Clinical Impact of a Protocol Involving Cone-Beam CT (CBCT), Fusion Imaging and Ablation Volume Prediction in Percutaneous Image-Guided Microwave Ablation in Patients with Hepatocellular Carcinoma Unsuitable for Standard Ultrasound (US) Guidance

Pierpaolo Biondetti; Anna Maria Ierardi; Elena Casiraghi; Alessandro Caruso; Pasquale Grillo; Serena Carriero; Carolina Lanza; Salvatore Alessio Angileri; Angelo Sangiovanni; Massimo Iavarone; Giuseppe Guzzardi; Gianpaolo Carrafiello

doi:10.3390/jcm12247598

Clinical Impact of a Protocol Involving Cone-Beam CT (CBCT), Fusion Imaging and Ablation Volume Prediction in Percutaneous Image-Guided Microwave Ablation in Patients with Hepatocellular Carcinoma Unsuitable for Standard Ultrasound (US) Guidance

J Clin Med. 2023 Dec 9;12(24):7598. doi: 10.3390/jcm12247598.

Authors

Affiliations

¹ Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy.
² Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.
³ AnacletoLab, Computer Science Department "Giovanni degli Antoni"-DI, Università degli Studi di Milano, 20133 Milan, Italy.
⁴ CINI National Laboratory in Artificial Intelligence and Intelligent Systems, 00185 Rome, Italy.
⁵ Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy.
⁶ Department of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.
⁷ Department of Radiology, Unit of Interventional Radiology, Ospedale Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.

Abstract

Purpose: to evaluate the clinical impact of a protocol for the image-guided percutaneous microwave ablation (MWA) of hepatocellular carcinoma (HCC) that includes cone-beam computed tomography (CBCT), fusion imaging and ablation volume prediction in patients with hepatocellular carcinoma unsuitable for standard ultrasound (US) guidance.

Materials and methods: this study included all patients with HCC treated with MWA between January 2021 and June 2022 in a tertiary institution. Patients were divided into two groups: Group A, treated following the protocol, and Group B, treated with standard ultrasound (US) guidance. Follow-up images were reviewed to assess residual disease (RD), local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Ablation response at 1 month was also evaluated according to mRECIST. Baseline variables and outcomes were compared between the groups. For 1-month RD, propensity score weighting (PSW) was performed.

Results: 80 consecutive patients with 101 HCCs treated with MWA were divided into two groups. Group A had 41 HCCs in 37 patients, and Group B had 60 HCCs in 43 patients. Among all baseline variables, the groups differed regarding their age (mean of 72 years in Group A and 64 years in Group B, respectively), new vs. residual tumor rates (48% Group A vs. 25% Group B, p < 0.05) and number of subcapsular tumors (56.7% Group B vs. 31.7% Group A, p < 0.05) and perivascular tumors (51.7% Group B vs. 17.1% Group A, p < 0.05). The protocol led to repositioning the antenna in 49% of cases. There was a significant difference in 1-month local response between the groups measured as the RD rate and mRECIST outcomes. LTP rates at 3 and 6 months, and IDR rates at 1, 3 and 6 months, showed no significant differences. Among all variables, logistic regression after PSW demonstrated a protective effect of the protocol against 1-month RD.

Conclusions: The use of CBCT, fusion imaging and ablation volume prediction during percutaneous MWA of HCCs provided a better 1-month tumor local control. Further studies with a larger population and longer follow-up are needed.

Keywords: cone-beam CT (CBCT); fusion imaging; hepatocellular carcinoma (HCC); microwave ablation.

Grants and funding

The Authors aknowledge the support of the APC fund of the University of Milan.