Background Real-time virtual navigation system (RVS) combined with contrast-enhanced ultrasound is a new method that combines the advantages of real-time dynamic imaging of ultrasound and accurate positioning of CT/MRI, which makes it plays an important role in the local ablation therapies.
Objective To explore the value of using real-time virtual navigation system combined with contrast-enhanced ultrasound in percutaneous ablation for hepatic tumors located in high-risk or undetectable areas by conventional B-mode ultrasound.
Methods Clinical data about 131 patients with hepatic tumors diagnosed by pathology or imaging from January 2017 to December 2018 in the Fifth Medical Center of Chinese PLA General Hospital were retrospectively analyzed, and contrast-enhanced ultrasound and enhanced CT/MRI were performed on 157 lesions. The lesions that were located in high-risk areas at hepatic dome, near the macrovascular of liver, near the heart, or near the gastrointestinal tract and invisible in conventional B-mode ultrasound (44 cases with 53 lesions) were included in the RVS-CEUS guided group, and lesions in non-high-risk areas and invisible in conventional B-mode ultrasound (36 cases with 44 lesions) were included in the CT guided group, and the high-risk sites and conventional B-mode ultrasound visible lesions (51 cases with 60 lesions) were included in the US guided group.
Results The success rate of CEUS and CT/MRI image fusion of 53 lesions in 44 patients in the RVS-CEUS guided group was 100%. The complete response rate of the RVS-CEUS guided group was significantly higher than that of the other two groups (96.23% vs 81.82% and 81.67%, P＜0.05), while the incomplete response rate was lower than that of the other two groups (3.77% vs 18.33% and 18.18%, P＜0.05). After 3 months of follow-up, there was no significant difference in local tumor progression rate among the three groups after treatment (28.30% vs 36.67% vs 38.64%, P=0.507). No severe complications or treatment-related deaths occurred in 131 patients treated with ablation in this study.
Conclusion Real-time virtual navigation system improves the accuracy and efficiency of tumor targeted ablation, which has exact clinical application value for hepatic tumor in the relatively taboo parts of previous thermal ablation, broadens the indications of percutaneous thermal ablation treatment, improves the detection rate of lesions in difficult imaging and high-risk location and the accuracy and safety of hepatic tumor in difficult parts of percutaneous thermal ablation.
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