超声造影对确定肝癌射频消融范围及治疗策略的应用价值

目的探讨射频消融(RFA)治疗前超声造影(CEUS)对制定消融范围及治疗策略的应用价值,并与RFA前未应用CEUS的治疗组比较疗效。方法161例原发性肝癌符合经皮RFA入选条件患者进行超声引导RFA治疗。其中,77例RFA前采用SonoVue行CEUS检查(CEUS组),84例RFA前未行CEUS检查(非CEUS组)。两组病例的临床资料无明显差异。肿瘤平均直径CEUS组(3.6±1.2)cm,非CEUS组(3.5±1.1)cm。治疗后采用常规超声、增强CT及(或)超声造影等影像检查进行规律性随访,至少随访6个月CT判断肿瘤灭活程度。结果CEUS组77例105灶行RFA治疗,造影动脉期显示59灶(56.2%)肿瘤范围较造影前增大,其中42灶(71.2%)造影前肿瘤边界不清;49灶(46.7%)肿瘤形态较常规超声更不规则,其中39灶(79.6%)为造影前边界不清。造影组>3.5 cm肿瘤52灶,37灶(71.1%)在动脉期显示主荷瘤血管。10例CEUS新发现≤2.0 cm病灶16个,其中3例为肝硬化随访病例,均进行RFA治疗。两组平均治疗次数为1.2次和1.5次。RFA后随访6~36个月,CEUS组完全灭活率高于非CEUS组(95.4%对87.8%,P=0.042)。CEUS组生存期高于非CEUS组[(34.2±1.2)月对(30.2±1.6)月,P=0.028]。结论RFA前CEUS可清晰显示肿瘤浸润范围,灵敏发现卫星灶及其他区域微小病灶,确认荷瘤血管,为准确制定消融方案,施行治疗策略,整体覆盖灭活肿瘤提供了可靠的依据,从而有效地提高RFA对肝癌的治疗水平。     

超声造影评价肝恶性肿瘤射频治疗疗效--与常规超声及增强CT比较

目的评价造影增强超声（CEUS）对判断肝恶性肿瘤射频消融疗效的应用价值。方法53例肝恶性肿瘤共71个病灶经射频消融治疗后行CEUS检查，其中原发性肝癌44例59个病灶、转移癌9例12个病灶。全部病灶采用超声造影剂SonoVue团注法行CEUS检查，并与同期常规超声及彩色超声、增强CT检查结果比较。超声仪为Technos DU8并使用CnTI实时超声造影匹配成像技术。结果CEUS观察71个病灶中，54个（76．1％）病灶在造影各时相均未强化，提示肿瘤完全灭活；13个（18．3％）病灶边缘局部动脉期增强，判断有肿瘤残存；4个（5．6％）病灶判断不清。最终诊断依据两种以上影像学检查并结合肿瘤标志物水平、穿刺活检、3个月以上随访进行综合判断。以最终诊断为金标准，CEUS诊断准确性91．5％（65／71），增强CT为93．9％（62／66），常规超声及彩色超声为67．6％（48／71）。CEUS与增强CT在评价肿瘤复发或残留方面的灵敏性、特异性、准确性差异均无显著性意义。结论CEUS可较准确地判断射频消融后肿瘤灭活程度，是评价射频消融疗效的有效方法，可成为肝癌局部治疗随访的重要手段，有较高临床应用价值。     

超声造影在原发性肝癌射频消融治疗中的应用价值

目的 探讨超声造影(CEUS)对原发性肝癌射频消融(RFA)治疗的疗效.方法 2010年1月至2013年12月收治的32例原发性肝癌患者(40个病灶)在超声引导下行RFA治疗.比较治疗后1个月超声造影与增强CT对RFA后疗效评价的差异性.结果 所有患者均能耐受RFA治疗,过程顺利,无严重并发症发生.其中28个病灶在常规超声引导下行RFA治疗,12个病灶在CEUS实时引导下行RFA治疗.40个病灶最终证实34个(85.0％)病灶完全消融,6个(15.0％)病灶部分消融.术后1个月,CEUS和增强CT对病灶完全消融判定的敏感性、特异性、阳性预测值、阴性预测值分别为97.1％和91.2％,83.3％和66.7％,97.1％和93.9％,83.3％和57.1％,两种方法比较均不具有统计学差异(P均＞0.05).结论 CEUS可以很好地引导原发性肝癌RFA治疗的精确定位,而且是评价RFA疗效的有效方法.     

