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Therapeutic Efficacy and Safety of Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma Abutting the Gastrointestinal Tract

¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-ku, Seoul 135-710, South Korea.
² Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.

View larger version (117K): [in a new window]   Fig. 1A. —52-year-old man with successful radiofrequency ablation of hepatocellular carcinoma abutting colon. Contrast-enhanced transverse CT scan obtained during arterial phase shows 1.8-cm-diameter hepatocellular carcinoma (arrows) in liver segment V that abuts colon (C). Also seen is hepatic cyst (arrowheads) in liver segment VI.

View larger version (119K): [in a new window]   Fig. 1B. —52-year-old man with successful radiofrequency ablation of hepatocellular carcinoma abutting colon. Oblique sonogram obtained during radiofrequency ablation shows slightly hypoechoic hepatocellular carcinoma (arrows) that abuts colon (C). Note 3-cm active tip (between electronic calipers) of internally cooled electrode running parallel to anterior hepatic angle. Single ablation was performed for 12 min.

View larger version (105K): [in a new window]   Fig. 1C. —52-year-old man with successful radiofrequency ablation of hepatocellular carcinoma abutting colon. Contrast-enhanced CT scan obtained 1 month after radiofrequency ablation shows unenhanced low-attenuation ablation zone (arrows). Notice ablation zone is larger than index tumor, representing satisfactory ablative margin. Findings indicate technical success. Also note normal appearance of colon (C) adjacent to ablation zone.

View larger version (124K): [in a new window]   Fig. 1D. —52-year-old man with successful radiofrequency ablation of hepatocellular carcinoma abutting colon. Contrast-enhanced CT scan obtained 16 months after radiofrequency ablation shows ablation zone (arrows) remains nonenhancing with substantial decrease in size, suggesting complete ablation. Patient has survived for 16 months with neither local tumor progression nor new hepatocellular carcinoma.

View larger version (94K): [in a new window]   Fig. 2A. —56-year-old man with residual unablated tumor after radiofrequency ablation of hepatocellular carcinoma abutting stomach (tumor number 3 in Table 1). Contrast-enhanced transverse CT scan obtained during arterial phase shows 3.6-cm-diameter hepatocellular carcinoma (arrows) in liver segment II that abuts stomach (S). Tumor is recurrent after initial remission with transcatheter arterial chemoembolization. Also seen are multiple iodized oil-retaining tumors (arrowheads) in right hepatic lobe.

View larger version (172K): [in a new window]   Fig. 2B. —56-year-old man with residual unablated tumor after radiofrequency ablation of hepatocellular carcinoma abutting stomach (tumor number 3 in Table 1). Transverse sonogram obtained during radiofrequency ablation shows slightly hypoechoic hepatocellular carcinoma (arrows). Note 3-cm active tip (arrowheads) of internally cooled electrode within tumor. Twice overlapping ablations were performed for 24 min.

View larger version (93K): [in a new window]   Fig. 2C. —56-year-old man with residual unablated tumor after radiofrequency ablation of hepatocellular carcinoma abutting stomach (tumor number 3 in Table 1). Contrast-enhanced CT scan obtained 1 month after radiofrequency ablation shows enhancing focus (arrowheads) in ablation zone (arrows) that represents residual unablated tumor. Stomach appears normal.

View larger version (102K): [in a new window]   Fig. 2D. —56-year-old man with residual unablated tumor after radiofrequency ablation of hepatocellular carcinoma abutting stomach (tumor number 3 in Table 1). Contrast-enhanced CT scan obtained 1 month after additional radiofrequency ablation with laparoscopic guidance shows nonenhancing low-attenuation ablation zone (arrows).

View larger version (99K): [in a new window]   Fig. 2E. —56-year-old man with residual unablated tumor after radiofrequency ablation of hepatocellular carcinoma abutting stomach (tumor number 3 in Table 1). Contrast-enhanced CT scan obtained 12 months after additional radiofrequency ablation shows ablation zone (arrows) remains nonenhanced with interval decrease in size, suggesting complete ablation.

View larger version (101K): [in a new window]   Fig. 3A. —68-year-old man with local tumor progression and abscess formation after radiofrequency ablation of hepatocellular carcinoma (tumor number 4 in Table 1). Contrast-enhanced CT scan obtained during arterial phase shows 2.2-cm-diameter hepatocellular carcinoma (arrows) in liver segment VI that abuts colon (C).

View larger version (130K): [in a new window]   Fig. 3B. —68-year-old man with local tumor progression and abscess formation after radiofrequency ablation of hepatocellular carcinoma (tumor number 4 in Table 1). Oblique sonogram obtained during radiofrequency ablation shows slightly hypoechoic hepatocellular carcinoma (arrows) that abuts colon (C). Note hooklike tines (arrowheads) of 3.5-cm multitined expandable electrode. Two overlapping ablations with tines partially deployed were performed for 15 min.

View larger version (112K): [in a new window]   Fig. 3C. —68-year-old man with local tumor progression and abscess formation after radiofrequency ablation of hepatocellular carcinoma (tumor number 4 in Table 1). Contrast-enhanced follow-up CT scan obtained 1 month after radiofrequency ablation shows ablation zone (arrows). Also seen is small perihepatic abscess (arrowheads) resulting from injury of lateral liver capsule and peritoneum. Colon (C) adjacent to ablation zone appears normal.

View larger version (122K): [in a new window]   Fig. 3D. —68-year-old man with local tumor progression and abscess formation after radiofrequency ablation of hepatocellular carcinoma (tumor number 4 in Table 1). Contrast-enhanced CT scan obtained 40 days after radiofrequency ablation shows perihepatic abscess has completely resolved after administration of IV antibiotics.

View larger version (116K): [in a new window]   Fig. 3E. —68-year-old man with local tumor progression and abscess formation after radiofrequency ablation of hepatocellular carcinoma (tumor number 4 in Table 1). Contrast-enhanced CT scan obtained during arterial phase 4 months after radiofrequency ablation shows small enhancing nodule (arrows) in inferomedial aspect of ablation zone that represents local tumor progression. Patient underwent transcatheter arterial chemoembolization for treatment of multiple recurrent tumors at another liver site (not shown).

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