Ultrasound-guided versus CT-guided microwave ablation for liver metastases reduces complications with comparable tumor control

Objective Microwave ablation (MWA) is a minimally invasive therapy for liver metastases. Image guidance, primarily ultrasound (US) and computed tomography (CT), is critical for precision, but their comparative safety profiles remain debated. This study aims to compare the incidence and severity of complications between US-guided and CT-guided MWA in patients with liver metastases.Methods After propensity score matching (PSM), retrospective analysis of 120 patients (2022–2024) undergoing US-guided (n = 60) or CT-guided (n = 60) MWA at a single tertiary referral center. Complications were classified using the Clavien–Dindo system. Statistical analysis included Student’s t test, χ2 tests, and logistic regression.Results Major complications (Clavien–Dindo ≥ III) occurred in 5% of US-guided vs. 13.3% of CT-guided cases (p = 0.04). US guidance correlated with fewer pneumothoraxes (0% vs. 8.3%, p = 0.02) and reduced radiation exposure (p < 0.001). There was no statistically significant difference in the 12-month local tumor progression (LTP) rate between the two groups (p = 0.79).Conclusion US-guided MWA demonstrates comparable tumor control to CT guidance with fewer complications and avoids radiation exposure, supporting its preferential use for high-risk patients.