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Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely.

Kim JW, Shin SS, Heo SH, Hong JH, Lim HS, Seon HJ, Hur YH, Park CH, Jeong YY, Kang HK - Korean J Radiol (2015)

Bottom Line: Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors.Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc.This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonnam National University Medical School, Gwangju 61469, Korea.

ABSTRACT
Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

No MeSH data available.


Related in: MedlinePlus

RF ablation using AA via sub-hepatic route in 44-year-old man.A. Longitudinal US image shows hypoechoic HCC (arrows) in segment 6 near ascending colon (arrowhead). B. Longitudinal US image demonstrates inserted angiosheath (arrowhead) and AA (asterisk) in sub-hepatic space. C. Longitudinal US image during RF ablation depicts transient hyperechoic ablation zone (asterisk), needle electrode (arrow), and angiosheath (arrowhead). D. Immediate follow-up contrast-enhanced CT image reveals low-attenuated RF ablation zone (asterisk) that sufficiently covers index tumor as well as intact adjacent colon (arrowhead). AA = artificial ascites, HCC = hepatocellular carcinoma, RF = radiofrequency, US = ultrasound
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Figure 2: RF ablation using AA via sub-hepatic route in 44-year-old man.A. Longitudinal US image shows hypoechoic HCC (arrows) in segment 6 near ascending colon (arrowhead). B. Longitudinal US image demonstrates inserted angiosheath (arrowhead) and AA (asterisk) in sub-hepatic space. C. Longitudinal US image during RF ablation depicts transient hyperechoic ablation zone (asterisk), needle electrode (arrow), and angiosheath (arrowhead). D. Immediate follow-up contrast-enhanced CT image reveals low-attenuated RF ablation zone (asterisk) that sufficiently covers index tumor as well as intact adjacent colon (arrowhead). AA = artificial ascites, HCC = hepatocellular carcinoma, RF = radiofrequency, US = ultrasound

Mentions: One of four different infusion routes may be selected according to the location of hepatic tumors (Fig. 1). If a tumor is located in the right lobe and segment 4, a perihepatic route through the right 7-8 intercostal space or a sub-hepatic route below the hepatic angle along the anterior axillary line is recommended (Fig. 2). If a tumor is found within segments 2, 3, and 4 abutting the diaphragm, a sub-xiphoid (sub-phrenic) route is appropriate for AA. If a tumor is located in segments 2 and 3 abutting the stomach, a gastrohepatic (lesser sac) route may be chosen (Fig. 3). Based on our experience, the infused fluid via a gastrohepatic route tends to flow into another peritoneal space, such as the sub-hepatic space, without fluid retention in the lesser sac. Therefore, in cases when a gastrohepatic route is used, an angiosheath needs to be inserted around the tumor, and fluid should be continuously infused during RF ablation.


Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely.

Kim JW, Shin SS, Heo SH, Hong JH, Lim HS, Seon HJ, Hur YH, Park CH, Jeong YY, Kang HK - Korean J Radiol (2015)

RF ablation using AA via sub-hepatic route in 44-year-old man.A. Longitudinal US image shows hypoechoic HCC (arrows) in segment 6 near ascending colon (arrowhead). B. Longitudinal US image demonstrates inserted angiosheath (arrowhead) and AA (asterisk) in sub-hepatic space. C. Longitudinal US image during RF ablation depicts transient hyperechoic ablation zone (asterisk), needle electrode (arrow), and angiosheath (arrowhead). D. Immediate follow-up contrast-enhanced CT image reveals low-attenuated RF ablation zone (asterisk) that sufficiently covers index tumor as well as intact adjacent colon (arrowhead). AA = artificial ascites, HCC = hepatocellular carcinoma, RF = radiofrequency, US = ultrasound
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644743&req=5

Figure 2: RF ablation using AA via sub-hepatic route in 44-year-old man.A. Longitudinal US image shows hypoechoic HCC (arrows) in segment 6 near ascending colon (arrowhead). B. Longitudinal US image demonstrates inserted angiosheath (arrowhead) and AA (asterisk) in sub-hepatic space. C. Longitudinal US image during RF ablation depicts transient hyperechoic ablation zone (asterisk), needle electrode (arrow), and angiosheath (arrowhead). D. Immediate follow-up contrast-enhanced CT image reveals low-attenuated RF ablation zone (asterisk) that sufficiently covers index tumor as well as intact adjacent colon (arrowhead). AA = artificial ascites, HCC = hepatocellular carcinoma, RF = radiofrequency, US = ultrasound
Mentions: One of four different infusion routes may be selected according to the location of hepatic tumors (Fig. 1). If a tumor is located in the right lobe and segment 4, a perihepatic route through the right 7-8 intercostal space or a sub-hepatic route below the hepatic angle along the anterior axillary line is recommended (Fig. 2). If a tumor is found within segments 2, 3, and 4 abutting the diaphragm, a sub-xiphoid (sub-phrenic) route is appropriate for AA. If a tumor is located in segments 2 and 3 abutting the stomach, a gastrohepatic (lesser sac) route may be chosen (Fig. 3). Based on our experience, the infused fluid via a gastrohepatic route tends to flow into another peritoneal space, such as the sub-hepatic space, without fluid retention in the lesser sac. Therefore, in cases when a gastrohepatic route is used, an angiosheath needs to be inserted around the tumor, and fluid should be continuously infused during RF ablation.

Bottom Line: Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors.Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc.This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonnam National University Medical School, Gwangju 61469, Korea.

ABSTRACT
Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

No MeSH data available.


Related in: MedlinePlus