European Radiology

, Volume 28, Issue 5, pp 1986–1993 | Cite as

Ultrasound-ultrasound image overlay fusion improves real-time control of radiofrequency ablation margin in the treatment of hepatocellular carcinoma

  • Yasunori MinamiEmail author
  • Tomohiro Minami
  • Satoru Hagiwara
  • Hiroshi Ida
  • Kazuomi Ueshima
  • Naoshi Nishida
  • Takamichi Murakami
  • Masatoshi Kudo



To assess the clinical feasibility of US-US image overlay fusion with evaluation of the ablative margin in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).


Fifty-three patients with 68 HCCs measuring 0.9–4.0 cm who underwent RFA guided by US-US overlay image fusion were included in this retrospective study. By an overlay of pre-/postoperative US, the tumor image could be projected onto the ablative hyperechoic zone. Therefore, the ablative margin three-dimensionally could be shown during the RFA procedure. US-US image overlay was compared to dynamic CT a few days after RFA for assessment of early treatment response. Accuracy of graded response was calculated, and the performance of US-US image overlay fusion was compared with that of CT using a Kappa agreement test.


Technically effective ablation was achieved in a single session, and 59 HCCs (86.8 %) succeeded in obtaining a 5-mm margin on CT. The response with US-US image overlay correctly predicted early CT evaluation with an accuracy of 92.6 % (63/68) (k = 0.67; 95 % CI: 0.39–0.95).


US-US image overlay fusion can be proposed as a feasible guidance in RFA with a safety margin and predicts early response of treatment assessment with high accuracy.

Key points

• US-US image overlay fusion visualizes the ablative margin during RFA procedure.

• Visualizing the margin during the procedure can prompt immediate complementary treatment.

• US image fusion correlates with the results of early evaluation CT.


Ablation techniques Hepatocellular carcinoma Liver Neoplasms Ultrasonography 





Barcelona clinic liver cancer


Contrast-enhanced ultrasonography


Hepatocellular carcinoma


Multidetector CT


Multiplanar reconstruction


Radiofrequency ablation


Region of interest


Standard deviation





The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Masatoshi Kudo.

Conflict 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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Yasunori Minami
    • 1
    Email author
  • Tomohiro Minami
    • 1
  • Satoru Hagiwara
    • 1
  • Hiroshi Ida
    • 1
  • Kazuomi Ueshima
    • 1
  • Naoshi Nishida
    • 1
  • Takamichi Murakami
    • 2
  • Masatoshi Kudo
    • 1
  1. 1.Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
  2. 2.Department of RadiologyKindai University Faculty of MedicineOsakaJapan

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