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Dimopoulos MP, Sotirchos VS, Dunnejaffe C, Petre EN, Moussa A, Soares K, Solomon SB, Sofocleous CT. Comparison of Effectiveness and Safety of Microwave Ablation of Colorectal Liver Metastases Adjacent versus Nonadjacent to the Diaphragm. J Vasc Interv Radiol 2024; 35:1814-1822. [PMID: 39187125 DOI: 10.1016/j.jvir.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/18/2024] [Accepted: 08/18/2024] [Indexed: 08/28/2024] Open
Abstract
PURPOSE To compare the effectiveness and safety of percutaneous microwave ablation (MWA) for colorectal liver metastasis (CLM) adjacent versus nonadjacent to the diaphragm. MATERIALS AND METHODS This was a retrospective analysis of a prospectively created MWA database, from 2 prospective clinical trials for patients with CLM treated in a single tertiary center from 2012 to 2023. CLM adjacent to the diaphragm was defined as a tumor located <1 cm from the diaphragm. Minimal ablation margin (MM) was calculated with 3-dimensional software using postablation contrast-enhanced computed tomography (CT). Adverse events were assessed with Common Terminology Criteria for Adverse Events (CTCAE) v5.0 classification for 6 months. RESULTS Two hundred nine CLMs underwent 191 MWA sessions in 143 patients. Mean tumor diameter was 1.52 cm (SD ± 0.53). Eighty-three of 209 (39.7%) CLMs were adjacent to the diaphragm. There was no difference in local tumor progression-free survival (LTPFS) between CLMs adjacent and nonadjacent to the diaphragm (hazard ratio [HR], 0.65; 95% CI, 0.37-1.16; P = .15). MMs of 5-10 mm and >10 mm were documented in 49.3% versus 46.8% (P = .83) and 21.6% versus 12.6% (P = .16) for CLMs adjacent versus nonadjacent to the diaphragm, respectively. Twelve-month LTPFS was similar between groups (HR, 0.65; 95% CI, 0.37-1.16; P = .15) without local tumor progression for MM of >10 mm. There were 3 Grade IV adverse events: 1 diaphragmatic perforation, 1 liver abscess, and 1 biloma. Pneumothorax was associated with location adjacent to the diaphragm (P < .001) and transpulmonary approach (P < .001). Median length of hospital stay was 2 days (interquartile range [IQR], 1-3 days) for patients who needed thoracostomy (n = 20, 9.6%) compared with 1 day (IQR, 1-8 days) for those who did not, without long-term sequelae. CONCLUSIONS MWA of CLM adjacent to the diaphragm is effective and safe, without difference in success and 12-month LTPFS. Pneumothorax was associated with location adjacent to the diaphragm and thoracostomy that resulted in longer hospitalization without long-term sequelae.
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Affiliation(s)
- M Platon Dimopoulos
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Interventional Radiology, University Hospital of Patras, Rio, Greece
| | - Vlasios S Sotirchos
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cynthia Dunnejaffe
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad Moussa
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Kulkarni CB, Pullara SK, C S R, Moorthy S. Complications of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Acad Radiol 2024; 31:2987-3003. [PMID: 38092590 DOI: 10.1016/j.acra.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 07/21/2024]
Abstract
Radiofrequency ablation (RFA) is a potentially curative treatment option for early Hepatocellular carcinoma. The RFA is considered safe with a relatively low incidence of complications ranging from 2%-7.9%. Though most of the complications are self-limiting, sometimes they can be life-threatening. The occurrence of the particular complication depends on various factors like tumour location and morphology, underlying disease and ablation technique. A detailed understanding of potential complications along with the associated risk factors will help to employ strategies to prevent them, identify them early and manage them when they occur. This article demonstrates various radiofrequency ablation-related complications and discusses the risk factors and technical strategies to minimise them and achieve complete ablation of the tumour.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
| | - Sreekumar Karumathil Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Rajsekar C S
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
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Bale R, Laimer G, Schullian P, Alzaga A. Stereotactic ablation: A game changer? J Med Imaging Radiat Oncol 2023; 67:886-894. [PMID: 37401185 DOI: 10.1111/1754-9485.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
For both primary and metastatic liver cancer, thermal ablation represents an interesting alternative to surgery. However, except for a small fraction of patients, conventional ultrasound- and CT-guided single-probe approaches have not achieved oncologic outcomes comparable with surgery. In this overview, we describe our stereotactic ablation workflow and discuss the short- and long-term results of stereotactic radiofrequency ablation (SRFA) and stereotactic microwave ablation (SMWA) for the treatment of primary and secondary liver tumours. The advantages of this method are discussed together with a summary of the existing stereotactic techniques for thermal ablation and the clinical data that support them. Stereotactic ablation is based on an optical navigation system and a specialized aiming tool. The workflow includes advanced three-dimensional planning, precise needle/probe placements according to the plan and intraoperative image fusion to check the needle positions and the ablation margins. Stereotactic ablation offers all the advantages of a minimally invasive procedure while producing oncological results comparable with surgery. The number of locally treatable liver cancers may be significantly expanded with these cutting-edge instruments and methods. We firmly believe that it can become a cornerstone in the treatment of liver cancers.
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Affiliation(s)
- Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Microwave ablation of colorectal liver metastases adjacent to the cardiophrenic angle: Parallel versus non-parallel placement of the antenna relative to the diaphragm. J Interv Med 2022; 5:153-158. [DOI: 10.1016/j.jimed.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/04/2022] [Accepted: 04/16/2022] [Indexed: 11/22/2022] Open
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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Garnon J, Cazzato RL, Auloge P, Ramamurthy N, Koch G, Gangi A. Adjunctive hydrodissection of the bare area of liver during percutaneous thermal ablation of sub-cardiac hepatic tumours. Abdom Radiol (NY) 2020; 45:3352-3360. [PMID: 32211949 DOI: 10.1007/s00261-020-02463-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report the technique of hydrodissection of the sub-diaphragmatic bare area of the liver, in order to protect the diaphragm/heart during percutaneous thermal ablation (PTA) of sub-cardiac hepatic tumours. MATERIALS AND METHODS Between January 2016 and December 2018, five patients (four female, one male; mean age 56.2 years) with five sub-cardiac liver tumours (two hepatocellular carcinoma, three metastases; mean size 39 mm) abutting the bare area (segments II/IVA) with expected ablation zones ≤ 5 mm from the myocardium were treated with PTA and adjunctive hydrodissection. Time to perform hydrodissection, distance between superior hepatic and diaphragmatic/pericardial surfaces before and after hydrodissection, ablation efficacy, complications, and local tumour progression (LTP) at last imaging follow-up were recorded. RESULTS Technical feasibility was 100%, with mean hydrodissection-volume of 126 ml (range 80-200 ml) and median hydrodissection-time of 9 min (range 8-45 min). Liver-diaphragmatic and liver-pericardial distance increased, respectively, from 2.4 mm (range 0-8 mm) to 10.8 mm (range 6-19 mm) and from 4 mm (range 1-10 mm) to 12.6 mm (range 8-20 mm) post-hydrodissection. All procedures were performed at full-power with complete tumour ablation and without complications (including peri-procedural haemodynamic/electrocardiographic disturbances, pericardial effusion and diaphragmatic hernia) or evidence of LTP at mean 12.2-month (range 1-26 month) follow-up. CONCLUSION Hydrodissection of the sub-diaphragmatic bare area of the liver is technically feasible and may potentially optimize safety PTA of sub-cardiac hepatic tumours.
