Kato Keizo, Abe Hiroshi, Ika Makiko, Sakamoto Yuhi, Takeuchi Mizuki, Komazaki Shingo, Takeda Shinichiro, Ito Sadahiro, Shimizu Shohei, Matsuo Ryota
Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Matsudo, Japan.
Division of General Medicine, Shinmatsudo Central General Hospital, Matsudo, Japan.
Oncology. 2025 May 26:1-13. doi: 10.1159/000546427.
Radiofrequency ablation (RFA) generally involves the insertion of a radiofrequency electrode into the hepatocellular carcinoma (HCC) nodule under ultrasonography (US) guidance. However, the procedure is often not feasible for patients whose HCC is undetectable on conventional US. Advances in imaging technology, such as fusion imaging (FI) and cone-beam computed tomography (CBCT), may enhance treatment precision and efficacy for these challenging cases. This study assessed the efficacy of RFA guided by FI and CBCT in managing HCC poorly visualized on US.
HCC nodules were classified into GOOD (clearly delineated), POOR (poorly delineated), and NONE (undetectable) based on US visualization. All nodules underwent RFA guided by FI and CBCT either in combination with transcatheter arterial chemoembolization (TACE) or without TACE. The technical success rate and local tumor progression post-RFA were evaluated using dynamic contrast-enhanced imaging. Between-group differences were analyzed retrospectively.
A total of 420 patients with 595 HCC nodules were enrolled. Complete ablation rates were 91.4%, 94.9%, and 86.2% in the GOOD, POOR, and NONE groups, respectively. For nodules with over 50% lipiodol accumulation, the complete ablation rates were 91.5%, 96.5%, and 88.8%; for those with less than 50% lipiodol accumulation, they were 95.5%, 100%, and 62.5%; and for those without lipiodol accumulation, they were 89.5%, 77.8%, and 82.4% in the GOOD, POOR, and NONE groups, respectively. Significant factors associated with complete ablation included larger nodule size and lipiodol accumulation. Cumulative local tumor progression rates at 1 year were 4.5%, 0%, and 3.8%, with no significant differences among groups.
FI and CBCT guidance effectively achieve local control for HCC, including nodules poorly visualized on US, with outcomes comparable to US-visible nodules, especially for those with lipiodol accumulation.
射频消融（RFA）通常需要在超声（US）引导下将射频电极插入肝细胞癌（HCC）结节内。然而，对于常规超声检查无法检测到HCC的患者，该操作往往不可行。融合成像（FI）和锥形束计算机断层扫描（CBCT）等成像技术的进步，可能会提高这些具有挑战性病例的治疗精度和疗效。本研究评估了FI和CBCT引导下的RFA治疗超声下难以显示的HCC的疗效。
根据超声显示情况，将HCC结节分为清晰（清晰界定）、模糊（界定不清）和无（无法检测到）三类。所有结节均在FI和CBCT引导下接受RFA治疗，可联合经动脉化疗栓塞术（TACE）或不联合TACE。使用动态对比增强成像评估技术成功率和RFA术后局部肿瘤进展情况。对组间差异进行回顾性分析。
共纳入420例患有595个HCC结节的患者。清晰组、模糊组和无组的完全消融率分别为91.4%、94.9%和86.2%。对于碘油积聚超过50%的结节，完全消融率分别为91.5%、96.5%和88.8%；对于碘油积聚少于50%的结节，分别为95.5%、100%和62.5%；对于无碘油积聚的结节，清晰组、模糊组和无组分别为89.5%、77.8%和82.4%。与完全消融相关的显著因素包括较大的结节大小和碘油积聚。1年时的累积局部肿瘤进展率分别为4.5%、0%和3.8%，组间无显著差异。
FI和CBCT引导可有效实现HCC的局部控制，包括超声下难以显示的结节，其结果与超声可见结节相当，尤其是对于有碘油积聚的结节。
