Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-mwx4w Total loading time: 0 Render date: 2024-06-23T10:48:01.573Z Has data issue: false hasContentIssue false

3 - Diagnostic imaging pre- and post-ablation

Published online by Cambridge University Press:  23 December 2009

Andy Adam
Affiliation:
University of London
Peter R. Mueller
Affiliation:
Massachussets General Hospital, Boston
Get access

Summary

Introduction

Hepatic malignant tumors are common worldwide. Surgical resection and, in rare instances, liver transplantation represent the gold standard of management, offering a chance of cure in selected patients. The overall 3-year survival rate in patients with hepatocellular carcinoma (HCC) who undergo surgical resection is between 47.2% and 83.9%, and the overall 5-year survival rate in patients with colorectal liver metastases who undergo surgical resection is between 35% and 58%. However, curative resection is frequently precluded because of medical comorbidities that render patients inoperable. Less than 25% of patients with either primary HCC or colorectal liver metastases are candidates for surgical resection.

Since the 1990s, radiofrequency ablation (RFA) of primary and secondary hepatic malignancies has had promising results in local control of tumors. With advances in imaging modalities and refinements of ablation technique, as well as more powerful generators, the outcome of RFA for hepatic tumors has improved significantly in the past several years. RFA can achieve complete necrosis of the tumor without adverse effects on liver function. To date, RFA is considered a reasonable alternative for patients with four or fewer hepatic tumors that are less than 3–5 cm in diameter. The absolute contraindications of RFA include extrahepatic disease, life expectancy less than 6 months, other active malignant disease, cirrhosis or hepatic insufficiency, portal hypertension or portal vein thrombosis, altered mental status, age less than 18 years, pregnancy, severe pulmonary disease, active infection, and refractory coagulopathy.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fong, Y, Sun, RL, Jarnagin, W, Blumgart, LH.An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999; 229: 790–800.CrossRefGoogle Scholar
Fong, Y, Kemeny, N, Paty, P, Blumgart, LH, Cohen, AM. Treatment of colorectal cancer: hepatic metastasis. Semin Surg Oncol 1996; 12: 219–52.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Hong, SN, Lee, SY, Choi, MS, et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol 2005; 39: 247–52.CrossRefGoogle ScholarPubMed
Vivarelli, M, Guglielmi, A, Ruzzenente, A, et al. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg 2004; 240: 102–7.CrossRefGoogle ScholarPubMed
Poon, RT, Fan, ST, Lo, CM, Liu, CL, Wong, J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999; 229: 216–22.CrossRefGoogle ScholarPubMed
Pawlik, TM, Choti, MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg 2007; 11: 1057–77.CrossRefGoogle ScholarPubMed
Gervais, DA, Arellano, RS, Mueller, PR. Percutaneous radiofrequency ablation of ovarian cancer metastasis to the liver: indications, outcomes, and role in patient management. AJR Am J Roentgenol 2006; 187: 746–50.CrossRefGoogle ScholarPubMed
Cho, CM, Tak, WY, Kweon, YO, et al. [The comparative results of radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma.]Korean J Hepatol 2005; 11: 59–71.Google Scholar
Abdalla, EK, Vauthey, JN, Ellis, LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818–27.CrossRefGoogle ScholarPubMed
Goldberg, SN, Gazelle, GS, Halpern, EF, et al. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol 1996; 3: 212–18.CrossRefGoogle ScholarPubMed
Yu, HC, Cheng, JS, Lai, KH, et al. Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy. World J Gastroenterol 2005; 11: 1439–44.CrossRefGoogle ScholarPubMed