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Kambadakone A, Baliyan V, Kordbacheh H, Uppot RN, Thabet A, Gervais DA, Arellano RS. Imaging guided percutaneous interventions in hepatic dome lesions: Tips and tricks. World J Hepatol 2017; 9:840-849. [PMID: 28740595 PMCID: PMC5504359 DOI: 10.4254/wjh.v9.i19.840] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/06/2017] [Accepted: 04/23/2017] [Indexed: 02/06/2023] Open
Abstract
Percutaneous hepatic interventions are generally safe given the fact that liver closely abuts the abdominal wall and hence it is easily accessible. However, the superior portion of liver, adjacent to the diaphragm, commonly referred as the "hepatic dome", presents unique challenges for interventionists. Percutaneous access to the hepatic dome may be restricted by anatomical factors and special considerations may be required to avoid injury to the surrounding organs. The purpose of this review article is to discuss certain specific maneuvers and techniques that can enhance the success and safety of interventions in the hepatic dome.
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Affiliation(s)
- Avinash Kambadakone
- Avinash Kambadakone, Vinit Baliyan, Hamed Kordbacheh, Raul N Uppot, Ashraf Thabet, Debra A Gervais, Ronald S Arellano, Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Vinit Baliyan
- Avinash Kambadakone, Vinit Baliyan, Hamed Kordbacheh, Raul N Uppot, Ashraf Thabet, Debra A Gervais, Ronald S Arellano, Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Hamed Kordbacheh
- Avinash Kambadakone, Vinit Baliyan, Hamed Kordbacheh, Raul N Uppot, Ashraf Thabet, Debra A Gervais, Ronald S Arellano, Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Raul N Uppot
- Avinash Kambadakone, Vinit Baliyan, Hamed Kordbacheh, Raul N Uppot, Ashraf Thabet, Debra A Gervais, Ronald S Arellano, Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Ashraf Thabet
- Avinash Kambadakone, Vinit Baliyan, Hamed Kordbacheh, Raul N Uppot, Ashraf Thabet, Debra A Gervais, Ronald S Arellano, Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Debra A Gervais
- Avinash Kambadakone, Vinit Baliyan, Hamed Kordbacheh, Raul N Uppot, Ashraf Thabet, Debra A Gervais, Ronald S Arellano, Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Ronald S Arellano
- Avinash Kambadakone, Vinit Baliyan, Hamed Kordbacheh, Raul N Uppot, Ashraf Thabet, Debra A Gervais, Ronald S Arellano, Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
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Fu JJ, Wang S, Yang W, Gong W, Jiang AN, Yan K, Chen MH. Protective and Heat Retention Effects of Thermo-sensitive Basement Membrane Extract (Matrigel) in Hepatic Radiofrequency Ablation in an Experimental Animal Study. Cardiovasc Intervent Radiol 2017; 40:1077-1085. [PMID: 28271330 DOI: 10.1007/s00270-017-1617-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/02/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the protective effect of using thermo-sensitive basement membrane extract (Matrigel) for hydrodissection to minimize thermal injury to nearby structures and to evaluate its heat sink effect on the ablation zone in radiofrequency ablation (RFA) of the liver. MATERIALS AND METHODS First, the viscosity profile and heat sink effect of Matrigel were assessed during RFA in vitro and ex vivo. Fresh pig liver tissue was used, and the temperature changes in Matrigel and in 5% dextrose in water (D5W) during RFA were recorded. Then, the size of the ablation zone in the peripheral liver after RFA was measured. Second, in an in vivo study, 45 Sprague-Dawley rats were divided into three groups of 15 rats each (Matrigel, D5W and control). In the experimental groups, artificial ascites with 10 ml of Matrigel or D5W were injected using ultrasound guidance prior to RFA. The frequency of thermal injury to the nearby organs was compared among the three groups, with assessments of several locations: near the diaphragm, the abdominal wall and the gastrointestinal (GI) tract. Finally, the biological degradation of Matrigel by ultrasound was evaluated over 60 days. RESULTS First, Matrigel produced a greater heat retention (less heat sink) effect than D5W during ex vivo ablation (63 ± 9 vs. 26 ± 6 °C at 1 min on the surface of the liver, P < 0.001). Hepatic ablation zone volume did not differ between the two groups. Second, thermal injury to the nearby structures was found in 14 of 15 cases (93.3%) in the control group, 8 of 15 cases (53.3%) in the D5W group, and 1 of 15 cases (6.7%) in the Matrigel group. Significant differences in the thermal injury rates for nearby structures were detected among the three groups (P < 0.001). The most significant difference in the thermal injury rate was found in locations near the GI tract (P = 0.003). Finally, Matrigel that was injected in vivo was gradually degraded during the following 60 days. CONCLUSIONS Using thermo-sensitive Matrigel as a hydrodissection material might help reduce the frequency of collateral thermal injury to nearby structures, especially in locations close to the GI tract, compared to conventional D5W. Additionally, Matrigel did not increase the heat sink effect on the ablation zone during ablation and was degraded over time in vivo.
