Korean J Radiol.  2018 Aug;19(4):560-567. 10.3348/kjr.2018.19.4.560.

Comparison of Chronologic Change in the Size and Contrast-Enhancement of Ablation Zones on CT Images after Irreversible Electroporation and Radiofrequency Ablation

• Scheck J
• Bruners P
• Schindler
• Kuhl C
• Isfort P

• KMID: 2413685
• DOI: http://doi.org/10.3348/kjr.2018.19.4.560

Abstract

OBJECTIVE
To compare short-, mid-, and long-term follow-up ablation zone volume alterations as well as imaging features on contrast-enhanced computed tomography (CT) after irreversible electroporation (IRE) of primary and secondary liver tumors with findings subsequent to radiofrequency ablation (RFA).
MATERIALS AND METHODS
Volume assessment of 39 ablation zones (19 RFA, 20 IRE) after intervention was performed at four time intervals (day 0 [t1; n = 39], day 1-7 [t2; n = 25], day 8-55 [t3; n = 28], after day 55 [t4; n = 23]) on dual-phase CT. Analysis of peripheral rim enhancement was conducted. Lesion's volume decrease relative to the volume at t1 was calculated and statistically analyzed with respect to patient's sex, age, ablation modality (IRE/RFA), and history of platinum-based chemotherapy (PCT).
RESULTS
No influence of patient's sex or age on ablation volume was detected. The decrease in ablation zones' volume was significantly larger (p < 0.05 for all time intervals) after IRE (arterial phase, 7.5%; venous phase, 9.7% of initial volume) compared to RFA (arterial phase, 39.6%; venous phase, 45.3% of initial volume). After RFA, significantly smaller decreases in the ablation volumes, in general, were detected in patients treated with PCT in their history (p = 0.004), which was not detected after IRE (p = 0.288). In the arterial phase, peripheral rim enhancement was frequently detected after both IRE and RFA. In the venous phase, rim-enhancement was depicted significantly more often following IRE at t1 and t2 (pt1 = 0.003, pt2 < 0.001).
CONCLUSION
As per our analysis, ablation zone volume decreased significantly in a more rapid and more profound manner after IRE. Lesion's remodeling after RFA but not IRE seems to be influenced by PCT, possibly due to the type of cell death induced by the different ablation modalities.

Keyword

IRE; RFA; CT; Tumor volume; Minimally invasive therapy

MeSH Terms

Catheter Ablation*
Cell Death
Drug Therapy
Electroporation*
Follow-Up Studies
Humans
Liver
Tumor Burden

Figure

• 

  Fig. 1 Relative changes in ablation volumes after RFA and IRE based on CT datasets in arterial phase (A) and venous phase (B).t1 = day 0, t2 = day 1–7, t3 = day 8–55, t4 = after day 55. CT = computed tomography, IRE = irreversible electroporation, RFA = radiofrequency ablation

• 

  Fig. 2 Appearance of hyperattenuating RE after IRE and RFA in CT datasets in arterial phase (A) and venous phase (B).RE = rim enhancement

• 

  Fig. 3 Typical appearance of ablation zones in CT follow-up, venous phase.A–C. Tumor treated with IRE. A. Imaging of lesion in patient with hepatic metastasis of breast cancer. B. Imaging of lesion on first day after treatment with IRE. Note substantial rim-like contrast enhancement. C. Imaging of lesion six months after IRE treatment. D–F. Tumor treated with RFA. D. Imaging of lesion in patient with hepatic metastasis of colorectal cancer. E. Imaging of lesion on first day after treatment with RFA. F. Imaging of lesion six months after RFA treatment. Arrows mark tumors in A, D and ablation zones in B, C, E, F.

• 

  Fig. 4 Influence of PCT on measured volume after RFA (A) and IRE (B) as function of time.PCT = platinum-based chemotherapy

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