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Chen J, Zhang B, Yan Y, Wei FQ, Lin ZY, Chen J. MR-Guided Microwave Ablation for Patients with Cirrhosis Complicated by Small Hepatocellular Carcinoma. J Vasc Interv Radiol 2025; 36:805-812.e1. [PMID: 39848318 DOI: 10.1016/j.jvir.2025.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 12/25/2024] [Accepted: 01/14/2025] [Indexed: 01/25/2025] Open
Abstract
PURPOSE To assess the technical effectiveness and therapeutic outcomes of percutaneous magnetic resonance (MR)-guided microwave ablation (MWA) in the treatment of patients with cirrhosis complicated by small hepatocellular carcinoma (HCC). MATERIALS AND METHODS A single-center, retrospective analysis of consecutive cases involving 1.5T MR-guided MWA for HCC was performed. Fifty-three patients with cirrhosis, harboring 74 HCC lesions with mean diameter of 13.0 mm (SD ± 6.0; range, 6.0-29.0 mm; median, 10.0 mm), were included in this study. Follow-up MR imaging was performed postprocedurally to assess technical effectiveness, whereas local progression-free survival (LPFS) and overall survival (OS) rates were calculated over the study period. RESULTS MR-guided MWA was performed with technical success in all cases with no severe adverse events occurring during the single-session treatment. The mean follow-up duration was 46.1 months (SD ± 17.9; median, 52 months). Local tumor progression was observed in 1 perivascular lesion, accounting for 1.9% of the cases. The mean recurrence-free survival was 31.1 months (SD ± 22.2), with a median of 24.5 months. LPFS rates at 1, 3, and 5 years were 98.1%. The OS rates at 1, 3, and 5 years were 96.2%, 84.9%, and 71.6%, respectively. CONCLUSIONS Percutaneous MR-guided MWA for small HCC in patients with cirrhosis demonstrated high technical success, accurate evaluation of ablation margins, and minimal local tumor progression after a single treatment session, resulting in favorable therapeutic outcomes.
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Affiliation(s)
- Jie Chen
- Department of Interventional Radiology, Sanming Second Hospital, Sanming, China
| | - Bing Zhang
- Department of Interventional Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuan Yan
- Department of Interventional Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Interventional Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fu-Qun Wei
- Department of Interventional Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Interventional Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zheng-Yu Lin
- Department of Interventional Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Interventional Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jin Chen
- Department of Interventional Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Interventional Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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Tombesi P, Cutini A, Di Vece F, Grasso V, Politti U, Capatti E, Sartori S. Surgery or Percutaneous Ablation for Liver Tumors? The Key Points Are: When, Where, and How Large. Cancers (Basel) 2025; 17:1344. [PMID: 40282520 PMCID: PMC12025409 DOI: 10.3390/cancers17081344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 04/08/2025] [Accepted: 04/15/2025] [Indexed: 04/29/2025] Open
Abstract
The most recent comparisons between liver resection (LR) and percutaneous thermal ablation (PTA) reported similar efficacy and survival outcomes for primary and secondary liver tumors ≤ 3 cm in size. Nevertheless, LR still remains the most popular treatment strategy worldwide, and percutaneous ablation is usually reserved to patients who are not surgical candidates. However, in our opinion, the debate should no longer be what is the most effective treatment for patients with resectable small liver cancer who are not candidates for liver transplantation, but rather when LR or PTA are best suited to the individual patient. Subcapsular tumors or tumors closely adjacent to critical structures or vulnerable organs should undergo LR because ablation can often not achieve an adequate safety margin. Conversely, PTA should be considered the first choice to treat central tumors because it has lower complication rates, lower costs, and shorter hospital stay. Furthermore, recent technical improvements in tumor targeting and accurate assessment of the extent of the safety margin, such as stereotactic navigation, fusion imaging and software powered by Artificial Intelligence enabling the immediate comparison between the pre-procedure planned margins and the ablation area, are also changing the approach to tumors larger than 3 cm. The next trials should be aimed at investigating up to what tumor size PTA supported by these advanced technologies can achieve outcomes comparable to LR.
