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) or Microwave 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...
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 except caudate lobe. Using additional tools of CEUS or fusion imaging the pre,
intra and immediate post RFA response...
Except in two cases all other lesions were considered as completely 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...
Ultrasound guidance is at times handicapped partly by lack of confident identification of lesion during ablation otherwise well seen on cross sectional imaging modalities and partly by deciding the end point of ablation merely on US due to difficulty in incorporating immediate time consuming post ablation PET or CECT.
This confusion can be minimised using real-time contrast US & fusion imaging
Contrast harmonic sonography...
Prince Aly Khan Hospital,Mumbai 400010
Hyunchul Rhim and Hyo K.
Radiofrequency Ablation of Hepatocellular Carcinoma: Pros and Cons,
Gut and Liver,
Practice Guidelines Committee,
American Association for the study of Liver Diseases.
Management of hepatcellular carcinoma.
Radiofrequency ablation of hepatocellular carcinoma.