Korean J Radiol.  2017 ;18(4):615-623. 10.3348/kjr.2017.18.4.615.

Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques

• Park HS
• Baek JH
• Park AW
• Chung SR
• Choi YJ
• Lee JH

• KMID: 2427230
• DOI: http://doi.org/10.3348/kjr.2017.18.4.615

Abstract

Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers.

Keyword

Radiofrequency ablation; Thyroid nodules; Technique; Ultrasound; Thermal ablation

MeSH Terms

Catheter Ablation/instrumentation/*methods
Humans
Neoplasm Recurrence, Local
Thyroid Neoplasms/diagnostic imaging/surgery
Thyroid Nodule/diagnostic imaging/*surgery
Ultrasonography

Figure

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  Fig. 1 Unidirectional ablation electrode. A. Longitudinal view. B. Transverse view. Active tip is partially insulated, so that it creates half-moon-shaped ablation zone. Red: ablation zone, white: non-insulated portion, black: insulated portion.

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  Fig. 2 Perithyroidal lidocaine injection. Collected lidocaine appears as anechoic band (arrows) separating thyroid gland and strap muscle.

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  Fig. 3 Ablation of feeding artery. A. Before thyroid RFA, main feeding artery from superior thyroid artery is identified on Doppler study. B. After ablation of main feeding artery, no more vascular signal is seen on Doppler study, suggesting complete ablation of vessels. RFA = radiofrequency ablation

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  Fig. 4 Artery-first ablation technique. Intranodular linear echogenicities (arrows) spreading to periphery of target nodule can be seen, which may be microbubbles filling arterioles.

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  Fig. 5 Artery-first ablation technique. After ablation of feeding artery, wedge-shaped hypoechoic change (arrows) can be seen. This wedge-shaped hypoechoic area represents infarction in area supplied by feeding artery.

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  Fig. 6 Hydrodissection technique. A. Needle of syringe with 5% dextrose (arrow) is inserted posterior to recurrent tumor. B. 5% dextrose is slowly injected (arrows) between target tumor and adjacent critical structures including trachea, esophagus and recurrent laryngeal nerve.

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