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Affiliation(s)
- Jing-Jing Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Song Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China.
| | - Wei Gong
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, 100850, China
| | - An-Na Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Min-Hua Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
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Artificial ascites and pneumoperitoneum to facilitate thermal ablation of liver tumors: a pictorial essay. Abdom Radiol (NY) 2017; 42:620-630. [PMID: 27665483 DOI: 10.1007/s00261-016-0910-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Image-guided percutaneous thermal ablation is increasingly utilized in the treatment of hepatic malignancies. Peripherally located hepatic tumors can be difficult to access or located adjacent to critical structures that can be injured. As a result, ablation of peripheral tumors may be avoided or may be performed too cautiously, leading to inadequate ablation coverage. In these cases, separating the tumor from adjacent critical structures can increase the efficacy and safety of procedures. Artificial ascites and artificial pneumoperitoneum are techniques that utilize fluid and gas, respectively, to insulate critical structures from the thermal ablation zone. Induction of artificial ascites and artificial pneumoperitoneum can enable complete ablation of otherwise inaccessible hepatic tumors, improve tumor visualization, minimize unintended thermal injury to surrounding organs, and reduce post-procedural pain. This pictorial essay illustrates and discusses the proper technique and clinical considerations for successful artificial ascites and pneumoperitoneum creation to facilitate safe peripheral hepatic tumor ablation.
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Valle LGM, Rochal RD, Rahal A, Garcia RG. Percutaneous CT-Guided Ablation in the Hepatic Dome: Artificially Induced Pneumothorax for Safe Transpleural Access. J Clin Imaging Sci 2015; 5:63. [PMID: 26713179 PMCID: PMC4683791 DOI: 10.4103/2156-7514.170732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/06/2015] [Indexed: 11/04/2022] Open
Abstract
Ablative therapies have become a great alternative to surgical treatment of hepatic nodules. Some technical difficulties may negatively influence the effectiveness of this therapy, such as lesions located near the diaphragm. The transthoracic approach is commonly used to access these lesions. However, it is associated with an increased risk of complications, such as pneumothorax, hemothorax, alveolar bleeding, and others. We report a case of a radiofrequency ablation of a lesion in the hepatic dome, where an artificially induced pneumothorax was performed to guarantee a safe and effective access. The air was easily injected by a spinal needle and later aspirated by a single-lumen catheter. Induced pneumothorax shoud be considered in ablation of hepatic dome lesions, mainly when the transhepatic access is not appropriate.
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Affiliation(s)
| | - Rafael Dahmer Rochal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Antônio Rahal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Laparoscopic repair of a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma: lessons from a case and the review of the literature. Int Surg 2015; 99:384-90. [PMID: 25058770 DOI: 10.9738/intsurg-d-14-00025.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We describe the case of a patient with a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma who was successfully treated by laparoscopic surgery. A 62-year-old man with a long history of hepatitis C-induced liver cirrhosis was admitted to our institution because of recurrent postprandial periumbilical pain. Eight years earlier, he had undergone radiofrequency ablation for hepatocellular carcinoma at hepatic segment VIII. Computed tomography, gastrografin enema examination revealed transverse colon obstruction because of a diaphragmatic hernia. We diagnosed diaphragmatic hernia associated with the prior radiofrequency ablation treatment. The patient underwent laparoscopic repair of the diaphragmatic hernia. Though the patient experienced the recurrence once, relaparoscopic treatment has improved the patient's conditions. Thus, diaphragmatic hernia can develop as a complication of radiofrequency ablation treatment. A laparoscopic approach is safe, feasible, and minimally invasive, even in patients with cirrhosis who develop iatrogenic diaphragmatic hernia as a complication of radiofrequency ablation treatment.
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Zhang NN, Lu W, Cheng XJ, Liu JY, Zhou YH, Li F. High-powered microwave ablation of larger hepatocellular carcinoma: evaluation of recurrence rate and factors related to recurrence. Clin Radiol 2015. [PMID: 26220125 DOI: 10.1016/j.crad.2015.06.092] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the safety and efficacy of high-powered (80-100 W) percutaneous microwave ablation (MWA) at a frequency of 2450±10 MHz for treating larger hepatocellular carcinoma (HCC) and to predict the risk factors of local recurrence after high-powered MWA. MATERIALS AND METHODS The study was approved by the Institutional Review Board, and informed consent was waived because of the retrospective study design. Forty-five patients with a total of 60 lesions received high-power (80-100 W) MWA at a frequency of 2450±10 MHz through a percutaneous approach that was guided by ultrasound. Of the 60 lesions with a maximum tumour measuring 3-8 cm, 46 lesions were 3-5 cm and 14 were 5-8 cm. The complete ablation rates, local recurrence rates, complications, and short-term survival were analysed. Ten possible risk factors for local recurrence were analysed. RESULTS The complete ablation rates were 82.61% for the first ablation and 100% for the second ablation for 3-5 cm lesions. The complete ablation rates were 64.29% (82.61% versus 64.29%, p=0.037) for the first ablation and 85.71% (100% versus 85.71%, p=0.055) for the second ablation for 5-8 cm lesions. Local recurrence was observed in 11 out of the 45 (24.44%) successfully treated patients. The 1-year and 2-year survival rates were 95.56% (43/45) and 86.67% (39/45), respectively. No procedure-related mortality was observed and no major bleeding, liver rupture, or liver abscesses occurred. Univariate analysis showed that a positive correlation existed between the number of lesions (p=0.022), proximity to the risk area (p=0.001), pre-ablation alpha-fetoprotein (AFP) levels (p=0.025), hepatitis B virus (HBV)-DNA replication (p=0.027) and local recurrence. Multivariate analysis identified HBV-DNA (p=0.031) and proximity to the risk area (p=0.039) as the independent prognosis factors causing postoperative HCC local recurrence. CONCLUSION High-powered MWA of larger hepatocellular carcinomas appears to be a safe and effective treatment. HBV-DNA and proximity to the risk area appear to be independent predictors of local tumour recurrence.
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Affiliation(s)
- N N Zhang
- Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China
| | - W Lu
- Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China.
