Intraoperative monitoring of malignant liver tumor microwave ablation using contrast-enhanced ultrasound: A preliminary study

Objective This study aimed to evaluate intraoperative assessment and monitoring of liver tumor ablations using contrast-enhanced ultrasound (CEUS). Methods Twenty patients (11 males [65%] and 9 females [45%]) with malignant lesions (cholangiocellular carcinoma (CCC), 1; hepatocellular carcinoma (HCC), 5; colorectal liver metastases (CRLM), 13; and one patient with alveolar echinococcosis) were examined intraoperatively with CEUS. Images were acquired in cine loops, covering the early arterial phase (0–15 s) up to the portal venous phase (1 min). Ablation was performed under real-time ultrasound guidance using microwave ablation (MWA). The generator output was adjusted up to 80 watts, up to 10 min. Post-ablation CEUS was conducted for immediate control. Results Twenty patients underwent ablation procedures. Ablation was carried out under ultrasound guidance with adjusted output settings between 40 and 80 watts and durations ranging from 2 to 5 min. Post-interventional CEUS confirmed complete devascularization in all planes. All patients underwent track ablation using 70 watts. At 6-month follow-up, no local recurrence was observed. Conclusion The preliminary findings demonstrate the feasibility of intraoperative CEUS during microwave ablation of liver lesions. The technique proves to be a safe and effective intraoperative tool, owing to its ability to provide verification of complete tumor devascularization.