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Percutaneous Radiofrequency Ablation with Artificial Ascites for Hepatocellular Carcinoma in the Hepatic Dome: Initial Experience

Hyunchul Rhim1, Hyo K. Lim, Young-sun Kim and Dongil Choi

1 All authors: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.


Figure 1
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  		Fig. 1 —Photograph of percutaneous radiofrequency ablation with artificial ascites. Note 6-French angiosheath inserted into perihepatic peritoneal space (arrow). Cool-tip RF is manufactured by Valleylab.

 

Figure 2
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  		Fig. 2A —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse contrast-enhanced CT scan before radiofrequency ablation shows hyperattenuating 1.0-cm nodule in liver segment VIII (arrow).

 

Figure 3
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  		Fig. 2B —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Intercostal oblique image at planning sonography shows subtle hypoechoic nodule only on deep inhalation (arrow).

 

Figure 4
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  		Fig. 2C —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Sonogram shows perihepatic artificial ascites (arrow) introduced via 6-French angiosheath (arrowhead).

 

Figure 5
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  		Fig. 2D —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Sonogram shows index tumor (arrow) more clearly, even on shallow breathing.

 

Figure 6
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  		Fig. 2E —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Sonogram shows targeting phase of procedure. Note radiofrequency electrode in index tumor (arrow).

 

Figure 7
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  		Fig. 2F —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Sonogram shows monitoring phase of procedure. Note hyperechoic radiofrequency ablation zone during ablation (arrow).

 

Figure 8
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  		Fig. 2G —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse contrast-enhanced CT scan obtained immediately after radiofrequency ablation shows nonenhancing radiofrequency ablation zone encompassing tumor (arrow). There is no evidence of collateral thermal damage to diaphragm.

 

Figure 9
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  		Fig. 2H —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse contrast-enhanced CT scan obtained at 1 month after radiofrequency ablation shows complete ablation without local tumor progression. Artificial ascites is completely absorbed without any complication.

 

Figure 10
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  		Fig. 2I —48-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse contrast-enhanced CT scan obtained at 9 months after radiofrequency ablation shows complete ablation without local tumor progression.

 

Figure 11
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  		Fig. 3A —69-year-old woman with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse contrast-enhanced CT scan before radiofrequency ablation shows hyperattenuating, 2-cm nodule in liver segment VIII (arrow).

 

Figure 12
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  		Fig. 3B —69-year-old woman with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse (B) and coronal (C) contrast-enhanced CT scans obtained immediately after radiofrequency ablation show nonenhancing radiofrequency ablation zone encompassing tumor (arrow). There is no evidence of collateral thermal damage of diaphragm. Note minimal shifting of artificial ascites (asterisk) into pleural cavity (arrowhead, B).

 

Figure 13
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  		Fig. 3C —69-year-old woman with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse (B) and coronal (C) contrast-enhanced CT scans obtained immediately after radiofrequency ablation show nonenhancing radiofrequency ablation zone encompassing tumor (arrow). There is no evidence of collateral thermal damage of diaphragm. Note minimal shifting of artificial ascites (asterisk) into pleural cavity (arrowhead, B).

 

Figure 14
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  		Fig. 3D —69-year-old woman with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse contrast-enhanced CT scan obtained at 1 month after radiofrequency ablation shows complete ablation without local tumor progression. Artificial ascites is completely absorbed without any complication.

 

Figure 15
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  		Fig. 3E —69-year-old woman with hepatocellular carcinoma in right hepatic dome (segment VIII). Transverse contrast-enhanced CT scan obtained at 7 months after radiofrequency ablation shows complete ablation without local tumor progression.

 

Figure 16
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  		Fig. 4A —63-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Patient has history of segment VII segmentectomy, radiofrequency ablation, and transarterial chemoembolization. Transverse contrast-enhanced CT scan before radiofrequency ablation shows partially lipolyzed nodule in liver segment VII (arrow).

 

Figure 17
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  		Fig. 4B —63-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Patient has history of segment VII segmentectomy, radiofrequency ablation, and transarterial chemoembolization. Intercostal oblique scan at planning sonography shows 2.5-cm hypoechoic nodule (arrow). However, there is no adequate radiofrequency electrode path because of overlapped costochondral junction.

 

Figure 18
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  		Fig. 4C —63-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Patient has history of segment VII segmentectomy, radiofrequency ablation, and transarterial chemoembolization. Sonogram shows perihepatic artificial ascites (arrow) around anterior perihepatic area. No fluid is accumulated around liver capsule bearing index tumor probably because of postoperative adhesions (arrowheads).

 

Figure 19
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  		Fig. 4D —63-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Patient has history of segment VII segmentectomy, radiofrequency ablation, and transarterial chemoembolization. Transverse (D) and coronal (E) contrast-enhanced CT scans obtained immediately after radiofrequency ablation show nonenhancing radiofrequency ablation zone (arrow) encompassing tumor. However, there is moderate thickening of diaphragm adjacent to radiofrequency ablation zone. Patient complained of right shoulder pain for 4 days after ablation.

 

Figure 20
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  		Fig. 4E —63-year-old man with hepatocellular carcinoma in right hepatic dome (segment VIII). Patient has history of segment VII segmentectomy, radiofrequency ablation, and transarterial chemoembolization. Transverse (D) and coronal (E) contrast-enhanced CT scans obtained immediately after radiofrequency ablation show nonenhancing radiofrequency ablation zone (arrow) encompassing tumor. However, there is moderate thickening of diaphragm adjacent to radiofrequency ablation zone. Patient complained of right shoulder pain for 4 days after ablation.

 

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