| | - X J Cheng
- Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China
| | - J Y Liu
- Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China
| | - Y H Zhou
- Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China
| | - F Li
- Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China
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Yu MH, Lee JY, Jun SR, Kim KW, Kim SH, Han JK, Choi BI. Radiofrequency Ablation with an Internally Cooled Monopolar Directional Electrode: Ex Vivo and in Vivo Experimental Studies in the Liver. Radiology 2015; 278:395-404. [PMID: 26172531 DOI: 10.1148/radiol.2015142269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the feasibility of using an internally cooled directional electrode (ICDE) to create sufficient directional ablation in the desired area and to investigate whether use of the ICDE reduces thermal injury to the adjacent organs. MATERIALS AND METHODS The animal care and use committee approved this animal study. In ex vivo studies of bovine livers and colons, temperature was measured in both ablation and nonablation directions with the ICDE, temperature at the liver-colon interface and the presence of burns on the colon were evaluated with each ICDE and internally cooled conventional electrode (ICCE), and the ablation area with the use of three ICDEs in the switching multichannel mode was evaluated. In an in vivo study of 10 pigs, 11 ablations were performed by using three ICDEs in the switching multichannel mode. In addition, the difference in thermal injury to the gallbladder and stomach was compared between use of the ICDE and the ICCE. Mann-Whitney test and the Fisher exact test were used for statistical analysis. RESULTS In the ex vivo study, the hepatic temperature in the nonablation direction was lower than 50°C; temperature higher than 47°C was maintained for less than 3 minutes, even 0.5 cm away from the ICDE; and the temperature at the liver-colon interface did not increase above 50°C. In the switching multichannel mode, a fused coagulation zone was created. In the in vivo study, confluent ablation was created in the inner circle of three ICDEs with a mean interelectrode distance of less than 2.6 cm. Use of the ICDE did not create a moderate-to-severe gallbladder wall injury in any of the pigs, but use of the ICCE caused injury in three of the five pigs (P > .05). The ICDE caused moderate-to-severe gastric wall injury at one of eight ablations, and the ICCE caused injury at eight of nine ablations (P < .05). CONCLUSION Use of an ICDE can create a sufficient ablation in the desired direction and can decrease thermal injury to the adjacent organs.
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Affiliation(s)
- Mi Hye Yu
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Jae Young Lee
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Su Ryoung Jun
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Kyung Won Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Se Hyung Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Joon Koo Han
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Byung Ihn Choi
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
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14
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Saito T, Chiba T, Ogasawara S, Inoue M, Wakamatsu T, Motoyama T, Kanogawa N, Suzuki E, Ooka Y, Tawada A, Matsubara H, Yokosuka O. Fatal Diaphragmatic Hernia following Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review. Case Rep Oncol 2015; 8:238-45. [PMID: 26120308 PMCID: PMC4478306 DOI: 10.1159/000431310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An 81-year-old man was admitted to our hospital because of right quadrant abdominal pain. On admission, his liver function was Child-Pugh grade C (10 points). Computed tomography (CT) revealed a diaphragmatic herniation of bowel loops into the right thoracic cavity, accompanied by pleural effusion. Although diaphragmatic hernia was successfully repaired by emergency surgery, he died of liver failure 23 days after the surgery. A retrospective reading of CT images revealed the presence of diaphragmatic injury after radiofrequency ablation (RFA) which had been conducted 33 months before the development of diaphragmatic hernia. Of importance, the lesion of the diaphragmatic injury was located on the estimated needle track of RFA for hepatocellular carcinomas in segment 5 and segment 5/8, but not adjacent to their ablation areas. Subsequently, diaphragmatic perforation had been observed 24 months before admission. This suggests that diaphragmatic hernia caused by RFA is not necessarily due to thermal damage of ablation and is possibly life-threatening, at least in some patients with an impaired liver function.
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Affiliation(s)
- Tomoko Saito
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masanori Inoue
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toru Wakamatsu
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tenyu Motoyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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15
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Kitchin D, Lubner M, Ziemlewicz T, Hinshaw JL, Alexander M, Brace CL, Lee F. Microwave ablation of malignant hepatic tumours: intraperitoneal fluid instillation prevents collateral damage and allows more aggressive case selection. Int J Hyperthermia 2015; 30:299-305. [PMID: 25144819 DOI: 10.3109/02656736.2014.936050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Theaim of this peper was to retrospectively review our experience utilising protective fluid instillation techniques during percutaneous microwave ablation of liver tumours to determine if fluid instillation prevents non-target injuries and allows a more aggressive case selection. MATERIALS AND METHODS This institute review board-approved, U.S. Health Insurance Portability and Accountability Act-compliant, retrospective study reviewed percutaneous microwave ablation of 151 malignant hepatic tumours in 87 patients, comparing cases in which protective fluid instillation was performed with those where no fluid was utilised. In cases utilising hydrodisplacement for bowel protection, a consensus panel evaluated eligibility for potential ablation without hydrodisplacement. Patient age, tumour size, local tumour progression rate, length of follow-up, complications, displacement distance/artificial ascites thickness, and treatment power/time were compared. RESULTS Fluid administration was utilised during treatment in 29/151 of cases: 10/29 for protection of bowel (8/10 cases not possible without fluid displacement), and 19/29 for body wall/diaphragm protection. Local tumour progression was higher when hydrodisplacement was used to protect bowel tissue; this may be due to lower applied power due to operator caution. Local tumour progression was not increased for artificial ascites. There was no difference in complications between the fluid group and controls. CONCLUSION Intraperitoneal fluid administration is a safe and effective method of protecting non-target structures during percutaneous hepatic microwave ablation. While hydrodisplacement for bowel protection allows more aggressive case selection, these cases were associated with higher rates of local tumour progression.
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Affiliation(s)
- Douglas Kitchin
- Department of Radiology, University of Wisconsin , Madison, Wisconsin , USA
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16
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McWilliams JP, Plotnik AN, Sako EY, Raman SS, Tan N, Siripongsakun S, Douek M, Lu DS. Safety of Hydroinfusion in Percutaneous Thermal Ablation of Hepatic Malignancies. J Vasc Interv Radiol 2014; 25:1118-24. [DOI: 10.1016/j.jvir.2013.12.562] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/21/2013] [Accepted: 12/21/2013] [Indexed: 12/18/2022] Open
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17
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Kim JS, Kim HS, Myung DS, Lee GH, Park KJ, Cho SB, Joo YE, Choi SK. A case of diaphragmatic hernia induced by radiofrequency ablation for hepatocellular carcinoma. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 62:174-8. [PMID: 24077629 DOI: 10.4166/kjg.2013.62.3.174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Because of its safety and treatment effectiveness, the popularity of radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) has gradually increased. However, some serious complications of RFA such as hepatic infarction, bowel perforation, and tumor seeding have been reported. Recently, we experienced a case of diaphragmatic hernia after RFA for HCC. A 61-year-old man with alcoholic cirrhosis was diagnosed with a 1.0 cm sized HCC in segment (S) 5 and a 1.3 cm sized HCC in S 8 of the liver. He was treated by transarterial chemoembolization and RFA. After RFA, an abdominal CT revealed a diaphragmatic defect with herniating mesentery. Twenty-two months after the RFA, the chest CT showed the diaphragmatic defect with herniating colon and mesentery. Because he had no symptoms, and surgical repair for the diaphragmatic hernia would be a high risk operation for him, we decided to treat the patient conservatively. For its great rarity, we report this case with a review of the literature.
