title: Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.
abstract: BACKGROUND
  To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation.
  
  
  METHODS
  Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.
  
  
  RESULTS
  The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043).
  
  
  CONCLUSIONS
  CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.
authors.forename: Kai
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.
authors.forename: Zhong-Zhen
authors.initials: ZZ
authors.lastname: Su
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.
authors.forename: Er-Jiao
authors.initials: EJ
authors.lastname: Xu
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.
authors.forename: Jin-Xiu
authors.initials: JX
authors.lastname: Ju
authors.affiliation: Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.
authors.forename: Xiao-Chun
authors.initials: XC
authors.lastname: Meng
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China. zhengrongqin345@sina.com.
authors.forename: Rong-Qin
authors.initials: RQ
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: Ablative margin; Contrast-enhanced ultrasound; Hepatocellular carcinoma; Image fusion; Intraoperative