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Multiple-Electrode Radiofrequency Ablation of Hepatic Malignancies: Initial Clinical Experience

¹ Department of Biomedical Engineering, University of Wisconsin, Madison, WI.
² Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53792-3252.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Multiple-electrode radiofrequency system (Cool-tip radiofrequency Switching Controller, Valleylab) consists of 200-W monopolar radiofrequency generator operating at 480 kHz (left, top box) and switching system (left, bottom box) that can be used to power up to three electrically independent electrodes (right) (SWCT1530, Valleylab).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —56-year-old man with 2.8-cm hepatocellular carcinoma treated with two electrodes. Preablation axial gadolinium-enhanced gradient-echo MR image shows tumor (arrow) near dome of liver.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —56-year-old man with 2.8-cm hepatocellular carcinoma treated with two electrodes. Postablation hepatic artery phase contrast-enhanced CT scan shows successful treatment with ablation zone (arrow) completely covering tumor.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Multiple-electrode radiofrequency ablation performed with three closely spaced electrodes to treat large ovarian cancer metastasis in 57-year-old woman. CT scan shows tumor with mean diameter of 5.1 cm (arrow).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Multiple-electrode radiofrequency ablation performed with three closely spaced electrodes to treat large ovarian cancer metastasis in 57-year-old woman. Intraprocedural CT scan obtained to confirm placement of three electrodes (arrow). Note that electrodes do not have to be placed parallel to one another.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Multiple-electrode radiofrequency ablation performed with three closely spaced electrodes to treat large ovarian cancer metastasis in 57-year-old woman. Postprocedure CT scan shows large confluent ablation zone (arrow) covering entire tumor.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —72-year-old man with large, irregular tumor mass formed by three hepatocellular carcinomas treated with multiple-electrode radiofrequency ablation. Preablation CT scan (A) and sonograms (B and C) show two small nodules measuring 2.8 cm (arrowhead, B) and 1.9 cm (arrowhead, C) adjacent to larger 5.6-cm nodule (arrows).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —72-year-old man with large, irregular tumor mass formed by three hepatocellular carcinomas treated with multiple-electrode radiofrequency ablation. Preablation CT scan (A) and sonograms (B and C) show two small nodules measuring 2.8 cm (arrowhead, B) and 1.9 cm (arrowhead, C) adjacent to larger 5.6-cm nodule (arrows).

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —72-year-old man with large, irregular tumor mass formed by three hepatocellular carcinomas treated with multiple-electrode radiofrequency ablation. Preablation CT scan (A) and sonograms (B and C) show two small nodules measuring 2.8 cm (arrowhead, B) and 1.9 cm (arrowhead, C) adjacent to larger 5.6-cm nodule (arrows).

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —72-year-old man with large, irregular tumor mass formed by three hepatocellular carcinomas treated with multiple-electrode radiofrequency ablation. First nodule was successfully ablated with 12-minute ablation using two electrodes (arrows). Second 12-minute ablation with three electrodes was used to treat distal aspect of larger tumor. Remaining portion of that tumor and third tumor were treated simultaneously with three electrodes (not shown).

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —72-year-old man with large, irregular tumor mass formed by three hepatocellular carcinomas treated with multiple-electrode radiofrequency ablation. Immediate postablation CT scan shows successful ablation of tumors with conglomerate ablation zone (arrow) measuring 5.4 x 8.9 cm.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —67-year-old woman with two hepatocellular carcinomas treated simultaneously with multiple-electrode radiofrequency ablation. Preablation CT scans show two tumors with mean diameters of 1.4 cm (arrow, A) and 1.6 cm (arrow, B).

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —67-year-old woman with two hepatocellular carcinomas treated simultaneously with multiple-electrode radiofrequency ablation. Preablation CT scans show two tumors with mean diameters of 1.4 cm (arrow, A) and 1.6 cm (arrow, B).

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —67-year-old woman with two hepatocellular carcinomas treated simultaneously with multiple-electrode radiofrequency ablation. Immediate postablation CT scan with contrast enhancement shows ablation zones (arrows) as areas of hypoattenuation. Mean ablation zone diameters were 2.1 and 2.6 cm, respectively. No evidence of local tumor progression was evident on 1-month follow-up scans (not shown).

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Multiple-electrode radiofrequency ablation of previously treated (radiofrequency ablation and cryoablation) 10-cm colorectal metastasis in 65-year-old woman. Preablation CT scan (A) and sonogram (B) show large tumor (arrow) abutting inferior vena cava (IVC, B).

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Multiple-electrode radiofrequency ablation of previously treated (radiofrequency ablation and cryoablation) 10-cm colorectal metastasis in 65-year-old woman. Preablation CT scan (A) and sonogram (B) show large tumor (arrow) abutting inferior vena cava (IVC, B).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Multiple-electrode radiofrequency ablation of previously treated (radiofrequency ablation and cryoablation) 10-cm colorectal metastasis in 65-year-old woman. Intraprocedural sonograms show three electrodes (small arrows, C) placed in tumor. Microbubbles (large arrows) forming during ablation approximate developing conglomerate zone of ablation.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —Multiple-electrode radiofrequency ablation of previously treated (radiofrequency ablation and cryoablation) 10-cm colorectal metastasis in 65-year-old woman. Intraprocedural sonograms show three electrodes (small arrows, C) placed in tumor. Microbubbles (large arrows) forming during ablation approximate developing conglomerate zone of ablation.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E — Multiple-electrode radiofrequency ablation of previously treated (radiofrequency ablation and cryoablation) 10-cm colorectal metastasis in 65-year-old woman. Postablation CT scan shows large hypoattenuating ablation zone (arrow) that covers tumor, indicative of successful treatment. However, 1-month follow-up CT scan (not shown) revealed persistent tumor (not shown) and patient declined further treatment.

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