肝细胞癌射频消融后局部肿瘤进展多因素分析

目的 探讨射频消融( radiofrequency ablation,RFA)治疗肝细胞癌(hepatocellular carcinoma,HCC)后局部肿瘤进展的危险因素,为进一步优化治疗提供依据.方法 回顾性分析246例患者343个肿瘤病灶行RFA规范化治疗的临床及随访资料,统计分析影响RFA局部疗效的相关因素.结果 肝细胞癌RFA治疗后局部肿瘤进展发生率为11.4％(39/343病灶),局部肿瘤进展发生的平均时间为12.0个月(3～28个月).单因素分析显示肿瘤大小、边界是否清晰、是否邻近血管、RFA前是否行超声造影(contrast-enhanced ultrasound,CEUS)与射频后局部肿瘤进展相关;COX多因素分析获得的独立影响因素是:肿瘤大小(P＜0.001)、是否邻近血管(P ＜0.001)和RFA前是否CEUS(P=0.018).结论 肿瘤大小、是否邻近血管和RFA前是否CEUS是局部肿瘤进展的独立影响因素,此结果有助于采取相应措施和策略,提高RFA疗效.     

实时超声造影在肝癌射频消融治疗前的应用研究

目的　探讨肝癌射频消融（RFA）前实时超声造影对确定消融范围和选择治疗方案的应用价值。方法　对RFA前239例肝癌患者315个病灶进行常规超声和低机械指数（MI〈0．2）实时超声造影检查（造影剂为Sono　Vue），比较分析肝癌常规超声与超声造影的图像差异及其对确定消融范围和选择治疗方案的影响。结果　192个病灶（60．9％）超声造影后肿瘤大小测值较造影前明显增大（P〈0．01），其中163个病灶设计消融范围较超声造影前明显扩大，29例因肿瘤≥6cm而改为手术切除；125个病灶（39．7％）超声造影后肿瘤形态更加不规则（P〈0．01），其中16例因显示形态不规则的肿瘤邻近重要结构而改为手术切除。结论　与常规超声比较，RFA前超声造影可以更清晰、更准确地显示肝癌的大小、形态和浸润范围，为确定消融范围和选择治疗方案提供可靠的依据。     

超声造影在肝癌射频消融治疗中的临床价值

目的 探讨超声造影(CEUS)在肝癌射频消融(RFA)治疗中的临床价值.方法 91 例肝癌患者在 RFA 治疗前后接受了 CEUS 检查,分别对 CEUS 在 RFA 治疗前、治疗过程中、治疗后的作用进行评价.以3个月以上的影像学检查及肿瘤标志物随访或穿刺活检的病理结果作为最终诊断.结果 RFA 前:91 例 114 枚肝癌病灶中 109(95.6%)枚 CEUS 可清晰显示边界;CEUS 测量病灶平均最大直径、面积与常规超声比较,差异有统计学意义(P<0.05);CEUS 对荷瘤血管的检出率为 61.4%.RFA 过程中:1枚常规超声未能显示的病灶在 CEUS 引导下完成 RFA 治疗;4枚病灶 RFA 后即刻 CEUS 发现残留,CEUS 引导下完成补充治疗.RFA后:88例获得随访,其中 49 例接受了同期的 CECT,CEUS 和 CECT 评价 RFA 治疗后病灶残留复发的敏感性、特异性、准确性比较,差异无统计学意义(P>0.05).结论 CEUS 在肝癌 RFA 治疗前,治疗过程中和治疗后均具有重要的临床价值.     

