Intra-Procedural CT/MR-Ultrasound Fusion Imaging Helps to Improve Outcomes of Thermal Ablation for Hepatocellular Carcinoma: Results in 502 Nodules

Abstract

Purpose The aim was to assess the value of intra-procedural CT/MR-ultrasound (CT/MR-US) fusion imaging in the management of thermal ablation for hepatocellular carcinoma (HCC).

Materials and Methods This retrospective study was approved by the institutional review board. From May 2010 to October 2016, 543 HCC nodules in 440 patients (387 men and 53 women; age range: 25–84 years) that met the Milan Criteria were treated by percutaneous thermal ablation using intra-procedural CT/MR-US fusion imaging. The HCC nodules were divided into subgroups and compared (≤ 3 cm and > 3 cm, or high-risk and low-risk location, or inconspicuous and conspicuous, respectively). Technique efficacy and major complication were calculated. Cumulative local tumor progression (LTP), tumor-free and overall survival rates were estimated with the Kaplan-Meier method.

Results CT/MR-US fusion imaging was successfully registered in 419 patients with 502 nodules. The technique efficacy rate of thermal ablation was 99.4 %. The major complication rate was 1.9 %. The cumulative LTP rates were 3.2 %, 5.6 % and 7.2 % at 1, 3, and 5 years, respectively. There were no significant differences for the comparisons of cumulative LTP rates between different subgroups (P = 0.541, 0.314, 0.329). The cumulative tumor-free survival rates were 74.8 %, 54.0 % and 37.5 % at 1, 3, and 5 years, respectively. The cumulative overall survival rates were 97.8 %, 87.1 % and 81.7 % at 1, 3, and 5 years, respectively.

Conclusion Intra-procedural CT/MR-ultrasound fusion imaging is a useful technique for percutaneous liver thermal ablation. It could help to achieve satisfying survival outcomes for HCC patients who meet the Milan Criteria.

Zusammenfassung

Zweck Das Ziel war es, den Wert der intraprozeduralen CT/MR-Ultraschall-Fusionsbildgebung (CT/MR-US) bei der Behandlung durch thermische Ablation bei hepatozellulärem Karzinom (HCC) zu beurteilen.

Materialien und Methoden Diese retrospektive Studie wurde vom Ethikkomitee des Instituts genehmigt. Von Mai 2010 bis Oktober 2016 wurden 543 HCC-Herde bei 440 Patienten (387 Männer und 53 Frauen; Altersgruppe: 25–84 Jahre), die die Mailand-Kriterien erfüllten, durch perkutane thermische Ablation mit intraprozeduraler CT/MR-US-Fusionsbildgebung behandelt. Die HCC-Herde wurden in Untergruppen eingeteilt und verglichen (≤ 3 cm und > 3 cm oder Hoch- und Niedrigrisiko-Lokalisation bzw. unauffällig und auffällig). Die Wirksamkeit der Technik und schwere Komplikationen wurden ermittelt. Die Raten für die kumulative lokale Tumorprogression (LTP), das rezidivfreie Überleben und das Gesamtüberleben wurden mit der Kaplan-Meier-Methode geschätzt.

Ergebnisse Die CT/MR-US-Fusionsbildgebung wurde bei 419 Patienten mit 502 Herden erfolgreich aufgenommen. Die Effizienzrate der Technik bei der thermischen Ablation betrug 99,4 %. Die Rate für schwere Komplikationen betrug 1,9 %. Die kumulativen LTP-Raten betrugen 3,2 % nach 1 Jahr, 5,6 % nach 3 Jahren bzw. 7,2 % nach 5 Jahren. Es gab keine signifikanten Unterschiede beim Vergleich der kumulativen LTP-Raten in den verschiedenen Untergruppen (p = 0,541, 0,314, 0,329). Das kumulative rezidivfreie Überleben betrug 74,8 % nach 1 Jahr, 54,0 % nach 3 Jahren und 37,5 % nach 5 Jahren. Das kumulative Gesamtüberleben betrug 97,8 % nach 1 Jahr, 87,1 % nach 3 Jahren und 81,7 % nach 5 Jahren.

Schlussfolgerung Die intraprozedurale CT/MR-US-Fusionsbildgebung ist eine nützliche Technik für die perkutane thermische Leberablation und könnte dazu beitragen, ein zufriedenstellendes Überlebens-Outcome für HCC-Patienten zu erzielen, die die Mailand-Kriterien erfüllen.

Key words

ultrasound - fusion imaging - hepatocellular carcinoma - thermal ablation - survival outcome

Publication History

Received: 31 December 2018

Accepted: 23 September 2019

Article published online:
31 October 2019

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