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CardioVascular and Interventional Radiology

, Volume 29, Issue 2, pp 270–275 | Cite as

Use of Semiflexible Applicators for Radiofrequency Ablation of Liver Tumors

  • G. GaffkeEmail author
  • B. Gebauer
  • F.D. Knollmann
  • T. Helmberger
  • J. Ricke
  • H. Oettle
  • R. Felix
  • C. Stroszczynski
Article

Abstract

Purpose

To evaluate the feasibility and potential advantages of the radiofrequency ablation of liver tumors using new MRI-compatible semiflexible applicators in a closed-bore high-field MRI scanner.

Methods

We treated 8 patients with 12 malignant liver tumors of different origin (5 colorectal carcinoma, 2 cholangiocellular carcinoma, 1 breast cancer) under MRI guidance. Radiofrequency ablation (RFA) was performed using 5 cm Rita Starburst Semi-Flex applicators (Rita Medical Systems, Milwaukee, WI, USA) which are suitable for MR- and CT-guided interventions and a 150 W RF generator. All interventions were performed in a closed-bore 1.5 T high-field MRI scanner for MRI-guided RFA using fast T1-weighted gradient echo sequences and T2-weighted ultra-turbo spin echo sequences. Control and follow-up MRI examinations were performed on the next day, at 6 weeks, and every 3 months after RFA. Control MRI were performed as double-contrast MRI examinations (enhancement with iron oxide and gadopentetate dimeglumine). All interventions were performed with the patient under local anesthesia and analgo-sedation.

Results

The mean diameter of the treated hepatic tumors was 2.4 cm (±0.6 cm, range 1.0–3.2 cm). The mean diameter of induced necrosis was 3.1 cm (±0.4 cm). We achieved complete ablation in all patients. Follow-up examinations over a duration of 7 months (±1.3 months, range 4–9 month) showed a local control rate of 100% in this group of patients. All interventions were performed without major complications; only 2 subcapsular hematomas were documented.

Conclusion

RFA of liver tumors using semiflexible applicators in closed-bore 1.5 T scanner systems is feasible. These applicators might simplify the RFA of liver tumors under MRI control. The stiff distal part of the applicator facilitates its repositioning.

