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Radiofrequency Ablation of Hepatocellular Carcinoma: Value of Virtual CT Sonography with Magnetic Navigation

Yasunori Minami1, Hobyung Chung1, Masatoshi Kudo1, Satoshi Kitai1, Shunsuke Takahashi1, Tatsuo Inoue1, Kuzuomi Ueshima1 and Hitoshi Shiozaki2

1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
2 Department of Surgery, Kinki University School of Medicine, Osaka, Japan.


Figure 1
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  		Fig. 1 —Diagram shows virtual CT sonography system composed of main unit, body of magnetic location detector unit, magnetic field generator, and magnetic sensor attached to sonographic transducer. In magnetic field, spatial information from transducer is only relative relation between magnetic generator and magnetic sensor. Common point between sonographic image and CT volume data can be set, and virtual CT sonography shows image corresponding to movement of transducer in magnetic field. MPR = multiplanar reconstruction; X, Y, and Z = axes.

 

Figure 2
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  		Fig. 2 —53-year-old man with hepatocellular carcinoma. Screen shot shows setting windows for virtual CT sonography. Main window shows transverse CT image at xiphoid level. Broken lines and cross-point in main window indicate axial, coronal, or sagittal central axes and center point. In workstation, positions of caliper cursor and transducer are aligned as common point at xiphoid level on skin. When user chooses OK, virtual display begins.

 

Figure 3
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  		Fig. 3A —67-year-old man with 1.4-cm distant recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation. Transverse arterial phase CT scan shows viable hepatocellular carcinoma (arrow) in segment VI of liver between portal vein and inferior vena cava and iodized oil accumulated on lesions (arrowheads).

 

Figure 4
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  		Fig. 3B —67-year-old man with 1.4-cm distant recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation. Virtual CT sonographic image (left) displayed with corresponding B-mode sonogram (right) shows enhanced hepatocellular carcinoma nodule (arrow), iodized oil accumulated on lesions (arrowhead), and hepatocellular carcinoma as isoechoic area (star). D1 = first distance. Inset showing transducer angle in plane of body trunk indicates images were obtained from subcostal view.

 

Figure 5
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  		Fig. 3C —67-year-old man with 1.4-cm distant recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation. B-mode sonographic image shows radiofrequency electrode needle inserted into isoechoic area, which is behind right portal vein.

 

Figure 6
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  		Fig. 3D —67-year-old man with 1.4-cm distant recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation. Portal phase dynamic CT scan obtained after radiofrequency ablation shows that tumor and surrounding area are not enhanced, indicating complete necrosis of lesion.

 

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