Suppression of popping rates in radiofrequency ablation under perfluorobutane microbubbles for hepatocellular carcinoma.

Abstract

Aim of the study: Popping during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) can cause complications such as bleeding and tumor seeding. Perfluorobutane microbubbles (Sonazoid, GE Healthcare) are employed to enhance visualization through the use of vascular and Kupffer imaging. This study aimed to assess the impact of Sonazoid on popping during RFA for HCC and evaluate popping and local recurrence rates.

Material and methods: We examined 135 patients and 308 nodules undergoing RFA for HCC using a unipolar needle electrode between December 2019 and December 2023. Popping and local recurrence rates were compared between RFA groups with and without Sonazoid.

Results: The cohort comprised 99 males and 36 females, with a mean age of 72 (range: 35-93) years. Background liver conditions included 21 hepatitis B virus (HBV), 44 hepatitis C virus (HCV), and 70 non-HBV/HCV cases. The group without Sonazoid had 267 nodes, while the Sonazoid group had 41 nodes. In energy-related comparisons, the Sonazoid group exhibited lower power (p = 0.039) and energy delivery (p = 0.013) and shorter cauterization time (p = 0.021). The popping rate during cauterization was significantly lower in the Sonazoid group (28.8% vs. 12.2%, p = 0.023). There was no significant difference in local recurrence rate between the two groups.

Conclusions: RFA with Sonazoid using a unipolar needle-type electrode reduced power output, enabling lower-energy ablation and shorter ablation times. This suggests a potential for suppressing the popping phenomenon. Low-power ablation did not affect local recurrence rates, highlighting RFA as a less invasive treatment strategy. Further studies with larger cohorts are needed to evaluate treatment efficacy.