Top

CardioVascular and Interventional Radiology

Published in:

01-12-2017 | Clinical Investigation

Ultrasound-Guided Radiofrequency Ablation Using a New Electrode with an Electromagnetic Position Sensor for Hepatic Tumors Difficult to Place an Electrode: A Preliminary Clinical Study

Authors: Tae Wook Kang, Min Woo Lee, Kyoung Doo Song, Hyunchul Rhim, Hyo Keun Lim, Wonseok Kang, Kyunga Kim

Published in: CardioVascular and Interventional Radiology | Issue 12/2017

Abstract

Purpose

To evaluate whether a new electrode embedded with an electromagnetic position sensor (EMPS) improves the technical feasibility of percutaneous radiofrequency ablation (RFA) in patients with hepatic tumors difficult to place an electrode under ultrasonography (US) guidance and to assess short-term therapeutic efficacy and safety.

Materials and Methods

This prospective study was approved by the institutional review board, and written informed consent was obtained from all patients. Between January 2015 and December 2016, 10 patients (7 men and 3 women; age range 52–75 years) with a single hepatic tumor (median 1.4 cm; range 1.1–1.8 cm) difficult to place an electrode under US guidance were enrolled. The technical feasibility of targeting and overlapping ablation during the RFA procedure was graded using a four-point scale and analyzed using the Wilcoxon signed rank test according to the use of EMPS. In addition, the rates of technical success, local tumor progression (LTP), and major complications were assessed.

Results

The use of the new RF electrode with EMPS significantly improved the technical feasibility of targeting and overlapping ablation (p = 0.002 and p = 0.003, respectively). After treatment, the technical success rate was 100%. LTP was not found in any patient during the follow-up period (median 8 months; range 4–22 months). No major procedure-related complications occurred.

Conclusions

The technical feasibility of percutaneous RFA improves with the use of this RF electrode embedded with an EMPS. Short-term therapeutic efficacy and safety after RFA using the electrode were promising in patients with hepatic tumors difficult to place an electrode under US guidance.

Available only for authorised users

Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379(9822):1245–55.CrossRefPubMed

Shady W, Petre EN, Gonen M, et al. Percutaneous radiofrequency ablation of colorectal cancer liver metastases: factors affecting outcomes—a 10-year experience at a single center. Radiology. 2016;278(2):601–11.CrossRefPubMed

Lee MW. Fusion imaging of real-time ultrasonography with CT or MRI for hepatic intervention. Ultrasonography. 2014;33(4):227–39.CrossRefPubMedPubMedCentral

Kim J, Yoon CJ, Seong NJ, Jeong SH, Kim JW. Fluoroscopy-guided radiofrequency ablation for small hepatocellular carcinoma: a retrospective comparison with ultrasound-guided ablation. Clin Radiol. 2015;70(9):1009–15.CrossRefPubMed

Rempp H, Unterberg J, Hoffmann R, et al. Therapy monitoring of magnetic resonance-guided radiofrequency ablation using T1- and T2-weighted sequences at 1.5 T: reliability of estimated ablation zones. Invest Radiol. 2013;48(6):429–36.CrossRefPubMed

Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242(2):158–71.CrossRefPubMedPubMedCentral

Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (>2 and <5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol. 2010;195(3):758–65.CrossRefPubMed

Minami Y, Chung H, Kudo M, et al. Radiofrequency ablation of hepatocellular carcinoma: value of virtual CT sonography with magnetic navigation. AJR Am J Roentgenol. 2008;190(6):W335–41.CrossRefPubMed

Song KD, Lee MW, Rhim H, Cha DI, Chong Y, Lim HK. Fusion imaging-guided radiofrequency ablation for hepatocellular carcinomas not visible on conventional ultrasound. AJR Am J Roentgenol. 2013;201(5):1141–7.CrossRefPubMed

10.

Appelbaum L, Mahgerefteh SY, Sosna J, Goldberg SN. Image-guided fusion and navigation: applications in tumor ablation. Tech Vasc Interv Radiol. 2013;16(4):287–95.CrossRefPubMed

11.

Min JH, Lim HK, Lim S, et al. Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US. Clin Mol Hepatol. 2014;20(1):61–70.CrossRefPubMedPubMedCentral

12.

Hakime A, Deschamps F, De Carvalho EG, Barah A, Auperin A, De Baere T. Electromagnetic-tracked biopsy under ultrasound guidance: preliminary results. Cardiovasc Interv Radiol. 2012;35(4):898–905.CrossRef

13.