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Guo Q, Yu Y, Ye R, Huang Z, Shi T. Clinical value of CEUS with tumour marker monitoring in evaluating the prognosis of HCC after MWA. Adv Med Sci 2025; 70:79-85. [PMID: 39755204 DOI: 10.1016/j.advms.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 11/30/2024] [Accepted: 01/02/2025] [Indexed: 01/06/2025]
Abstract
PURPOSE This study aims to evaluate the prognostic value of contrast-enhanced ultrasound (CEUS) combined with tumour markers in patients with hepatocellular carcinoma (HCC) undergoing microwave ablation (MWA). METHODS MWA patients with HCC were divided into good prognosis (n = 75) and poor prognosis (n = 69) groups. The levels of alpha-fetoprotein (AFP), carbohydrate antigen (CA19-9), and carcinoembryonic antigen (CEA) before and after MWA were analysed using an independent sample t-test. The correlation between prognosis, ablation lesion area, and tumour marker levels were analysed by Pearson's correlation. The diagnostic power of the ablation lesion area combined with tumour marker levels for the prognosis of patients with MWA was analysed using receiver operating characteristic (ROC) curves. RESULTS The levels of AFP, CA19-9, and CEA in the good prognosis group were significantly lower than those in the poor prognosis group (all P < 0.001). The levels of all tumour markers were significantly negatively correlated with the prognosis of patients who underwent MWA (all r < 0, P < 0.001) and positively correlated with the area of tumour-ablated lesions (r > 0, P < 0.001). Moreover, the diagnostic efficacy of CEUS combined with tumour markers for the prognosis of patients who underwent MWA was significantly higher than that of either single diagnostic modality. CONCLUSIONS CEUS combined with tumour marker monitoring can effectively improve the accuracy of prognostic diagnosis in patients with MWA and provide a reference for timely and reasonable treatment and therapeutic evaluation.
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Affiliation(s)
- Qiang Guo
- Zhejiang Chinese Medical University, Hangzhou, PR China; Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, PR China
| | - Yang Yu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, PR China
| | - Ruyun Ye
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, PR China
| | - Zhiliang Huang
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, PR China.
| | - Tingting Shi
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, PR China.
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Fazlollahi F, Makary MS. Precision oncology: The role of minimally-invasive ablation therapy in the management of solid organ tumors. World J Radiol 2025; 17:98618. [PMID: 39876886 PMCID: PMC11755905 DOI: 10.4329/wjr.v17.i1.98618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 12/16/2024] [Accepted: 01/18/2025] [Indexed: 01/21/2025] Open
Abstract
Solid organ tumors present a significant healthcare challenge, both economically and logistically, due to their high incidence and treatment complexity. In 2023, out of the 1.9 million new cancer cases in the United States, over 73% were solid organ tumors. Ablative therapies offer minimally invasive solutions for malignant tissue destruction in situ, often with reduced cost and morbidity compared to surgical resection. This review examines the current Food and Drug Administration-approved locoregional ablative therapies (radiofrequency, microwave, cryogenic, high-intensity focused ultrasound, histotripsy) and their evolving role in cancer care. Data were collected through a comprehensive survey of the PubMed-indexed literature on tumor ablation techniques, their clinical indications, and outcomes. Over time, emerging clinical data will help establish these therapies as the standard of care in solid organ tumor treatment, supported by improved long-term outcomes and progression-free survival.
