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Percutaneous Radiofrequency Ablation of Hepatic Metastases for Symptomatic Relief of Neuroendocrine Syndromes

Adam R. Henn1, Edward A. Levine2, William McNulty3 and Ronald J. Zagoria1

1 Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.
2 Department of Surgical Oncology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1088.
3 Hanover Medical Specialists, 1520 Physicians Dr., Wilmington, NC 28401.



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  		Fig. 1A. —60-year-old woman with insulinoma that was well controlled with octreotide, but who developed debilitating life-threatening symptoms when not receiving continuous octreotide therapy. Her fasting insulin dropped from preablation level of 40.1 µU/mL with octreotide therapy to 7.9 µU/mL without octreotide injections. Contrast-enhanced CT scan obtained 1 month before ablation procedure shows heterogeneous mass (arrows) in liver.

 


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  		Fig. 1B. —60-year-old woman with insulinoma that was well controlled with octreotide, but who developed debilitating life-threatening symptoms when not receiving continuous octreotide therapy. Her fasting insulin dropped from preablation level of 40.1 µU/mL with octreotide therapy to 7.9 µU/mL without octreotide injections. CT scan obtained during radiofrequency ablation procedure shows cluster electrode (arrow) with its tip in insulinoma (arrowheads).

 


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  		Fig. 1C. —60-year-old woman with insulinoma that was well controlled with octreotide, but who developed debilitating life-threatening symptoms when not receiving continuous octreotide therapy. Her fasting insulin dropped from preablation level of 40.1 µU/mL with octreotide therapy to 7.9 µU/mL without octreotide injections. Contrast-enhanced CT scan obtained immediately after radiofrequency ablation procedure, which included nine ablations, shows ablated tumor as sharply marginated nonenhancing area. Note small volume of persistent bright enhancement (arrows) at periphery that was believed to be untreated and viable tumor.

 


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  		Fig. 1D. —60-year-old woman with insulinoma that was well controlled with octreotide, but who developed debilitating life-threatening symptoms when not receiving continuous octreotide therapy. Her fasting insulin dropped from preablation level of 40.1 µU/mL with octreotide therapy to 7.9 µU/mL without octreotide injections. Contrast-enhanced CT scan obtained 12 months after ablation shows sharply demarcated low-density area of ablated tissue surrounded by residual tumor that has grown since B and C.

 


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  		Fig. 2A. —52-year-old woman with carcinoid syndrome and single metastasis in liver. Patient refused surgery and could not afford medical therapy for control of her worsening symptoms. Contrast-enhanced CT scan before ablation shows 5.6-cm metastasis in left lobe of liver.

 


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  		Fig. 2B. —52-year-old woman with carcinoid syndrome and single metastasis in liver. Patient refused surgery and could not afford medical therapy for control of her worsening symptoms. Contrast-enhanced CT scan obtained 2 weeks after ablation shows ablated tumor as sharply demarcated low-attenuation lesion with no visible enhancement.

 


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  		Fig. 2C. —52-year-old woman with carcinoid syndrome and single metastasis in liver. Patient refused surgery and could not afford medical therapy for control of her worsening symptoms. Contrast-enhanced CT scan obtained 8 months after ablation shows some shrinkage of ablated tumor and no evidence of local recurrence. New lesion (arrow) is visible in liver segment VIII. Note slight prominence of intrahepatic bile ducts not seen on earlier scans. Bile duct dilatation suggests partial obstruction from occult mass or ablation-induced stricture.

 

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