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Journal of Oncology
Volume 2019, Article ID 4049287, 8 pages
Research Article

Quantitative Volumetric Assessment of Ablative Margins in Hepatocellular Carcinoma: Predicting Local Tumor Progression Using Nonrigid Registration Software

1Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
2Technical Medicine, University of Twente, Enschede, Netherlands
3Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
4Biomedical Photonic Imaging Group, TechMed Centre, University of Twente, Enschede, Netherlands
5Department of Robotics and Mechatronics, University of Twente, Enschede, Netherlands

Correspondence should be addressed to P. Hendriks; ln.cmul@skirdneh.p

Received 25 April 2019; Revised 13 July 2019; Accepted 28 August 2019; Published 19 September 2019

Academic Editor: Roberto Iezzi

Copyright © 2019 P. Hendriks et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. After radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC), pre- and postinterventional contrast-enhanced CT (CECT) images are usually qualitatively interpreted to determine technical success, by eyeballing. The objective of this study was to evaluate the feasibility of quantitative assessment, using a nonrigid CT-CT coregistration algorithm. Materials and Methods. 25 patients treated with RFA for HCC between 2009 and 2014 were retrospectively included. Semiautomated coregistration of pre- and posttreatment CECT was performed independently by two radiologists. In scans with a reliable registration, the tumor and ablation area were delineated to identify the side and size of narrowest RFA margin. In addition, qualitative assessment was performed independently by two other radiologists to determine technical success and the anatomical side and size of narrowest margin. Interobserver agreement rates were determined for both methods, and the outcomes were compared with occurrence of local tumor progression (LTP). Results. CT-CT coregistration was technically feasible in 18/25 patients with almost perfect interobserver agreement for quantitative analysis (κ = 0.88). The interobserver agreement for qualitative RFA margin analysis was κ = 0.64. Using quantitative assessment, negative ablative margins were found in 12/18 patients, with LTP occurring in 8 of these patients. In the remaining 6 patients, quantitative analysis demonstrated complete tumor ablation and no LTP occurred. Conclusion. Feasibility of quantitative RFA margin assessment using nonrigid coregistration of pre- and postablation CT is limited, but appears to be a valuable tool in predicting LTP in HCC patients ().