{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:39:37Z","timestamp":1774431577789,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Liver cancer is a major health concern worldwide. Radiofrequency ablation is a safe treatment option that can be guided by either ultrasound, computer tomography (CT), or fluoroscopy. Although ultrasound-guided radiofrequency ablation is commonly used in clinical practice, radiofrequency ablation guided by CT is more precise but requires more time and does not offer real-time monitoring, which may result in complications such as pneumothorax or organ damage. Objectives: In this study, we investigated the effect of ultrasound, CT, and combined ultrasound\/CT guidance on patient survival and complication development. Methods: A total of 982 radiofrequency ablation sessions conducted on 553 patients were analyzed. Clinical outcomes were assessed during follow-up to determine the survival and recurrence rates of malignant tumors. Results: Overall, the three guidance approaches exhibited significant differences in terms of tumor size, number, complication development, and treatment duration. However, no significant differences were observed in survival rate. A comparison of the effect of CT guidance and ultrasound guidance on complication development revealed a higher odds ratio for CT guidance in some cases. A comparison of combined ultrasound\/CT guidance and ultrasound guidance revealed nonsignificant differences in complication development. A comparison of CT guidance and combined ultrasound\/CT guidance revealed a higher odds ratio for CT guidance in some cases. Radiofrequency ablation is a safe and effective treatment for liver tumors. However, CT has an increased incidence of complications. Conclusions: Combined ultrasound\/computer tomography guidance is recommended for patients with multiple or large tumors or tumors near the hepatic dome or diaphragm.<\/jats:p>","DOI":"10.3390\/diagnostics15141754","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T10:26:53Z","timestamp":1752229613000},"page":"1754","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Overall Survival and Complication Rates in the Treatment of Liver Carcinoma: A Comparative Study of Ultrasound, Computed Tomography, and Combined Ultrasound and Computed Tomography Guidance for Radiofrequency Ablation"],"prefix":"10.3390","volume":"15","author":[{"given":"Chia-Hsien","family":"Chien","sequence":"first","affiliation":[{"name":"Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung City 813, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Ling","family":"Chiang","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology, Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung City 813, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9983-0535","authenticated-orcid":false,"given":"Huei-Lung","family":"Liang","sequence":"additional","affiliation":[{"name":"Division of Abdominal Radiology, Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung City 813, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jer-Shyung","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology, Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung City 813, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1603-6879","authenticated-orcid":false,"given":"Chia-Jung","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung City 824, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cha, D.I., Lee, M.W., Hyun, D., Ahn, S.H., Jeong, W.K., and Rhim, H. (2023). Combined transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma infeasible for ultrasound-guided percutaneous radiofrequency ablation: A comparative study with general ultrasound-guided radiofrequency ablation outcomes. Cancers, 15.","DOI":"10.3390\/cancers15215193"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lee, L.H., Hwang, J.I., Cheng, Y.C., Wu, C.Y., Lee, S.W., Yang, S.S., Yeh, H.Z., Chang, C.S., and Lee, T.Y. (2017). Comparable outcomes of ultrasound versus computed tomography in the guidance of radiofrequency ablation for hepatocellular carcinoma. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0169655"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jval.2018.10.004","article-title":"Comparative effectiveness of CT- vs. ultrasound-guided percutaneous radiofrequency ablation among medicare patients 65 years of age or older with hepatocellular carcinoma","volume":"22","author":"Huo","year":"2018","journal-title":"Value Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ding, H., Su, M., Zhu, C., Wang, L., Zheng, Q., and Wan, Y. (2017). CT-guided versus laparoscopic radiofrequency ablation in recurrent small hepatocellular carcinoma against the diaphragmatic dome. Sci. Rep., 7.","DOI":"10.1038\/srep44583"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s00261-018-1693-y","article-title":"Hemobilia after CT-guided radiofrequency ablation of liver tumors: Frequency, risk factors, and clinical significance","volume":"44","author":"Hsieh","year":"2019","journal-title":"Abdom. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"112026","DOI":"10.1016\/j.ejrad.2025.112026","article-title":"Hepatobiliary phase MRI-guided radiofrequency ablation of small hepatocellular carcinomas invisible on precontrast MRI","volume":"186","author":"Ebel","year":"2025","journal-title":"Eur. J. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s13244-022-01178-8","article-title":"Single-centre survival analysis over 10 years after MR-guided radiofrequency ablation of liver metastases from different tumour entities","volume":"13","author":"Olthof","year":"2022","journal-title":"Insights Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e30725","DOI":"10.1097\/MD.0000000000030725","article-title":"Multipolar radiofrequency ablation via three bipolar electrodes with C-arm type X-ray fluoroscopy assistance for hepatocellular carcinoma: An observational study","volume":"101","author":"Tanaka","year":"2022","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"608","DOI":"10.3748\/wjg.v12.i4.608","article-title":"Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome","volume":"12","author":"Toyoda","year":"2006","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s11604-021-01148-y","article-title":"Feasibility, safety, and efficacy of artificial carbon dioxide pneumothorax for computed tomography fluoroscopy-guided percutaneous radiofrequency ablation of hepato-cellular carcinoma","volume":"39","author":"Shibamoto","year":"2021","journal-title":"Jpn. J. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1080\/13645706.2021.1995436","article-title":"Safety margin for CT- and US-guided radiofre-quency ablation after TACE of HCC in the hepatic dome","volume":"31","author":"Mitani","year":"2022","journal-title":"Minim. Invasive Ther. Allied. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7751","DOI":"10.2147\/CMAR.S212127","article-title":"Combined ultrasound\/computed tomography guidance in percutaneous radiofrequency ablation after transarterial chemoembolization for hepatocellular carcinoma in the hepatic dome","volume":"11","author":"Kan","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"660","DOI":"10.21873\/cdp.10269","article-title":"Combined ultrasound and computed tomography guidance in radiofrequency ablation for hepatocellular carcinoma reduces local recurrence rate","volume":"3","author":"Nagasawa","year":"2023","journal-title":"Cancer Diagn. Progn."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Li, H., Vogl, T.J., Chen, K.A., and Adwan, H. (2025). A comparison of the efficacy and safety of US-, CT-, and MR-guided radiofrequency and microwave ablation for HCC: A systematic review and network meta-analysis. Cancers, 17.","DOI":"10.3390\/cancers17030409"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1111\/j.1440-1746.2011.06812.x","article-title":"Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: A systematic review","volume":"26","author":"Cho","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1148\/radiol.2017162756","article-title":"Radiofrequency ablation versus hepatic resection for small hepatocellular carci-noma: Systematic review of randomized controlled trials with meta-analysis and trial sequential analysis","volume":"287","author":"Xu","year":"2018","journal-title":"Radiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3456","DOI":"10.1097\/JS9.0000000000002302","article-title":"Liver resection versus radiofrequency ablation for solitary small hepatocellular carcinoma measuring \u22643 cm: A systematic review and meta-analysis","volume":"111","author":"Yang","year":"2025","journal-title":"Int. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s00423-023-02858-9","article-title":"Radiofrequency ablation versus liver resection and liver transplantation for small combined hepatocellular-cholangiocarcinoma stratified by tumor size","volume":"408","author":"Peng","year":"2023","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1053\/j.gastro.2008.02.090","article-title":"Diagnosis and treatment of hepatocellular carcinoma","volume":"134","author":"Marrero","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s12253-014-9868-5","article-title":"Comparison of the effectiveness and safety of ultrasound-and CT-guided percutaneous radiofrequency ablation of non-operation hepatocellular carcinoma","volume":"21","author":"Wu","year":"2015","journal-title":"Pathol. Oncol. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s12957-024-03330-8","article-title":"Comparison of liver resection and radiofrequency ablation in long-term survival among patients with early-stage hepatocellular carcinoma: A meta-analysis of randomized trials and high-quality propensity score-matched studies","volume":"22","author":"Hu","year":"2024","journal-title":"World J. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yue, Y.Y., and Zhou, W.L. (2020). Hepatic resection is associated with improved long-term survival compared to radio-frequency ablation in patients with multifocal hepatocellular carcinoma. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.00110"},{"key":"ref_23","first-page":"6881","article-title":"Comparison of ultrasound guided versus CT guided radiofrequency ablation on liver function, serum PIVKA-II, AFP levels and recurrence in patients with primary hepatocellular carcinoma","volume":"13","author":"Yu","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/hpb.12014","article-title":"Percutaneous radiofrequency ablation versus surgical radiofrequency ablation for malignant liver tumours: The long-term results","volume":"15","author":"Wong","year":"2013","journal-title":"HPB"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1002\/cncr.20892","article-title":"Percutaneous radiofrequency ablation for hepatocellular carcinoma: An analysis of 1000 cases","volume":"103","author":"Tateishi","year":"2005","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/SLA.0000000000002751","article-title":"Treatment optimization for hepatocellular carcinoma in elderly patients in a Japanese nationwide cohort","volume":"270","author":"Kaibori","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1148\/radiol.2343040350","article-title":"Early-stage hepatocellular carcinoma in patients with cirrhosis: Long-term results of percutaneous image-guided radiofrequency ablation","volume":"234","author":"Lencioni","year":"2005","journal-title":"Radiology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1007\/s00330-006-0461-5","article-title":"Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: Long-term results and prog-nostic factors in a large single-institution series","volume":"17","author":"Choi","year":"2007","journal-title":"Eur. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1002\/hep.23181","article-title":"Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic factors in 235 Western patients with cirrhosis","volume":"50","author":"Mahamoudi","year":"2009","journal-title":"Hepatology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1148\/radiol.2020200109","article-title":"A single-center retrospective analysis of periprocedural variables affecting local tumor progression after radiofrequency ablation of colorectal cancer liver metastases","volume":"298","author":"Han","year":"2021","journal-title":"Radiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1159\/000502744","article-title":"Complications after radiofrequency ablation for hepatocellular carcinoma: A multicenter study involving 9411 Japanese patients","volume":"9","author":"Maeda","year":"2020","journal-title":"Liver Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"107","DOI":"10.4254\/wjh.v6.i3.107","article-title":"Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors","volume":"6","author":"Fonseca","year":"2014","journal-title":"World J. Hepatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1754\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:08:22Z","timestamp":1760033302000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,11]]},"references-count":32,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15141754"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15141754","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,11]]}}}