Keywords

Intervention Liver Metastasis MRI Radiofrequency ablation 

References

  1. 1.
    Lehnert T, Golling M (2001) Indications and outcome of liver metastases resection. Radiologe 42:40–48Google Scholar
  2. 2.
    Ott R, Wein A, Hohenberger W (2001) Liver metastases: Primary or multimodal therapy? Chirurgie 71:887–897 (in German)Google Scholar
  3. 3.
    Gillams AR, Lees WR (2000) Survival after percutaneous, image-guided, thermal ablation of hepatic metastases from colorectal cancer. Dis Colon Rectum 43:656–661CrossRefPubMedGoogle Scholar
  4. 4.
    Hong SN, Lee SY, Choi MS, et al. (2005) Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol 39:247–252CrossRefPubMedGoogle Scholar
  5. 5.
    Pereira PL, Trubenbach J, Schmidt D (2003) Radiofrequency ablation: Basic principles, techniques and challenges. Fortschr Rontgenstr 175:20–27 (in German)Google Scholar
  6. 6.
    Livraghi T, Solbiati L, Meloni F, et al. (2003) Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection The “test-of-time approach”. Cancer 97:3027–3035CrossRefPubMedGoogle Scholar
  7. 7.
    Friedman M, Mikityansky I, Kam A, et al. (2004) Radiofrequency ablation of cancer. Cardiovasc Intervent Radiol 27:427–434CrossRefPubMedGoogle Scholar
  8. 8.
    Varro Z, Locklin JK, Wood BJ (2004) Laser navigation for radiofrequency ablation. Cardiovasc Intervent Radiol 27:512–515CrossRefPubMedGoogle Scholar
  9. 9.
    Livraghi T, Giorgio A, Marin G, et al. (1995) Hepatocellular carcinoma and cirrhosis in 746 patients: Long-term results of percutaneous ethanol injection. Radiology 197:101–108PubMedGoogle Scholar
  10. 10.
    Lewin JS, Connell CF, Duerk JL, et al. (1998) Interactive MRI-guided radiofrequency ablation of abdominal tumors: Clinical trial for evaluation of safety and feasibility. J Magn Reson Imaging 8:40–47PubMedGoogle Scholar
  11. 11.
    Vogl TJ, Mack M, Straub R, et al. (2000) Percutaneous interstitial thermotherapy of malignant liver tumors. Fortschr Rontgenstr 172:12–22 (in German)Google Scholar
  12. 12.
    Tacke J (2003) Percutaneous radiofrequency ablation: Clinical indications and results. Fortschr Rontgenstr 175:156–168 (in German)Google Scholar
  13. 13.
    Mahnken AH, Buecker A, Spuentrup E, et al. (2004) Guided radiofrequency ablation of hepatic malignancies at 1.5 T: Initial results. J Magn Reson Imaging 19:342–348CrossRefPubMedGoogle Scholar
  14. 14.
    Stroszczynski C, Gretschel S, Gaffke G, et al. (2002) Laser-induced thermotherapy (LITT) for malignant liver tumors: The role of sonography in catheter placement and observation of the therapeutic procedure. Ultraschall Med 23:163–167CrossRefPubMedGoogle Scholar
  15. 15.
    Huppert PE, Trübenbach J, Schick F, et al. (2000) MRI-guided percutaneous radiofrequency ablation of hepatic neoplasms: first technical and clinical experiences. Fortschr Rontgenstr 172:692–700 (in German)Google Scholar
  16. 16.
    Kelekis AD, Terraz S, Roggan A, et al. (2003) Percutaneous treatment of liver tumors with an adapted probe for cooled-tip, impedance-controlled radio-frequency ablation under open-magnet MR guidance: Initial results. Eur Radiol 13:1100–1105PubMedGoogle Scholar
  17. 17.
    Kettenbach J, Kostler W, Rucklinger E, et al. (2003) Percutaneous saline-enhanced radiofrequency ablation of unresectable hepatic tumors: Initial experience in 26 patients. AJR Am J Roentgenol 180:1537–1545PubMedGoogle Scholar
  18. 18.
    Puls R, Kroncke TJ, Kluner C, et al. (2003) Double contrast MRI of thermally ablated liver metastases. Fortschr Rontgenstr 175:1467–1470 (in German)Google Scholar
  19. 19.
    Pech M, Spors B, Wieners G, et al. (2004) Comparison of different MRI sequences with and without application of Gd-BOPTA as follow-up after LITT. Fortschr Rontgenstr 176:550–555 (in German)Google Scholar
  20. 20.
    Lazebnik RS, Weinberg BD, Breen MS, et al. (2003) Sub-acute changes in lesion conspicuity and geometry following MR-guided radiofrequency ablation. J Magn Reson Imaging 18:353–359PubMedGoogle Scholar
  21. 21.
    Lazebnik RS, Breen MS, Fitzmaurice M, et al. (2003) Radio-frequency-induced thermal lesions: Subacute magnetic resonance appearance and histological correlation. J Magn Reson Imaging 18:487–495PubMedGoogle Scholar
  22. 22.
    Isbert C, Ritz JP, Schilling A, et al. (2002) Laser induced thermotherapy (LITT) of experimental liver metastasis: detection of residual tumors using Gd-DTPA enhanced MRI. Lasers Surg Med 30:280–289CrossRefPubMedGoogle Scholar
  23. 23.
    Jansen SJ, Otten W, van de Velde CJ, et al. (2004) The impact of the perception of treatment choice on satisfaction with treatment, experienced chemotherapy burden and current quality of life. Br J Cancer 91:56–61CrossRefPubMedGoogle Scholar
  24. 24.
    Livraghi T, Giorgio A, Marin G, et al. (1995) Hepatocellular carcinoma and cirrhosis in 746 patients: Long-term results of percutaneous ethanol injection. Radiology 197:101–108PubMedGoogle Scholar
  25. 25.
    Sturm JW, Keese M (2004) Multimodal treatment of hepatocellular carcinoma (HCC). Onkologie 27:294–303PubMedGoogle Scholar
  26. 26.
    Puls R, Stroszczynski C, Gaffke G, et al. (2003) Laser-induced thermotherapy (LITT) of liver metastases: MR-guided percutaneous insertion of an MRI-compatible irrigated microcatheter system using a closed high-field unit. J Magn Reson Imaging 17:663–670CrossRefPubMedGoogle Scholar
  27. 27.
    Gebauer B, Gaffke G, Hunerbein M, et al. (2003) Flexible applicator systems for radiofrequency ablation (RFA) of hepatic tumors. Fortschr Rontgenstr 175:1720–1723 (in German)Google Scholar
  28. 28.
    Gaffke G, Gebauer B, Gnauck M, et al. (2005) Potential advantages of the MRI for the radiofrequency ablation of liver tumors. Fortschr Rontgenstr 177:77–83 (in German)Google Scholar
  29. 29.
    Zhang Q, Chung YC, Lewin JS, et al. (1998) A method for simultaneous RF ablation and MRI. J Magn Reson Imaging 8:110–114PubMedGoogle Scholar
  30. 30.
    Vallone P, Gallipoli A, Izzo F, et al. (2003) Local ablation procedures in primary liver tumors: Levovist US versus spiral CT to evaluate therapeutic results. Anticancer Res 23:5075–5079PubMedGoogle Scholar
  31. 31.
    Solbiati L, Goldberg SN, Ierace T, et al. (1999) Radio-frequency ablation of hepatic metastases: Postprocedural assessment with a US microbubble contrast agent–early experience. Radiology 211:643–649PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • G. Gaffke
    • 1
    Email author
  • B. Gebauer
    • 1
  • F.D. Knollmann
    • 1
  • T. Helmberger
    • 2
  • J. Ricke
    • 1
  • H. Oettle
    • 3
  • R. Felix
    • 1
  • C. Stroszczynski
    • 1
  1. 1.Klinik für Strahlenheilkunde und Poliklinik, ChariteUniversitätsmedizin BerlinBerlinGermany
  2. 2.Institut für klinische Radiologie GrosshadernUniversität MünchenMunichGermany
  3. 3.Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie der CharitéUniversitätsmedizin Berlin, Campus-Virchow-KlinikumBerlinGermany

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