K (2007) Radiofrequency ablation with real-time virtual sonography system for treating hepatocellular carcinoma difficult to detect by ultrasonography. J Clin Biochem Nutr 40(1):66–72PubMedCentralPubMedCrossRefGoogle Scholar
- 37.Nakai M, Sato M, Sahara S, Takasaka I, Kawai N, Minamiguchi H, Tanihata H, Kimura M, Takeuchi N (2009) Radiofrequency ablation assisted by real-time virtual sonography and CT for hepatocellular carcinoma undetectable by conventional sonography. Cardiovasc Interv Radiol 32(1):62–69 Epub 2008 Nov 6CrossRefGoogle Scholar
- 39.Wang X, Sofocleous CT, Erinjeri JP, Petre EN, Gonen M, Do KG, Brown KT, Covey AM, Brody LA, Alago W, Thornton RH, Kemeny NE, Solomon SB (2013) Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Interv Radiol 36(1):166–175CrossRefGoogle Scholar
- 40.Shyn PB, Mauri G, Oliva Alencar R, Tatli S, Shah SH, Morrison PR, Catalano PJ, Silverman SG (2014) Percutaneous image-guided Cryoablation of liver tumors: predicting local progression on 24-hour MR imaging. AJR Am J Roentgenol [Epub ahead of print]Google Scholar
- 43.Mauri G, Porazzi E, Cova L, Restelli U, Tondolo T, Bonfanti M, Cerri A, Ierace T, Croce D, Solbiati L (2014) Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment. Insights Into Imaging [Epub ahead of print]Google Scholar