Available online 28 July 2023

Ablation margin quantification is a promising tool to define technical success of thermal ablation of liver tumors, but no widely validated or standardized workflow is currently available.

A standardized scanning protocol and workflow for ablation margin quantification was developed, yielding high inter-observer agreement for tumor segmentation and ablation margin quantification.

Standardized quantification of the minimal ablation margin helps identify patients at risk of developing local tumor progression.

The primary objective of this study was to determine the feasibility of ablation margin quantification using a standardized scanning protocol during thermal ablation (TA) of hepatocellular carcinoma (HCC), and a rigid registration algorithm. Secondary objectives were to determine the inter- and intra-observer variability of tumor segmentation and quantification of the minimal ablation margin (MAM).

Twenty patients who underwent thermal ablation for HCC were included. There were thirteen men and seven women with a mean age of 67.1 ± 10.8 (standard deviation [SD]) years (age range: 49.1–81.1 years). All patients underwent contrast-enhanced computed tomography examination under general anesthesia directly before and after TA, with preoxygenated breath hold. Contrast-enhanced computed tomography examinations were analyzed by radiologists using rigid registration software. Registration was deemed feasible when accurate rigid co-registration could be obtained. Inter- and intra-observer rates of tumor segmentation and MAM quantification were calculated. MAM values were correlated with local tumor progression (LTP) after one year of follow-up.

Co-registration of pre- and post-ablation images was feasible in 16 out of 20 patients (80%) and 26 out of 31 tumors (84%). Mean Dice similarity coefficient for inter- and intra-observer variability of tumor segmentation were 0.815 and 0.830, respectively. Mean MAM was 0.63 ± 3.589 (SD) mm (range: -6.26–6.65 mm). LTP occurred in four out of 20 patients (20%). The mean MAM value for patients who developed LTP was -4.00 mm, as compared to 0.727 mm for patients who did not develop LTP.

Ablation margin quantification is feasible using a standardized contrast-enhanced computed tomography protocol. Interpretation of MAM was hampered by the occurrence of tissue shrinkage during TA. Further validation in a larger cohort should lead to meaningful cut-off values for technical success of TA.

Ablation margin

Computed tomography

Thermal ablation

Hepatocellular carcinoma

Image processing

Barcelona Clinic Liver Cancer

Contrast-enhanced computed tomography

Common terminology criteria for adverse events

European Association for the Study of the Liver

Estimated glomerular filtration rate

Hepatocellular carcinoma

Intraclass correlation coefficient

Liver Imaging Reporting and Data System

Local tumor progression

Minimal ablation margin

Magnetic resonance imaging

Radiofrequency ablation

Volumetric Dice similarity coefficient

© 2023 The Author(s). Published by Elsevier Masson SAS on behalf of Société française de radiologie.