Korean J Radiol.  2020 Sep;21(9):1077-1086. 10.3348/kjr.2019.0910.

Effect of Perfluorobutane Microbubbles onRadiofrequency Ablation for Hepatocellular Carcinoma:Suppression of Steam Popping and Its ClinicalImplication

  • 1Departments of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2Departments of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 3Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 4Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea


To evaluate the effect of perfluorobutane microbubbles (Sonazoid®, GE Healthcare) on steam popping duringradiofrequency (RF) ablation for treating hepatocellular carcinoma (HCC), and to assess whether popping affects treatmentoutcomes.
Materials and Methods
The institutional review board approved this retrospective study, which included 90 consecutivepatients with single HCC, who received percutaneous RF ablation as the first-line treatment. The patients were divided intotwo groups, based on the presence or absence of the popping phenomenon, which was defined as an audible sound with asimultaneous sudden explosion within the ablation zone as detected via ultrasonography during the procedure. The factorscontributing to the popping phenomenon were identified using multivariable logistic regression analysis. Local tumor progression(LTP) and disease-free survival (DFS) were assessed using the Kaplan-Meier method with the log-rank test for performingcomparisons between the two groups.
The overall incidence of the popping phenomenon was 25.8% (24/93). Sonazoid® was used in 1 patient (4.2%) inthe popping group (n = 24), while it was used in 15 patients (21.7%) in the non-popping group (n = 69). Multivariableanalysis revealed that the use of Sonazoid® was the only significant factor for absence of the popping phenomenon (oddsratio = 0.10, p= 0.048). There were no significant differences in cumulative LTP and DFS between the two groups (p= 0.479and p= 0.424, respectively).
The use of Sonazoid® has a suppressive effect on the popping phenomenon during RF ablation in patients withHCC. However, the presence of the popping phenomenon may not affect clinical outcomes.


Liver; Hepatocellular carcinoma; Radiofrequency ablation; Contrast media; Explosions
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