Percutaneous Radiofrequency Ablation of Hepatic Tumors During Temporary Venous Occlusion
T. de Baere1,
B. Bessoud1,
C. Dromain1,
M. Ducreux2,
V. Boige2,
N. Lassau1,
T. Smayra1,
B. V. Girish1,
A. Roche1 and
D. Elias3
1
Département d'Imagerie
Médicale, Service de Radiologie
Interventionnelle, Institut Gustave Roussy, 94805 Villejuif Cedex,
France.
2
Département de
Médecine, Institut Gustave Roussy, 94805
Villejuif Cedex, France.
3
Département de Chirurgie, Institut Gustave
Roussy, 94805 Villejuif Cedex, France.
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Fig. 1A. —62-year-old man with cirrhosis and 38 x 36 mm
hepatocellular carcinoma at junction of segments VII and VIII. T1-weighted MR
image acquired after injection of gadolinium reveals tumor exhibiting strong
contrast enhancement.
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Fig. 1B. —62-year-old man with cirrhosis and 38 x 36 mm
hepatocellular carcinoma at junction of segments VII and VIII. Color Doppler
sonogram obtained 3 min after injection of 4 g of SHU508A (Levovist; Schering,
Berlin, Germany) shows hypervascular tumor. Note color highlights contact
right hepatic vein wall, showing strong contrast enhancement.
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Fig. 1C. —62-year-old man with cirrhosis and 38 x 36 mm
hepatocellular carcinoma at junction of segments VII and VIII. Sonogram
obtained after catheterization of right hepatic vein shows hypoechoic tumor
(arrow) traversed by hyperechoic line (arrowhead) caused by
guidewire in hepatic vein.
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Fig. 1D. —62-year-old man with cirrhosis and 38 x 36 mm
hepatocellular carcinoma at junction of segments VII and VIII. Fluoroscopic
image after inflation of occlusion balloon in vein shows cluster needle
(arrow) with its tip in tumor located in upper portion of segment
VIII. Note occlusive venography of right hepatic vein, previously occluded
with 20-mm balloon (arrowhead).
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Fig. 1E. —62-year-old man with cirrhosis and 38 x 36 mm
hepatocellular carcinoma at junction of segments VII and VIII. Sonogram
obtained after two 15-min sessions of radiofrequency ablation associated with
right hepatic vein occlusion shows hyperechoic area (largest axis, 72 mm)
corresponding to radiofrequency-induced area of destruction.
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Fig. 1F. —62-year-old man with cirrhosis and 38 x 36 mm
hepatocellular carcinoma at junction of segments VII and VIII. Doppler
sonogram obtained 3 min after second injection of 4 g of SHU508A and 20 min
after E shows absence of enhancement in radiofrequency-treated area and
hepatic vein remains patent.
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Fig. 1G. —62-year-old man with cirrhosis and 38 x 36 mm
hepatocellular carcinoma at junction of segments VII and VIII. T1-weighted MR
image acquired 2 months after A-F shows area of tissue necrosis larger
than tumor itself.
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Fig. 2A. —55-year-old woman with 45-mm-diameter metastasis from lung
carcinoma that has increased in size despite use of three types of
chemotherapy. CT scan shows tumor close to right lateral portal branch.
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Fig. 2B. —55-year-old woman with 45-mm-diameter metastasis from lung
carcinoma that has increased in size despite use of three types of
chemotherapy. Portography image obtained after puncture of portal branch in
segment III under sonographic guidance shows patent portal branches.
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Fig. 2C. —55-year-old woman with 45-mm-diameter metastasis from lung
carcinoma that has increased in size despite use of three types of
chemotherapy. Conventional radiograph shows triple-cluster needle in tumor
with 8-mm occlusion balloon inflated in involved portal branch.
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Fig. 2D. —55-year-old woman with 45-mm-diameter metastasis from lung
carcinoma that has increased in size despite use of three types of
chemotherapy. Portography image immediately after deflation of balloon shows
partial occlusion of previously temporarily occluded portal branch
(arrow). Note change in cluster needle position when compared with
C, because it has been repositioned to another location for
radiofrequency delivery.
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Fig. 2E. —55-year-old woman with 45-mm-diameter metastasis from lung
carcinoma that has increased in size despite use of three types of
chemotherapy. CT scan obtained 6 months after A-D shows no enhancement
in treated area.
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Fig. 3A. —37-year-old woman with 13-mm-diameter metastasis from breast
carcinoma. Sonogram reveals small hypoechoic metastasis (arrow) in
contact with middle hepatic vein wall. Note guidewire in vein
(arrowhead).
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Fig. 3B. —37-year-old woman with 13-mm-diameter metastasis from breast
carcinoma. Sonogram shows radiofrequency needle (arrow) in tumor
(arrowhead).
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Fig. 3C. —37-year-old woman with 13-mm-diameter metastasis from breast
carcinoma. Venogram obtained immediately before balloon inflation shows close
proximity of tumor to vein, underlined by incomplete filling of vein at level
of insertion of radiofrequency needle into tumor.
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Fig. 3D. —37-year-old woman with 13-mm-diameter metastasis from breast
carcinoma. Sonogram immediately after completion of treatment shows
hyperechoic area covering tumor site.
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Fig. 3E. —37-year-old woman with 13-mm-diameter metastasis from breast
carcinoma. Venogram obtained immediately after completion of radiofrequency
delivery and after deflation of occlusion balloon shows occlusion of middle
hepatic vein.
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Copyright © 2002 by the American Roentgen Ray Society.
