Department of Ultrasound, Laizhou People's Hospital, Laizhou City, PR China.
Department of Medical Imaging, Laizhou People's Hospital, Laizhou City, PR China.
Acta Radiol. 2023 Sep;64(9):2506-2517. doi: 10.1177/02841851231187638. Epub 2023 Jul 28.
Ultrasound-guided percutaneous thermal ablation has become an alternative treatment for small hepatocellular carcinoma (HCC). Recent evidence suggests that fusion imaging (FI) may improve the feasibility and efficacy of thermal ablation for HCC, while the clinical evidence remains limited.
To compare FI versus ultrasound-guided thermal ablation for HCC.
Relevant cohort or randomized controlled trials were found by searching Medline, Web of Science, Cochrane Library, and Embase. The pooling of results was performed using a random-effects model incorporating heterogeneity.
In this meta-analysis, 15 studies involving 1472 patients (1831 tumors) for FI-guided ablation and 1380 patients (1864 tumors) for ultrasound-guided ablation were included. Pooled results showed that compared to conventional HCC ablation guided by ultrasound, the FI-guided procedure showed a similar technique efficacy rate (risk ratio [RR] = 1.01, 95% confidence interval [CI] = 1.00-1.02, = 0.25; = 30%). However, FI-guided tumor ablation was associated with a lower incidence of overall complications (RR = 0.70, 95% CI = 0.50-0.97, = 0.03; = 0%). Moreover, patients receiving FI-guided tumor ablation had a lower risk of local tumor progression during follow-up than those with ultrasound-guided ablation (RR = 0.61, 95% CI = 0.47-0.78, < 0.001; = 13%). Subgroup analysis according to FI strategy, imaging techniques in controls, and tumor diameter showed consistent results (p for subgroup difference all >0.05).
FI-guided thermal ablation may be more effective and safer than ultrasound-guided ablation for patients with HCC.
超声引导下经皮热消融已成为小肝癌（HCC）的一种替代治疗方法。最近的证据表明，融合成像（FI）可能提高 HCC 热消融的可行性和疗效，但其临床证据仍然有限。
比较 FI 与超声引导下热消融治疗 HCC。
通过检索 Medline、Web of Science、Cochrane 图书馆和 Embase 查找相关的队列或随机对照试验。使用包含异质性的随机效应模型进行结果汇总。
在这项荟萃分析中，纳入了 15 项研究，共涉及 FI 引导消融的 1472 例患者（1831 个肿瘤）和超声引导消融的 1380 例患者（1864 个肿瘤）。汇总结果显示，与常规超声引导 HCC 消融相比，FI 引导的手术技术有效率相似（风险比 [RR] = 1.01，95%置信区间 [CI] = 1.00-1.02， = 0.25； = 30%）。然而，FI 引导的肿瘤消融与总并发症发生率较低相关（RR = 0.70，95% CI = 0.50-0.97， = 0.03； = 0%）。此外，与超声引导消融相比，接受 FI 引导肿瘤消融的患者在随访期间局部肿瘤进展的风险较低（RR = 0.61，95% CI = 0.47-0.78， < 0.001； = 13%）。根据 FI 策略、对照组中的成像技术和肿瘤直径进行的亚组分析得出了一致的结果（亚组差异的 p 值均>0.05）。
FI 引导的热消融可能比超声引导的消融对 HCC 患者更有效和更安全。