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Affiliation(s)
- Jong Sun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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18
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Shah KN, Clary BM. Endoscopic and Percutaneous Approaches to the Treatment of Biliary Tract and Primary Liver Tumors. Surg Oncol Clin N Am 2014; 23:207-30. [DOI: 10.1016/j.soc.2013.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Schullian P, Weiss H, Klaus A, Widmann G, Kranewitter C, Mittermair C, Margreiter R, Bale R. Laparoscopic liver packing to protect surrounding organs during thermal ablation. MINIM INVASIV THER 2014; 23:294-301. [DOI: 10.3109/13645706.2014.897956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Knuttinen MG, Van Ha TG, Reilly C, Montag A, Straus C. Unintended thermal injuries from radiofrequency ablation: organ protection with an angioplasty balloon catheter in an animal model. J Clin Imaging Sci 2014; 4:1. [PMID: 24678433 PMCID: PMC3952378 DOI: 10.4103/2156-7514.126018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/04/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate a novel approach of using a balloon catheter as a protective device to separate liver from the diaphragm or nearby bowel during radiofrequency ablation (RFA) of hepatic dome tumors in an animal model. MATERIALS AND METHODS All experimental procedures were approved by animal Institutional Review Board. Using a 3 cm RF needle electrode, 70 hepatic ablation zones were created using ultrasound in 7 pigs. 50 lesions were created using balloon interposition between liver and diaphragm; 20 lesions were created using the balloon device interposed posteriorly between liver and bowel. Additional 21 control lesions were performed. Animals were sacrificed immediately; diaphragm and bowel were then visually inspected and sectioned. Diaphragmatic and bowel injury was then classified according to the depth of thickness. RESULTS Control lesions caused full thickness injury, either to diaphragm or bowel. During ablation of lesions with balloon interposition, there was significantly less diaphragmatic injury, P < 0.001 and less bowel injury, P < 0.01. CONCLUSION Using balloon interposition as a protective device has advantages over previous saline infusion or CO2 insufflation, providing a safe way to expand percutaneous RFA of liver tumors located on the undersurface of the diaphragm. In addition, this method may be used in protection of other organs adjacent to areas being ablated.
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Affiliation(s)
- Martha-Grace Knuttinen
- Department of Vascular and Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois 60612, USA
| | - Thuong G Van Ha
- Department of Interventional Radiology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
| | - Christopher Reilly
- Department of Interventional Radiology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
| | - Anthony Montag
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
| | - Christopher Straus
- Department of Interventional Radiology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
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21
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Zhou M, He H, Cai H, Chen H, Hu Y, Shu Z, Deng Y. Diaphragmatic perforation with colonic herniation due to hepatic radiofrequency ablation: A case report and review of the literature. Oncol Lett 2013; 6:1719-1722. [PMID: 24260068 PMCID: PMC3834111 DOI: 10.3892/ol.2013.1625] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/26/2013] [Indexed: 12/13/2022] Open
Abstract
Radiofrequency ablation (RFA) has been widely accepted as an alternative treatment for unresectable primary and metastatic hepatic tumors, with satisfactory rates of local response and significant improvements in rates of overall survival. Numerous large series studies have shown that RFA is safe and effective, with a low mortality rate and a low major complication rate. Major complications, including diaphragmatic perforation and hernia, have rarely been previously reported. The current case report presents a case of diaphragmatic hernia with perforation of the incarcerated colon in the thoracic cavity 12 months following hepatic RFA, and reviews nine previously reported cases of diaphragmatic hernia. Comprehensive analysis of the nine cases demonstrated possibilities leading to diaphragmatic hernia following diaphragmatic thermal injury as a consequence of hepatic RFA. Clinicians and radiologists must consider diaphragmatic thermal damage following hepatic RFA for liver tumors adjacent to the diaphragm, particularly for patients with symptoms of ileus, dyspnea, chest pain, pleural effusion and right shoulder pain.
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Affiliation(s)
- Meiqi Zhou
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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22
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Contrast media-doped hydrodissection during thermal ablation: optimizing contrast media concentration for improved visibility on CT images. AJR Am J Roentgenol 2012; 199:677-82. [PMID: 22915411 DOI: 10.2214/ajr.11.7999] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study is to determine a concentration of iodinated contrast media in saline and 5% dextrose in water (D5W) for organ hydrodissection, a technique used to physically separate and protect tissues adjacent to thermal ablations. MATERIALS AND METHODS A total of 28 samples were prepared from 1:1000-1:1 iohexol or iothalamate meglumine contrast media in either normal saline or D5W. Samples alone or juxtaposed with a homogeneous liver-mimicking phantom were imaged by CT using 80-120 kVp and 10-300 mAs. Mean CT numbers and noise were measured from the fluid, background air, phantom adjacent to the fluid, and phantom distant from the fluid. Visibility was determined from the contrast-to-noise ratio between the fluid and phantom, whereas streaking artifact was quantified by relative noise in the phantom. Measures were individually fit using multiple linear regression to determine an optimal contrast-to-fluid ratio for increased visualization without streaking. Contrast media- and blood-doped saline and D5W were also tested to determine whether such doping altered their electrical conductivity. RESULTS Iohexol concentration most influenced CT number; volumetric ratios of 1:1000-1:1 produced 20 HU to over 3000 HU. CT numbers were weakly dependent on x-ray tube voltage, whereas contrast-to-noise ratio and streaking artifacts were somewhat dependent on tube output. An optimal ratio of iohexol in fluid was determined to be 1:50. There was no significant difference between the electrical impedances of doped and pure saline or D5W (p > 0.5, all cases). CONCLUSION A 1:50 ratio of iohexol in saline or D5W provides an optimal combination of increased visibility on CT without streaking artifacts.
