Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 5/2020

Open Access 01-05-2020 | Computed Tomography | Interventional

Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation

Authors: Gregor Laimer, Peter Schullian, Nikolai Jaschke, Daniel Putzer, Gernot Eberle, Amilcar Alzaga, Bruno Odisio, Reto Bale

Published in: European Radiology | Issue 5/2020

Login to get access

Abstract

Objectives

To assess the minimal ablative margin (MAM) by image fusion of intraprocedural pre- and post-ablation contrast-enhanced CT images and to evaluate if it can predict local tumor progression (LTP) independently. Furthermore, to determine a MAM with which a stereotactic radiofrequency ablation (SRFA) can be determined successful and therefore used as an intraprocedural tool to evaluate treatment success.

Methods

A total of 110 patients (20 women, 90 men; mean age 63.7 ± 10.2) with 176 hepatocellular carcinomas were assessed by retrospective analysis of prospectively collected data. The MAM was determined through image fusion of intraprocedural pre- and post-ablation images using commercially available rigid imaging registration software. LTP was assessed in contrast-enhanced CTs or MR scans at 3–6-month intervals.

Results

The MAM was the only significant independent predictor of LTP (p = 0.036). For each millimeter increase of the MAM, a 30% reduction of the relative risk for LTP was found (OR = 0.7, 95% CI 0.5–0.98, p = 0.036). No LTP was detected in lesions with a MAM > 5 mm. The overall LTP rate was 9 of 110 (8.2%) on a patient level and 10 of 173 (5.7%) on a lesion level. The median MAM was 3.4 (1.7–6.9) mm. The mean overall follow-up period was 26.0 ± 10.3 months.

Conclusions

An immediate assessment of the minimal ablative margin (MAM) can be used as an intraprocedural tool to evaluate the treatment success in patients treated with stereotactic RFA. A MAM > 5 mm has to be achieved to consider an ablation as successful.

