Transcatheter CT Hepatic Arteriography versus Conventional CT Guidance for Percutaneous Microwave Ablation of Small Hepatocellular Carcinoma Tumors

Qian Yu; Zaynab Ahmed; Wesley Lim; Gloria Hwang; Michael Zhang; Daniel Kwak; Chuanhong Liao; Mikin Patel; Chih-Yi Liao; Anjana Pillai; John Fung; Thuong Van Ha; Brian Funaki; Osman Ahmed

doi:10.1148/rycan.250106

Transcatheter CT Hepatic Arteriography versus Conventional CT Guidance for Percutaneous Microwave Ablation of Small Hepatocellular Carcinoma Tumors

Radiol Imaging Cancer. 2026 May;8(3):e250106. doi: 10.1148/rycan.250106.

Authors

Affiliations

¹ Vascular and Interventional Radiology, University of Chicago Medical Center, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637.
² Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Ill.
³ Biostatistics Laboratory and Research Computing Group, University of Chicago, Chicago, Ill.
⁴ Department of Medicine; Hematology and Oncology, University of Chicago Medical Center, University of Chicago, Chicago, Ill.
⁵ Division of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medical Center, University of Chicago, Chicago, Ill.
⁶ Department of Surgery, Section of Transplant Surgery, The University of Chicago Medicine, Chicago, Ill.

Abstract

Purpose To evaluate the safety and efficacy of transcatheter CT hepatic arteriography (angio-CT)-guided percutaneous microwave ablation (AA) for small hepatocellular carcinoma tumors and compare its outcomes with those of conventional CT-guided microwave ablation (CA). Materials and Methods The authors performed a retrospective review of patients with hepatocellular carcinoma tumors less than 3 cm in size treated with AA and CA from June 2019 to August 2024 at a single institution. Hepatic arteriography was performed after transarterial catheterization in an angio-CT hybrid suite. CA was performed with or without US. The authors evaluated the target-lesion radiologic response according to modified Response Evaluation Criteria in Solid Tumors criteria at follow-up contrast-enhanced CT or MRI. Target-lesion progression-free survival (PFS) and overall survival were calculated using the Kaplan-Meier method. Cox regression hazard models were used to identify variables associated with PFS. Adverse events were retrospectively reviewed. Results A total of 70 patients and 85 tumors were included in this study (mean age, 63.2 years ± 9.5 [SD]; 49 male patients). Thirty-six tumors (27 patients) were treated with AA. Forty-nine tumors (43 patients) were treated with CA. The 3-month complete response rate (100% vs 79.6%; P = .0042) and the 2-year PFS rate (95.8% vs 68.5%; log-rank P = .0099) were higher for the AA group than the CA group. Overall survival was similar between the groups (log-rank P = .583). In the multivariable analysis, AA but not CA was independently associated with increased PFS (P = .009). One patient from the CA group developed hemorrhagic shock after ablation. No other severe adverse events or grade 3 or above hepatic toxicities occurred. Conclusion For hepatocellular carcinoma tumors less than 3 cm in size, AA resulted in higher initial response and PFS rates than CA with comparable safety profile. Keywords: Angio-CT, Hepatocellular Carcinoma, Microwave Ablation Supplemental material is available for this article. © RSNA, 2026.

Keywords: Angio-CT; Hepatocellular Carcinoma; Microwave Ablation.

Publication types

Comparative Study

MeSH terms

Aged
Carcinoma, Hepatocellular* / diagnostic imaging
Carcinoma, Hepatocellular* / surgery
Catheter Ablation* / methods
Computed Tomography Angiography* / methods
Female
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / surgery
Male
Microwaves* / therapeutic use
Middle Aged
Radiography, Interventional* / methods
Retrospective Studies
Tomography, X-Ray Computed* / methods
Treatment Outcome