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23
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Iversen H, Lenz S, Dueholm M. Ultrasound-guided radiofrequency ablation of symptomatic uterine fibroids: short-term evaluation of effect of treatment on quality of life and symptom severity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:445-451. [PMID: 22378629 DOI: 10.1002/uog.11118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the feasibility of ultrasound-guided radiofrequency ablation (USgRFA) for the treatment of women with symptomatic uterine fibroids in relation to volume of fibroid. METHODS Forty-three women with symptomatic fibroids underwent USgRFA for treatment of uterine fibroids. Improvements in fibroid symptoms and quality of life were measured by the Uterine Fibroid Symptom and Quality of Life questionnaire scores at baseline and 3, 6 and 9 months after the intervention, and analyzed in relation to baseline fibroid volume. Volume reduction of fibroids was measured and the frequency of adverse events and re-interventions was recorded. RESULTS Following USgRFA, mean Symptom Severity Scores (SSS) decreased from 60.7 ± 17.8 to 31.2 ± 19.5, corresponding to an improvement of 48.6%. The total Health-Related Quality of Life (HRQOL) score improved by 46.4% from 55.6 ± 20.9 to 81.4 ± 16.6. There was no correlation between fibroid volume at baseline and improvement in SSS and HRQOL scores. Fibroid volume was reduced in all patients, by a mean of 69.7 ± 19.4%. Two (4.7%) patients underwent hysterectomy. No adverse events occurred. CONCLUSION USgRFA reduces fibroid symptom and size even in patients with larger fibroids. USgRFA is a promising new treatment for fibroids in gynecological settings and should be further investigated.
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Affiliation(s)
- H Iversen
- Gynecologic Department, Naestved Hospital, University of Copenhagen, Naestved, Denmark.
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24
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Li M, Yu XL, Liang P, Liu F, Dong B, Zhou P. Percutaneous microwave ablation for liver cancer adjacent to the diaphragm. Int J Hyperthermia 2012; 28:218-26. [PMID: 22515343 DOI: 10.3109/02656736.2012.665565] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The aim of the study was to prospectively evaluate the safety and effectiveness of percutaneous microwave (MW) ablation for liver cancer adjacent to the diaphragm. MATERIALS AND METHODS From May 2005 to June 2008, 89 patients with 96 hepatic lesions adjacent to the diaphragm (the shortest distance from the lesion margin to the diaphragm less than 5 mm), who underwent ultrasound (US)-guided percutaneous MW ablation, were included in the study group. A total of 100 patients with 127 hepatic lesions not adjacent to the diaphragm (the shortest distance from the lesion to the diaphragm and the first or second branch of the hepatic vessels more than 10 mm), who underwent US-guided percutaneous MW ablation, were included in the control group. During the ablation the temperature of marginal ablation tissue proximal to the diaphragm was monitored and controlled at 50°-60°C for more than 10 min in the study group. We compared the results of ablation between the two groups. RESULTS A total of 91 of 96 tumours (94.8%) in the study group and 123 of 127 tumours (96.9%) in the control group achieved complete ablation (P > 0.05). Local tumour progression was found in 18 of 96 tumours (18.8%) in the study group and 21 of 127 tumours (16.5%) in the control group during follow-up after MW ablation (P > 0.05). No major complications occurred in either group. CONCLUSIONS Under strict temperature monitoring, percutaneous MW ablation is safe and can achieve a high complete ablation rate for the treatment of hepatic tumours adjacent to the diaphragm.
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Affiliation(s)
- Meng Li
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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25
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Singh M, Singh G, Pandey A, Cha CH, Kulkarni S. Laparoscopic repair of iatrogenic diaphragmatic hernia following radiofrequency ablation for hepatocellular carcinoma. Hepatol Res 2011; 41:1132-6. [PMID: 22032681 DOI: 10.1111/j.1872-034x.2011.00865.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Radiofrequency ablation (RFA) is commonly used for treating unresectable hepatic malignancies. Some commonly associated complications of RFA include fever, symptomatic pleural effusion, abscess, hepatoma and hepatic insufficiency. Here, we report a case of diaphragmatic hernia in a patient following RFA for hepatic malignancy with cirrhosis.
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Affiliation(s)
- Mansher Singh
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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26
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Tsoumakidou G, Buy X, Garnon J, Enescu J, Gangi A. Percutaneous Thermal Ablation: How to Protect the Surrounding Organs. Tech Vasc Interv Radiol 2011; 14:170-6. [DOI: 10.1053/j.tvir.2011.02.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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27
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Radiofrequency Ablation for Hepatocellular Carcinoma Abutting the Diaphragm: Comparison of Effects of Thermal Protection and Therapeutic Efficacy. AJR Am J Roentgenol 2011; 196:907-13. [DOI: 10.2214/ajr.10.4584] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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28
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McWilliams JP, Yamamoto S, Raman SS, Loh CT, Lee EW, Liu DM, Kee ST. Percutaneous ablation of hepatocellular carcinoma: current status. J Vasc Interv Radiol 2010; 21:S204-13. [PMID: 20656230 DOI: 10.1016/j.jvir.2009.11.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 10/28/2009] [Accepted: 11/07/2009] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is an increasingly common disease with dismal long-term survival. Percutaneous ablation has gained popularity as a minimally invasive, potentially curative therapy for HCC in nonoperative candidates. The seminal technique of percutaneous ethanol injection has been largely supplanted by newer modalities, including radiofrequency ablation, microwave ablation, cryoablation, and high-intensity focused ultrasound ablation. A review of these modalities, including technical success, survival rates, and complications, will be presented, as well as considerations for treatment planning and follow-up.
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Affiliation(s)
- Justin P McWilliams
- Department of Interventional Radiology, University of California Los Angeles Medical Center, 757 Westwood Plaza, Suite 2125C, Los Angeles, CA 90095, USA.
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29
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Mendiratta-Lala M, Brook OR, Midkiff BD, Brennan DD, Thornton E, Faintuch S, Sheiman RG, Goldberg SN. Quality initiatives: strategies for anticipating and reducing complications and treatment failures in hepatic radiofrequency ablation. Radiographics 2010; 30:1107-22. [PMID: 20442337 DOI: 10.1148/rg.304095202] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Radiofrequency (RF) ablation is one of several local treatment strategies that can be used for the destruction of a variety of primary and secondary liver tumors. As experience with RF ablation grows, it becomes increasingly evident that successful ablation requires meticulous technique. In addition, knowledge of potential complications is critical for both the interventionalist and the radiologist, whose postablation interpretation can facilitate identification of complications and treatment failures. Hepatic RF ablation offers significant advantages in that it is less invasive than surgery and carries a low risk of major complications. Successful prevention of complications and treatment failures begins at initial consultation and continues with preablation evaluation of specific patient factors such as coagulation profiles, use of medications, and risk factors for infection. Other predisposing factors include background liver cirrhosis, prior hepatectomy, and portal hypertension. During ablation, careful attention must be given to tumor size, number, and location. For large or multiple ablations, separate ablation sessions can help reduce the prevalence of postablation syndrome, and clustered electrodes and multiple overlapping treatment zones may be used to reduce the risk of treatment failure. It is critical to reevaluate tumors during ablation to determine the best approach and to compensate for changes in size and relative location due to patient positioning. With use of these strategies, hepatic RF ablation can be performed with greater safety, better patient tolerance, and a reduced risk of complications and treatment failures.
