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Li et al. Hepatoma Res. 2025;11:25 https://dx.doi.org/10.20517/2394-5079.2025.63 Page 7 of 17

Table 1. Summary of ablation efficacy evaluation methods
Method Characteristics Drawbacks
Ultrasound Cost-effective and convenient [50] Low resolution and poor sensitivity
The imaging effect is affected by the operator
CEUS Cost-effective and efficient, with sensitivity comparable to contrast- Difficult to accurately assess lesions located deep,
[70]
enhanced CT above the hepatic dome, or in patients with limited
[70]
positioning
Not suitable for patients with allergic tendencies
Ultrasound Allows integration of information from different imaging modalities, Complex operation and registration, time-consuming,
Fusion Imaging leveraging the advantages of each to comprehensively evaluate, highly dependent on experience [50]
eliminate or minimize the drawbacks of each modality High equipment requirements, many influencing factors,
Aids in intraoperative assessment of ablation margins, detection of image registration deformation
[70]
residual tumors, and supplementary ablation
CT Fast scanning speed, wide applicability Due to bleeding, edema, exudation, and infiltration of
Immediate intraoperative evaluation is primarily used to determine inflammatory cells around the ablation zone, accurate
the presence of complications such as pneumothorax, bleeding, or tumor evaluation requires several weeks post-ablation
[71-73]
injury to adjacent organs, and to make timely interventions
MRI No radiation exposure, high resolution, excellent for vascular imaging, Slow imaging speed
can display temperature in real-time [74-76] Ablation equipment must be compatible with MRI to
ensure real-time imaging
Operation is more complex
CTHA Higher sensitivity for detecting small hepatic lesions both Requires catheter placement and specialized technical
preoperatively and intraoperatively [11,12] expertise
CTHA-guided MWA takes longer than conventional CT
PET/CT Can clearly delineate tumors before, during, and after ablation [49] Expensive, patients are subjected to higher radiation
doses, higher false-positive rates
Novel imaging Capable of clearly identifying tumor margins, and some methods can Still some time required before clinical translation and
techniques distinguish between residual active tumors and ablated dead application
[47]
tumors
CEUS: Contrast-enhanced ultrasound; CT: computed tomography; MRI: magnetic resonance imaging; CTHA: CT hepatic arteriography; PET/CT:
positron emission tomography/computed tomography; MWA: microwave ablation.

imaging has shown promise in detecting and assessing liver tumors . Owing to its real-time capability and
[12]
operational convenience, CEUS provides valuable intraoperative guidance, particularly in resource-limited
settings.

Initially developed as a diagnostic tool, CTHA has demonstrated additional advantages in accurately
delineating tumor and vascular anatomy, improving puncture guidance, and enabling real-time monitoring
[11]
of the ablation zone . CTHA can detect small lesions that are often missed by conventional contrast-
enhanced CT or MRI, thereby reducing the need for repeat scans and minimizing radiation exposure .
[11]
Although its application is limited by higher costs and the requirement for catheter insertion, CTHA holds
significant promise for optimizing ablation procedures. With its superior spatial resolution and vascular
imaging capabilities, CTHA offers more precise treatment navigation, particularly in complex cases
involving ill-defined tumor margins or lesions adjacent to critical structures.

Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) has demonstrated
significant potential for real-time evaluation of ablation efficacy. By administering 18F-FDG tracers both
[45]
before and after ablation, the immediate assessment of treatment response can be achieved . Furthermore,
the combination of 13N-ammonia-based metabolic and perfusion imaging allows for accurate delineation
of tumor margins within minutes post-ablation . This approach highlights the feasibility of PET/CT as an
[46]
integrated imaging modality that supports pre-ablation path planning, intraoperative needle positioning,
immediate post-ablation assessment, and long-term follow-up. By providing dynamic insights into tumor
metabolic activity, PET/CT facilitates early detection of residual or recurrent lesions and aids in the
development of personalized therapeutic strategies.