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Hepatocellular Carcinoma Treated with Radio-frequency Ablation: Spectrum of Imaging Findings¹

¹ From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, South Korea. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received March 13, 2002; revision requested April 25 and received June 10; accepted June 10. Address correspondence to H.K.L. (e-mail: hklim@smc.samsung.co.kr).

Contrast material–enhanced Doppler or gray-scale harmonic ultrasonography (US) may help determine the completeness or long-term therapeutic efficacy of radio-frequency (RF) ablation of hepatocellular carcinoma (HCC). Successfully treated HCC is devoid of vascularity at color or power Doppler US. When the tumor is not completely treated, residual viable tumor can be detected. These contrast-enhanced US techniques may also help identify residual tumor when performed during repeat RF ablation, when accurate localization of viable tumor is needed. To date, contrast-enhanced computed tomography (CT) has been the most widely used imaging modality in the evaluation of therapeutic response after RF ablation of HCC. At follow-up CT, successfully ablated lesions appear as low-attenuation areas with no foci of contrast enhancement either within or at the periphery of the treated lesion, whereas any foci of enhancement indicate residual or recurrent tumor. Reactive hyperemia in tissue surrounding the ablated lesion, iatrogenic arterioportal shunting, and small intralesional air pockets are frequently seen at immediate follow-up CT. Gadolinium-enhanced dynamic magnetic resonance imaging is also useful in assessing therapeutic response following RF ablation of HCC, particularly when CT findings are inconclusive. Familiarity with these imaging findings is helpful in this setting.

© RSNA, 2003

Index Terms: Liver neoplasms, 76.323 • Liver neoplasms, CT, 76.1211 • Liver neoplasms, MR, 76.1214 • Liver neoplasms, therapy • Liver neoplasms, US, 76.1298 • Radiofrequency (RF) ablation, 761.1269

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