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Affiliation(s)
- Mishal Mendiratta-Lala
- Department of Radiology, Beth Israel Deaconess Medical Center, One Deaconess Rd, W/ML 302, Boston, MA 02215, USA.
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30
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Yamakado K, Nakatsuka A, Takaki H, Sakurai H, Isaji S, Yamamoto N, Shiraki K, Takeda K. Subphrenic versus nonsubphrenic hepatocellular carcinoma: combined therapy with chemoembolization and radiofrequency ablation. AJR Am J Roentgenol 2010; 194:530-535. [PMID: 20093620 DOI: 10.2214/ajr.09.2917] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This retrospective study was conducted to evaluate the clinical utility of the combination of chemoembolization and real-time CT fluoroscopically guided radiofrequency ablation in the treatment of patients with subphrenic hepatocellular carcinoma (HCC). MATERIALS AND METHODS Patients who had a single HCC with a maximum diameter of 5 cm or less were included in the study. None of the patients was a candidate for surgery, and all underwent combination therapy as initial treatment. The patients were divided into two groups based on tumor location. In all, the 93 men and 38 women (mean age, 67.9 +/- 9.4 years; range, 43-83 years) had 46 subphrenic HCCs and 85 nonsubphrenic HCCs. No differences were found in the pretreatment baseline characteristics of the two patient groups. Safety profiles, local tumor progression rates, and prognoses were compared. RESULTS Tumor enhancement disappeared after 58 radiofrequency sessions (1.3 sessions/tumor) in patients with subphrenic HCC and after 104 radiofrequency sessions (1.2 sessions/tumor) in patients with nonsubphrenic HCC. The 5-year local tumor progression rates (subphrenic, 3% [95% CI, 0.2-12%]; nonsubphrenic, 9% [95% CI, 3-20%]; p = 0.31) and survival rates (subphrenic, 63% [95% CI, 36-81%]; nonsubphrenic, 69% [95% CI, 53-81%]; p = 0.55) were similar for the two patient groups. Although the incidence of self-limited pneumothorax was significantly higher among the patients with subphrenic HCC (13.8% vs 3.85%; p < 0.03), other complication rates were similar for the two patient groups. CONCLUSION Combination therapy with chemoembolization and real-time CT-guided radiofrequency ablation is safe and useful even when HCC is in the subphrenic region.
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Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol 2010; 193:1686-90. [PMID: 19933665 DOI: 10.2214/ajr.09.2904] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of CT-guided injection of 5% dextrose in water solution (D5W) into the retroperitoneum to displace organs adjacent to renal cell carcinoma. MATERIALS AND METHODS An interventional radiology database was searched to identify the cases of patients who underwent CT-guided percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma in which D5W was injected into the retroperitoneal space to displace structures away from the targeted renal tumor. The number of organs displaced and the distance between the renal tumor and adjacent organs before and after displacement with D5W were assessed. RESULTS The cases of 135 patients with 139 biopsy-proven renal cell carcinomas who underwent 154 percutaneous CT-guided radiofrequency ablation procedures were found in the search. Thirty-one patients with 33 renal cell carcinomas underwent 36 ablation procedures after injection of D5W into the retroperitoneal space. Fifty-five organs were displaced away from renal cell carcinoma with this technique. The average distance between adjacent structures and renal cell carcinomas before displacement was 0.36 cm (range, 0.1-1.0 cm). The average distance between structures and adjacent renal cell carcinomas after displacement was 1.94 cm (range, 1.1-4.3 cm) (p < 0.0001). The average volume of D5W used to achieve organ displacement was 273.5 mL. No complications were associated with this technique. CONCLUSION CT-guided injection of D5W into the retroperitoneum is an effective method for displacing vital structures away from renal cell carcinoma.
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Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol 2009; 19:2630-40. [PMID: 19557416 DOI: 10.1007/s00330-009-1463-x] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 03/18/2009] [Accepted: 04/24/2009] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to assess the feasibility, safety and efficacy of radiofrequency ablation (RFA) with the use of artificial ascites for hepatocellular carcinoma (HCC) adjacent to the diaphragm and gastrointestinal tract. One hundred forty-three patients with 181 HCCs who underwent US-guided percutaneous RFA with the use of artificial ascites were retrospectively reviewed. Among the 181 HCCs, 148 HCCs were defined as problematic nodules for two major reasons: poor sonic window or possible thermal injury. We artificially induced ascites before performing RFA by dripping 5% dextrose in a water solution. We assessed the technical success of introducing artificial ascites, technical feasibility of the use of artificial ascites and complications. The technical success rate, as well as the primary and secondary technique success rate, was assessed by regular follow-up CT examinations. RFA with artificial ascites was successfully achieved in 130 of 143 patients. The primary technique effectiveness was 85.3%. During follow-up (mean, 20.4 months), remote intrahepatic recurrence occurred in 49 patients and local tumor progression occurred in 15 patients. Three (2.1%) of the 143 patients experienced major complications (hemoperitoneum, lobar infarction and biloma) related to the RFA procedure. The use of artificial ascites is a simple and useful technique to minimize collateral thermal injury and to improve the sonic window.
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Kang TW, Rhim H, Kim EY, Kim YS, Choi D, Lee WJ, Lim HK. Percutaneous radiofrequency ablation for the hepatocellular carcinoma abutting the diaphragm: assessment of safety and therapeutic efficacy. Korean J Radiol 2009; 10:34-42. [PMID: 19182501 PMCID: PMC2647171 DOI: 10.3348/kjr.2009.10.1.34] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To assess the safety and therapeutic efficacy of a percutaneous radiofrequency (RF) ablation for the hepatocellular carcinoma (HCC) abutting the diaphragm. Materials and Methods We retrospectively assessed 80 patients who underwent a percutaneous RF ablation for a single nodular (< 4 cm) HCC over the last four years. Each patient underwent an ultrasound-guided RF ablation using internally cooled electrodes for the first-line treatment. We divided patients into two subgroups based on whether the index tumor was abutting (less than 5 mm) the diaphragm or not: group A (abutting; n = 31) versus group B (non-abutting; n = 49). We compared the two subgroups for complications and therapeutic efficacy using image and the review of medical records. The statistical assessment included an independent t-test, Fisher's exact test, and chi-square test. Results The assessment of the diaphragmatic swelling at CT immediately following the procedure was more severe in group A than group B (mean thickness change:1.44 vs. 0.46 mm, p = 0.00). Further, right shoulder pain was more common in group A than B (p = 0.01). Although minor complications (hemothorax 1 case, pleural effusion 1 case) were noted only in group A, no major thoracic complication occurred in either group. The technical success rate was lower in group A than group B (84% vs. 98%, p = 0.03). As well, the primary and secondary technique effectiveness rates in group A and group B were 90% versus 98% (p = 0.29) and 79% versus 91% (p = 0.25), respectively. The local tumor progression rate was higher in group A than in group B (29% vs. 6%, p = 0.02). Conclusion We found that the percutaneous RF ablation for the HCC abutting the diaphragm is a safe procedure without major complications. However, it is less effective with regard to technical success and local tumor control.
