J Korean Soc Radiol.  2014 Feb;70(2):111-118. 10.3348/jksr.2014.70.2.111.

Radiofrequency Ablation of Hepatocellular Carcinoma Located in the Liver Dome Under Intermittent CT Fluoroscopy Guidance

• Park D
• Cho YK
• Cho HJ
• Kim MY

• KMID: 1839419
• DOI: http://doi.org/10.3348/jksr.2014.70.2.111

Abstract

PURPOSE
To evaluate the clinical effectiveness of an intermittent computed tomography (CT) fluoroscopy-guided radiofrequency (RF) ablation of hepatocellular carcinoma located in the liver dome.
MATERIALS AND METHODS
Between 2005 and 2010 23 patients with hepatocellular carcinoma (HCC) nodules located in the liver dome underwent an intermittent CT fluoroscopy-guided RF ablation. The primary endpoint was the local tumor progression. Procedure-related complications occurred in 3 of 23 patients. To evaluate the prognostic factors for the local tumor progression, univariate and multivariate analyses were performed using the Cox proportional hazards model. The chi-squared test was performed to evaluate the association of access route and procedure-related complication. The study was approved by the Institutional Review Board of our hospital.
RESULTS
The Tumor sizes ranged between 1.0 and 2.9 cm. An initial complete ablation was achieved in all patients. The median follow-up period was 31 months and the major complication rate was 4.3%. The cumulative rate of local tumor progression at 3 years was 20%. The univariate analysis revealed that only serum total bilirubin level (p = 0.048) and prior chemoembolization were statistically significant (p = 0.044), but there was no independently significant prognostic factor on multivariate analysis. Procedure-related complications occurred in 3 of 23 patients.
CONCLUSION
For HCC located in the liver dome an intermittent CT fluoroscopy-guided RF ablation could be performed safely and effectively.

MeSH Terms

Bilirubin
Carcinoma, Hepatocellular*
Catheter Ablation*
Ethics Committees, Research
Fluoroscopy*
Follow-Up Studies
Humans
Liver*
Multivariate Analysis
Proportional Hazards Models
Bilirubin

Figure

• 

  Fig. 1 A 62-year-old woman with hepatocellular carcinoma located in the right hepatic dome. A. Arterial phase of the contrast-enhanced computed tomography (CT) scan shows a 1.6 cm sized hypervascular nodule with spotty iodized oil uptake in liver (arrow). Delayed phase CT scan (not shown here) reveals washout of contrast media, confirming the radiologic diagnosis of hepatocellular carcinoma (HCC). B. Intermittent CT fluoroscopic spot images are taken to confirm that the electrode is at the appropriate position and trajectory until the electrode tip is positioned in the target. C. On an unenhanced CT scan obtained during the procedure of radiofrequency (RF) ablation under CT fluoroscopy guided transhepatic approach, the tins of a multitined expandable electrode are deployed within the tumor. The duration of application of RF energy was 13 minutes. D. Portal phase of the contrast-enhanced CT scan obtained immediately after the RF ablation shows a 2.4 cm diameter ablated zone (arrow). The RF needle was not completely retracted before the operator convinced that the tumor has been sufficiently ablated. E. Arterial (not shown here) and portal phase of the contrast-enhanced CT scan obtained one month after RF ablation shows no definite evidence of residual or recurred HCC nodule (arrow). F. Arterial phase of the contrast-enhanced CT scan obtained 68 months after RF ablation shows no definite evidence of residual or recurred HCC nodules (arrow). Note that the extent of the ablated area has been much reduced than before.

• 

  Fig. 2 A diagram of the cumulative local tumor progression rate of hepatocellular carcinoma after RF ablation under CT fluoroscopy. Note that the cumulative 3-year local tumor progression rate was 20%.

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