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Affiliation(s)
- Farbod Fazlollahi
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Li H, Vogl TJ, Chen KA, Adwan H. A Comparison of the Efficacy and Safety of US-, CT-, and MR-Guided Radiofrequency and Microwave Ablation for HCC: A Systematic Review and Network Meta-Analysis. Cancers (Basel) 2025; 17:409. [PMID: 39941779 PMCID: PMC11816381 DOI: 10.3390/cancers17030409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 01/19/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open
Abstract
Objectives: The aim of this study was to compare the efficacy and safety of thermal ablation, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA), for hepatocellular carcinoma (HCC) using US-, CT-, and MR-guidance. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched for studies comparing US, CT, and MR guidance in thermal ablation for HCC. Observational studies and randomized controlled trials (RCTs) were included. Overall survival (OS), local tumor recurrence (LTR), primary technique effectiveness (PTE), and major complications were assessed with network meta-analysis. Results: One RCT and 13 retrospective cohort studies reporting on 2349 patients were included. For OS at 3 years, compared to CT, US had hazard ratios (HRs) of 0.98 (95%CI: 0.77-1.26), and MR had HRs of 1.60 (95%CI: 0.51-5.00); For OS at 5 years, US had HRs of 0.80 (95%CI: 0.64-1.01), and MR had HRs of 1.23 (95%CI: 0.52-2.95) compared to CT. LTR rates, PTE, and major complications did not show statistical significance among the three guidance modalities (LTR: RR = 0.29 (95%CI: 0.08-1.14), p = 0.97 MR vs. CT; RR = 0.25 (95%CI: 0.06-1.02), p = 0.97 MR vs. US; PTE: RR = 1.06 (95%CI: 0.96-1.17), p = 0.90 MR vs. CT; RR = 1.08 (95%CI: 0.98-1.20), p = 0.90 MR vs. US. Major complications: RR = 0.27 (95%CI: 0.13-0.59), p = 0.94 MR vs. CT; RR = 0.41 (95%CI: 0.10-1.74), p = 0.94 MR vs. US). Conclusions: CT-, US-, and MR-guided RFA and MWA are equally effective and safe for HCC patients.
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Affiliation(s)
- Hao Li
- Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (H.L.); (H.A.)
| | - Thomas J. Vogl
- Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (H.L.); (H.A.)
| | - Kuei-An Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan City 33305, Taiwan;
| | - Hamzah Adwan
- Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (H.L.); (H.A.)
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Biscaldi T, L'Huillier R, Milot L, N'Djin WA. Interstitial Dual-Mode Ultrasound With a 3-mm MR-Compatible Catheter for Image-Guided HIFU and Directional In Vitro Tissue Ablations. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:1588-1605. [PMID: 39259638 DOI: 10.1109/tuffc.2024.3458067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Current interstitial techniques of tumor ablation face challenges that ultrasound (US) technologies could meet. The ablation radius and directionality of the US beam could improve the efficiency and precision. Here, a nine-gauge magnetic resonance (MR)-compatible dual-mode US catheter prototype was experimentally evaluated for ultrasound image-guided high-intensity focused ultrasound (USgHIFU) conformal ablations. The prototype consisted of 64 piezocomposite linear-array elements and was driven by an open research programmable dual-mode US platform. After verifying the US image guidance capabilities of the prototype, the high-intensity focused US (HIFU) output performances (dynamic focusing and HIFU intensities) were quantitatively characterized, together with the associated 3-D HIFU-induced thermal heating in tissue phantoms [using MR thermometry (MRT)]. Finally, the ability to produce robustly HIFU-induced thermal ablations in in vitro liver was studied experimentally and compared to numerical modeling. Investigations of several HIFU dynamic focusing allowed overcoming the challenges of miniaturizing the device: monofocal focusing maximized deep energy deposition, while multifocal strategies eliminated grating lobes. The linear-array design of the prototype made it possible to produce interstitial US images of tissue and tumor mimics in situ. Multifocal pressure fields were generated without grating lobes and transducer surface intensities reached up to . Seventeen elementary thermal ablations were performed in vitro. Rotation of the catheter proved the directionality of ablation, sparing nontargeted tissue. This experimental proof of concept demonstrates the feasibility of treating volumes comparable to those of primary solid tumors with a miniaturized USgHIFU catheter whose dimensions are close to those of tools traditionally used in interventional radiology while offering new functionalities.
