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Purpose <p>Stereotactic body radiation therapy (SBRT) is effective for hepatocellular carcinoma (HCC), and accurate fiducial marker placement is essential for motion-compensated tracking. We assessed the targeting accuracy and safety achieved with magnetic resonance imaging–ultrasound (MRI–US) fusion guidance and explored factors associated with placement error.</p> Methods <p>In this single-center cohort, 44 patients with HCC underwent SBRT with percutaneous fiducial placement under Gd-EOB-DTPA–enhanced MRI–US fusion. A region of interest (ROI) adjacent to the tumor was defined during planning, and the distance difference |A–B| between the planned tumor–ROI distance (A) and the post-procedure tumor–marker distance (B) was used as the targeting error. Predictors of error &gt; 5&#xa0;mm were explored using a random-forest model.</p> Results <p>Median targeting error was 6.79&#xa0;mm (range: 4.06–13.19&#xa0;mm). In the exploratory model, a longer ROI–tumor distance appeared to have relatively higher feature-importance values for errors &gt; 5&#xa0;mm, whereas tumor depth and sonographic visibility contributed minimally. During follow-up, four local recurrences and twenty intrahepatic metastases occurred. The cumulative incidence of intrahepatic metastasis was 14.2%, 16.7%, and 24.1% at 180, 360, and 540&#xa0;days, respectively. Two patients (7.4%) progressed from Child–Pugh class A to B at 6&#xa0;months.</p> Conclusions <p>MRI–US fusion guidance enabled sub-centimeter fiducial placement accuracy in this cohort. A shorter tumor–ROI distance may be associated with smaller targeting error, although this remains exploratory. Tumor depth and visibility showed limited influence on placement accuracy.</p> Graphical Abstract <p></p>

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Fiducial marker placement for hepatocellular carcinoma using magnetic resonance imaging–ultrasound fusion guidance: targeting accuracy and determinants of error (with video)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月24日

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  • Katsuhiko Tsutsumi,
  • Kenta Yamamoto,
  • Yumi Oie,
  • Takayuki Miyachi,
  • Yutaka Kato,
  • Kentaro Yamao,
  • Takuya Ishikawa,
  • Yoji Ishizu,
  • Takashi Honda,
  • Hiroki Kawashima

摘要

Purpose

Stereotactic body radiation therapy (SBRT) is effective for hepatocellular carcinoma (HCC), and accurate fiducial marker placement is essential for motion-compensated tracking. We assessed the targeting accuracy and safety achieved with magnetic resonance imaging–ultrasound (MRI–US) fusion guidance and explored factors associated with placement error.

Methods

In this single-center cohort, 44 patients with HCC underwent SBRT with percutaneous fiducial placement under Gd-EOB-DTPA–enhanced MRI–US fusion. A region of interest (ROI) adjacent to the tumor was defined during planning, and the distance difference |A–B| between the planned tumor–ROI distance (A) and the post-procedure tumor–marker distance (B) was used as the targeting error. Predictors of error > 5 mm were explored using a random-forest model.

Results

Median targeting error was 6.79 mm (range: 4.06–13.19 mm). In the exploratory model, a longer ROI–tumor distance appeared to have relatively higher feature-importance values for errors > 5 mm, whereas tumor depth and sonographic visibility contributed minimally. During follow-up, four local recurrences and twenty intrahepatic metastases occurred. The cumulative incidence of intrahepatic metastasis was 14.2%, 16.7%, and 24.1% at 180, 360, and 540 days, respectively. Two patients (7.4%) progressed from Child–Pugh class A to B at 6 months.

Conclusions

MRI–US fusion guidance enabled sub-centimeter fiducial placement accuracy in this cohort. A shorter tumor–ROI distance may be associated with smaller targeting error, although this remains exploratory. Tumor depth and visibility showed limited influence on placement accuracy.

Graphical Abstract