Abstract
Purpose
To evaluate the value of pre-radiofrequency ablation (RFA) MR and post-RFA CT registration for the assessment of the therapeutic response of hepatocellular carcinoma (HCC).
Materials and Methods
A total of 178 patients with single HCC who received RFA as an initial treatment and had available pre-RFA MR and post-RFA CT images were included in this retrospective study. Two independent readers (one experienced radiologist, one inexperienced radiologist) scored the ablative margin (AM) of treated tumors on a four-point scale (1, residual tumor; 2, incomplete AM; 3, borderline AM; 4, sufficient AM), in two separate sessions: (1) visual comparison between pre-and post-RFA images; (2) with addition of nonrigid registration for pre- and post-RFA images. Local tumor progression (LTP) rates between low-risk (response score, 3–4) and high-risk groups (1–2) were analyzed using the Kaplan–Meier method at each interpretation session.
Results
The patients’ reassignments after using the registered images were statistically significant for inexperienced reader (p < 0.001). In the inexperienced reader, LTP rates of low- and high-risk groups were significantly different with addition of registered images (session 2) (p < 0.001), but not significantly different in session 1 (p = 0.101). However, in the experienced reader, LTP rates of low- and high-risk groups were significantly different in both interpretation sessions (p < 0.001). Using the registered images, the cumulative incidence of LTP at 2 years was 3.0–6.6%, for the low-risk group, and 18.6–27.8% for the high-risk group.
Conclusion
Registration between pre-RFA MR and post-RFA CT images may allow better assessment of the therapeutic response of HCC after RFA, especially for inexperienced radiologists, helping in the risk stratification for LTP.
Similar content being viewed by others
References
Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol. 2013;47(Suppl):S2–6. doi:10.1097/MCG.0b013e3182872f29.
Bruix J, Sherman M. American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2. doi:10.1002/hep.24199.
Chen X, Chen Y, Li Q, Ma D, Shen B, Peng C. Radiofrequency ablation versus surgical resection for intrahepatic hepatocellular carcinoma recurrence: a meta-analysis. J Surg Res. 2015;195(1):166–74. doi:10.1016/j.jss.2015.01.042.
Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg. 2011;98(9):1210–24. doi:10.1002/bjs.7669.
Yang HJ, Lee JH, Lee DH, Yu SJ, Kim YJ, Yoon JH, et al. Small single-nodule hepatocellular carcinoma: comparison of transarterial chemoembolization, radiofrequency ablation, and hepatic resection by using inverse probability weighting. Radiology. 2014;271(3):909–18. doi:10.1148/radiol.13131760.
Cucchetti A, Piscaglia F, Cescon M, Colecchia A, Ercolani G, Bolondi L, et al. Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. J Hepatol. 2013;59(2):300–7. doi:10.1016/j.jhep.2013.04.009.
Pompili M, Saviano A, de Matthaeis N, Cucchetti A, Ardito F, Federico B, et al. Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma ≤3 cm. Results of a multicenter Italian survey. J Hepatol. 2013;59(1):89–97. doi:10.1016/j.jhep.2013.03.009.
Kim YS, Lim HK, Rhim H, Lee MW, Choi D, Lee WJ, et al. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol. 2013;58(1):89–97. doi:10.1016/j.jhep.2012.09.020.
Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol. 2012;107(4):569–77. doi:10.1038/ajg.2011.425 quiz 78.
Zhou Y, Zhao Y, Li B, Xu D, Yin Z, Xie F, et al. Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterol. 2010;10:78. doi:10.1186/1471-230X-10-78.
Lee DH, Lee JM, Lee JY, Kim SH, Yoon JH, Kim YJ, et al. Radiofrequency ablation of hepatocellular carcinoma as first-line treatment: long-term results and prognostic factors in 162 patients with cirrhosis. Radiology. 2014;270(3):900–9. doi:10.1148/radiol.13130940.
Cho YK, Rhim H, Noh S. Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: a systematic review. J Gastroenterol Hepatol. 2011;26(9):1354–60. doi:10.1111/j.1440-1746.2011.06812.x.
Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update. J Vasc Interv Radiol. 2014;25(11):1691–1705 e4. doi:10.1016/j.jvir.2014.08.027.
Shin S, Lee JM, Kim KW, Joo I, Han JK, Choi BI, et al. Postablation assessment using follow-up registration of CT images before and after radiofrequency ablation (RFA): prospective evaluation of midterm therapeutic results of RFA for hepatocellular carcinoma. AJR Am J Roentgenol. 2014;203(1):70–7. doi:10.2214/AJR.13.11709.
