title: Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations.
abstract: Radiofrequency ablation (RFA) is an effective and real-time targeting modality for small hepatocellular carcinomas (HCCs). However, mistargeting may occur when the target tumor is confused with cirrhotic nodules or because of the poor conspicuity of the index tumor under ultrasonography (US). Real-time virtual sonography (RVS) can provide the same reconstruction computed tomography images as US images. The aim of this study is to investigate the usefulness of RVS-assisted RFA for HCCs that are inconspicuous or conspicuous under US. A total of 21 patients with 28 HCC tumors-divided into US inconspicuous and high-risk subgroup (3 tumors in 3 patients), US inconspicuous and nonhigh-risk subgroup (5 tumors in 4 patients), US conspicuous and high-risk subgroup (16 tumors in 14 patients), and US conspicuous and nonhigh-risk subgroup (4 tumors in 3 patients)-underwent RVS-assisted RFA between May 2012 and June 2014 in our institution. The mean diameter of the nodules was 2.0 ± 1.1 cm. The results showed that the complete ablation rate is 87.5% (7/8) in the US undetectable group and 75% (15/20) in the US detectable group. A comparison between six tumors with incomplete ablation and 22 tumors with complete ablation showed higher alpha-fetoprotein level (mean, 1912 ng/mL vs. 112 ng/mL) and larger tumor size (mean diameter, 26 mm vs. 16 mm) in the incomplete ablation nodules (both p < 0.05). In conclusion, RVS-assisted RFA is useful for tumors that are difficult to detect under conventional US and may also be useful for tumors in high-risk locations because it may prevent complication induced by mistargeting.
authors.affiliation: Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Cheng-Han
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkuo Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkuo Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chen-Chun
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkuo Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Wei
authors.initials: W
authors.lastname: Teng
authors.affiliation: Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkuo Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: lsmpaicyto@gmail.com.
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Lin
authors.affiliation: Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Cheng-Tang
authors.initials: CT
authors.lastname: Chiu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation; D003199:Computer Systems; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014465:Ultrasonics; D014463:Ultrasonography
keywords: Hepatocellular carcinoma; High-risk location; Radiofrequency ablation; Real-time virtual sonography; Ultrasonography inconspicuous tumor