Key Points

• An intraoperatively measured minimal ablative margin (MAM) > 5 mm correlates with complete remission.
• MAM is the only significant independent predictor of LTP (OR = 0.7, 95% CI 0.5–0.98, p = 0.036) after stereotactic RFA of hepatocellular carcinoma.
• Image fusion using commercially available rigid imaging registration software is possible, even though considerably complex. Therefore, improved (semi-)automatic fusion software is highly desirable.
Literature
1.
Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255CrossRef
2.
3.
Facciorusso A, Di Maso M, Muscatiello N (2016) Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia 32:339–344CrossRef
4.
Langenbach MC (2019) RFA vs resection of HCC: exploring the past to improve the future. Eur Radiol 29:2677–2678CrossRef
5.
Heimbach JK, Kulik LM, Finn RS et al (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67:358–380CrossRef
6.
Kasugai H, Osaki Y, Oka H, Kudo M, Seki T, Osaka Liver Cancer Study Group (2007) Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3,891 ablations in 2,614 patients. Oncology 72(Suppl 1):72–75
7.
Livraghi T, Meloni F, Di Stasi M et al (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47:82–89CrossRef
8.
N'Kontchou G, Mahamoudi A, Aout M et al (2009) Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology 50:1475–1483CrossRef
9.
Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226:441–451CrossRef
10.
Uhlig J, Sellers CM, Stein SM, Kim HS (2019) Radiofrequency ablation versus surgical resection of hepatocellular carcinoma: contemporary treatment trends and outcomes from the United States National Cancer Database. Eur Radiol 29:2679–2689CrossRef
11.
Cha DI, Kang TW, Song KD et al (2019) Radiofrequency ablation for subcardiac hepatocellular carcinoma: therapeutic outcomes and risk factors for technical failure. Eur Radiol 29:2706–2715CrossRef
12.
Bale R, Widmann G, Haidu M (2011) Stereotactic radiofrequency ablation. Cardiovasc Intervent Radiol 34:852–856CrossRef
13.
Bale R, Widmann G, Stoffner DI (2010) Stereotaxy: breaking the limits of current radiofrequency ablation techniques. Eur J Radiol 75:32–36CrossRef
14.
Haidu M, Dobrozemsky G, Schullian P et al (2012) Stereotactic radiofrequency ablation of unresectable intrahepatic cholangiocarcinomas: a retrospective study. Cardiovasc Intervent Radiol 35:1074–1082CrossRef
15.
Bale R, Schullian P, Eberle G et al (2019) Stereotactic radiofrequency ablation of hepatocellular carcinoma: a histopathological study in explanted livers. Hepatology 70(3):840–850
16.
Bale R, Schullian P, Schmuth M, Widmann G, Jaschke W, Weinlich G (2016) Stereotactic radiofrequency ablation for metastatic melanoma to the liver. Cardiovasc Intervent Radiol 39:1128–1135CrossRef
17.
Bale R, Richter M, Dünser M, Levy E, Buchberger W, Schullian P (2018) Stereotactic radiofrequency ablation for breast cancer liver metastases. J Vasc Interv Radiol 29:262–267CrossRef
18.
Bale R, Freund M, Bodner G, Kovacs P, Jaschke W (2002) Precise computer-assisted liver tumor puncture for biopsy and thermal ablation. 88th Scientific Assembly and Annual Meeting of the Radiological-Society-of-North-AmericaRadiology 225(S):242
19.
Bale R, Widmann G, Schullian P et al (2012) Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases. Eur Radiol 22:930–937CrossRef
20.
Bale R, Widmann G (2007) Navigated CT-guided interventions. Minim Invasive Ther Allied Technol 16:196–204CrossRef
21.
Lafaro K, Grandhi MS, Herman JM, Pawlik TM (2016) The importance of surgical margins in primary malignancies of the liver. J Surg Oncol 113:296–303CrossRef
22.
Dong S, Wang Z, Wu L, Qu Z (2016) Effect of surgical margin in R0 hepatectomy on recurrence-free survival of patients with solitary hepatocellular carcinomas without macroscopic vascular invasion. Medicine (Baltimore) 95:e5251CrossRef
23.
Shi M, Guo RP, Lin XJ et al (2007) Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg 245:36–43CrossRef
24.
Motoyama T, Ogasawara S, Chiba T et al (2014) Coronal reformatted CT images contribute to the precise evaluation of the radiofrequency ablative margin for hepatocellular carcinoma. Abdom Imaging 39:262–268CrossRef
25.
Nakazawa T, Kokubu S, Shibuya A et al (2007) Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol 188:480–488CrossRef
26.
Hocquelet A, Trillaud H, Frulio N et al (2016) Three-dimensional measurement of hepatocellular carcinoma ablation zones and margins for predicting local tumor progression. J Vasc Interv Radiol 27:1038–45.e2CrossRef
27.
European Association for the Study of the Liver (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236
28.
Nishikawa H, Inuzuka T, Takeda H et al (2011) Percutaneous radiofrequency ablation therapy for hepatocellular carcinoma: a proposed new grading system for the ablative margin and prediction of local tumor progression and its validation. J Gastroenterol 46:1418–1426CrossRef
29.
Jiang C, Liu B, Chen S, Peng Z, Xie X, Kuang M (2018) Safety margin after radiofrequency ablation of hepatocellular carcinoma: precise assessment with a three-dimensional reconstruction technique using CT imaging. Int J Hyperthermia 34:1135–1141CrossRef
30.
Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY (2010) The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol 195:758–765CrossRef
31.
Tomonari A, Tsuji K, Yamazaki H et al (2013) Feasibility of fused imaging for the evaluation of radiofrequency ablative margin for hepatocellular carcinoma. Hepatol Res 43:728–734CrossRef
32.
Makino Y, Imai Y, Igura T et al (2013) Utility of computed tomography fusion imaging for the evaluation of the ablative margin of radiofrequency ablation for hepatocellular carcinoma and the correlation to local tumor progression. Hepatol Res 43:950–958CrossRef
33.
Solbiati M, Muglia R, Goldberg SN et al (2019) A novel software platform for volumetric assessment of ablation completeness. Int J Hyperthermia 36:337–343CrossRef
34.
Nishikawa H, Osaki Y, Iguchi E et al (2013) Radiofrequency ablation for hepatocellular carcinoma: the relationship between a new grading system for the ablative margin and clinical outcomes. J Gastroenterol 48:951–965CrossRef
35.
Putzer D, Schullian P, Braunwarth E et al (2018) Integrating interventional oncology in the treatment of liver tumors. Eur Surg 50:117–124CrossRef
Metadata
Title
Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation
Authors
Gregor Laimer
Peter Schullian
Nikolai Jaschke
Daniel Putzer
Gernot Eberle
Amilcar Alzaga
Bruno Odisio
Reto Bale
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06609-7

Other articles of this Issue 5/2020

European Radiology 5/2020 Go to the issue

Gastrointestinal

Value of combined multiparametric MRI and FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation

Imaging Informatics and Artificial Intelligence

Marginal radiomics features as imaging biomarkers for pathological invasion in lung adenocarcinoma

Imaging Informatics and Artificial Intelligence

Differentiation of supratentorial single brain metastasis and glioblastoma by using peri-enhancing oedema region–derived radiomic features and multiple classifiers

Magnetic Resonance

The prognostic value of late gadolinium enhancement in myocarditis and clinically suspected myocarditis: systematic review and meta-analysis

Chest

Airway tapering: an objective image biomarker for bronchiectasis

Oncology

Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients—a bi-institutional comprehensive cancer center review