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. 2025 Jul 10.
doi: 10.1007/s00270-025-04111-w. Online ahead of print.

CT-guided Thermal Ablation of Liver Tumors Using Intraprocedural CT-CT Fusion for Applicator Position and Ablation Completeness Assessment: a Single-Center Comparative Analysis

Koen H M Verdonschot  1 , Sjoerd F M Jenniskens  2 , Peter B van den Boezem  3 , Eric T T L Tjwa  4 , Johannes H W de Wilt  3 , Jurgen J Fütterer  2 , Martijn W J Stommel  3 , Christiaan G Overduin  2
Affiliations

CT-guided Thermal Ablation of Liver Tumors Using Intraprocedural CT-CT Fusion for Applicator Position and Ablation Completeness Assessment: a Single-Center Comparative Analysis

Koen H M Verdonschot et al. Cardiovasc Intervent Radiol. .

Abstract

Purpose: To compare outcomes of CT-guided thermal ablation of liver tumors with versus without use of intraprocedural CT-CT image fusion.

Materials and methods: This retrospective cohort study included all patients treated with CT-guided percutaneous thermal ablation for hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) between January 2017 and April 2023 at our institution. From October 2019, intraprocedural CT-CT deformable image fusion (IF) using dedicated software (Vitrea, Canon Medical) was introduced to the thermal ablation procedure workflow to visually assess applicator placement before ablation and ablation completeness posttreatment. Local tumor progression (LTP) was assessed on follow-up imaging. LTP-free survival (LTPFS) between groups with and without IF was estimated with the Kaplan-Meier method and risk factors for LTP were identified with Cox regression analysis.

Results: A total of 113 patients treated in 139 sessions were included; 66 treatments for 86 tumors without use of IF (56 HCC; 30 CRLM) and 73 treatments for 92 tumors with use of IF (46 HCC; 46 CRLM). Two-year LTPFS was significantly improved with use of IF for both HCC (97% vs. 74%; p = .009) and CRLM (82% vs. 56%; p = .033). On univariate regression analysis, use of IF was a predominant factor significantly associated with improved LTPFS in patients with HCC (HR: 0.21, p = .037) and CRLM (HR: 0.38, p = .042).

Conclusion: In this single-center study, the use of software-based intraprocedural CT-CT image fusion for applicator position and ablation completeness assessment was associated with improved local tumor progression-free survival after CT-guided thermal ablation of HCC and CRLM.

Keywords: Image fusion; Liver malignancies; Local tumor progression-free survival (LTPFS); Thermal ablation.

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Conflict of interest statement

Declarations. Conflict of interest: J.H.W. de Wilt received grants to his institution, not related to this research from Dutch Cancer Society, ZONMW, Roche, Medtronic. The other authors declare that they have no conflict of interest. Ethical Approval: For this type of study, formal consent is not required. Informed Consent: This study has obtained IRB approval from the local institutional review board of Radboudumc and the need for informed consent was waived. Consent for Publication: For this type of study, consent for publication is not required.

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