Fusion imaging-guided radiofrequency ablation for residual hepatocellular carcinoma invisible on ultrasound after transcatheter arterial chemoembolization

Abstract

Purpose

This study aimed to investigate the technical efficiency and therapeutic response of fusion imaging (considered as virtual navigation) between contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) for the guidance of radiofrequency ablation (RFA) in patients with residual hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).

Methods

For this prospective study, 98 patients with residual HCC lesions after TACE treatment were enrolled between June 2017 and December 2020. All the lesions were invisible on conventional ultrasound scans. Percutaneous RFA was performed using either CEUS (CEUS group, 52 lesions) or virtual navigation (VN group, 46 lesions) guidance. The lesion display rate, disease-free survival rate, local recurrence rate, overall survival rate and complication incidence were calculated and compared.

Results

Fusion imaging had a significant impact on the RFA outcomes (hazard ratio, 2.629; 95% confidence interval, 1.256–5.505; p = .01). The median disease-free survival time of the VN group was significantly higher than that of the CEUS group (10.9 vs. 8.8 months; p = .007). The local recurrence rates after 3, 6 and 12 months in the VN group were significantly lower than those in the CEUS group (p = .014, .002 and .011). The minor complication rate was not significantly different between the two groups.

Conclusions

CEUS–CECT/CEMRI fusion imaging for guiding RFA enables an efficient and useful therapy of inconspicuous HCC lesions after TACE. The novel solution prolongs the disease-free survival time and reduces the long-term local recurrence of residual lesions treated when using virtual-navigation (VN)-guided RFA.

Keywords:

• Fusion imaging
• radiofrequency ablation
• transcatheter arterial chemoembolization
• hepatocellular carcinoma
• contrast-enhanced ultrasound

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the National Key R&D Program of China [2018YFC0114900], the National Natural Science Foundation of China [81971623], Key Project of Natural Science Foundation of Zhejiang Province [LZ20H180001], the Major Research Plan of the National Natural Science Foundation of China [91630311], Zhejiang Society Joint Foundation for Mathematical Medicine [LSY19H180015] and the Natural Science Foundation of Zhejiang Province [SZ20H180002].