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Schmidt VF, Öcal O, Walther V, Fabritius MP, Dietrich O, Kazmierczak PM, Weiss L, Deniz S, Ümütlü MR, Puhr-Westerheide D, Wildgruber M, Ricke J, Seidensticker M. Clinical benefits of MRI-guided freehand biopsy of small focal liver lesions in comparison to CT guidance. Eur Radiol 2024; 34:5507-5516. [PMID: 38319427 PMCID: PMC11364707 DOI: 10.1007/s00330-024-10623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To compare clinical success, procedure time, and complication rates between MRI-guided and CT-guided real-time biopsies of small focal liver lesions (FLL) < 20 mm. METHODS A comparison of a prospectively collected MRI-guided cohort (n = 30) to a retrospectively collected CT-guided cohort (n = 147) was performed, in which patients underwent real-time biopsies of small FLL < 20 mm in a freehand technique. In both groups, clinical and periprocedural data, including clinical success, procedure time, and complication rates (classified according to CIRSE guidelines), were analyzed. Wilcoxon rank sum test, Pearson's chi-squared test, and Fisher's exact test were used for statistical analysis. Additionally, propensity score matching (PSM) was performed using the following criteria for direct matching: age, gender, presence of liver cirrhosis, liver lobe, lesion diameter, and skin-to-target distance. RESULTS The median FLL diameter in the MRI-guided cohort was significantly smaller compared to CT guidance (p < 0.001; 11.0 mm vs. 16.3 mm), while the skin-to-target distance was significantly longer (p < 0.001; 90.0 mm vs. 74.0 mm). MRI-guided procedures revealed significantly higher clinical success compared to CT guidance (p = 0.021; 97% vs. 79%) as well as lower complication rates (p = 0.047; 0% vs. 13%). Total procedure time was significantly longer in the MRI-guided cohort (p < 0.001; 38 min vs. 28 min). After PSM (n = 24/n = 38), MRI-guided procedures still revealed significantly higher clinical success compared to CT guidance (p = 0.039; 96% vs. 74%). CONCLUSION Despite the longer procedure time, freehand biopsy of small FLL < 20 mm under MR guidance can be considered superior to CT guidance because of its high clinical success and low complication rates. CLINICAL RELEVANCE STATEMENT Biopsy of small liver lesions is challenging due to the size and conspicuity of the lesions on native images. MRI offers higher soft tissue contrast, which translates into a higher success of obtaining enough tissue material with MRI compared to CT-guided biopsies. KEY POINTS • Image-guided biopsy of small focal liver lesions (FLL) is challenging due to inadequate visualization, leading to sampling errors and false-negative biopsies. • MRI-guided real-time biopsy of FLL < 20 mm revealed significantly higher clinical success (p = 0.021; 97% vs. 79%) and lower complication rates (p = 0.047; 0% vs. 13%) compared to CT guidance. • Although the procedure time is longer, MRI-guided biopsy can be considered superior for small FLL < 20 mm.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Viktoria Walther
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Olaf Dietrich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Lena Weiss
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Muzzafer R Ümütlü
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Tombesi P, Cutini A, Grasso V, Di Vece F, Politti U, Capatti E, Labb F, Petaccia S, Sartori S. Past, present, and future perspectives of ultrasound-guided ablation of liver tumors: Where could artificial intelligence lead interventional oncology? Artif Intell Cancer 2024; 5:96690. [DOI: 10.35713/aic.v5.i1.96690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024] Open
Abstract
The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound (US) guidance. Later, radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide. In the past decade, microwave ablation systems have achieved larger ablation areas than radiofrequency ablation, suggesting that the 3-cm barrier could be broken in the treatment of liver tumors. Likewise, US techniques to guide percutaneous ablation have seen important progress. Contrast-enhanced US (CEUS) can define and target the tumor better than US and can assess the size of the ablation area after the procedure, which allows immediate retreatment of the residual tumor foci. Furthermore, fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS. Recently, software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures, aiding in procedure planning, assessing ablation completeness, and targeting the residual viable foci with greater precision than CEUS. Hopefully, this could lead to the ablation of tumors up to 5-7 cm in size.
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Affiliation(s)
- Paola Tombesi
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Andrea Cutini
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Valentina Grasso
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Francesca Di Vece
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Ugo Politti
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Eleonora Capatti
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | | | | | - Sergio Sartori
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
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Montalti R, Cassese G, Zidan A, Rompianesi G, Cesare Giglio M, Campanile S, Arena L, Maione M, Troisi RI. Local recurrence risk factors and outcomes in minimally invasive thermal ablation for liver tumors: a single-institution analysis. HPB (Oxford) 2024; 26:682-690. [PMID: 38342647 DOI: 10.1016/j.hpb.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Minimally Invasive thermal ablation (MITA) of liver tumors is a commonly performed procedure, alone or in combination with liver resection. Despite being a first-option strategy for small lesions, it is technically demanding, and many concerns still exist about local disease control. METHODS Consecutive patients undergoing MITA from 1-2019 to 12-2022 were retrospectively enrolled. Risk factors of local recurrence were investigated through univariate and multivariable cox regression analysis. RESULTS At the multivariable analysis of the 207 nodules undergoing MITA, RFA was associated with worse local Recurrence Free Survival (lRFS) than MWA (HR 2.87 [95 % CI 0.96-8.66], p = 0.05), as well as a concomitant surgical resection (HR 3.89 [95 % CI 1.06-9.77], p = 0.02). A concomitant surgical resection showed worse lRFS in the subgroup analysis of both HCC (HR 3.98 [95 % CI 1.16-13.62], p = 0.02) and CRLM patients (HR 2.68 [95 % CI 0.66-5.92], p = 0.04). Interestingly, a tumor size between 30 and 40 mm was not associated to worse lRFS. CONCLUSION MWA may reduce the risk of local recurrence in comparison to RFA, while MITA associated to liver resection may face an increased risk of local recurrence. Further prospective studies are needed to confirm such results.
