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Radiofrequency Ablation of Hepatocellular Carcinoma: Predicting Success Using Contrast-Enhanced Sonography

Marcus J. Dill-Macky1,2, Murray Asch1, Peter Burns3 and Stephanie Wilson1

1 Department of Medical Imaging, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada.
2 Princess Margaret Hospital 3-923, University of Toronto, 610 University Ave., Toronto, Ontario M5G 2M9, Canada.
3 Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.


Figure 1
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  		Fig. 1A —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase enhanced sonogram obtained immediately after procedure illustrates difficulty in interpreting these studies due to reactive marginal hypervascularity (straight arrows), large perfusion anomaly (asterisk), and residual vessel traversing ablation zone (curved arrow).

 

Figure 2
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  		Fig. 1B —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Portal-phase enhanced sonogram clearly depicts margins of ablation zone. Reactive marginal hypervascularity and perfusion anomaly are difficult to identify.

 

Figure 3
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  		Fig. 1C —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase CT scan obtained at 2-week follow-up shows perfusion anomaly seen at enhanced sonography (asterisk); however, reactive marginal hypervascularity has resolved.

 

Figure 4
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  		Fig. 1D —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Portal-phase CT scan obtained at same level as C clearly shows margins of ablation zone. Perfusion anomaly is no longer visible.

 

Figure 5
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  		Fig. 2A —43-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase enhanced sonogram shows hypervascular nodule (straight arrow) beside ablation zone (curved arrows).

 

Figure 6
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  		Fig. 2B —43-year-old man after radiofrequency ablation of hepatocellular carcinoma. Portal-phase enhanced sonogram shows washout of nodule (arrow), in keeping with malignant cause.

 

Figure 7
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  		Fig. 2C —43-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase (C) and portal-phase (D) CT scans confirm sonographic suspicion that residual disease (straight arrow, C) is present beyond margin of ablation zone (curved arrow, C), indicating unsuccessful targeting at time of ablation.

 

Figure 8
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  		Fig. 2D —43-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase (C) and portal-phase (D) CT scans confirm sonographic suspicion that residual disease (straight arrow, C) is present beyond margin of ablation zone (curved arrow, C), indicating unsuccessful targeting at time of ablation.

 

Figure 9
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  		Fig. 3A —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase enhanced sonogram obtained immediately after procedure depicts residual disease as small area of marginal hypervascularity not detected prospectively in masked interpretation (arrow).

 

Figure 10
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  		Fig. 3B —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Portal-phase enhanced sonogram cannot differentiate residual disease from background liver.

 

Figure 11
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  		Fig. 3C —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Enhanced sonogram obtained at 2-week follow-up clearly depicts residual disease (arrow) identified prospectively in masked interpretation.

 

Figure 12
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  		Fig. 3D —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Enhanced sonogram showing washout of residual disease adds confidence to diagnosis (arrow).

 

Figure 13
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  		Fig. 3E —59-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase CT scan confirms residual disease identified at enhanced sonography (arrow). Asterisk denotes old, partially calcified ablation site.

 

Figure 14
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  		Fig. 4A —48-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase enhanced sonogram obtained immediately after ablation depicts subtle residual disease as eccentric hypervascular mass (arrow) not recognized by masked reviewers. Also seen is prominent, rindlike marginal reactive hypervascularity.

 

Figure 15
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  		Fig. 4B —48-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase enhanced sonogram obtained at 2-week follow-up depicts subtle residual disease (arrow)—again, not recognized during masked interpretation. Marginal reactive hypervascularity has resolved.

 

Figure 16
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  		Fig. 4C —48-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase (C) and portal-phase (D) CT scans obtained at 2-week follow-up confirm enhanced sonography finding of residual disease (arrows).

 

Figure 17
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  		Fig. 4D —48-year-old man after radiofrequency ablation of hepatocellular carcinoma. Arterial-phase (C) and portal-phase (D) CT scans obtained at 2-week follow-up confirm enhanced sonography finding of residual disease (arrows).

 

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