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.

中文翻译：

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融合成像引导射频消融治疗经导管动脉化疗栓塞后超声不可见的残留肝细胞癌

摘要

目的

本研究旨在探讨对比增强超声 (CEUS) 和对比增强计算机断层扫描/磁共振成像 (CECT/CEMRI) 之间融合成像（视为虚拟导航）在射频消融指导中的技术效率和治疗反应。 RFA) 用于经导管动脉化疗栓塞 (TACE) 后残留肝细胞癌 (HCC) 的患者。

方法

在这项前瞻性研究中，2017 年 6 月至 2020 年 12 月期间，纳入了 98 名 TACE 治疗后残留 HCC 病灶的患者。所有病灶在常规超声扫描中均不可见。使用 CEUS（CEUS 组，52 个病灶）或虚拟导航（VN 组，46 个病灶）引导进行经皮 RFA。计算比较病灶显示率、无病生存率、局部复发率、总生存率和并发症发生率。

结果

融合成像对 RFA 结果有显着影响（风险比，2.629；95% 置信区间，1.256–5.505；p  = .01）。VN 组的中位无病生存时间显着高于 CEUS 组（10.9 个月与8.8 个月；p  = .007）。VN 组 3、6 和 12 个月后的局部复发率显着低于 CEUS 组（p  = .014、.002 和 .011）。两组的轻微并发症发生率无显着差异。

结论

用于引导 RFA 的 CEUS-CECT/CEMRI 融合成像能够有效治疗 TACE 后不显眼的 HCC 病变。当使用虚拟导航 (VN) 引导的 RFA 时，新的解决方案延长了无病生存时间并减少了残留病灶的长期局部复发。