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Radiofrequency Thermal Ablation of Hepatocellular Carcinoma

Using Contrast-Enhanced Harmonic Power Doppler Sonography to Assess Treatment Outcome

¹ Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplants, and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, I-56125 Pisa, Italy.
² Unit of Interventional Ultrasound, Policlinico S. Matteo IRCCS, Via Golgi 6, I-90133 Pavia, Italy.
³ Department of Radiology, National Cancer Institute, Via Venezian 1, I-20133 Milan, Italy.

View larger version (165K): [in a new window]   Fig. 1A. —Complete response of hepatocellular carcinoma after radiofrequency thermal ablation in 67-year-old woman. Unenhanced oblique subcostal power Doppler sonogram obtained before radiofrequency thermal ablation shows no intratumoral blood flow within lesion (arrows).

View larger version (141K): [in a new window]   Fig. 1B. —Complete response of hepatocellular carcinoma after radiofrequency thermal ablation in 67-year-old woman. Harmonic oblique subcostal power Doppler sonogram obtained 30 sec after contrast agent injection (but before radiofrequency ablation) shows rich vascularity of lesion.

View larger version (174K): [in a new window]   Fig. 1C. —Complete response of hepatocellular carcinoma after radiofrequency thermal ablation in 67-year-old woman. Contrast-enhanced helical CT scan obtained in arterial phase before radiofrequency ablation shows clear-cut intratumoral enhancement of lesion (arrow).

View larger version (136K): [in a new window]   Fig. 1D. —Complete response of hepatocellular carcinoma after radiofrequency thermal ablation in 67-year-old woman. Contrast-enhanced oblique subcostal power Doppler sonogram obtained after radiofrequency thermal ablation shows that intratumoral power signals have disappeared.

View larger version (159K): [in a new window]   Fig. 1E. —Complete response of hepatocellular carcinoma after radiofrequency thermal ablation in 67-year-old woman. Contrast-enhanced helical CT scan obtained in arterial phase after radiofrequency thermal ablation shows lesion to have homogeneous hypoattenuation, suggesting complete response.

View larger version (138K): [in a new window]   Fig. 2A. —Incomplete response of hepatocellular carcinoma after radiofrequency thermal ablation in 61-year-old woman. Unenhanced axial epigastric power Doppler sonogram obtained after radiofrequency thermal ablation shows no intratumoral blood flow within lesion (arrows).

View larger version (126K): [in a new window]   Fig. 2B. —Incomplete response of hepatocellular carcinoma after radiofrequency thermal ablation in 61-year-old woman. Contrast-enhanced axial epigastric harmonic power Doppler sonogram obtained after radiofrequency thermal ablation shows a small, circumscribed area of residual blood flow in the medial aspect of the tumor. Doppler spectral analysis of residual blood signal shows high-frequency pulsatile flow.

View larger version (99K): [in a new window]   Fig. 2C. —Incomplete response of hepatocellular carcinoma after radiofrequency thermal ablation in 61-year-old woman. Contrast-enhanced helical CT scan obtained in arterial phase after radiofrequency thermal ablation shows small enhancing area of residual viable tumor in medial aspect of lesion (arrow), corresponding to enhancing portion on contrast-enhanced harmonic power Doppler sonogram (B).

View larger version (189K): [in a new window]   Fig. 3A. —Complete response of hepatocellular carcinoma after repeated radiofrequency thermal ablation performed with contrast-enhanced power Doppler sonographic guidance in 65-year-old man. Unenhanced oblique subcostal power Doppler sonogram obtained after first radiofrequency ablation shows small circumscribed area of residual blood flow in posteromedial aspect of tumor (arrow).

View larger version (174K): [in a new window]   Fig. 3B. —Complete response of hepatocellular carcinoma after repeated radiofrequency thermal ablation performed with contrast-enhanced power Doppler sonographic guidance in 65-year-old man. Harmonic oblique subcostal power Doppler sonogram obtained 30 sec after contrast agent injection reveals larger area of enhancement in medial aspect of tumor (arrows).

View larger version (141K): [in a new window]   Fig. 3C. —Complete response of hepatocellular carcinoma after repeated radiofrequency thermal ablation performed with contrast-enhanced power Doppler sonographic guidance in 65-year-old man. Contrast-enhanced helical CT scan obtained in arterial phase after first radiofrequency ablation shows large enhancing area of residual viable tumor in medial aspect of lesion (arrow), corresponding to enhancing portion on contrast-enhanced power Doppler sonogram (B).

View larger version (124K): [in a new window]   Fig. 3D. —Complete response of hepatocellular carcinoma after repeated radiofrequency thermal ablation performed with contrast-enhanced power Doppler sonographic guidance in 65-year-old man. Contrast-enhanced helical CT scan obtained in arterial phase after repeated radiofrequency ablation performed under contrast-enhanced power Doppler sonographic guidance shows lesion to have homogeneous hypoattenuation, suggesting complete response.

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