Learning objectives
To describe state-of-the art imaging post liver thermal ablation and response criteria,
To analyze optimal imaging timing in relation to therapeutic and follow-up strategies,
To illustrate future imaging potential and developments
Background
Hepatocellular carcinoma is the sixth most common cancer type and the third most common cause of cancer-related death.
Hepatic metastases are the most common liver tumors; liver is the most common site of metastasis,
second only to lymph nodes.
Due to the hepatic anatomy and perfusion,
metastasis can originate from any primary tumor; however most common sites of origin include colon,
breast,
lung and pancreas.
Image-guided tumor ablation provides curative treatment in properly selected patients or appropriate therapeutic options whenever surgical techniques are precluded.
Whenever...
Imaging findings OR Procedure details
Immediately post ablation session,
a Computed Tomography scan including (non-contrast,
arterial and portal phase) of the upper abdomen (from lung base to right kidney level) should be performed in order to identify (and possibly treat) any potential complications (eg pneumothorax,
hemorrhage etc.)
After patient's discharge from the hospital a common follow-up strategy for assessment of tumor response includes contrast enhanced multiphasic (non-contrast,
arterial,
portal,
delayed phases) imaging with Computed Tomography or Magnetic Resonance at 1st and then every 3 months post ablation session.
Total ablation...
Conclusion
Accurate interpretation of post-ablation imaging findings is crucial for therapeutic and follow-up strategies.
Computed Tomography (CT) can be used for the immediate assessment of the ablation (including efficacy and potential complications) or whenever MRI is not available.
Magnetic Resonance Imaging (MRI) plays the most important role in patients’ follow-up post liver thermal ablation therapies.
DW-MR imaging has proved its promising character for the noninvasive assessment of tumor response to thermal ablation and prediction of tumor response.
Contrast Enhanced Ultrasound (CEUS) is a promising imaging modality...
References
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Modified RECIST (mRECIST) assessment for hepatocellular carcinoma.
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Pianou N,
Kelekis N,
Chatziioannou S.
Impact of 18F-FDG PET/CT on therapeutic decisions in patients with colorectal cancer and liver metastases.
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Poulou LS,
Ziakas PD,
Ziogas DC,
Doxani C,
Xyla V,
Vakrinos G,
Voulgarelis M,
Thanos L.
FDG-PET for detecting local tumor recurrence of ablated liver metastases: a diagnostic meta-analysis.
Biomarkers.
2012;17(6):532-8.
Delumeau S,
Lebigot J,
Ridereau-Zins C,
Bouvier...
Personal Information
Nikolaos L.
Kelekis
Professor of Diagnostic and Interventional Radiology
2nd Radiology Dpt,
University General Hospital "ATTIKON",
Athens/GR
[email protected]
Dimitrios K.
Filippiadis
Interventional Radiologist - Consultant
2nd Radiology Dpt,
University General Hospital "ATTIKON",
Athens/GR
[email protected]
Maria Mademli
Consultant of Radiology
2nd Radiology Dpt,
University General Hospital "ATTIKON",
Athens/GR
[email protected]