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Affiliation(s)
- Roberto Montalti
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy; Department of Public Health, Federico II University, Naples, Italy
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy.
| | - Ahmed Zidan
- Department of Surgery, Assiut University Hospital, Assiut, Egypt
| | - Gianluca Rompianesi
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Silvia Campanile
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Lorenza Arena
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Marco Maione
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
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Zhao Y, Bai J, Wang X, Zhang Y, Yan X, Qi J, Xia X, Feng Y, Duan B. Threatment Strategies for Recurrent Hepatocellular Carcinoma Patients: Ablation and its Combination Patterns. J Cancer 2024; 15:2193-2205. [PMID: 38495485 PMCID: PMC10937274 DOI: 10.7150/jca.93885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
With the development of guidance technology and ablation equipment, ablative procedures have emerged as important loco-regional alternatives to surgical resection for recurrent hepatocellular carcinoma (rHCC) patients. Currently, ablation modalities used in clinical practice mainly include radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA), cryoablation (CRA), high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE). Accumulated comparative data of ablation versus surgical resection reveal noninferior responses and outcomes but superior adverse effects. Moreover, studies demonstrate that ablation may serve as an excellent procedure for rHCC given its exact minimal invasiveness and immune modulation. We focus on the current status of ablation in clinical practice for rHCC and discuss new research in the field, including ablation combined with these other modalities, such as targeted therapy and immunotherapy.
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Affiliation(s)
- Ya'ning Zhao
- Department of Medical Oncology of Baoji Central Hospital, Baoji 721008, Shaanxi Province, China
| | - Jun Bai
- Department of Medical Oncology of Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Xi Wang
- Department of Medical Oncology of Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Yaoren Zhang
- Department of Ultrasonography of Baoji Central Hospital, Baoji 721008, Shaanxi Province, China
| | - Xiaohong Yan
- Department of Medical Oncology of Baoji Central Hospital, Baoji 721008, Shaanxi Province, China
| | - Jun'an Qi
- Department of Hepatobiliary Surgery of Baoji Central Hospital, Baoji 721008, Shaanxi Province, China
| | - Xueyan Xia
- Department of Medical Oncology of Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Yuansong Feng
- Department of Medical Oncology of Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Baojun Duan
- Department of Medical Oncology of Baoji Central Hospital, Baoji 721008, Shaanxi Province, China
- Department of Medical Oncology of Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
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Li S, Zhou Z, Wu S, Wu W. Ultrasound Homodyned-K Contrast-Weighted Summation Parametric Imaging Based on H-scan for Detecting Microwave Ablation Zones. ULTRASONIC IMAGING 2023; 45:119-135. [PMID: 36995065 DOI: 10.1177/01617346231162928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The homodyned-K (HK) distribution is a generalized model of envelope statistics whose parameters α (the clustering parameter) and k (the coherent-to-diffuse signal ratio) can be used to monitor the thermal lesions. In this study, we proposed an ultrasound HK contrast-weighted summation (CWS) parametric imaging algorithm based on the H-scan technique and investigated the optimal window side length (WSL) of the HK parameters estimated by the XU estimator (an estimation method based on the first moment of the intensity and two log-moments, which was used in the proposed algorithm) through phantom simulations. H-scan diversified ultrasonic backscattered signals into low- and high-frequency passbands. After envelope detection and HK parameter estimation for each frequency band, the α and k parametric maps were obtained, respectively. According to the contrast between the target region and background, the (α or k) parametric maps of the dual-frequency band were weighted and summed, and then the CWS images were yielded by pseudo-color imaging. The proposed HK CWS parametric imaging algorithm was used to detect the microwave ablation coagulation zones of porcine liver ex vivo under different powers and treatment durations. The performance of the proposed algorithm was compared with that of the conventional HK parametric imaging and frequency diversity and compounding Nakagami imaging algorithms. For two-dimensional HK parametric imaging, it was found that a WSL equal to 4 pulse lengths of the transducer was sufficient for estimating the α and k parameters in terms of both parameter estimation stability and parametric imaging resolution. The HK CWS parametric imaging provided an improved contrast-to-noise ratio over conventional HK parametric imaging, and the HK αcws parametric imaging achieved the best accuracy and Dice score of coagulation zone detection.
