ArticleJournal of medical ultrasonics (2001)2026
Fiducial marker placement for hepatocellular carcinoma using magnetic resonance imaging-ultrasound fusion guidance: targeting accuracy and determinants of error (with video).
Article in Journal of medical ultrasonics (2001), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeStereotactic body radiation therapy (SBRT) is effective for hepatocellular carcinoma (HCC), and accurate fiducial marker placement is essential for motion-compensated tracking. We assessed the targeting accuracy and safety achieved with magnetic resonance imaging-ultrasound (MRI-US) fusion guidance and explored factors associated with placement error.
methodsIn this single-center cohort, 44 patients with HCC underwent SBRT with percutaneous fiducial placement under Gd-EOB-DTPA-enhanced MRI-US fusion. A region of interest (ROI) adjacent to the tumor was defined during planning, and the distance difference |A-B| between the planned tumor-ROI distance (A) and the post-procedure tumor-marker distance (B) was used as the targeting error. Predictors of error > 5 mm were explored using a random-forest model.
resultsMedian targeting error was 6.79 mm (range: 4.06-13.19 mm). In the exploratory model, a longer ROI-tumor distance appeared to have relatively higher feature-importance values for errors > 5 mm, whereas tumor depth and sonographic visibility contributed minimally. During follow-up, four local recurrences and twenty intrahepatic metastases occurred. The cumulative incidence of intrahepatic metastasis was 14.2%, 16.7%, and 24.1% at 180, 360, and 540 days, respectively. Two patients (7.4%) progressed from Child-Pugh class A to B at 6 months.
conclusionsMRI-US fusion guidance enabled sub-centimeter fiducial placement accuracy in this cohort. A shorter tumor-ROI distance may be associated with smaller targeting error, although this remains exploratory. Tumor depth and visibility showed limited influence on placement accuracy.
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