Irreversible electroporation of a hepatocellular carcinoma lesion adjacent to a transjugular intrahepatic portosystemic shunt stent graft

Abstract

We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.

Keywords: Carcinoma, hepatocellular; Catheter Ablation, radiofrequency; Irreversible electroporation; Liver neoplasms; Radiology, interventional.

Fig. 1

Pre-interventional angiography and intra-procedural CT scan and pre- and post-ablation MR images. A. Angiographic image during TACE. Celiac arteriography shows diffuse arteriovenous shunts (white arrow). TACE failed due to shunt. B. CT image during CT fluoroscopy-guided IRE. Precontrast CT shows low-attenuation ablation defect abutting TIPS stent graft (arrows). Note deployment of electrodes adjacent to TIPS stent graft. TACE = transarterial chemoembolization, TIPS = transjugular intrahepatic portosystemic shunt. C-F. Pre- and post-ablation MR images. C. Preablation diffusion-weighted MR Image (b = 1000 sec/mm²) shows slightly hyperintense HCC (white arrow) adjacent to TIPS stent graft (white arrowhead). D. Preablation T1-weighted image during hepatobiliary phase shows hypointense HCC which measures 2.2 × 4.0 cm (black arrow). E. 8-week postablation diffusion-weighted MR-image (b = 1000 sec/mm²) shows complete ablation of HCC (arrow). F. 8-week postablation T1-weighted MR-image shows hypointense sharp demarcation of ablation zone. HCC = hepatocellular carcinoma, TIPS = transjugular intrahepatic portosystemic shunt