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Affiliation(s)
- Sinan Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Zhuhuang Zhou
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Shuicai Wu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Weiwei Wu
- College of Biomedical Engineering, Capital Medical University, Beijing, China
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12
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Crespo E, Hermosín A, Villalba Á, Daguer E, Flores J, Periañez J, Martínez-Galdámez M, Santos E. Uncooled TATO microwave system for liver ablation. Hepat Oncol 2023; 9:HEP46. [PMID: 37009421 PMCID: PMC10064260 DOI: 10.2217/hep-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
Aim: To evaluate the safety and efficacy of uncooled TATO microwave ablation (MWA) for primary and metastatic liver cancer. Materials & methods: This was a retrospective study on percutaneous liver ablations performed with TATO MWA. Twenty-five ablations were performed; 11 (44%) were performed for hepatocellular carcinoma, 14 (56%) for colorectal carcinoma, gastric and pancreatic metastases. Results: Adverse events were reported only in one (4%) ablation: an abscess that was observed in the ablated area and was resolved with a percutaneous drainage and antibiotic therapy. Local tumor control rate was 92% at the 3-month follow-up. Conclusion: TATO MWA was safe and effective with high reproducibility in treating primary and secondary liver cancer with satisfactory technical and clinical outcomes.
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Affiliation(s)
- Eduardo Crespo
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Hermosín
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Villalba
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo Daguer
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - José Flores
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Periañez
- Vascular & Interventional Radiology at Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Mario Martínez-Galdámez
- Department of Vascular & Interventional Radiology, Hospital Clínico Universitario de Valladolid, Spain
| | - Ernesto Santos
- Vascular & Interventional Radiology at Memorial Sloan Kettering Cancer Center, NY 10065, USA
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Glandorf J, Horstmann D, Düx DM, Wacker F, Gutberlet M, Hensen B. Free-breathing 3D Stack-of-Stars Gradient Echo Sequence in MR-guided Percutaneous Liver Interventions: Evaluation of Workflow and Diagnostic Quality. Cardiovasc Intervent Radiol 2023; 46:274-279. [PMID: 36609862 PMCID: PMC9892107 DOI: 10.1007/s00270-022-03350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate workflow efficiency and diagnostic quality of a free-breathing 3D stack-of-stars gradient echo (Radial GRE) sequence compared to a breath-hold 3D Cartesian gradient echo (Cartesian GRE) sequence for needle position control in MR-guided liver interventions. MATERIALS AND METHODS 12 MR-guided liver interventions were performed on a 1.5 T Siemens Aera and analyzed retrospectively. 15 series of the Radial GRE sequence were compared to 14 series of the Cartesian GRE sequence regarding the time interval between two consecutive live-scans for needle tracking (Tracking-2-Tracking-Time). The quality of both sequences was compared by the SNR within comparable slices in liver and tumor ROIs. The CNR was calculated by subtraction of the SNR values. Subjective image quality scores of three radiologists were assessed and inter-rater reliability was tested by Fleiss' kappa. Values are given as mean ± SD. P-values < 0.05 were considered as significant. RESULTS The median Tracking-2-Tracking-Time was significantly shorter for the Radial GRE sequence, 185 ± 42 s vs. 212 ± 142 s (p = 0.04) and the median SNR of the liver and tumor ROIs were significantly higher in the Radial GRE sequence, 249 ± 92 vs. 109 ± 67 (p = 0.03) and 165 ± 74 vs. 77 ± 43 (p = 0.02). CNR between tumor and liver ROIs showed a tendency to be higher for the Radial GRE sequence without significance, 68 ± 48 vs. 49 ± 32 (p = 0.28). Mean subjective image quality was 3.33 ± 1.08 vs. 2.62 ± 0.95 comparing Radial and Cartesian GRE with a Fleiss' kappa of 0.39 representing fair inter-rater reliability. CONCLUSION A free-breathing 3D stack-of-stars gradient echo sequence can simplify the workflow and reduce intervention time, while providing superior image quality. Under local anesthesia, it increases patient comfort and reduces potential risks for needle dislocations in MR-guided liver interventions by avoiding respiratory arrests for needle position control.
