Complications after Thermal Ablation of Hepatocellular Carcinoma and Liver Metastases: Imaging Findings

Abstract

Tumour ablation is a strategy of treatment of hepatic tumours in patients with small hepatocellular carcinoma (HCC) (<3 cm) or in patients unfit for surgical resection. Moreover, tumor ablation can be used as an adjuvant therapy or may be used in association with resection in case of patients with poor functional liver disease. These types of treatment usually could be performed percutaneously under image guidance. The most clinically verified and used ablation modalities are Radiofrequency Ablation (RFA) and microwave ablation (MWA). However, despite both of them are considered minimally invasive techniques, they could be related to post-procedural complications. The International Working Group on Image-Guided Tumor and the Society of Interventional Radiology (SIR) identified major and minor post-ablative complications. Major complications, as vascular complications, occur in 2.2% to 3.1% of cases and include all the high risk pathological conditions which could increase the level of care or result in hospital admission or substantially prolonged hospital stay (SIR classifications C–E). Minor complications, as biliary complications, occur in 5% to 8.9% and include self-limiting conditions that are considered to be of low risk for the patient’s outcome. The purpose of this review is to summarise the main pathological ultrasound (US) and Computed Tomography (CT) findings, that may arise after ablative treatment. To simplify the analysis, the pathological pictures are divided according to the site of damage into vascular, biliary and extrahepatic complications.

Imaging Assessment of Interval Metastasis from Melanoma

“…Therefore, the combination of US findings, such as round or oval morphology, markedly hypoechoic structure, focal or nodular and asymmetric cortical thickening, and hilum loss or dislocation with anarchic distribution of the vascular signal, regardless of size, is virtually diagnostic of metastasis [ 14 , 28 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ].…”

Imaging Features of Main Hepatic Resections: The Radiologist Challenging

“…Imaging, with regard to hepatic resection, should be employed in different phases: staging, treatment planning, intra-treatment evaluation, and treatment response assessment, which includes technical success, treatment efficacy, and complications [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ].…”

“…Usually, US is the first tool employed during the post-surgical phase to assess abdominal complications and to evaluate treatment efficacy. CT with contrast agents, normally, is utilized as a follow-up tool to evaluate efficacy and recurrence, while it is the first tool employed in emergency setting (e.g., major complications as posthepatectomy hemorrhage (PHH)) [ 35 , 36 , 37 ]. MRI with cholangiopancreatography sequences (MRCP) or with hepatospecific contrast agent (EOB-MRI) is the best modality for diagnosis of early postoperative bile duct injuries and ischemic cholangitis, while during follow-up this tool is a problem solver for indeterminate liver lesions, e.g., new lesions versus abscesses [ 35 , 36 , 37 ].…”

Risk Assessment and Pancreatic Cancer: Diagnostic Management and Artificial Intelligence

“…PanINs surgical resected patients have a five-year survival rate higher than 85% compared to PDAC resected patients [68]. Additionally, a precursor of PDAC could be intraductal papillary mucinous neoplasms (IPMNs) [69][70][71][72][73][74][75][76][77][78][79][80][81]. IPMNs can be classified based on histology and duct involvement (mainduct type or side branch: branch-duct type) [82].…”