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Effect of Artificial Ascites on Thermal Injury to the Diaphragm and Stomach in Radiofrequency Ablation of the Liver: Experimental Study with a Porcine Model

Eun Joo Lee1,2, Hyunchul Rhim1, Hyo K. Lim1, Dongil Choi1, Won Jae Lee1 and Kwang Sun Min3

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, Korea.
2 Present address: Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
3 Department of Pathology, Hallym Medical Center, College of Medicine, University of Hallym, Seoul, Korea.


Figure 1
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  		Fig. 1 —Graph shows incidence of immediate CT findings after radiofrequency ablation in experimental (light gray) and control (dark gray) groups.

 

Figure 2
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  		Fig. 2A —Control pig with diaphragmatic hernia. Coronal reformation CT image after radiofrequency ablation shows low attenuation of diaphragm adjacent to radiofrequency ablation zone (arrow).

 

Figure 3
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  		Fig. 2B —Control pig with diaphragmatic hernia. Coronal reformation CT image obtained 7 days after radiofrequency ablation shows hepatic herniation through perforated diaphragm (arrows).

 

Figure 4
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  		Fig. 2C —Control pig with diaphragmatic hernia. Postmortem photograph shows perforation (arrow) of diaphragm.

 

Figure 5
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  		Fig. 2D —Control pig with diaphragmatic hernia. Photomicrograph shows extensive coagulative cell infiltration (arrows). (H and E, x12.5)

 

Figure 6
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  		Fig. 3A —Control pig with sealed-off gastric abscess. Axial CT scan after radiofrequency ablation shows extensive gastric wall thickening (arrows).

 

Figure 7
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  		Fig. 3B —Control pig with sealed-off gastric abscess. Axial CT scan obtained 7 days after radiofrequency ablation shows abscess pocket (arrow) with wall thickening and low attenuation.

 

Figure 8
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  		Fig. 3C —Control pig with sealed-off gastric abscess. Postmortem photograph shows broad thermal injury (arrows) at serosal surface of stomach.

 

Figure 9
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  		Fig. 3D —Control pig with sealed-off gastric abscess. Photomicrograph of stomach section with grade 5 injury shows coagulative necrosis (arrows) of muscularis propria and inflammatory cell infiltration through all layers of stomach and focal ulceration (arrowheads). (H and E, x12.5)

 

Figure 10
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  		Fig. 4A —Experimental group pig with artificial ascites. Coronal reformation CT image after radiofrequency ablation shows separation between diaphragm and hepatic dome with accumulation of infused saline solution. Two radiofrequency ablated zones exhibit low attenuation.

 

Figure 11
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  		Fig. 4B —Experimental group pig with artificial ascites. Coronal reformation CT image 7 days after radiofrequency ablation shows artificial ascites has disappeared and attenuation is low in radiofrequency ablation zone.

 

Figure 12
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  		Fig. 4C —Experimental group pig with artificial ascites. Postmortem photograph shows normal-appearing diaphragm.

 

Figure 13
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  		Fig. 4D —Experimental group pig with artificial ascites. Postmortem photograph shows normal-appearing stomach.

 

Figure 14
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  		Fig. 5 —Graph shows microscopic results of analysis for severity of diaphragmatic injuries. Light gray indicates experimental group; dark gray, control group.

 

Figure 15
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  		Fig. 6 —Graph shows results of microscopic analysis for severity of gastric injuries. Light gray indicates experimental group; dark gray, control group.

 

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