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Affiliation(s)
- Julian Glandorf
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Dominik Horstmann
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Daniel Markus Düx
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bennet Hensen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Feng X, Das SK, Feng GL, Liu Y, Liu Y, Li B, Du Y. Efficacy and Safety of MRI and CT Guided VX2 Hepatic Para-vascular Tumor Model in Rabbits. Curr Med Imaging 2023; 19:1302-1307. [PMID: 36177619 DOI: 10.2174/1573405618666220929094804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of 1.5 T MRI and CT-guided VX2 hepatic para-vascular tumor model in rabbits. MATERIALS AND METHODS Sixty New Zealand white rabbits were randomly and equally divided into MRI-guided group (n=30) and CT-guided group (n=30). Rabbit VX2 tumor fragments were implanted beside the rabbit hepatic great vessels under MRI and CT guidance in the MRI and CT group to evaluate the success rate of tumor model establishment, puncture needle display and tip peripheral vascular situation, operation time and safety. RESULTS In the MRI-guided group, 29 rabbits (29/30, 96.7%) had a successful establishment of liver tumor model, and 1 rabbit had needle metastasis. In the CT-guided group, 24 rabbits (24/30, 80%) had a successful establishment of liver tumor model, while 2 rabbits had needle metastasis, 3 rabbits had metastases in other parts of the liver, and 1 had an unknown cause of death. The differences in tumor model establishment success rate between the two groups were statistically significant (χ2 = 4.043, P < 0.05). The fold number of artifacts at T1WI was 7.26±0.38 for the 20 G coaxial puncture needle in the MRI-guided group and 2.51±0.57 for the 20 G coaxial puncture needle in the CT-guided group, and the difference was statistically significant (t=36.76, P < 0.001), but star-shaped hypodense artifacts would appear around the needle tip. The operation time was longer in the MRI-guided group than in the CT-guided group (13.32±2.45 minutes in the MRI-guided group vs. 8.42±1.46 minutes in the CTguided group; t=9.252, P < 0.001). A small number of ascites occurred in 2 patients (2/30, 6.67%) in the CT-guided group; no serious complications such as liver abscess, jaundice or diaphragmatic perforation were observed in both groups. CONCLUSION Compared with CT, MRI-guided hepatic para-vascular tumor implantation in rabbits might be a more effective modeling method. Although the needle tip pseudopacity of the puncture needle is large and the operation time is long, the incidence of complications is low.
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Affiliation(s)
- Xu Feng
- Department of Radiology, The Second People's Hospital of Yibin, Yibin, Sichuan 644000, P.R. China
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Sushant K Das
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Gui-Ling Feng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yan Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Ying Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Bing Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yong Du
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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15
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Hao MZ, Hu YB, Chen QZ, Chen ZX, Lin HL. Efficacy and safety of computed tomography-guided microwave ablation with fine needle-assisted puncture positioning technique for hepatocellular carcinoma. World J Gastrointest Oncol 2022; 14:1727-1738. [PMID: 36187402 PMCID: PMC9516651 DOI: 10.4251/wjgo.v14.i9.1727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In microwave ablation (MWA), although computed tomography (CT) scanning can overcome gas interference, it cannot achieve real-time localization. Therefore, the puncture technique is more important in CT-guided ablation.
AIM To compare the fine needle-assisted puncture (FNP) positioning technique and the conventional puncture (CP) technique for the safety and efficacy of CT-guided MWA in treating hepatocellular carcinoma (HCC).
