Abstract:Percutaneous ablation of HCC may cause several changes. Knowledge of their CT appearance is mandatory to correctly assess and manage this tumor.
“…In the past decade, a variety of complications related to thermal ablation procedures have been reported [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. These include early complications such as bleeding, infection, ground pad burn, hepatic vascular damage, visceral damage, and late complications such as bile duct injury and tumor seeding along the electrode track [11,12,18,21].…”
Although bile duct changes were frequent after the radiofrequency ablation of hepatocellular carcinoma, most were of no clinical significance, and major complications requiring additional treatment were rare.
“…In the past decade, a variety of complications related to thermal ablation procedures have been reported [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. These include early complications such as bleeding, infection, ground pad burn, hepatic vascular damage, visceral damage, and late complications such as bile duct injury and tumor seeding along the electrode track [11,12,18,21].…”
Although bile duct changes were frequent after the radiofrequency ablation of hepatocellular carcinoma, most were of no clinical significance, and major complications requiring additional treatment were rare.
“…The typical characteristics of a recurrent lesion include a wide rim with a nodular and irregular border [21] which is hyperdense on arterial phase [22]. The penumbra of an ablative zone after RFA treatment is often narrow, with a smooth or regular border, and decreases in enhancement over time.…”
Introduction
The imaging features of unresectable hepatic malignancies that underwent radiofrequency ablation (RFA) in combination with lyso-thermosensitive liposomal doxorubicin (LTLD) were determined.
Materials and Methods
A phase I dose escalation study combining RFA with LTLD was performed with peri- and post- procedural CT and MRI. Imaging features were analyzed and measured in terms of ablative zone size and surrounding penumbra size. The dynamic imaging appearance was described qualitatively immediately following the procedure and at one month follow-up. The control group receiving liver RFA without LTLD was compared to the study group in terms of imaging features and post ablative zone size dynamics at follow-up.
Results
Post treatment scans of hepatic lesions treated with RFA and LTLD have distinctive imaging characteristics when compared to those treated with RFA alone. The addition of LTLD resulted in a regular or smooth enhancing rim on T1W MRI which often correlated with increased attenuation on CT. The LTLD treated ablation zones were stable or enlarged in the four weeks following ablation in 69% of study subjects as opposed to conventional RFA where the ablation zone underwent involution compared to immediate-post procedure.
Conclusion
The imaging features following RFA with LTLD were different from those after standard RFA and can mimic residual or recurrent tumor. Knowledge of the subtle findings between the two groups can help avoid misinterpretation and proper identification of treatment failure in this setting. Increased size of the LTLD treated ablation zone after RFA suggests ongoing drug-induced biological effects.
“…A few case reports have described PVT as a complication of percutaneous RFA of hepatic tumors [10,11]. PVT is considered a poor prognostic factor with HCC, and for years was considered a contraindication for TACE, based on the presumption that these patients are prone to hepatic insufficiency resulting from the ischemic insult.…”
Portal vein thrombosis (PVT) may not be an absolute contraindication for hepatic radiofrequency ablation (RFA). Although the data are sparse, PVT is commonly considered a contraindication to RFA. PVT has actually been described as a complication following RFA. RFA was used to treat a 3.9 × 2.9 cm primary hepatocellular carcinoma (HCC) in a patient with concomitant PVT without complication. RFA can be safely performed in this setting but further studies could clarify this issue.
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