超声造影评价兔肝VX2肿瘤射频消融疗效的研究

目的与组织病理对照，探讨超声造影（contrast enhanced uhrasonography，CEUS）在肝肿瘤射频消融治疗（radiofrequency ablation，RFA）疗效判断中的可靠性。 方法建立8只兔肝VX3肿瘤模型，并进行RFA，有选择地控制消融范围，确保有存活肿瘤组织。在ERFA后4d，CEUS和组织病理检查，比较CEUS获得的消融灶最大径与病理标本的最大径，CEUS切面与病理切片层面基本一致的情况下，分析CEUS与组织病理的相关性。 结果CEUS发现7个消融灶内有残存肿瘤组织，4个消融灶周边出现明显的良性增强带，与组织病理检查对应一致。CEUS获得的消融灶最大径与病理标本的最大径无统计学差异，CEUS和组织病理获得的肝肿瘤坏死成分占病灶总面积的百分比具有良好的相关性（r=0．986）。 结论CEUS在RFA后早期能较准确地鉴别RFA引起的凝固样坏死与残存的肿瘤组织，辨别消融灶周边的良性增强，是评价RFA疗效的有效方法，具有较高的临床应用价值。     

融合成像超声造影术中即时评估肝癌射频消融疗效

目的 探讨融合成像超声造影(CEUS)在肝癌射频消融(RFA)术中即时评估消融疗效的临床价值.方法 行肝癌RFA治疗的患者90例,在RFA后分别行融合成像CEUS和常规CEUS评价消融效果,同时定义每组中二维超声显示欠佳、直径＞5 cm及穿刺入径困难的病灶为困难病灶,以消融术后1个月的CT/MRI结果为金标准,比较两组病例及其中困难病例的完全消融率.结果 融合成像CEUS组及常规CEUS组分别有48及68个病灶,困难病例分别有19及18个,两组病例的病灶大小、困难病灶比例、联合行经动脉化疗栓塞或经皮无水酒精注射治疗的比例差异无统计学意义(P =0.052,P=0.136,P=0.185,P=1.000).术后随访提示融合成像CEUS组及常规CEUS组完全消融率分别为100％(48/48)和92.6％ (63/68),两者比较差异无统计学意义(P=0.145).两组中困难病例的完全消融率分别为100％(19/19)及72.2％(13/18),两组比较差异有统计学意义(P=0.020).结论 融合成像CEUS能在术中即时评价消融疗效,尤其能提高困难病例的完全消融率,可作为常规CEUS的补充方法.     

低杆温微波刀与冷循环射频消融在肝肿瘤治疗中的临床应用

目的探讨低杆温微波刀（cool-needle microwave coagulation treatment，MCT）与冷循环射频消融（cool-tipradiofrequency ablation，RFA）在恶性肝肿瘤治疗中的临床应用价值。方法超声引导下冷循环射频消融治疗原发性肝癌患者20例共22个病灶，而经超声引导下低杆温微波刀治疗原发性肝癌和肝转移癌19例共21个病灶，治疗前后经超声造影、增强CT或／和增强MRI检查明确诊断及评价疗效。结果22个病灶经一次RFA治疗后完全消融16个，5例经再次RFA后达完全消融；21个病灶经一次MCT治疗后16个达完全消融，4例经再次MCT治疗后达完全消融。两者一次完全消融率分别为72．7％（RFA）和76．2％（MCT），差异无统计学意义。结论低杆温MCT和冷循环RFA均能有效地原位灭活肝肿瘤，是有效的非手术治疗恶性肝肿瘤的方法之一。     

本期图片精选

图1，2经皮消融阻断荷瘤血管前超声造影和彩色多普勒超声声像图。图1示超声造影动脉期肿瘤呈团状增强（箭头所示为肿瘤部位）；图2为彩色多普勒血流成像示肿瘤周边及内部血管走行（箭头所示为荷瘤血管及进入肿瘤部位）图3应用描记计。量软件计算造影增强区及灌注缺失区面积图4根据超声造影结果指导消融肿瘤活性区域及周边区域（箭头所示）     

Computer-Aided Color Parameter Imaging of Contrast-Enhanced Ultrasound Evaluates Hepatocellular Carcinoma Hemodynamic Features and Predicts Radiofrequency Ablation Outcome