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Buy X, Tok CH, Szwarc D, Bierry G, Gangi A. Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring. Cardiovasc Intervent Radiol 2009; 32:529-34. [PMID: 19219496 DOI: 10.1007/s00270-009-9524-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 01/13/2009] [Accepted: 01/16/2009] [Indexed: 11/26/2022]
Abstract
Percutaneous image-guided thermal ablation of tumor is widely used, and thermal injury to collateral structures is a known complication of this technique. To avoid thermal damage to surrounding structures, several protection techniques have been reported. We report the use of a simple and effective protective technique combining carbon dioxide dissection and thermocouple: CO(2) displaces the nontarget structures, and its low thermal conductivity provides excellent insulation; insertion of a thermocouple in contact with vulnerable structures achieves continuous thermal monitoring. We performed percutaneous thermal ablation of 37 tumors in 35 patients (4 laser, 10 radiofrequency, and 23 cryoablations) with protection of adjacent vulnerable structures by using CO(2) dissection combined with continuous thermal monitoring with thermocouple. Tumor locations were various (19 intra-abdominal tumors including 4 livers and 9 kidneys, 18 musculoskeletal tumors including 11 spinal tumors). CO(2) volume ranged from 10 ml (epidural space) to 1500 ml (abdominal). Repeated insufflations were performed if necessary, depending on the information given by the thermocouple and imaging control. Dissection with optimal thermal protection was achieved in all cases except two patients where adherences (one postoperative, one arachnoiditis) blocked proper gaseous distribution. No complication referred to this technique was noted. This safe, cost-effective, and simple method increases the safety and the success rate of percutaneous thermal ablation procedures. It also offers the potential to increase the number of tumors that can be treated via a percutaneous approach.
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Affiliation(s)
- Xavier Buy
- Department of Radiology B, University Hospital of Strasbourg, 1, place de l'Hôpital, 67000, Strasbourg, France
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Colorectal Liver Metastases: Radiofrequency Ablation. COLORECTAL CANCER 2009. [DOI: 10.1007/978-1-4020-9545-0_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Francesco FD, Sandro SD, Doria C, Ramirez C, Iaria M, Navarro V, Silvestry S, Needleman L, Frank A. Diaphragmatic Hernia Occurring 15 Months after Percutaneous Radiofrequency Ablation of a Hepatocellular Cancer. Am Surg 2008. [DOI: 10.1177/000313480807400207] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | - Victor Navarro
- Department of Medicine, Division of Gastroenterology and Hepatology
| | - Scott Silvestry
- Department of Surgery, Division of Cardiothoracic Surgery, and
| | - Laurence Needleman
- Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Adam Frank
- Department of Surgery, Division of Transplantation
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Percutaneous Radiofrequency Ablation with Artificial Ascites for Hepatocellular Carcinoma in the Hepatic Dome: Initial Experience. AJR Am J Roentgenol 2008; 190:91-8. [DOI: 10.2214/ajr.07.2384] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Head HW, Dodd GD, Dalrymple NC, Prasad SR, El-Merhi FM, Freckleton MW, Hubbard LG. Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: frequency of diaphragmatic injury. Radiology 2007; 243:877-84. [PMID: 17517940 DOI: 10.1148/radiol.2433060157] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively determine the frequency of diaphragmatic injury when percutaneous hepatic radiofrequency (RF) ablation is performed adjacent to the diaphragm. MATERIALS AND METHODS Institutional Review Board approval was obtained for our HIPAA-compliant study. Informed consent for the ablation procedure and for use of related data for future research was obtained from each patient. A retrospective review was conducted of 215 patients undergoing percutaneous RF ablation of hepatic tumors. Twenty-nine patients (21 men and eight women; age, 41-89 years) were identified with tumors abutting the diaphragm. Episodes of right shoulder pain were recorded. A panel of radiologists blinded to the patients' clinical histories reviewed their imaging for evidence of diaphragmatic injury and ablation success. A generalized estimating equation model and the Fisher exact test were used for statistical analysis. RESULTS The 29 patients had a total of 33 tumors abutting the diaphragm. Tumor size was 1.3-5.5 cm (mean, 3.2 cm +/- 1.1). After ablation, five (17%) patients reported right shoulder pain. In four, pain was mild or moderate, with symptoms lasting 2-14 days (median, 5.5 days). Three of these showed diaphragmatic thickening on postablation computed tomographic (CT) scans. One patient had severe pain lasting 2 weeks, followed by milder pain for 2 months. This patient's postablation CT images showed focal nodular diaphragmatic thickening. This patient was treated with a multitined device; the other four, with straight-needle devices. Local tumor progression was seen in 14 tumors (42.4%). Tumors 3 cm or smaller had a much lower local progression rate than tumors larger than 3 cm (12.5% vs 70.6%). CONCLUSION Of 29 patients who had ablation of hepatic tumors adjacent to the diaphragm, five (17%) had diaphragmatic injury, which was clinically apparent with right shoulder pain.
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Affiliation(s)
- Hayden W Head
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7800, San Antonio, TX 78229, USA.
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Brace CL, Laeseke PF, Prasad V, Lee FT. Electrical isolation during radiofrequency ablation: 5% dextrose in water provides better protection than saline. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2006; 2006:5021-5024. [PMID: 17947126 DOI: 10.1109/iembs.2006.260086] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We quantify the ability of 0.9% NaCl (saline) and 5% dextrose in water (D5W) to protect tissues during RF ablation. Using computer simulations and phantom experiments, we determined that D5W provides significantly more electrical isolation than saline, which reduces unwanted heating of the adjacent tissue. Saline actually increased the amount of RF current in the adjacent tissue. Based on these results, we conclude that D5W is preferable to saline as a protective fluid.
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