Multi-Modality Guided Focal Liver Ablation

Hepatocellular carcinoma (HCC) is the fifth most common diagnosed malignancy and the third most frequent cause of cancer related deaths worldwide, and it has a wide geographical variation. Incidence is particularly high in Asia and sub-Saharan Africa due to the large incidence of hepatitis B and C, both of which are complicated by hepatic cirrhosis, which is the greatest risk factor for HCC. Recently, increasing trends in HCC have been reported from several Western countries. Furthermore, the liver is the second most common site of metastatic cancer arising in other organs. Although the most effective method of treating liver cancer is surgical resection, about two-thirds of liver cancer patients have non-resectable tumour at diagnosis because of the size or location of the tumour. For some of these patients, focal ablative therapy, in particular, radiofrequency or micro-wave (thermal) ablation, then becomes the treatment of choice. The current standard of care uses CT images for planning and 2D ultrasound image guidance for intraoperative guidance of the ablation probe(s) into the target lesion. However, this approach suffers from several disadvantages, which we propose to overcome by the development of 3D ultrasound (3D US) imaging, registered with pre-procedural CT to plan and guide the ablation procedure. We hypothesize that compared to the conventional 2D US approach, the use of 3D US will show the features of liver masses and the hepatic vasculature more clearly, and allow guidance of the ablation probes to the target more accurately. We further hypothesize that the 3D US-guided approach will allow more accurate monitoring of the ablation zone during the procedure and at follow up. Thus, our goal is to develop a hand-held 3D US scanner system able to accommodate any US transducer for acquiring 3D US images and guiding therapy applicators.