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Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.

Li K, Su ZZ, Xu EJ, Ju JX, Meng XC, Zheng RQ - BMC Cancer (2016)

Bottom Line: The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded.The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min.The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.

ABSTRACT

Background: To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation.

Methods: Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.

Results: The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043).

Conclusion: CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.

No MeSH data available.


Related in: MedlinePlus

a1 and a2 For the lesion in Fig. 2, ultrasound image was fused with the MR image; a1 shows the overlapped ultrasound and MR image with the tumor in blue and the AM in yellow, and a2 shows the MR image with the tumor outlined and the AM. After ablation, CEUS-MR image fusion showed an inadequate AM (arrow in b1); b2 shows the MR image with the tumor outlined and the AM. After supplementary ablation, the inadequate AM became an adequate AM (arrow in c1); c2 shows the MR image with the tumor outlined and the AM
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Fig3: a1 and a2 For the lesion in Fig. 2, ultrasound image was fused with the MR image; a1 shows the overlapped ultrasound and MR image with the tumor in blue and the AM in yellow, and a2 shows the MR image with the tumor outlined and the AM. After ablation, CEUS-MR image fusion showed an inadequate AM (arrow in b1); b2 shows the MR image with the tumor outlined and the AM. After supplementary ablation, the inadequate AM became an adequate AM (arrow in c1); c2 shows the MR image with the tumor outlined and the AM

Mentions: After ablation according to the predetermined plan, CEUS-CT/MR image fusion detected 55 lesions that did not achieve adequate AMs in 208 quadrants. Inadequate AMs were caused by blood vessels in 142 (68.3 %) quadrants and by non-vessels in 66 (31.7 %) quadrants. Supplementary ablation was applied in 18 lesions. In 12 of the 18 lesions, an inadequate AM in all quadrants resulted from non-vessel-related causes. In the other 6 lesions, inadequate AM in some quadrants resulted from non-vessel-related causes and in some other quadrants from blood vessel-related causes. In the 18 lesions, supplementary ablation was only applied to 44 quadrants with an inadequate AM due to non-vessel-related causes. After supplementary ablation, the inadequate AMs in the 44 quadrants became adequate AMs (Fig. 3). Because of supplementary ablation, 21.8 % (12/55) of the lesions with inadequate AMs achieved adequate AMs and 21.2 % (44/208) of the quadrants with inadequate AMs achieved adequate AMs. Finally, 43 lesions that did not achieve adequate AMs in 164 quadrants, including 142 quadrants (86.6 %) for blood vessel-related reasons and 22 quadrants (13.4 %) for non-vessel-related reasons (Table 2).Fig. 3


Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.

Li K, Su ZZ, Xu EJ, Ju JX, Meng XC, Zheng RQ - BMC Cancer (2016)

a1 and a2 For the lesion in Fig. 2, ultrasound image was fused with the MR image; a1 shows the overlapped ultrasound and MR image with the tumor in blue and the AM in yellow, and a2 shows the MR image with the tumor outlined and the AM. After ablation, CEUS-MR image fusion showed an inadequate AM (arrow in b1); b2 shows the MR image with the tumor outlined and the AM. After supplementary ablation, the inadequate AM became an adequate AM (arrow in c1); c2 shows the MR image with the tumor outlined and the AM
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4836159&req=5

Fig3: a1 and a2 For the lesion in Fig. 2, ultrasound image was fused with the MR image; a1 shows the overlapped ultrasound and MR image with the tumor in blue and the AM in yellow, and a2 shows the MR image with the tumor outlined and the AM. After ablation, CEUS-MR image fusion showed an inadequate AM (arrow in b1); b2 shows the MR image with the tumor outlined and the AM. After supplementary ablation, the inadequate AM became an adequate AM (arrow in c1); c2 shows the MR image with the tumor outlined and the AM
Mentions: After ablation according to the predetermined plan, CEUS-CT/MR image fusion detected 55 lesions that did not achieve adequate AMs in 208 quadrants. Inadequate AMs were caused by blood vessels in 142 (68.3 %) quadrants and by non-vessels in 66 (31.7 %) quadrants. Supplementary ablation was applied in 18 lesions. In 12 of the 18 lesions, an inadequate AM in all quadrants resulted from non-vessel-related causes. In the other 6 lesions, inadequate AM in some quadrants resulted from non-vessel-related causes and in some other quadrants from blood vessel-related causes. In the 18 lesions, supplementary ablation was only applied to 44 quadrants with an inadequate AM due to non-vessel-related causes. After supplementary ablation, the inadequate AMs in the 44 quadrants became adequate AMs (Fig. 3). Because of supplementary ablation, 21.8 % (12/55) of the lesions with inadequate AMs achieved adequate AMs and 21.2 % (44/208) of the quadrants with inadequate AMs achieved adequate AMs. Finally, 43 lesions that did not achieve adequate AMs in 164 quadrants, including 142 quadrants (86.6 %) for blood vessel-related reasons and 22 quadrants (13.4 %) for non-vessel-related reasons (Table 2).Fig. 3

Bottom Line: The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded.The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min.The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.

ABSTRACT

Background: To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation.

Methods: Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.

Results: The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043).

Conclusion: CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.

No MeSH data available.


Related in: MedlinePlus