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Thermal ablation with fusion imaging guidance of hepatocellular carcinoma without conspicuity on conventional or contrast-enhanced US: surrounding anatomical landmarks matter

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Aim

Evaluating clinical and technical factors affecting thermal ablation of B-Mode/CEUS inconspicuous HCC nodules, relying only on fusion imaging (FI) performed under conscious sedation and using previously acquired CT or MR.

Materials and methods

Among 367 HCC nodules treated in the study period, data of 37 B-mode/CEUS undetectable HCC nodules treated with FI-guided ablation were extracted from our prospectively collected institutional database. Analyzed variables included patients’ sex, age, cirrhosis etiology, Child–Pugh status, size of the lesion, liver segment, subcapsular or central liver site, type of imaging used for fusion (MR/CT), and the presence of surrounding anatomical landmarks (SAL) < 3 cm from the index lesion.

Results

The primary efficacy was 59.4% (22/37 nodules); nine lesions (24.3%) were partially ablated (PA), six lesions (16.7%) were mistargeted (MA). Eight nodules were retreated with a CA obtained in all cases (100% CA, secondary efficacy in 30/37—81.1%). LTP was observed in 2/30 cases (6.7%). Two minor complications were registered (Clavien–Dindo, Grade1, CIRSE Classification Grade 2). SAL were related to a better ablation outcome (37.5% vs 84.6% p = 0.01). No differences were observed between CA group and PA–MA group in terms of lesion size (15.4 mm vs 14.9 mm p = 0.63), liver segment (p = 0.58), subcapsular or central liver site (8/22 36% vs 4/15 26.7% p = 0.84), and imaging (MR vs CT, p = 0.72).

Conclusion

Even in the presence of potentially critical conditions (completely B-Mode/CEUS inconspicuous nodules, spontaneous breathing, and previously acquired CT or MRI), FI-only guidance is safe and allows having good primary, secondary efficacy and LTP rates. The outcome of the procedure is heavily affected by the presence of SAL.

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Authors and Affiliations

  1. Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy

    Marco Calandri & Andrea Veltri

  2. Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy

    Valeria Ruggeri, Paolo Fonio & Carlo Gazzera

  3. Gastro-Hepatology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy

    Patrizia Carucci

  4. Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy

    Stefano Mirabella

Authors
  1. Marco Calandri
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  2. Valeria Ruggeri
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  3. Patrizia Carucci
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  4. Stefano Mirabella
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  5. Andrea Veltri
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  6. Paolo Fonio
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  7. Carlo Gazzera
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Correspondence to Marco Calandri.

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The authors declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975.

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Informed consent was obtained from all patients included in the study.

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Calandri, M., Ruggeri, V., Carucci, P. et al. Thermal ablation with fusion imaging guidance of hepatocellular carcinoma without conspicuity on conventional or contrast-enhanced US: surrounding anatomical landmarks matter. Radiol med 124, 1043–1048 (2019). https://doi.org/10.1007/s11547-019-01057-1

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  • DOI: https://doi.org/10.1007/s11547-019-01057-1

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