Application Of UC-CT/MRI Fusion Imaging In Ablation Therapy For Hepatic Carcinoma

Objective The objective of our study was to assess whether fusion imaging of conventional ultrasound (US) and liver computed tomography (CT) or magnetic resonance imaging(MRI) can enhance the detectability of hepatic carcinomas and is safety feasibility of guidance for ablation of hepatic carcinomas not visible on ultrasound.Methods In this prospective study,49 patients with 65 hepatic carcinomas planned to undergo ablation were recruited in the research, all of them were display clearly on CT/MRI,21(32.3%) of them were not visible on conventional US. Planning ultrasound for percutaneous ablation was performed using conventional US first and then using fusion imaging later during the same session, the successful fusion rate was calculated. If fusion fails, this will be removed from the case. After the success of the fusion, we evaluated how many lesions initially not visible on conventional US could be visualized after applying the fusion imaging technique, the false-positive lesion of conventional US was also assessed with the results of fusion imaging used as a reference standard. True-positive detection rates on conventional US and fusion imaging we are compared by Fisher’s Exact Test. Lesions visible on conventional US were ablated under the guidance of the conventional US. Lesions not visible on conventional US were ablated under the guidance of the fusion imaging technique. Complications and death were observed during and after ablation; all the patients were performed contrast enhanced US (CEUS) examination 24 hour after ablation to check whether the lesion had been residual, if residual the lesion was ablation again instantly; all the patients received contrast-enhanced CT or MRI and serum alpha-fetoprotein (AFP) test one month after ablation to check whether the lesion had been completely ablated.Results The successful rate of image fusion was 97.0%(63/65),2 patients with a single nodular lesion which visible on conventional US failed to fuse image. The successful rate of image fusion is 97.0%(63/65).In the successful fusion of lesions, out of 21 initially invisible lesions on conventional US,11 (52.4%) became visible after image fusion, out of 42 initially visible lesions on conventional US, there was no false-positive lesion.The true-positive detection rate on conventional US was 66.7%(42/63), whereas it was increased to 84.1% (53/63)after image fusion, respectivery(P=0.000003). Complete ablations were achieved in 97.6%(41/42)of distinctly visualized lesions and in 100%(21/21)of not visualized lesions on conventional US. No severe complications and death occurred.Conclusion Fusion imaging of US-CT/MRI can improve the detectability of hepatic carcinoma lesions. It can be applied in ablation for the treatment of hepatic carcinoma not visible on US. It is a safe and feasible supplementary for ablation.