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Should fat in the radiofrequency ablation zone of hepatocellular adenomas raise suspicion for residual tumour?

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To assess the significance of fat in the radiofrequency ablation (RFA) zone of hepatocellular adenomas (HCA), and its association with tumoral fat and hepatic steatosis.

Methods

The radiological archive was searched for patients with ablated HCAs and follow-up magnetic resonance imaging between January 2008 and June 2014. Age, sex, risk factors and duration of clinical and imaging follow-up were recorded. Pre-RFA imaging was assessed for tumour size, intra-tumoral fat and steatosis. Post-RFA imaging was reviewed for size, enhancement and intra-ablational fat. Intra-ablational fat was classified as peripheral, central or mixed; the association of these distributions with steatosis and tumoral fat was assessed using Fisher’s exact test.

Results

Sixteen patients with 26 ablated HCAs were included. Fat was present in 23/26 (88 %) ablation zones. Only 1/26 (4 %) showed serial enlargement and enhancement suggestive of residual disease; the enhancing area did not contain fat. All remaining ablations showed involution and/or diminishing fat content without suspicious enhancement (mean follow-up, 27 months; range, 2–84 months). The peripheral and mixed/central patterns of intra-ablational fat were associated with steatosis (P = 0.0005) and tumoral fat (P = 0.0003), respectively.

Conclusion

Fat in the ablation zone of HCAs is a common finding which, in isolation, does not indicate residual tumour.

Key Points

• Fat in the RFA zone of HCAs is a common finding on MRI.

• The distribution of fat is associated with hepatic steatosis and intra-tumoral fat.

• In isolation, intra-ablational fat of treated HCAs does not indicate residual tumour.

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Acknowledgments

The scientific guarantor of this publication is Dr. Mostafa Atri. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Mr. Mohamed Abdolell, B.Sc. M.Sc. P.Stat. kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, cross sectional study, performed at one institution.

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Author notes

  1. Andreu F. Costa

    Present address: Department of Diagnostic Radiology, QE II Health Sciences Centre – VG Site, Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada

Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Munk Building, 1c-571, 585 University Avenue, Toronto, Ontario, Canada, M5G 2N2

    Andreu F. Costa, Dilkash Kajal, André Pereira & Mostafa Atri

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  1. Andreu F. Costa
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Correspondence to Andreu F. Costa.

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Supplementary Fig. 1

Boxplot comparing qualitative and semi-quantitative assessments of steatosis. The calculated MR signal fat fraction is plotted according to the subjective grade of steatosis assigned (none/mild, moderate and severe). The mean fat fraction and standard deviation for each group are denoted by the dashed horizontal line and error bars, respectively (JPG 12 kb)

High resolution image (TIF 11609 kb)

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Costa, A.F., Kajal, D., Pereira, A. et al. Should fat in the radiofrequency ablation zone of hepatocellular adenomas raise suspicion for residual tumour?. Eur Radiol 27, 1704–1712 (2017). https://doi.org/10.1007/s00330-016-4496-y

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  • DOI: https://doi.org/10.1007/s00330-016-4496-y

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