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Helping the Hepatic Surgeon |
1 From the Divisions of Diagnostic Imaging (H.C., E.M.L., R.A.D., H.K., C.L.D., S.H., C.C.) and Surgical Oncology (S.C.), University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030. Recipient of a Cum Laude award for an education exhibit at the 2000 RSNA scientific assembly. Received February 9, 2001; revision requested April 11 and received May 16; accepted May 29. Address correspondence to E.M.L. (e-mail: eloyer@di.mdacc.tmc.edu).
An alternative to surgical resection of liver tumors, radio-frequency ablation induces in situ thermal coagulation necrosis through the delivery of high-frequency alternating current to the tissues. Imaging helps to detect treatable lesions, guide the placement of the probe, and assess the effect of therapy. Computed tomography (CT) is used most frequently to determine whether the ablation is complete and to screen for early recurrences that may benefit from reablation. Complete ablation creates an area of necrosis that, at CT, is of low attenuation compared with the surrounding liver tissue, is often homogeneous, and has smooth margins. The most important features are the size of the necrotic defect, which, immediately after treatment, should be larger than that of the pretreatment tumor, and the sharpness of the margins, which indicates an abrupt change in attenuation between the necrotic tissue and surrounding liver tissue. Enhancement, when present, is due to perfusion abnormality or granulation tissue and forms a regular rim or a homogeneous zone at the margin of the defect. It is seen immediately after ablation but may be prolonged. Enhancement is affected by the scanning technique. Over time, the size of the defect remains stable or decreases. Any variation from this general pattern is suggestive of incomplete ablation or recurrence.
Index Terms: Liver neoplasms, CT, 761.12114 • Liver neoplasms, MR, 761.12141 • Liver neoplasms, therapy, 761.30, 761.1269 • Radiofrequency (RF) ablation, 761.1269
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