Fused Microwave Ablation of an 'Invisible' Lesion in Segment VI

Fused Microwave Ablation of an 'Invisible' Lesion in Segment VI


CAS-One IR multi-modality fusion enabled a Microwave Ablation of an HCC suspected lesion. A biopsy was also performed using CT guidance, since the lesion was not visible on ultrasound.

Video showing the fusion of CT and MRI imaging

Name: Dr. Hans Martin Gissler, Dr. Christophe Hälg, Dr. Tim Ohletz and Dr. Irene Winzeler-Jörger

Institution: Kantonsspital Aarau (Switzerland)

Patient age and sex: 77 years, male

Initial condition:

  • Patient with a history of cryptogene liver cirrhosis, Child A, MELD 8, arterial hypertonia and diabetes mellitus type 2
  • During routine monitoring in May 2020, there was a suspicious lesion detected in a sonogram in Segment VI
  • This was followed by an MRI in June 2020, which showed a malignant (HCC) suspected lesion
  • In a follow up sonogram intended to biopsy the lesion, it could not be detected, declared 'invisible', and therefore was not biopsied
  • However, the tumour board decided to perform a percutaneous ablation treatment with curative intend and to get the biopsy during the intervention


  • For this lesion that is invisible on CE-CT as well, ablation and biopsy was not possible because of the lack of anatomical landmarks
  • Treatment was conducted with the support of CAS-One IR and its ability to fuse MRI (and CT) images
  • Patient was treated with MWA after taking a biopsy over the same track


Case Aarau Overview 2Left: Planning scan with fused MRI (50/50 view), Middle: Needle verification scan, Right: CE-Control Scan after the ablation

  • Quality Ablation with CAS-One IR showcases a complete ablation on post-ablation scan with a sufficient safety margin
  • Follow-up sonogram one day post-ablation does not show any abnormalities 
  • The biopsy of the lesion revealed chronic, partially active hepatitis with cirrhosis without malignancy
  • Control MRI in 6 months is indicated, but not yet conducted

Learn more about the stereotactic navigation system CAS-One IR.


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