title: Real-time US-CT/MRI image fusion for guidance of thermal ablation of liver tumors undetectable with US: results in 295 cases.
abstract: OBJECTIVE
  This study was designed to assess feasibility of US-CT/MRI fusion-guided ablation in liver tumors undetectable with US.
  
  
  METHODS
  From 2002 to 2012, 295 tumors (162 HCCs and 133 metastases; mean diameter 1.3 ± 0.6 cm, range 0.5-2.5 cm) detectable on contrast-enhanced CT/MRI, but completely undetectable with unenhanced US and either totally undetectable or incompletely conspicuous with contrast-enhanced US (CEUS), were treated in 215 sessions using either internally cooled radiofrequency or microwave with standard ablation protocols, guided by an image fusion system (Virtual Navigation System, Esaote S.p.A., Genova, Italy) that combines US with CT/ MRI images. Correct targeting and successful ablation of tumor were verified after 24 hours with CT or MRI.
  
  
  RESULTS
  A total of 282 of 295 (95.6 %) tumors were correctly targeted with successful ablation achieved in 266 of 295 (90.2 %). Sixteen of 295 (5.4 %) tumors were correctly targeted, but unsuccessfully ablated, and 13 of 295 (4.4 %) tumors were unsuccessfully ablated due to inaccurate targeting. There were no perioperative deaths. Major complications were observed in 2 of the 215 treatments sessions (0.9 %).
  
  
  CONCLUSIONS
  Real-time virtual navigation system with US-CT/MRI fusion imaging is precise for targeting and achieving successful ablation of target tumors undetectable with US alone. Therefore, a larger population could benefit from ultrasound guided ablation procedures.
authors.affiliation: Unit of Interventional Oncologic Radiology, Department of Diagnostic Imaging, Azienda Ospedaliera Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Varese, Italy, vanni.mauri@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mauri
authors.forename: Luca
authors.initials: L
authors.lastname: Cova
authors.forename: Stefano
authors.initials: S
authors.lastname: De Beni
authors.forename: Tiziana
authors.initials: T
authors.lastname: Ierace
authors.forename: Tania
authors.initials: T
authors.lastname: Tondolo
authors.forename: Anna
authors.initials: A
authors.lastname: Cerri
authors.forename: S Nahum
authors.initials: SN
authors.lastname: Goldberg
authors.forename: Luigi
authors.initials: L
authors.lastname: Solbiati
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D015641:Radiography, Interventional; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA