Korean J Radiol.  2012 Feb;13(1):34-43. 10.3348/kjr.2012.13.1.34.

Percutaneous Radiofrequency Ablation with Multiple Electrodes for Medium-Sized Hepatocellular Carcinomas

• Lee J
• Lee JM
• Yoon JH
• Lee JY
• Kim SH
• Lee JE
• Han JK
• Choi BI

• KMID: 1058791
• DOI: http://doi.org/10.3348/kjr.2012.13.1.34

Abstract

OBJECTIVE
To prospectively evaluate the safety and short-term therapeutic efficacy of switching monopolar radiofrequency ablation (RFA) with multiple electrodes to treat medium-sized (3.1-5.0 cm), hepatocellular carcinomas (HCC).
MATERIALS AND METHODS
In this prospective study, 30 patients with single medium-sized HCCs (mean, 3.5 cm; range, 3.1-4.4 cm) were enrolled. The patients were treated under ultrasonographic guidance by percutaneous switching monopolar RFA with a multichannel RF generator and two or three internally cooled electrodes. Contrast-enhanced CT scans were obtained immediately after RFA, and the diameters and volume of the ablation zones were then measured. Follow-up CT scans were performed at the first month after ablation and every three months thereafter. Technical effectiveness, local progression and remote recurrence of HCCs were determined.
RESULTS
There were no major immediate or periprocedural complications. However, there was one bile duct stricture during the follow-up period. Technical effectiveness was achieved in 29 of 30 patients (97%). The total ablation time of the procedures was 25.4 +/- 8.9 minutes. The mean ablation volume was 73.8 +/- 56.4 cm3 and the minimum diameter was 4.1 +/- 7.3 cm. During the follow-up period (mean, 12.5 months), local tumor progression occurred in three of 29 patients (10%) with technical effectiveness, while new HCCs were detected in six of 29 patients (21%).
CONCLUSION
Switching monopolar RFA with multiple electrodes in order to achieve a sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow up for the treatment of medium-sized HCCs.

Keyword

Liver; Interventional procedures; Radiofrequency ablation; Preliminary clinical study

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/radiography/*surgery
Catheter Ablation/instrumentation/*methods
Contrast Media/diagnostic use
Disease Progression
Electrodes
Female
Humans
Iohexol/analogs & derivatives/diagnostic use
Kaplan-Meier Estimate
Liver Neoplasms/radiography/*surgery
Male
Middle Aged
Neoplasm Recurrence, Local
Prospective Studies
Tomography, X-Ray Computed/*methods
Ultrasonography, Interventional

Figure

• 

  Fig. 1 71-year-old man with 4.3-cm-diameter hepatocellular carcinoma treated by switching monopolar radiofrequency ablation.A. Contrast-enhanced T1-weighted image during arterial phase showing hyperenhancing hepatocellular carcinoma in segment VI (arrow). B. Immediate contrast-enhanced CT scan during portal venous phase after radiofrequency ablation procedure demonstrating creation of sufficient ablation zones to cover tumor (arrow). C. 14-month follow-up CT scan during portal phase showing no evidence of local tumor progression in region surrounding radiofrequency ablation zone (arrow).

• 

  Fig. 2 63-year-old man with 4.3-cm-diameter hepatocellular carcinoma treated by switching monopolar radiofrequency ablation.A. Pre-ablation CT scan during arterial phase showing hyperenhancing 4.3-cm-diameter hepatocellular carcinoma nodule (arrow). B. Immediate post-ablation CT scan during portal phase showing no definite residual enhancing tumor (arrow). C. Arterial phase nine-month follow-up CT scan showing local tumor progression (arrow) on superior side of radiofrequency ablation defect. D. Follow-up CT scan obtained immediately after second radiofrequency ablation using two single electrodes in switching monopolar mode showing complete ablation of recurrent hepatocellular carcinoma (arrow).

• 

  Fig. 3 72-year-old man with 3.2-cm-diameter hepatocellular carcinoma treated by switching monopolar radiofrequency ablation.A. Pre-ablation CT scan during arterial phase showing hyperenhancing 3.2-cm-diameter hepatocellular carcinoma nodule (arrow) in segment VI of liver. B. Six-month follow-up CT scan during portal phase showing mildly dilated intrahepatic ducts (arrowheads) with stricture at hilar level. No evidence of local tumor progression from radiofrequency ablation zone is evident (arrow).

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