A Feasibility Study: Evaluation of Radiofrequency Ablation Therapy to Hepatocellular Carcinoma Using Image Registration of Preoperative and Postoperative CT

Rationale and Objectives The therapeutic response to radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) often is evaluated by comparing pre- and post-RFA computed tomography (CT). However, judgment about whether an ablative margin, ie, 5–10 mm of normal hepatic tissue, is ensured sometimes is difficult. The aim of this study is to assess the feasibility of fusion images of pre- and post-RFA CT. Materials and Methods HCCs (n = 20) sized 13 ± 5 mm (range, 4–23 mm) were included. For pre-RFA CT, the arterial phase of intravenous dynamic CT (n = 17), CT arterioportography (n = 2), and CT hepatic arteriography (n = 1) was used. Using automatic image registration software (n = 20) and a manual segmentation technique (n = 4), fusion images were created in combination with post-RFA CT (equilibrium phase of intravenous CT). Results Automatic image registration and manual segmentation technique took approximately 2–3 and 5 minutes, respectively. Total time required for the creation of fusion images was less than 10 minutes in all cases. Fusion images enabled easier understanding of the relationship between the tumor and ablation zone, helping judge whether an ablative margin was ensured. Conclusion Fusion of pre- and post-RFA CT images is considered a feasible tool in the evaluation of RFA therapy for HCC.