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Hepatic radiofrequency under CT-fluoroscopy guidance

Radiofrequenza epatica fluoro-TC guidata

  • Abdominal Radiology Radiologia Addominale
  • Published:
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Abstract

Purpose

This study was done to assess the effectiveness and advantages of computed tomography (CT) fluoroscopy as a guide for locating and treating lesions that are not amenable to ultrasound (US) guidance, and to evaluate the CT signs of immediate technical success and the short-term results.

Materials and methods

Over the past year, we selected 14 patients (four women and ten men; mean age 73, range 61–83 years) out of 103 candidates for hepatic radiofrequency ablation (RFA). The 14 lesions comprised seven residual tumours after combined embolisation and US-guided RFA of a large hepatocellular carcinoma (HCC), which were indistinguishable from necrosis or surrounding healthy parenchyma; two HCC nodules in locations that were inaccessible by US; five metastases (two from renal carcinoma, two from colorectal adenocarcinoma and one from lung carcinoma), of which one could not be distinguished from the surrounding healthy parenchyma on US and four were inaccessible by US. Lesion diameters were between 1.4 and 3.5 cm. The procedures were performed in the CT room with anaesthesiological assistance using a coaxial LeVeen needle electrode (14 gauge, 2-to 4-cm array diameter). Immediate technical success was evaluated by multidetector CT (MDCT), and follow-up was carried out with MDCT at 3 and 6 months and yearly thereafter.

Results

Immediate technical success was obtained in 13/14 patients; one case required further placement of the electrode due to incomplete ablation of a hypervascular lesion. In 2/3 metastatic lesions with portal vein supply, there were no recurrences at 3 and 6 months; in 1/3, we observed disease progression, with the appearance of additional nodules at 6 months. The two metastases with arterial supply showed no signs of recurrence at 3 months; one case developed a recurrence along the ablation margin, with the appearance of satellite nodules at 6 months. In two HCC nodules, there was immediate technical success and no recurrence at 3 and 6 months. Of the seven residual tumours of HCC, all treated with immediate technical success, we observed disease progression, with the appearance of satellite nodules at 3 months in one case, at 6 months in another and at 12 months in another; 3/7 patients were free of disease at 12-month follow-up; 1/7 died 5 months later due to causes unrelated to the procedure.

Conclusions

CT fluoroscopy is overcoming the limitations of CT in locating and treating lesions with different hepatic vascularisation and those unamenable to US; furthermore, it reduces the length of the procedure, thanks to the faster and more accurate placement of the needle electrode. MDCT proved to be a reliable method in the assessment of immediate and short-term results of RFA.

Riassunto

Obiettivo

Valutare l’efficacia e i vantaggi della guida fluoro-TC nel localizzare e trattare lesioni non raggiungibili o non fattibili con guida ecografica e valutarne i segni TC di successo tecnico immediato e a breve distanza di tempo.

Materiali e metodi

Nell’ultimo anno abbiamo selezionato 14/103 pazienti (4 femmine e 10 maschi) candidati a un trattamento di radiofrequenza (RF) epatica, età media 73 anni (range 61–83) portatori di 14 lesioni epatiche: 7 residui di grosso HCC, esito di terapia combinata mediante embolizzazione e RF eco-guidata non distinguibili dalla necrosi o dal parenchima epatico sano circostante; 2 noduli di HCC non raggiungibili con guida ecografica per sede; 5 metastasi (2 da carcinoma del rene, 2 da adenocarcinoma del colon-retto e 1 da carcinoma del polmone), di cui 1 non distinguibile dal parenchima sano circostante all’ecografia e 4 non raggiungibili per sede. Le lesioni presentavano diametro compreso tra 1,4 e 3,5 cm. Le procedure sono state espletate in sala TC in assistenza anestesiologica con ago elettrodo di LeVeen coassiale (14 gauge, diametro apertura uncini da 2 a 4 cm). Il successo tecnico immediato è stato valutato con TC multistrato (TCMS) post-procedura; il follow-up è stato espletato mediante TCMS a 3, 6 mesi e successivamente annualmente.

Risultati

È stato ottenuto successo tecnico immediato in 13/14 pazienti; in 1 caso e stata necessaria un’infissione ulteriore per parziale ablazione di lesione ipervascolarizzata. Nelle 3 lesioni metastatiche a prevalente vascolarizzazione veno-portale si è documentato successo tecnico immediato e assenza di recidiva a 3 e 6 mesi in 3 casi; un paziente ha sviluppato a 6 mesi una progressione di malattia per comparsa di altre lesioni ripetitive. Le 2 metastasi a prevalente vascolarizzazione arteriosa, non hanno evidenziato a 3 mesi segni TC di recidiva; a 6 mesi in 1 caso si è documentata una recidiva lungo il margine di ablazione e comparsa di microlesioni satelliti. I 2 noduli di HCC trattati hanno ottenuto entrambi successo tecnico immediato e assenza di recidiva a 3 e 6 mesi dal trattamento. Dei 7 residui di HCC, tutti trattati con successo tecnico immediato, 1/7 ha avuto ripresa di malattia per comparsa di noduli satelliti a 3 mesi, 1/7 a 6 mesi e 1/7 a 12 mesi; 3/7 sono liberi da malattia al followup a 12 mesi; 1 è deceduto prima dei 6 mesi per cause non correlate alla procedura.

Conclusioni

La guida fluoro-TC ha attualmente superato i limiti della TC nel localizzare e trattare lesioni a differente vascolarizzazione epatica e quelle non fattibili sotto guida ecografica; inoltre ha ridotto i tempi di procedura per il più veloce ed accurato posizionamento dell’ago-elettrodo. La TCMS si è dimostrata metodica affidabile nella valutazione dei risultati della RF immediati e a breve distanza.

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Authors and Affiliations

  1. Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy

    D. Laganà, G. Carrafiello, M. Mangini, D. Lumia, L. Mocciardini & C. Fugazzola

  2. Department of Oncology, University of Insubria, Viale Borri 57, 21100, Varese, Italy

    C. Chini & G. Pinotti

  3. Department of Anaesthesiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy

    S. Cuffari

Authors
  1. D. Laganà
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  2. G. Carrafiello
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  3. M. Mangini
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  4. D. Lumia
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  5. L. Mocciardini
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  6. C. Chini
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  8. S. Cuffari
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  9. C. Fugazzola
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Correspondence to D. Laganà or M. Mangini.

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Laganà, D., Carrafiello, G., Mangini, M. et al. Hepatic radiofrequency under CT-fluoroscopy guidance. Radiol med 113, 87–100 (2008). https://doi.org/10.1007/s11547-008-0224-2

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  • DOI: https://doi.org/10.1007/s11547-008-0224-2

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