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Percutaneous Saline-Enhanced Radiofrequency Ablation of Unresectable Hepatic Tumors: Initial Experience in 26 Patients

Joachim Kettenbach1, Wolfgang Köstler2, Ernst Rücklinger3, Burkhard Gustorff4, Michael Hüpfl4, Florian Wolf1, Katarina Peer5, Martina Weigner6, Johannes Lammer1, W. Müller7 and S. Nahum Goldberg8

1 Department of Diagnostic Radiology, Division of Angiography and Interventional Radiology, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
2 Department of Internal Medicine I, Division of Oncology, University of Vienna Medical School, A-1090 Vienna, Austria.
3 Statistical Analyses Methodical Consulting, Treustr. 15/11, A-1200 Vienna, Austria.
4 Department of Anesthesiology and Intensive Care (B), University of Vienna Medical School, A-1090 Vienna, Austria.
5 Department of Radiotherapy, University of Vienna Medical School, A-1090 Vienna, Austria.
6 Wilhelminenspital, Montlearstr. 37, A-1160 Vienna, Austria.
7 University Department Biomedical Engineering, Fachhochschule Furtwangen, Jakob-Kienzle-Str. 17, D-78054 Villingen-Schwenningen, Germany.
8 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd., Boston, MA 02215.



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  		Fig. 1A. —70-year-old man with primary hepatic tumor. Preprocedural axial T2-weighted MR image (true fast imaging with steady-state free precession; TR/TE, 10/5; flip angle, 70°; echo-train length, 1; thickness, 7mm; matrix, 256 x 256) obtained after IV administration of particles of superparamagnetic iron oxide shows hyperintense primary hepatic tumor (arrow) 4 cm in diameter at level of hepatic dome.

 


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  		Fig. 1B. —70-year-old man with primary hepatic tumor. Follow-up CT scan obtained 3 days after radiofrequency ablation shows hypodense nonenhancing area (largest diameter, 5.4 x 4.0 cm), which indicates coagulation necrosis and complete ablation of tumor.

 


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  		Fig. 1C. —70-year-old man with primary hepatic tumor. Follow-up CT scan at 6 months shows decrease in size of coagulation necrosis (largest diameter, 3.9 x 3.2 cm). No tumor recurrence was observed, and tumor markers reached normal values.

 


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  		Fig. 2. —Photograph shows MR imaging–compatible radiofrequency ablation electrode for saline-enhanced technique (15-gauge diameter, 20-cm length). Outlets and water pockets (arrowheads) in tip provide saline infusion through needle into surrounding tissue.

 

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