Aims and objectives
During last 15 yrs therapeutic approach to primary & metastatic disease has changed and improved.Besides surgical hepatic resection newer less invasive non surgical options are:
a)Chemical Ablation-Percutaneous Ethanol Injection (PEI)
b)Thermal Ablation-Radofrequency ablation (RFA) orMicrowave ablation
RFA has particularly gained importance over a period of time even though there are definite known pros and cons of the procedure.Using appropriate selection and exclusion criterias the overall efficacy can be increased as shown in tables 1 ;2 &3.
The purpose of this prospective study conducted in small...
Methods and materials
Nine consecutive liver lesions; four metastatic and five primary HCC were considered suitable for US guided radiofrequency ablation with earlier CECT or PET CT or contrast MRI.
Total 4 metastatic lesions; one from breast and three from colonic primary are included in this study (Fig 12) .The size of these lesions was from 1.3cm to 4.7 cm located in various segments exceptcaudate lobe.Using additional tools of CEUS or fusion imaging the pre,
intra and immediate post RFA response was correctly judged; later confirmed on contrast...
Results
Except in two cases all other lesions were considered ascompletely ablated based on pre and post CEUS enhancement pattern.
One metastatic lesion showed definite peripheral enhancement and was ablated in additional sitting within 3 hours (as shown in case 5-figure 11).
In other case CEUS showed minimal doubtful enhancement which on follow up PET imaging was reported as post RFA inflammatory response showing reducing SUV (standardized uptake values) on subsequent scan with no further abnormal uptake on CEUS after three months.
Conclusion
Ultrasoundguidance is at times handicapped partly by lack of confident identification of lesionduringablation otherwise well seen on cross sectional imaging modalities and partly by deciding the end point ofablation merely on US due to difficulty in incorporating immediate timeconsuming post ablation PET or CECT.
Thisconfusioncan be minimisedusingreal-timecontrast US &fusionimaging
Contrast harmonic sonography guided RFA has better ablation rate after a single treatment session.
Fusion imaging using prior CT/MR data increases speed of detection of lesion and precise targeting.
Both these techniques makes ultrasound a even...
Personal information
Dr.
Shenaz Momin
M.D.,D.M.R.E.
Additional Professor,
Radiology Dept.
Nair Hospital,
Mumbai 400008
India
[email protected]
Dr.
Asif A.
Momin
M.D.,
D.M.R.D.,
D.M.R.E.,
D.N.B.
Head,
Imaging
Prince Aly Khan Hospital,Mumbai 400010
India.
[email protected]
References
Hyunchul Rhim and Hyo K.
Lim,
Radiofrequency Ablation of Hepatocellular Carcinoma: Pros and Cons,
Gut and Liver,
Vol.
4,
Suppl.
1,
September 2010,
pp.
S113-118
Rhim H,
Eur Radiol,
2009
Bruix J,
Sherman M,
Practice Guidelines Committee,
American Association for the study of Liver Diseases.
Management of hepatcellular carcinoma.
Hepatology 2005;42:1208-36
Wen YL,
Kudo M,
Zheng RQ,
Minami Y,
Chung H,
Suetomi Y,
etal.
Radiofrequency ablation of hepatocellular carcinoma.
Therapeutic response using contrast-enhanced coded phase-inversion harmonic sonography.AJR Am J Roentgen 2003;181:57-63
Cioni D,
Lencioni R,...