Review
doi: 10.1055/s-0040-1720952.
Epub 2020 Dec 11.
Percutaneous Thermal Ablation for Hepatocellular Carcinoma
Affiliations
- PMID: 33328709
- PMCID: PMC7732567
- DOI: 10.1055/s-0040-1720952
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Review
Percutaneous Thermal Ablation for Hepatocellular Carcinoma
Semin Intervent Radiol.
2020 Dec.
No abstract available
Conflict of interest statement
Conflict of Interest None declared.
Figures
Adequate separation could not be achieved with hydrodissection and ablation was not performed. Focal 17 mm hepatocellular carcinoma in the setting of cirrhosis and prior right hepatectomy and prior tumor ablation. Initial axial contrast-enhanced (
a
) and coronal T2 (
b
) MRI images demonstrate focal subcapsular lesion (white arrows) with adjacent bowel. Intraprocedural images demonstrate probe placement (
c
) and a hydrodissection needle with contrast-laced sterile water (
d
), without sufficient displacement of the bowel. Ablation was not performed.
Use of intravenous (IV) contrast to visualize a target lesion. CT-guided microwave ablation with lesion not visible initially (yellow arrow) (
a
). Lesion visualized and biopsy needle placed after IV contrast administration (yellow arrow) (
b
). Microwave probe placed in lesion and ablation performed (
c
). Postablation contrast CT shows ablation cavity covering the area of the previously identified lesion (
d
).
Example of hydrodissection. The colon is noted to be in close proximity to the lesion (
a
). An 18-G needle is advanced in the fat between the colon and liver (
b
). Instillation of D5W with dilute contrast displaces the colon laterally (
c
). An ablation probe is advanced into the region of the known lesion on the medial aspect of the remnant left lobe of the liver (
d
). Postablation image demonstrates hypoenhancement of the liver surrounding the region of the lesion, suggesting a technically adequate ablation (
e
). One-month follow-up MRI showing no residual disease in the region of ablation and normal appearance of adjacent colon (f).
Two examples of mechanical displacement. Stomach (white arrow) is immediately adjacent to the left lobe liver lesion (yellow arrow) (
a
). After hydrodissection did not produce enough separation, a balloon (thin white arrow) was introduced between the stomach (thick white arrow) and the liver lesion (yellow arrow) (
b
). Different patient with lesion (yellow arrow) adjacent to the stomach (white arrow) (
c
). This separation is achieved using an 18-G needle between both structures and applying gentle pressure to displace the stomach, allowing for safe ablation (
d
).
Ablation hepatocellular carcinoma (HCC) near vascular structures. Contrast-enhanced MRI demonstrating an enhancing HCC (yellow arrow) anterior to the inferior vena cava (IVC) (white arrow) (
a
). Ultrasound image during microwave ablation probe placement in the tumor (yellow arrow) anterior to the IVC (white arrow) (
b
). Postablation portal venous phase CT demonstrating the ablation zone abutting the IVC (white arrow) (
c
).
Crossing pleural, pericardial, or mediastinal fat to reach hepatic dome tumors. Example of an anterior route through the mediastinal and pleural to ablate a segment 4A 22-mm hepatocellular carcinoma (yellow arrow) on initial contrast-enhanced CT (using 70 cc) (
a
). Using CT fluoroscopy, an anterior approach is used to reach the hepatic dome tumor through pleural and pericardial fat (
b
). Care must be taken to avoid the internal mammary artery. Postablation repeat contrast-enhanced CT image demonstrates technically successful ablation (
c
).
Three-dimensional targeting of hepatic dome tumor via external markers. Hyperenhancing lateral dome lesion (white arrow) on preprocedural contrast-enhanced imaging (
a
). Area of lesion is surrounded by lung requiring off axis route to the lesion (
b
). Markings on anteroposterior (
c
) and lateral (
d
) images depicting the location of fiducial needles (red line and dot) that can be used to guide the operator in an off axis approach to the lesion (yellow arrows). Intraprocedural image depicting probe placement with two small fiducial needles in place directly over the lesion in the anteroposterior and lateral positions as marked on the patient's skin (
e
).
Gallbladder aspiration to reduce risk of gallbladder wall injury during ablation. A 61-year-old male with cirrhosis and a 10-mm segment 5 hepatocellular carcinoma abutting the superior edge of the gallbladder (
a
). On procedure day, significant dilation of the gallbladder from fasting (
b
). Cholecystokinin administered (0.02 μg/kg IV) with partial decompression at 30 minutes (
c
). Aspiration of bile with a Yueh needle resulted in complete decompression (
d
). Successful thermal ablation performed (38 × 20 mm) without gallbladder injury (
e
).
References
-
- Livraghi T, Meloni F, Di Stasi M. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology. 2008;47(01):82–89. - PubMed
-
- Feng K, Yan J, Li X. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol. 2012;57(04):794–802. - PubMed
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- Liao M, Zhong X, Zhang J. Radiofrequency ablation using a 10-mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: a prospective randomized trial. J Surg Oncol. 2017;115(08):971–979. - PubMed