Schraml C, Clasen S, Schwenzer NF, Koenigsrainer I, Herberts T, Claussen CD, et al. Diagnostic performance of contrast-enhanced computed tomography in the immediate assessment of radiofrequency ablation success in colorectal liver metastases. Abdom Imaging. 2008;33(6):643–51. doi:10.1007/s00261-007-9351-9.
Fujioka C, Horiguchi J, Ishifuro M, Kakizawa H, Kiguchi M, Matsuura N, et al. A feasibility study: evaluation of radiofrequency ablation therapy to hepatocellular carcinoma using image registration of preoperative and postoperative CT. Acad Radiol. 2006;13(8):986–94. doi:10.1016/j.acra.2006.05.011.
Niculescu G, Foran DJ, Nosher J. Non-rigid registration of the liver in consecutive CT studies for assessment of tumor response to radiofrequency ablation. Conf Proc IEEE Eng Med Biol Soc. 2007;2007:856–9. doi:10.1109/iembs.2007.4352425.
Giesel FL, Mehndiratta A, Locklin J, McAuliffe MJ, White S, Choyke PL, et al. Image fusion using CT, MRI and PET for treatment planning, navigation and follow up in percutaneous RFA. Exp Oncol. 2009;31(2):106–14.
Brock KK, Dawson LA, Sharpe MB, Moseley DJ, Jaffray DA. Feasibility of a novel deformable image registration technique to facilitate classification, targeting, and monitoring of tumor and normal tissue. Int J Radiat Oncol Biol Phys. 2006;64(4):1245–54. doi:10.1016/j.ijrobp.2005.10.027.
Kim KW, Lee JM, Klotz E, Kim SJ, Kim SH, Kim JY, et al. Safety margin assessment after radiofrequency ablation of the liver using registration of preprocedure and postprocedure CT images. AJR Am J Roentgenol. 2011;196(5):W565–72. doi:10.2214/AJR.10.5122.
Lee JM, Park JW. Choi BI 2014 KLCSG-NCC Korea Practice Guidelines for the management of hepatocellular carcinoma: HCC diagnostic algorithm. Dig Dis (Basel, Switzerland). 2014;32(6):764–77. doi:10.1159/000368020.
Mitchell DG, Bruix J, Sherman M, Sirlin CB. LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions. Hepatology. 2015;61(3):1056–65. doi:10.1002/hep.27304.
Murray KF, Carithers RL Jr. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology. 2005;41(6):1407–32. doi:10.1002/hep.20704.
Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima T, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology. 2005;129(1):122–30.
N’Kontchou G, Mahamoudi A, Aout M, Ganne-Carrie N, Grando V, Coderc E, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology. 2009;50(5):1475–83. doi:10.1002/hep.23181.
Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (>2 and <5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol. 2010;195(3):758–65. doi:10.2214/ajr.09.2954.
Kim YS, Rhim H, Cho OK, Koh BH, Kim Y. Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol. 2006;59(3):432–41. doi:10.1016/j.ejrad.2006.03.007.
Liu CH, Arellano RS, Uppot RN, Samir AE, Gervais DA, Mueller PR. Radiofrequency ablation of hepatic tumours: effect of post-ablation margin on local tumour progression. Eur Radiol. 2010;20(4):877–85. doi:10.1007/s00330-009-1610-4.
Makino Y, Imai Y, Igura T, Hori M, Fukuda K, Sawai Y, et al. Comparative evaluation of three-dimensional Gd-EOB-DTPA-enhanced MR fusion imaging with CT fusion imaging in the assessment of treatment effect of radiofrequency ablation of hepatocellular carcinoma. Abdom Imaging. 2015;40(1):102–11. doi:10.1007/s00261-014-0201-2.
Funding
This study was not funded by any grant.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Author 1 is an employee of Siemens Healthcare. The prototype software (HepaCare version 3.0) utilized in this study was provided by Siemens Healthcare. However, control of all data and information submitted for publication was given to the authors who were not affiliated with Siemens Healthcare. For the remaining authors, they have nothing to disclose.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study before performing radiofrequency ablation. Since the subsequent follow-up liver MR or CT images were obtained during routine clinical practice, the requirement for written informed consent was waived. This retrospective, single-center study was approved by our institutional review board.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Park, J., Lee, J.M., Lee, D.H. et al. Value of Nonrigid Registration of Pre-Procedure MR with Post-Procedure CT After Radiofrequency Ablation for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 40, 873–883 (2017). https://doi.org/10.1007/s00270-017-1571-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-017-1571-y