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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 show the CEUS-CT fused image. a1 shows the overlapped image of CEUS and CT. The HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. The ablative area in CEUS was anechoic and is outlined with a dotted line (arrowhead). In a1, the ablative area just covers the tumor, and part of the AM is not covered by the ablative area (arrow). Thus, the CEUS-CT fused image shows that this HCC lesion has an inadequate AM at the site indicated by the arrow. In the CT image in a2, the HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. One month after ablation, the CT revealed complete ablation of the lesion, and the serum AFP fell to a normal level. However, 9 months after ablation, the serum AFP again increased. LTP was shown by CEUS (b) and CT (c) at the same site with an inadequate AM as in a1 (arrow)
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Fig4: a1 and a2 show the CEUS-CT fused image. a1 shows the overlapped image of CEUS and CT. The HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. The ablative area in CEUS was anechoic and is outlined with a dotted line (arrowhead). In a1, the ablative area just covers the tumor, and part of the AM is not covered by the ablative area (arrow). Thus, the CEUS-CT fused image shows that this HCC lesion has an inadequate AM at the site indicated by the arrow. In the CT image in a2, the HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. One month after ablation, the CT revealed complete ablation of the lesion, and the serum AFP fell to a normal level. However, 9 months after ablation, the serum AFP again increased. LTP was shown by CEUS (b) and CT (c) at the same site with an inadequate AM as in a1 (arrow)

Mentions: The median follow-up periods for lesions with adequate AMs and inadequate AMs were 23 months (6–37 months) and 25 months (4–37 months), respectively, and there was no significant difference between the follow-up periods of the 2 groups (p = 0.778). During follow-up, 6 LTPs were detected, and the rate of LTP was 4.8 % (6/125). One LTP occurred in a lesion with an adequate AM at 6 months after ablation, and the rate of LTP in this group was 1.2 % (1/82). This patient concomitantly presented multiple intrahepatic occurrences and subsequently received TACE. The other 5 LTPs occurred in lesions with inadequate AMs at 4, 6, 9, 10 and 12 months after ablation, and the rate of LTP in this group was 11.6 % (5/43). The rate of LTP in inadequate AM quadrants due to blood vessel-related and non-vessel-related causes were 2.1 % (3/142) and 9.1 % (2/22), respectively, and this difference was not significant (p = 0.134). The positions of LTP matched the positions of inadequate AMs, as detected by CEUS-CT/MR image fusion (Fig. 4).Fig. 4


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 show the CEUS-CT fused image. a1 shows the overlapped image of CEUS and CT. The HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. The ablative area in CEUS was anechoic and is outlined with a dotted line (arrowhead). In a1, the ablative area just covers the tumor, and part of the AM is not covered by the ablative area (arrow). Thus, the CEUS-CT fused image shows that this HCC lesion has an inadequate AM at the site indicated by the arrow. In the CT image in a2, the HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. One month after ablation, the CT revealed complete ablation of the lesion, and the serum AFP fell to a normal level. However, 9 months after ablation, the serum AFP again increased. LTP was shown by CEUS (b) and CT (c) at the same site with an inadequate AM as in a1 (arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: a1 and a2 show the CEUS-CT fused image. a1 shows the overlapped image of CEUS and CT. The HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. The ablative area in CEUS was anechoic and is outlined with a dotted line (arrowhead). In a1, the ablative area just covers the tumor, and part of the AM is not covered by the ablative area (arrow). Thus, the CEUS-CT fused image shows that this HCC lesion has an inadequate AM at the site indicated by the arrow. In the CT image in a2, the HCC lesion and 5-mm AM are outlined in blue and yellow, respectively. One month after ablation, the CT revealed complete ablation of the lesion, and the serum AFP fell to a normal level. However, 9 months after ablation, the serum AFP again increased. LTP was shown by CEUS (b) and CT (c) at the same site with an inadequate AM as in a1 (arrow)
Mentions: The median follow-up periods for lesions with adequate AMs and inadequate AMs were 23 months (6–37 months) and 25 months (4–37 months), respectively, and there was no significant difference between the follow-up periods of the 2 groups (p = 0.778). During follow-up, 6 LTPs were detected, and the rate of LTP was 4.8 % (6/125). One LTP occurred in a lesion with an adequate AM at 6 months after ablation, and the rate of LTP in this group was 1.2 % (1/82). This patient concomitantly presented multiple intrahepatic occurrences and subsequently received TACE. The other 5 LTPs occurred in lesions with inadequate AMs at 4, 6, 9, 10 and 12 months after ablation, and the rate of LTP in this group was 11.6 % (5/43). The rate of LTP in inadequate AM quadrants due to blood vessel-related and non-vessel-related causes were 2.1 % (3/142) and 9.1 % (2/22), respectively, and this difference was not significant (p = 0.134). The positions of LTP matched the positions of inadequate AMs, as detected by CEUS-CT/MR image fusion (Fig. 4).Fig. 4

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