Korean J Radiol.  2009 Aug;10(4):366-376. 10.3348/kjr.2009.10.4.366.

Percutaneous Radiofrequency Ablation of Hepatocellular Carcinomas Adjacent to the Gallbladder with Internally Cooled Electrodes: Assessment of Safety and Therapeutic Efficacy

• Kim SW
• Rhim H
• Park M
• Kim H
• Kim YS
• Choi D
• Lim HK

• KMID: 1777265
• DOI: http://doi.org/10.3348/kjr.2009.10.4.366

Abstract

OBJECTIVE
The objective of this study was to evaluate the safety and therapeutic efficacy of percutaneous radiofrequency (RF) ablation for the treatment of hepatocellular carcinomas (HCCs) adjacent to the gallbladder with the use of internally cooled electrodes.
MATERIALS AND METHODS
We retrospectively assessed 45 patients with 46 HCCs (mean size, 2.2 cm) adjacent to the gallbladder (< or =1.0 cm) treated with RF ablation using an internally cooled electrode system. An electrode was inserted into the tumor either parallel (n = 38) or perpendicular (n = 8) to the gallbladder wall. The safety and therapeutic efficacy of the procedures were assessed with clinical and imaging follow-up examinations. Follow-up with the use of CT ranged from four to 45 months (mean, 19 months). The association between variables (electrode direction, electrode type, tumor size, tumor location, lobar location) and the presence of a residual tumor or local tumor progression was also analyzed.
RESULTS
There were no major complications and minor complications were noted in three patients (7%) including one case of vasovagal syncope and two cases of bilomas. Wall thickening of the gallbladder adjacent to the RF ablation zone was noted in 14 patients (41%) as determined on immediate follow-up CT imaging. Wall thickening showed complete disappearance on subsequent follow-up CT imaging. The primary technique effectiveness rate was 96% (44/46) based on one-month follow-up CT imaging. Local tumor progression was noted in six (14%) of 44 completely ablated tumors during the follow-up period. The direction of electrode insertion (perpendicular), tumor size (> or =3 cm) and tumor location (a tumor that abutted the gallbladder) were associated with an increased risk of early incomplete treatment. No variable was significantly associated with local tumor progression.
CONCLUSION
Percutaneous RF ablation of HCCs adjacent to the gallbladder using an internally cooled electrode is a safe and effective treatment. Significant risk factors that lead to early incomplete treatment include tumor size, tumor location and electrode direction.

Keyword

Radiofrequency (RF) ablation; Liver neoplasms; Gallbladder; Computed tomography (CT)

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular/*surgery
Catheter Ablation/instrumentation/*methods
Cholecystography
*Electrodes
Female
Follow-Up Studies
*Gallbladder
Humans
Liver Neoplasms/*surgery
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Direction of electrode insertion (long arrows). It was categorized as parallel (A) or perpendicular (B) according to direction of electrode tip for gallbladder wall. Distance indicates safety distance between electrode and gallbladder wall.

• 

  Fig. 2 Imaging findings for 69-year-old woman with residual unablated tumor after radiofrequency ablation where vasovagal syncope occurred during procedure. Electrode was inserted into tumor perpendicular to gallbladder wall. A. Contrast-enhanced CT scan obtained during arterial phase shows 1.5-cm hepatocellular carcinoma (arrow) abutting gallbladder (double arrows) in liver segment IV. B. Sagittal sonogram obtained during radiofrequency ablation shows slightly hyperechoic mass (double arrows). Also, note 2-cm active tip (arrow) of electrode between electronic calipers. C. Contrast-enhanced CT scan obtained immediately after radiofrequency ablation shows residual unablated tumor (arrow) seen as crescent-shape enhancing lesion located at deep portion of ablation zone. D. Non-enhanced CT scan obtained after transcatheter arterial chemoembolization shows Lipiodol uptake (arrow) by residual unablated tumor.

• 

  Fig. 3 Imaging findings for 66-year-old woman with hepatocellular carcinoma who had gallbladder wall thickening after radiofrequency ablation are presented. Electrode was inserted into tumor perpendicular to gallbladder wall. A. Arterial phase CT scan shows 1.6-cm hepatocellular carcinoma (arrow) adjacent to gallbladder in liver segment V. In addition, gallstone (double arrows) is noted. B. Contrast-enhanced CT scan obtained immediately after radiofrequency ablation shows low-attenuation ablation zone (arrow) larger than tumor. Also, note mild wall thickening of gallbladder adjacent to ablation zone (double arrows). C. Contrast-enhanced CT scan obtained one month after radiofrequency ablation shows disappearance of gallbladder wall thickening.

• 

  Fig. 4 Imaging findings for 57-year-old man with hepatocellular carcinoma are presented. Electrode was inserted into tumor parallel to gallbladder wall. A. Arterial phase CT scan shows 2.4-cm hepatocellular carcinoma (arrow) abutting gallbladder in liver segment V. B. Immediate follow-up CT image after radiofrequency ablation show low-attenuation ablation zone (arrow) and mild focal wall thickening of gallbladder (double arrows). C. Contrast-enhanced CT scan obtained one month after radiofrequency ablation shows disappearance of gallbladder wall thickening.

• 

  Fig. 5 Imaging findings for 59-year-old man with local tumor progression after radiofrequency ablation are presented. Electrode was inserted into tumor parallel to gallbladder wall. A. Contrast-enhanced CT scan obtained during arterial phase shows 3.0-cm hepatocellular carcinoma (arrow) adjacent to gallbladder in liver segment V. B. Oblique sonogram obtained during radiofrequency ablation shows hypoechoic mass adjacent to gallbladder. Single ablation with 3-cm single straight electrode (arrows) was performed for 12 minutes. Also, note 3-cm active tip of electrode between electronic calipers. C. Contrast-enhanced CT scan obtained immediately after radiofrequency ablation shows low-attenuation ablation zone with peripheral hyperemia (arrow). D. Contrast-enhanced CT scan obtained three months after radiofrequency ablation shows nodular enhancing lesion (arrow) at inferomedial aspect of ablation zone that is indicative of local tumor progression.

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