Computer-aided color parameter imaging (CPI) is a novel technique for contrast-enhanced ultrasound (CEUS) that can highlight hemodynamic features of focal lesions. The purpose of the study was to investigate the role of CPI in evaluation of hepatocellular carcinoma (HCC) hemodynamic features and prognosis after radiofrequency ablation (RFA). One hundred twenty-one patients with HCC underwent CEUS with CPI analysis before RFA. Eighty-nine patients had pathologically proven well- to moderately differentiated HCC (WM-HCC), and 32 patients had poorly differentiated or undifferentiated HCC (PU-HCC). Perfusion features of CEUS and contrast-enhanced computed tomography/magnetic resonance imaging were compared with CPI parameters for WM-HCC and PU-HCC. The results indicated that 67.4% of WM-HCC had a centrifugal perfusion CPI pattern, whereas 84.4% of PU-HCC tumors had a centripetal pattern (p < 0.001, odds ratio = 11.2). The specificity, sensitivity and accuracy of the CPI perfusion pattern regarding HCC pathological grade were higher than those with routine CEUS (84.4% vs. 9.4%, p < 0.001; 67.4% vs. 3.4%, p < 0.001; 71.9% vs. 5.0%, p < 0.001). Moreover, multivariable analysis revealed that the CPI perfusion pattern was an independent risk factor for progression-free survival post-RFA (centripetal group: 28.3 ± 4.1 mo vs. centrifugal group: 45.8 ± 4.4 mo, p = 0.002). A novel CPI technique for CEUS could non-invasively provide valuable hemodynamic information and predict prognosis for HCC patients treated by RFA.     

超声造影指导射频消融治疗小肝癌的应用价值

目的 探讨超声造影(CEUS)指导射频消融治疗小肝癌的应用价值.方法 70例经病理诊断的肝恶性肿瘤患者共104个病灶为研究对象;其中39例54个病灶采用SonoVue团注法行CEUS检查并引导治疗(CEUS组),同期常规超声引导消融治疗的31例50个病灶为对照组.病灶大小0.7～2.7cm,平均(1.60±0.43)cm.两组病例临床一般指标差异无统计学意义.结果 CEUS组中13例17个病灶的范围较常规超声显示清晰(31.5%),其中1.5 cm以下病灶12个,均在CEUS引导下消融治疗.CEUS组与对照组治疗结果比较,术后1个月肿瘤灭活率分别为100%和92%,肿瘤的治疗次数分别为(1.00±0.00)次和(1.08±0.27)次;随访8～52个月(平均21个月),肿瘤局部复发率分别为0和4%.肿瘤灭活率及治疗次数两组间差异有统计学意义.结论 CEUS可改善小肿瘤的显示率并引导精确定位,有效提高灭活率,减少治疗次数,有较高的临床应用价值.

Abstract：

Objective To investigate the value of contrast enhanced ultrasonography (CEUS) in the treatment of small hepatic malignancies with radiofrequency ablation(RFA). Methods Seventy patients with 104 pathologically proved malignant liver lesions treated by RFA (size 0.7 -2.7 cm) were divided into 2 groups including CEUS group and control group. In CEUS group,39 patients(54 lesions) were treated with RFA guided by CEUS, while in control group 31 patients (50 lesions) were guided by conventional ultrasonography. There was no significant difference between clinical data of the two groups. Results Seventeen tumors(among them,12 lesions were less than 1.5 cm in diameter) in 13 patients showed more clearly on CEUS image than on conventional ultrasonography image (31.5% ) in CEUS group. The tumor necrosis rate at one month after RFA was 100% in CEUS group,and 92% in control group ( P = 0. 034).The number of RFA sessions per tumor was 1.00± 0.00 in CEUS group,and 1.08 ± 0.27 in control group (P = 0.000). Local tumor progression rate was 0 in CEUS group and 4% in control group ( P = 0. 138)during the period of 8 - 52 months follow-up (average 21 months). Conclusions CEUS can not only improve the display of small hepatic malignancies but also provide precise guidance in contrast with conventional ultrasonography. Compared with control group, RFA of small hepatic malignancies guided by CEUS lower the number of RFA sessions, enhance the tumor necrosis rate, decrease post-RFA local progression and therefore it has extensive clinical value.     

