Marco Calandri1, Valeria Ruggeri2, Patrizia Carucci3, Stefano Mirabella4, Andrea Veltri5, Paolo Fonio2, Carlo Gazzera2. 1. Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy. marco.calandri@unito.it. 2. Department of Surgical Sciences, Radiology Institute, Città della Salute e della Scienza, Torino, University of Torino, Turin, Italy. 3. Gastro-Hepatology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy. 4. Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy. 5. Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Torino), University of Torino, Turin, Italy.
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.
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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