Estimation of tumor coverage after RF ablation of hepatocellular carcinoma using single 2D image slices

To assess the technical success of radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC), an artificial intelligence (AI) model was developed to estimate the tumor coverage without the need for segmentation or registration tools.

A secondary retrospective analysis of 550 patients in the multicenter and multinational OPTIMA trial (3-7 cm solidary HCC lesions, randomized to RFA or RFA + LTLD) identified 182 patients with well-defined pre-RFA tumor and 1-month post-RFA devascularized ablation zones on enhanced CT. The ground-truth, or percent tumor coverage, was determined based on the result of semi-automatic 3D tumor and ablation zone segmentation and elastic registration. The isocenter of the tumor and ablation was isolated on 2D axial CT images. Feature extraction was performed, and classification and linear regression models were built. Images were augmented, and 728 image pairs were used for training and testing. The estimated percent tumor coverage using the models was compared to ground-truth. Validation was performed on eight patient cases from a separate institution, where RFA was performed, and pre- and post-ablation images were collected.

In testing cohorts, the best model accuracy was with classification and moderate data augmentation (AUC = 0.86, TPR = 0.59, and TNR = 0.89, accuracy = 69%) and regression with random forest (RMSE = 12.6%, MAE = 9.8%). Validation in a separate institution did not achieve accuracy greater than random estimation. Visual review of training cases suggests that poor tumor coverage may be a result of atypical ablation zone shrinkage 1 month post-RFA, which may not be reflected in clinical utilization.

An AI model that uses 2D images at the center of the tumor and 1 month post-ablation can accurately estimate ablation tumor coverage. In separate validation cohorts, translation could be challenging.