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Effect of Vascular Occlusion on Radiofrequency Ablation of the Liver

Results in a Porcine Model

¹ Department of Radiology, E3/311 CSC, University of Wisconsin, 600 Highland Ave., Madison, WI 53792.
² Department of Surgery, University of Wisconsin, Madison, WI 53729.
³ Department of Pathology, University of Wisconsin, Madison, WI 53729.

View larger version (95K): [in a new window]   Fig. 1. —Multiprong radiofrequency probe (model 30; RITA Medical Systems, Mountain View, CA) used in this study.

View larger version (151K): [in a new window]   Fig. 2A. —Gross axial liver sections show range of radiofrequency lesion shapes. Lesion obtained without vascular occlusion has discontinuous, unpredictable areas of necrosis centered around probe prongs.

View larger version (161K): [in a new window]   Fig. 2B. —Gross axial liver sections show range of radiofrequency lesion shapes. Specimen obtained with hepatic artery occlusion shows deep clefts between prongs. Note concavities exceeding 50% of measured radius.

View larger version (145K): [in a new window]   Fig. 2C. —Gross axial liver sections show range of radiofrequency lesion shapes. Lesion obtained after portal vein occlusion reveals shallower clefts. Radial concavities are less than 50% of radius.

View larger version (165K): [in a new window]   Fig. 2D. —Gross axial liver sections show range of radiofrequency lesion shapes. Lesion obtained after Pringle maneuver yields roughly circular configuration.

View larger version (154K): [in a new window]   Fig. 3A. —Vascular impressions on radiofrequency lesions. Gross specimen obtained after radiofrequency without vascular occlusion shows deep clefts caused by patent vessels (arrows). Lesion is particularly susceptible to deformity by vessels in areas between probe prongs.

View larger version (139K): [in a new window]   Fig. 3B. —Vascular impressions on radiofrequency lesions. Gross specimen obtained after Pringle maneuver (hepatic artery and portal vein occlusion) shows circular configuration of lesion and lack of effect on lesion shape by occluded portal venous branch (arrow).

View larger version (136K): [in a new window]   Fig. 4A. —Zones of necrosis after radiofrequency ablation. Section of normal liver outside lesion area shows normal trabeculae (between arrows) and vesicular nuclei in intact hepatocytes. Occasional erythrocytes were present in intact sinusoids (arrows). (H and E, x200)

View larger version (140K): [in a new window]   Fig. 4B. —Zones of necrosis after radiofrequency ablation. Hemorrhagic zone shows extensive disruption of trabecular structure and sinusoids with hemorrhage (arrowhead). Loose hepatocytes contain pyknotic nuclei. (H and E, x200)

View larger version (136K): [in a new window]   Fig. 4C. —Zones of necrosis after radiofrequency ablation. Pale central zone of lesion shows thin indistinct trabeculae composed of thin hepatocytes with indistinct cell borders and pyknotic nuclei. Sinusoidal endothelium is separated from trabeculae (arrowhead) and contains indistinct remnants of erythrocytes (arrow).

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