Harrison, , Koneru, B, Baramipour, P, et al. Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg 2003; 197: 759–64.CrossRefGoogle ScholarPubMed
Chen, MS, Zhang, YJ, Li, JQ, et al. [Randomized clinical trial of percutaneous radiofrequency ablation plus absolute ethanol injection compared with radiofrequency ablation alone for small hepatocellular carcinoma.]Zhonghua Zhong Liu Za Zhi 2005; 27: 623–5.Google Scholar
Namasivayam, S, Salman, K, Mittal, PK, Martin, D, Small, WC. Hypervascular hepatic focal lesions: spectrum of imaging features. Curr Probl Diagn Radiol 2007; 36: 107–23.CrossRefGoogle ScholarPubMed
Sahani, DV, Kalva, SP. Imaging the liver. Oncologist 2004; 9: 385–97.CrossRefGoogle ScholarPubMed
Brink, JA. Use of high concentration contrast media (HCCM): principles and rationale – body CT. Eur J Radiol 2003; 45 (Suppl 1): S53–8.CrossRefGoogle ScholarPubMed
Itoh, S, Ikeda, M, Achiwa, M, et al. Multiphase contrast-enhanced CT of the liver with a multislice CT scanner: effects of iodine concentration and delivery rate. Radiat Med 2005; 23: 61–9.Google ScholarPubMed
Awai, K, Takada, K, Onishi, H, Hori, S. Aortic and hepatic enhancement and tumor-to-liver contrast: analysis of the effect of different concentrations of contrast material at multi-detector row helical CT. Radiology 2002; 224: 757–63.CrossRefGoogle ScholarPubMed
Wilson, SR, Jang, HJ, Kim, TK, Burns, PN. Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans. J Ultrasound Med 2007; 26: 775–87.CrossRefGoogle ScholarPubMed
Boozari, B, Lotz, J, Galanski, M, Gebel, M. [Diagnostic imaging of liver tumours: current status.]Internist (Berl) 2007; 48: 8–20.CrossRefGoogle Scholar
Quaia, E, Calliada, F, Bertolotto, M, et al. Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 2004; 232: 420–30.CrossRefGoogle Scholar
Janica, JR, Lebkowska, U, Ustymowicz, A, et al. Contrast-enhanced ultrasonography in diagnosing liver metastases. Med Sci Monit 2007; 13 (Suppl 1): 111–15.Google ScholarPubMed
Braga, HJ, Choti, MA, Lee, VS, et al. Liver lesions: manganese-enhanced MR and dual-phase helical CT for preoperative detection and characterization comparison with receiver operating characteristic analysis. Radiology 2002; 223: 525–31.CrossRefGoogle ScholarPubMed
Laghi, A. Multidetector CT (64 slices) of the liver: examination techniques. Eur Radiol 2007; 17: 675–83.CrossRefGoogle ScholarPubMed
Schima, W, Kulinna, C, Langenberger, H, Ba-Ssalamah, A. Liver metastases of colorectal cancer: US, CT or MR? Cancer Imaging 2005; 5 (Spec no A): S149–56.CrossRefGoogle ScholarPubMed
Holalkere, NS, Sahani, DV, Blake, MA, et al. Characterization of small liver lesions: added role of MR after MDCT. J Comput Assist Tomogr 2006; 30: 591–6.CrossRefGoogle ScholarPubMed
Lai, DT, Fulham, M, Stephen, MS, et al. The role of whole-body positron emission tomography with [18F]fluorodeoxyglucose in identifying operable colorectal cancer metastases to the liver. Arch Surg 1996; 131: 703–7.CrossRefGoogle Scholar
Desai, DC, Zervos, EE, Arnold, MW, et al. Positron emission tomography affects surgical management in recurrent colorectal cancer patients. Ann Surg Oncol 2003; 10: 59–64.CrossRefGoogle ScholarPubMed
Gallowitsch, HJ, Kresnik, E, Gasser, J, et al. F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging. Invest Radiol 2003; 38: 250–6.CrossRefGoogle Scholar
Sun, L, Wu, H, Guan, YS. Positron emission tomography/computer tomography: challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies. World J Gastroenterol 2007; 13: 2775–83.CrossRefGoogle ScholarPubMed
Kula, Z, Szefer, J, Zuchora, Z, Romanowicz, G, Pietrzak, T. [Evaluation of positron emission tomography by using F-18-fluorodeoxyglucose in diagnosis of recurrent colorectal cancer.]Pol Merkur Lekarski 2004; 17 (Suppl 1): 63–6.Google Scholar