The use of contrast-enhanced ultrasonography in the selection of patients with hepatocellular carcinoma for radio frequency ablation therapy.

OBJECTIVE: The purpose of this study was to evaluate the use of contrast-enhanced ultrasonography (CEUS) in selecting patients with hepatocellular carcinoma (HCC) for radio frequency ablation (RFA). METHODS: One hundred seventy-nine patients with HCC were divided into 2 groups before receiving RFA: a CEUS group and a control group. The patients were concatenated and alternately apportioned into these 2 groups. In the CEUS group, 92 patients underwent pre-RFA CEUS using the contrast agent sulfur hexafluoride and enhanced computed tomography or magnetic resonance imaging before RFA for selecting suitable cases for RFA, and in the control group, conventional ultrasonography and enhanced computed tomography or magnetic resonance imaging were performed in 87 patients for selecting patients. RESULTS: In the CEUS group, 9 patients (9.8%) were excluded for RFA therapy by CEUS. The other 83 patients (90.2%), with a total of 114 lesions, were treated by RFA. In the control group, 5 patients (5.7%) were excluded for RFA. The other 82 patients (94.3%), with a total of 107 lesions, were treated by RFA. During the follow-up period of 18 to 50 months, the primary technique effectiveness rates in the CEUS and control groups were 94.7% and 87.9%, respectively (P = .1182). The local tumor progression rate, the new HCC rate, and the repeated RFA rate of the CEUS group were significantly lower than those of the control group (P = .033, .004, and .001, respectively). CONCLUSIONS: Pre-RFA CEUS provides important information for selecting suitable patients for RFA. The use of CEUS in selecting patients with HCC can decrease post-RFA local tumor progression and improve the efficacy of RFA therapy.     

超声造影对肝转移癌射频消融的应用价值

目的 探讨超声造影(CEUS)在射频消融(RFA)治疗肝转移癌中的应用价值.方法 141例经临床及病理确诊并拟行RFA的肝转移癌患者,其中102例行CEUS检查,86例被确定符合RFA适应证(A组)为研究对象;同期RFA前未行CEUS检查的39例定为对照组(B组).根据造影灌注特征及病灶数目、大小、形态、浸润范围、位置、与周围结构关系等确定RFA适应证并制定方案进行治疗;B组根据常规超声及CT或MR诊断结果治疗.结果 102例CEUS后计16例确定为非RFA适应证,其中3例10个灶经6～10个疗程化疗后显示病灶内或周边无强化征象,考虑无活性;13例造影后显示病灶浸润范围大于8 cm或多于7个灶或紧邻膈顶、第二肝门等部位并分界不清等.A组中36例(41.9%)病灶增多1～3个(计58灶),大小约8～15 mm,其中79.4%(46/58个灶)仅在实质期显示,共计86例209个灶行RFA治疗;造影后49.7%(75/151灶)显示较原病灶范围增大,其中69.3%(52/75灶)在动脉期增强范围增大,30.7%(23/75灶)在廓清时弱回声范围增大,增大范围均被消融治疗.经1～3个月增强CT随访,肿瘤灭活率A组为94.7%(198/209),B组为87.6%(99/113);2～17个月局部复发A组为7.1%(15/209),B组为14.1%(16/113);A组37.2%(32/86例)出现新生转移灶,B组为43.5%(17/39例);两组灭活率及复发率差异均有统计学意义.结论 超声造影可为射频治疗肝转移癌适应证的选择和治疗范围的确定提供参考依据,从而有效提高疗效并降低复发率,是RFA治疗肝转移癌重要的辅助方法.     

Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT

We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.     

