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

• Published in: European radiology Vol. 28; no. 5; pp. 1986 - 1993
• Main Authors: Minami, Yasunori, Minami, Tomohiro, Hagiwara, Satoru, Ida, Hiroshi, Ueshima, Kazuomi, Nishida, Naoshi, Murakami, Takamichi, Kudo, Masatoshi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2018; Springer Nature B.V
• Subjects: Ablation; Accuracy; Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Catheter Ablation - methods; Computed tomography; Computer vision; Diagnostic Radiology; Evaluation; Feasibility Studies; Female; Hepatobiliary-Pancreas; Hepatocellular carcinoma; Humans; Image processing; Image Processing, Computer-Assisted - methods; Imaging; Internal Medicine; Interventional Radiology; Liver - diagnostic imaging; Liver - pathology; Liver - surgery; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Radio frequency; Radiofrequency ablation; Radiology; Retrospective Studies; Safety margins; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional - methods; Ultrasound; United States > US; Hepatocellular carcinoma; Liver; Neoplasms; Ablation techniques; Ultrasonography
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-5162-8

Objectives 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). Methods 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. Results 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). Conclusion 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.