METHODS This retrospective study included 124 patients with 166 tumor nodules from February 2018 and June 2021. Seventy patients received CT-guided MWA under the FNP technique (FNP group), and 54 patients received MWA under the CP technique (CP group). Intergroup comparisons were made regarding local tumor progression (LTP), recurrence-free survival (RFS), overall survival (OS), and complications. The influencing variables of LTP and RFS were analyzed through univariate and multivariate regressions.
RESULTS The 1-, 2-, and 3-year cumulative incidences of LTP in the FNP group were significantly lower than those in the CP group (7.4%, 12.7%, 21.3% vs 13.7%, 32.9%, 36.4%; P = 0.038). The 1-, 2-, and 3-year RFS rates in the FNP group were significantly higher than those in the CP group (80.6%, 73.3%, 64.0% vs 83.3%, 39.4%, and 32.5%, respectively; P = 0.008). The FNP technique independently predicted LTP and RFS. Minor complications in the FNP group were lower than those in the CP group (P < 0.001). The difference in median OS was insignificant between the FNP and CP groups (P = 0.229).
CONCLUSION The FNP technique used in CT-guided MWA may improve outcomes in terms of LTP, RFS, and procedure-related complications for HCC.
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Affiliation(s)
- Ming-Zhi Hao
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
- Department of Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Yu-Bin Hu
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Qi-Zhong Chen
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Zhang-Xian Chen
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Hai-Lan Lin
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
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Solbiati LA, Arai Y. Interventional oncology of liver tumors: how it all started and where are we now. Br J Radiol 2022; 95:20220434. [PMID: 35776630 PMCID: PMC9815741 DOI: 10.1259/bjr.20220434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023] Open
Abstract
Liver was the very first organ for which interventional procedures were applied for the local treatment of primary and secondary malignancies. In this paper, the history of Interventional Oncology of liver, from the very beginning to the current situation, is summarized, including both percutaneous and intravascular procedures, and together with the evolution of the techniques for image guidance. The main ongoing developments, such as new techniques, combined interventional treatments and association of local interventions with new drugs are briefly described, too.
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Affiliation(s)
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center, Tokyo, Japan
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Stefanini M, Simonetti G. Interventional Magnetic Resonance Imaging Suite (IMRIS): How to build and how to use. Radiol Med 2022; 127:1063-1067. [DOI: 10.1007/s11547-022-01537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/18/2022] [Indexed: 01/10/2025]
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MR-guided microwave ablation of hepatocellular carcinoma (HCC): is general anesthesia more effective than local anesthesia? BMC Cancer 2021; 21:562. [PMID: 34001036 PMCID: PMC8130145 DOI: 10.1186/s12885-021-08298-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background Percutaneous magnetic resonance-guided (MR-guided) MWA procedures have traditionally been performed under local anesthesia (LA) and sedation. However, pain control is often difficult to manage, especially in some cases when the tumor is large or in a specific location, such as near the abdominal wall or close to the hepatic dome. This study retrospectively compared the results of general anesthesia (GA) and local anesthesia (LA) for MR-guided microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC ≤ 5.0 cm) to investigate whether different anesthesia methods lead to different clinical outcomes. Methods The results of the analysis include procedure-related complications, imaging response, and the time to complete two sets of procedures. According to the type of anesthesia, the Kaplan-Meier method was used to compare the local tumor progression (LTP) of the two groups who underwent MR-guided MWA. Results All patients achieved technical success. The mean ablation duration of each patient in the GA group and LA group was remarkably different (P = 0.012). Both groups had no difference in complications or LTP (both P > 0.05). Notably, the tumor location (challenging locations) and the number of lesions (2–3 lesions) could be the main factors affecting LTP (p = 0.000, p = 0.015). Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) was not associated with longer LTP (P = 0.237), while tumor location (challenging locations) and the number of lesions (2–3 lesions) were both related to shorter LTP (P = 0.000, P = 0.020, respectively). Additionally, multivariate Cox regression further revealed that the tumor location (regular locations) and the number of lesions (single) could independently predict better LTP (P = 0.000, P = 0.005, respectively). Conclusions No correlation was observed between GA and LA for LTP after MR-guided MWA. However, tumors in challenging locations and the number of lesions (2–3 lesions) appear to be the main factors affecting LTP.
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