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. 2018 Dec 14;24(46):5215–5222. doi: 10.3748/wjg.v24.i46.5215

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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.

This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

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45-year-old man with a history of left hemihepatectomy for hepatocellular carcinoma. A 6-mm recurrent hepatocellular carcinoma (HCC) in segment 5 of the liver is seen on magnetic resonance imaging. The nodule (arrow) shows arterial enhancement (A), washout on transitional phase (B), high signal intensity on both T2- and diffusion-weighted images (C and D), and low signal intensity on hepatobiliary phase (E). On planning ultrasound (US) with fusion imaging (F), the nodule was invisible using real-time US image (left figure) at the corresponding site of the fused magnetic resonance image (right figure). When contrast-enhanced ultrasound (CEUS) using Sonazoid (GE Healthcare, Oslo, Norway) was added to fusion imaging, there was a nodule (arrow) with arterial enhancement (G) and low echogenicity in the post-vascular phase (H). Under CEUS-added fusion imaging guidance (I), the radiofrequency (RF) electrode was accurately placed through the tumor (arrow). At follow up computed tomography obtained immediately after RF ablation (J), the index tumor was completely ablated with sufficient ablative margin (arrowhead).