CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S22
DOI: 10.1055/s-0041-1730703

Reduce Confusion! Using Combined Contrast Ultrasound and Fusion Technique During Radiofrequency Ablation of Liver Space-occupying Lesions

Asif Abalal Momin
Prince Aly Khan Hospital, Mumbai, India
Shenaz A Momin
B. Y. L. Nair Hospital, Mumbai, India
› Author Affiliations

Background: Purpose of this prospective study conducted in small oncology hospital is to highlight using either contrast-enhanced ultrasound (CEUS) with or without computed tomography (CT) fusion imaging to treat liver lesions well seen on positron emission tomography (PET)/CT or magnetic resonance imaging (MRI), but inconspicuous on ultrasound during radiofrequency and alcohol ablation of liver space-occupying lesions. Methods: Nine consecutive liver lesions; of size ranging from 1.2 to 4.7 cm; four metastatic and five primary HCC were subjected for US-guided radiofrequency or alcohol ablation earlier detected on either PET/CT or MRI. Using additional tools of CEUS or fusion imaging the pre, intra, and immediate post-RFA response was correctly judged; later confirmed on CT or PET study. In two cases, additional alcohol ablation was used to avoid heat sink effect due to main portal vein proximity and difficult RFA approach. Results: Except in two cases, all other lesions were considered as completely ablated based on pre- and post-CEUS enhancement pattern conducted before the patient was allowed to go home. One metastatic lesion showed definite peripheral enhancement and was reablated in additional sitting within next 2 h. In other case, CEUS showed minimal doubtful enhancement which on follow-up PET imaging was reported as post-RFA inflammatory response showing reducing standardized uptake values on repeat PET with absent enhancement on CEUS after 3 months. Conclusion: US guidance is at times handicapped by lack of confident identification of a lesion during ablation or by deciding the end-point of ablation merely on B-mode US due to difficulty in carrying out of immediate postablation PET/CT. This confusion can be minimized using real-time contrast US and fusion imaging to achieve the end-point.

Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India