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Usefulness of Three-dimensional Sonography in Procedures of Ablation for Liver Cancers

Initial Experience

Departments of Medical Ultrasonics (H.-X.X., X.-Y.X., Z.-F.X., G.-J.L.) and Hepatobiliary Surgery (X.-Y.Y., M.-D.L.), The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China.

Address correspondence and reprint requests to Ming-De Lu, MD, DMSc, Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, People’s Republic of China. E-mail: lumd{at}21cn.com.

Objective. To investigate the usefulness of three-dimensional sonography in procedures of ablation for liver cancers. Methods. Two- and three-dimensional sonography were used in guiding 18 chemical ablation procedures (7 with boiling carboplatin ablation and 11 with ethanol ablation) and 21 radio frequency ablation procedures for treatment of liver cancers. The applicator conspicuity depicted by the 2 imaging modalities, the confidence level of the operator in determining the position relationship between the applicator and the tumor using the 2 imaging modalities, and the alteration of ablation procedures were evaluated. Results. Three-dimensional sonography was better than two-dimensional sonography in delineation of multitined, expandable electrode tips in radio frequency ablation procedures, whereas the 2 modalities were equal in depicting percutaneous transhepatic cholangiography needle tips in chemical ablation procedures. Three-dimensional sonography significantly enhanced the confidence level in defining the spatial relationship between applicator and tumor in comparison with two-dimensional sonography (P < .01). Suboptimal applicator placement was detected in 6 (15%) of 39 ablation procedures on three-dimensional sonography: 3 chemical ablation procedures and 3 radio frequency ablation procedures. Applicator adjustment was required in 3 chemical ablation procedures. In 15 (38%) of 39 procedures, three-dimensional sonography allowed better visualization of the position relationship between the applicator and adjacent critical structures. Conclusions. Three-dimensional sonography was useful in delineation of expandable radio frequency electrodes, improvement of operator confidence level, determination of applicator placement, and visualization of the position relationship between the applicator and adjacent critical structures during procedures of liver cancer ablation under image guidance.

Key Words: chemical ablation • liver • radio frequency ablation • three-dimensional sonography • tumor • two-dimensional sonography

Abbreviations: CT, computed tomography • HCC, hepatocellular carcinoma • PTC, percutaneous transhepatic cholangiography • RF, radio frequency • 3D, three-dimensional • 2D, two-dimensional

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