Jung EM, Friedrich C, Hoffstetter P, et al. Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions: first results. PLoS ONE. 2012;7(3):e33956.CrossRefPubMedPubMedCentral

14.

Tomonari A, Tsuji K, Yamazaki H, et al. Feasibility of the virtual needle tracking system for percutaneous radiofrequency ablation of hepatocellular carcinoma. Hepatol Res. 2013;43(12):1352–5.CrossRefPubMed

15.

Kang TW, Lee MW, Choi SH, et al. A novel electrode with electromagnetic tip tracking in ultrasonography-guided radiofrequency ablation: a phantom, ex vivo, and in vivo experimental study. Invest Radiol. 2015;50(2):81–7.CrossRefPubMed

16.

Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Radiology. 2014;273(1):241–60.CrossRefPubMedPubMedCentral

17.

Rhim H, Choi D, Kim YS, Lim HK, Choe BK. Ultrasonography-guided percutaneous radiofrequency ablation of hepatocellular carcinomas: a feasibility scoring system for planning sonography. Eur J Radiol. 2010;75(2):253–8.CrossRefPubMed

18.

Lee MW, Rhim H, Cha DI, Kim YJ, Lim HK. Planning US for percutaneous radiofrequency ablation of small hepatocellular carcinomas (1–3 cm): value of fusion imaging with conventional US and CT/MR images. J Vasc Interv Radiol. 2013;24(7):958–65.CrossRefPubMed

19.

Kang TW, Lim HK, Lee MW, et al. Long-term therapeutic outcomes of radiofrequency ablation for subcapsular versus nonsubcapsular hepatocellular carcinoma: a propensity score matched study. Radiology. 2016;280(1):300–12.CrossRefPubMed

20.

Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. Perivascular versus nonperivascular small HCC treated with percutaneous RF ablation: retrospective comparison of long-term therapeutic outcomes. Radiology. 2014;270(3):888–99.CrossRefPubMed

21.

Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up. Clin Radiol. 2013;68(12):e641–51.CrossRefPubMed

22.

Venkatesan AM, Kadoury S, Abi-Jaoudeh N, et al. Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation. Radiology. 2011;260(3):848–56.CrossRefPubMedPubMedCentral

23.

Krucker J, Xu S, Venkatesan A, et al. Clinical utility of real-time fusion guidance for biopsy and ablation. J Vasc Interv Radiol. 2011;22(4):515–24.CrossRefPubMedPubMedCentral

24.

Nakazawa T, Kokubu S, Shibuya A, et al. Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol. 2007;188(2):480–8.CrossRefPubMed

25.

Hakime A, Barah A, Deschamps F, et al. Prospective comparison of freehand and electromagnetic needle tracking for US-guided percutaneous liver biopsy. J Vasc Interv Radiol. 2013;24(11):1682–9.CrossRefPubMed

26.

Dodd GD 3rd, Frank MS, Aribandi M, Chopra S, Chintapalli KN. Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. AJR Am J Roentgenol. 2001;177(4):777–82.CrossRefPubMed

Title: Ultrasound-Guided Radiofrequency Ablation Using a New Electrode with an Electromagnetic Position Sensor for Hepatic Tumors Difficult to Place an Electrode: A Preliminary Clinical Study
Authors: Tae Wook Kang
Min Woo Lee
Kyoung Doo Song
Hyunchul Rhim
Hyo Keun Lim
Wonseok Kang
Kyunga Kim
Publication date: 01-12-2017
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 12/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-017-1751-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ultrasound-Guided Radiofrequency Ablation Using a New Electrode with an Electromagnetic Position Sensor for Hepatic Tumors Difficult to Place an Electrode: A Preliminary Clinical Study

Abstract

Purpose

Materials and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2017

Limited Post-observation Period in Pediatric Outpatient Ultrasound-Guided Liver Biopsies

Erratum to: Prospective Clinical and Pharmacological Evaluation of the Delcath System’s Second-Generation (GEN2) Hemofiltration System in Patients Undergoing Percutaneous Hepatic Perfusion with Melphalan

Lung Biopsy: Don’t Forget Air Embolism!

Compartment Syndrome after Embolization of Arteriovenous Malformation

Magnetic Resonance Signal Intensity Ratio Measurement Before Uterine Artery Embolization: Ability to Predict Fibroid Size Reduction

Duplex Ultrasound Versus Clinical Surveillance in the Prediction of TIPS Malfunction Placed for Refractory Ascites: Is Ultrasound Surveillance Useful?