Goldberg, SN, Hahn, PF, Tanabe, KK, et al. Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 1998; 9: 101–11.CrossRefGoogle ScholarPubMed
Goldberg, SN, Solbiati, L, Hahn, PF, et al. Large-volume tissue ablation with radio frequency by using a clustered, internally cooled electrode technique: laboratory and clinical experience in liver metastases. Radiology 1998; 209: 371–9.CrossRefGoogle ScholarPubMed
Dromain, C, Baere, T, Elias, D, et al. Hepatic tumors treated with percutaneous radio-frequency ablation: CT and MR imaging follow-up. Radiology 2002; 223: 255–62.CrossRefGoogle ScholarPubMed
Filippone, A, Iezzi, R, Di Fabio, F, et al. Multidetector-row computed tomography of focal liver lesions treated by radiofrequency ablation: spectrum of findings at long-term follow-up. J Comput Assist Tomogr 2007; 31: 42–52.CrossRefGoogle ScholarPubMed
Ninomiya, T, Seo, Y, Yano, Y, et al. Evaluation of the therapeutic effect using MD-CT immediately after RFA for HCC. Hepatogastroenterology 2006; 53: 558–60.Google ScholarPubMed
Nghiem, HV, Francis, IR, Fontana, R, et al. Computed tomography appearances of hypervascular hepatic tumors after percutaneous radiofrequency ablation therapy. Curr Probl Diagn Radiol 2002; 31: 105–11.CrossRefGoogle ScholarPubMed
Lim, HK, Choi, D, Lee, WJ, et al. Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology 2001; 221: 447–54.CrossRefGoogle ScholarPubMed
Rossi, S, Buscarini, E, Garbagnati, F, et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 1998; 170: 1015–22.CrossRefGoogle ScholarPubMed
Goldberg, SN, Gazelle, GS, Compton, CC, Mueller, PR, Tanabe, KK. Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic–pathologic correlation. Cancer 2000; 88: 2452–63.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Rowland, IJ, Rivens, I, Chen, L, et al. MRI study of hepatic tumours following high intensity focused ultrasound surgery. Br J Radiol 1997; 70: 144–53.CrossRefGoogle ScholarPubMed
Livraghi, T, Goldberg, SN, Monti, F, et al. Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases. Radiology 1997; 202: 205–10.CrossRefGoogle ScholarPubMed
Anderson, GS, Brinkmann, F, Soulen, MC, Alavi, A, Zhuang, H. FDG positron emission tomography in the surveillance of hepatic tumors treated with radiofrequency ablation. Clin Nucl Med 2003; 28: 192–7.CrossRefGoogle ScholarPubMed
Blokhuis, TJ, Schaaf, MC, Tol, MP, et al. Results of radio frequency ablation of primary and secondary liver tumors: long-term follow-up with computed tomography and positron emission tomography-18F-deoxyfluoroglucose scanning. Scand J Gastroenterol Suppl 2004; (241): 93–7.CrossRefGoogle ScholarPubMed
Donckier, V, Laethem, JL, Goldman, S, et al. [F-18] fluorodeoxyglucose positron emission tomography as a tool for early recognition of incomplete tumor destruction after radiofrequency ablation for liver metastases. J Surg Oncol 2003; 84: 215–23.CrossRefGoogle ScholarPubMed
Veit, P, Antoch, G, Stergar, H, et al. Detection of residual tumor after radiofrequency ablation of liver metastasis with dual-modality PET/CT: initial results. Eur Radiol 2006; 16: 80–7.CrossRefGoogle ScholarPubMed
Langenhoff, BS, Oyen, WJ, Jager, GJ, et al. Efficacy of fluorine-18-deoxyglucose positron emission tomography in detecting tumor recurrence after local ablative therapy for liver metastases: a prospective study. J Clin Oncol 2002; 20: 4453–8.CrossRefGoogle ScholarPubMed
Fong, Y, Saldinger, PF, Akhurst, T, et al. Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastases. Am J Surg 1999; 178: 282–7.CrossRefGoogle ScholarPubMed
Rhim, H, Yoon, KH, Lee, JM, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 2003; 23: 123–34.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×