A Feasibility Study for Determining Ablative Margin with 3D-CEUS-CT/MR Image Fusion after Radiofrequency Ablation of Hepatocellular Carcinoma

Abstract

Purpose: To explore the feasibility and value of 3D-CEUS-CT/MR image fusion in evaluating ablative margin (AM) after radiofrequency ablation of hepatocellular carcinoma.

Methods and materials: There were 49 HCC in 41 patients enrolled in our prospective study. The AM were evaluated with 3D-CEUS-CT/MR image fusion, the results were divided into two groups: in group A, the tumor was completely ablated with a 5 mm AM; in group B, the tumor was completely ablated, but a 5 mm AM was not obtained. The time used in US-CT/MR image fusion and 3 D image post-processing, the technical success rate of 3D-CEUS-CT/MR image fusion and the relation between LTP and AM were observed.

Results: The time taken for US-CT/MR image fusion and 3 D image post-processing was 9.2 ± 2.1 min (6 – 12 min), 14.6 ± 2.6 min (9 – 20 min), respectively. The technical success rate of 3D-CEUS-CT/MR image fusion was 81.6 % (40/49). 27 HCC had sufficient AM (group A) and 13 HCC had insufficient AM (group B). The LTP rates in groups A and B were 0/27 and 4/13, respectively. There was a significant difference between groups A and B (P = 0.002). There was a significant negative correlation between LTP and AM (r = –1.000, P< 0.001), and the locations of LTP and insufficient AM were concordant.

Conclusions: The results suggest that 3D-CEUS-CT/MR image fusion is feasible and useful in evaluating the AM after HCC ablation.

Zusammenfassung

Ziel: Untersuchung der Durchführbarkeit und des Wertes der 3DCEUS-CT/MR-Bildfusion zur Beurteilung des Ablationsrandes (ablative margin = AM) nach Radiofrequenzablation des hepatozellulären Karzinoms (HCC).

Material und Methoden: In unsere prospektive Studie wurden 49 HCCs von 41 Patienten aufgenommen. Der AM wurde mittels 3D-CEUS-CT/MR-Bildfusion beurteilt und die Ergebnisse in zwei Gruppen aufgeteilt: Gruppe A mit kompletter Ablation des Tumors und einem 5 mm großem AM, Gruppe B mit kompletter Tumorablation ohne Erhalt eines 5 mm AM. Der Zeitaufwand der 3D-CEUS-CT/MR-Bildfusion und der 3D-Bild-Nachbearbeitung, die technische Erfolgsrate der 3D-CEUS-CT/MR Bildfusion sowie das Verhältnis zwischen LTP und AM wurden verfolgt.

Ergebnisse: Der Zeitaufwand für die US-CT/MR Bildfusion betrug 9,2 ± 2,1 min (6 – 12 min) und für die 3D-Bild-Nachbearbeitung 14,6 ± 2,6 min (9 – 20 min). Die technische Erfolgsrate der 3D-CEUS-CT/MR-Bildfusion betrug 81,6 % (40/49). Einen ausreichenden AM (Gruppe A) hatten 27 HCC und einen nicht ausreichenden AM (Gruppe B)13 HCCs. Die LTP-Raten (local tumor progression) in Gruppe A betrugen 0/27 und in Gruppe B 4/13 mit einem signifikanten Unterschied zwischen beiden Gruppen (p = 0,002). Zwischen LTP und AM wurde eine signifikante negative Korrelation beobachtet (r = –1,000, p < 0,001) und die Bereiche von LTP und nicht ausreichendem AM stimmten überein.

Schlussfolgerung: Die Ergebnisse weisen auf die Durchführbarkeit der 3D-CEUS-CT/MR-Bildfusion hin und auf deren Wert für die Beurteilung des AM nach HCC-Ablation.

Key words

3-D ultrasound - radiofrequency (RF) ablation - treatment effects - tumor - MR-imaging

^* S. Zhong-Zhen and L. Kai contributed equally to this work and are considered co-first authors.

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