超声造影对肝脏恶性肿瘤射频治疗的疗效评估

目的探讨实时超声造影在肝脏恶性肿瘤射频治疗疗效评估的临床应用价值。方法对149例肝脏恶性肿瘤患者(168个病灶)在射频消融治疗后进行Sonovue实时超声造影检查,并与增强CT检查比较。结果 168个病灶中实时超声造影检查显示37个病灶有残留,增强CT检查显示39个病灶有残留。结论超声造影是评价肝恶性肿瘤射频消融治疗疗效的一种可靠方法。     

超声造影对肝癌微波消融治疗适应症选择的应用评价

目的评价超声造影对制定肝癌微波消融治疗方案的价值。方法 116例患者,共130个肝癌病灶,微波消融治疗前行常规灰阶超声和超声造影检查。结果 51个病灶(39.2%,51/130)CEUS检查后,病灶的最大径线较常规灰阶超声的测值增大;除了原130个病灶外,CEUS检查后另发现9个常规灰阶超声未能显示的新病灶,这些病灶均经病理或其他影像技术证实;共33个病灶(25.3%,33/130)可清晰地显示滋养血管。根据微波消融治疗入选标准,共111例患者,123个病灶接受超声引导下微波消融治疗。结论在微波消融治疗前,超声造影可以帮助了解患者肝癌病灶的性质、大小、数目和滋养血管等情况,有助于微波治疗适应症的选择和治疗方案的制定。     

射频消融与醋酸注射对大鼠肝脏超声影像及病理学改变的研究

目的比较射频消融与醋酸经皮注射对大鼠肝脏的超声影像及病理学改变产生的影响。方法20只健康sD大鼠均分为射频组（10只）和醋酸注射组（10只）,射频组大鼠开腹后对其肝组织给予射频消融;醋酸注射组大鼠在超声实时监视下经皮醋酸肝脏注射治疗,其后即刻应用二维B型超声及彩色多普勒超声观察肝脏局部损伤的特点;并在即刻处死后取大鼠肝脏进行病理学观察。结果大鼠肝脏射频消融灶超声影像表现为边界较为清晰的强回声团,其内未见明显血流信号;病理检查显示从射频消融灶中心到周边呈凝固性坏死一细胞变性一肉芽组织形成的演变特点。经皮醋酸肝脏注射后,注射部位超声影像表现为局限性多发点片状强回声,病理组织学检查呈现出多灶性凝固性坏死,周边肝细胞变性。结论射频消融与经皮醋酸肝脏注射均可对大鼠肝脏造成凝固性坏死,前者损伤范围较为局限;后者造成的损伤范围较为弥散。     

Radiofrequency ablation of problematically located hepatocellular carcinoma: tailored approach

BACKGROUND: The challenge for radiofrequency ablation (RFA) of hepatocellular carcinomas (HCC) in problematic locations is that the outcome is limited due to insufficient ablation or injury of nearby structures. This study aimed to evaluate effective strategy and treatment results of RFA in these cases. METHODS: Ultrasound guided percutaneous RFA was performed in 326 HCC patients. Among them, 249 tumors in 215 patients located at liver periphery, including 54 adjacent to GI tract, 110 close to the diaphragm, 49 close to the gallbladder, and 36 tumors close to liver surface. The sizes of the tumors ranged 1.2-7.0 cm (average 3.7 +/- 1.3 cm). Individualized treatment strategy was established for tumors in various locations, including "artificial ascites", "lift-expand" electrode placement, "draw-expand" electrode placement, "Supplementary ablation", and "accumulative multiple ablations" techniques. Treatment outcome was compared with another 64 central-located tumors (control group) in the same patients. One-month post-RFA contrast CT was used to evaluate early necrosis rate of the treated tumors. RESULTS: Early tumor necrosis were obtained in 91.6% (228/249) of the problematically located HCC, including 90.7% (49/54) of the tumors adjacent to GI tract, 90.9% (100/110) near the diaphragm, 91.8% (45/49) by the gallbladder, and 94.4% (34/36) close to liver surface. The necrosis rate of control group was 98.4% (63/64), which was higher than the tumors close to diaphragm (P = 0.049). Local tumor recurrence was 8.4% (21/249), comparing with 3.1% (2/64) of the control group (P > 0.05). The 1-, 2- and 3-year survival rate of this group were 81.6%, 63.8%, and 53.6%, respectively. Major complications occurred in 3.2% (11/343) of the treatment sessions, including hemorrhage in two, nearby structure injury in five, and needle tract seeding in four patients. CONCLUSIONS: Individualized treatment strategy for problematically located HCC is helpful in improving RFA outcome and expanding the application range of the therapy.