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Planning Sonography to Assess the Feasibility of Percutaneous Radiofrequency Ablation of Hepatocellular Carcinomas

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.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —60-year-old man with hepatocellular carcinoma. Arterial phase CT image shows 1-cm hyperattenuating nodule in segment III (arrow).

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —60-year-old man with hepatocellular carcinoma. Planning sonography image shows no discrete nodule in segment III. Sonography-guided percutaneous radiofrequency ablation is determined to be infeasible due to inconspicuous tumor.

View larger version (72K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —60-year-old man with hepatocellular carcinoma. Another planning sonography image obtained 7 months after A and B shows 1.5-cm hypoechoic nodule in segment III (arrow).

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —60-year-old man with hepatocellular carcinoma. Arterial phase CT image 3 months after radiofrequency ablation shows 2.5-cm radiofrequency ablation zone (arrow) without local tumor progression.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —51-year-old man with hepatocellular carcinoma. Arterial phase CT image shows 2.3-cm hyperattenuating nodule in segment VII (arrow).

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —51-year-old man with hepatocellular carcinoma. Delayed phase CT image shows hypoattenuating nodule surrounded by larger portal vein (arrow).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —51-year-old man with hepatocellular carcinoma. Planning Doppler sonography image shows hypoechoic mass clearly, but there is no adequate electrode path due to large portal vein along path (arrow). In addition, possibility of heat sink effect is very high. Sonography-guided radiofrequency ablation is deemed infeasible in this patient because of inadequate electrode path and high risk of heat sink effect.

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —51-year-old man with hepatocellular carcinoma. Angiographic image obtained during transarterial chemoembolization, performed as alternative to percutaneous radiofrequency ablation, shows ovoid tumor staining in right lobe of liver (arrow).

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —53-year-old woman with hepatocellular carcinoma. Arterial phase CT image shows 1.2-cm hyperattenuating nodule (arrow) in segments V and VIII that is close to hepatic flexure of colon (arrowhead).

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —53-year-old woman with hepatocellular carcinoma. Unenhanced CT image obtained immediately after transarterial chemoembolization, performed as alternative to radiofrequency ablation, shows compact iodized oil–laden (Lipiodol, Andre Guerbet) nodule (arrow). Note abutting colonic loop.

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