Efficacy of fusion imaging for immediate post‐ablation assessment of malignant liver neoplasms: A systematic review

Abstract Background Percutaneous thermal ablation has become the preferred therapeutic treatment option for liver cancers that cannot be resected. Since ablative zone tissue changes over time, it becomes challenging to determine therapy effectiveness over an extended period. Thus, an immediate post‐procedural evaluation of the ablation zone is crucial, as it could influence the need for a second‐look treatment or follow‐up plan. Assessing treatment response immediately after ablation is essential to attain favorable outcomes. This study examines the efficacy of image fusion strategies immediately post‐ablation in liver neoplasms to determine therapeutic response. Methodology A comprehensive systematic search using PRISMA methodology was conducted using EMBASE, MEDLINE (via PUBMED), and Cochrane Library Central Registry electronic databases to identify articles that assessed the immediate post‐ablation response in malignant hepatic tumors with fusion imaging (FI) systems. The data were retrieved on relevant clinical characteristics, including population demographics, pre‐intervention clinical history, lesion characteristics, and intervention type. For the outcome metrics, variables such as average fusion time, intervention metrics, technical success rate, ablative safety margin, supplementary ablation rate, technical efficacy rate, LTP rates, and reported complications were extracted. Results Twenty‐two studies were included for review after fulfilling the study eligibility criteria. FI's immediate technical success rate ranged from 81.3% to 100% in 17/22 studies. In 16/22 studies, the ablative safety margin was assessed immediately after ablation. Supplementary ablation was performed in 9 studies following immediate evaluation by FI. In 15/22 studies, the technical effectiveness rates during the first follow‐up varied from 89.3% to 100%. Conclusion Based on the studies included, we found that FI can accurately determine the immediate therapeutic response in liver cancer ablation image fusion and could be a feasible intraprocedural tool for determining short‐term post‐ablation outcomes in unresectable liver neoplasms. There are some technical challenges that limit the widespread adoption of FI techniques. Large‐scale randomized trials are warranted to improve on existing protocols. Future research should emphasize improving FI's technological capabilities and clinical applicability to a broader range of tumor types and ablation procedures.


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1 Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b)Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a) Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b) record linkage (e.g. identified through ICD codes on database records)* c) Self-report with no reference to original structured injury data or imaging d) No  Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. No description Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort ) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* ) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. No description Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls based on image guided intervention * b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient.
0 OUTCOME 1 Assessment of outcome a. Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b. record linkage (e.g. identified through ICD codes on database records)* c. Self-report with no reference to original structured injury data or imaging d. Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 c) OUTCOME 1 Assessment of outcome a) Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b) record linkage (e.g. identified through ICD codes on database records)* c) Self-report with no reference to original structured injury data or imaging d) No description Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 c) OUTCOME 1 Assessment of outcome a) Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b) record linkage (e.g. identified through ICD codes on database records)* c) Self-report with no reference to original structured injury data or imaging d) No description Representativeness of the exposed cohort a) Consecutive eligible participants were selected, participants were randomly selected, or all participants were invited to participate from the source population* b) Not satisfying requirements in part (a), or not stated. Comparability of cohorts on the basis of the design or analysis a) Study controls for previous injury* b) Study controls for age* Note: Exposed and non-exposed individuals must be matched in the design and/or confounders must be adjusted for in the analysis. Alone statements of no differences between groups or that differences were not statistically significant are not sufficient. 0 c) OUTCOME 1 Assessment of outcome a) Independent or blind assessment stated, or confirmation of the outcome by reference to secure records (e.g. imaging, structured injury data, etc.)* b) record linkage (e.g. identified through ICD codes on database records)* c) Self-report with no reference to original structured injury data or imaging d) No description