Comparison of CBCTA and CECT Guidance Using Electromagnetic Navigation for Percutaneous Liver Microwave Ablation: A Retrospective Non-Randomized Observational Study

• Published in: Journal of vascular and interventional radiology
• Main Authors: Lloret, Maximiliano R., Pisoni, Serena, Armiñana, Arturo, Mora, Daniel F., Picado, Adrián, Martínez, José J., Alcaide, Julien, Martí-Bonmatí, Luis
• Format: Journal Article
• Language: English
• Published: United States 01.08.2025
• Subjects: Electromagnetic navigation; Angiography; Treatment Outcome; Cone Beam CT; Liver Neoplasms; Percutaneous Ablation; Microwaves
• ISSN: 1051-0443; 1535-7732; 1535-7732
• DOI: 10.1016/j.jvir.2025.07.023

To evaluate whether C-arm Cone-Beam CT with Angiography (CBCTA) guidance is non-inferior to standard contrast-enhanced CT (CECT) guidance for hepatic microwave ablation (MWA) using an electromagnetic navigation system (IMACTIS CT-Navigation™ System) in tumors not visible on ultrasound (US). This retrospective, single-center, non-randomized study included 79 patients with liver neoplasms treated with MWA between September 2019 and June 2024. Patients were sequentially allocated to CBCTA (n=53) or CECT (n=26) groups based on modality availability. The primary outcome was technique efficacy, defined by absence of tumor on imaging immediately post-procedure, at 1-3 months, and 4-6 months. Secondary endpoints included procedural time, effective radiation dose, and 30-day adverse events. Comparisons used t-tests, Fisher's test, and Mann-Whitney U tests (p < 0.05). Technique efficacy was comparable between CBCTA and CECT at all time points: immediate (technical success) (100% vs. 100%, p=1.000), 1-3 months (87% vs. 73%, p=0.208), and 4-6 months (81% vs. 71%, p=0.463). No significant differences were found in radiation dose (37.96 vs. 32.36 mSv, p=0.276) or adverse events (11% vs. 11%, p=1.000). Two deaths occurred in the CBCTA group: one due to hospital-acquired pneumonia and one from colonic perforation, possibly related to inadequate technique selection. CBCTA procedures were significantly longer (98.44 vs. 62.03 minutes, p=0.0001). This study suggests that CBCTA-guided MWA using electromagnetic navigation offers comparable short-term efficacy and safety to CECT guidance, but with longer procedural times. The small non-randomized cohort is subject to selection bias and further studies are needed to confirm these findings.