DOI: 10.1148/rg.241025144
Radiofrequency Thermal Ablation of Abdominal Tumors: Lessons Learned from Complications1
Hyunchul Rhim, MD,
Gerald D. Dodd, III, MD,
Kedar N. Chintapalli, MD,
Bradford J. Wood, MD,
Damian E. Dupuy, MD,
Julia L. Hvizda, RN,
Patrick E. Sewell, MD and
S. Nahum Goldberg, MD
1 From the Department of Diagnostic Radiology, Hanyang University Hospital, 17 Haengdang-Dong, Sungdong-Ku, 133–792 Seoul, Korea (H.R.); the Department of Radiology, University of Texas Health Science Center at San Antonio (G.D.D., K.N.C.); the Special Procedures Division, Diagnostic Radiology Department, National Institutes of Health Clinical Center and National Cancer Institute, Bethesda, Md (B.J.W., J.L.H.); the Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI (D.E.D.); the Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (P.E.S.); and the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (S.N.G.). Recipient of a Magna Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received August 29, 2002; revision requested November 20; final revision received July 7, 2003; accepted July 7. G.D.D. is a stockholder in Rita Medical Systems, Mountain View, Calif. Address correspondence to H.R. (e-mail: rhimhc@hanyang.ac.kr).
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Figure 1a. RF-induced thermal damage to adjacent organs from liver RF ablation in a pig model. (a) Photograph of the gross specimen shows a large area of coagulation (solid arrows) that extends to involve the entire thickness of the gallbladder wall (open arrow). This type of injury could potentially lead to perforation or cholecystitis. (b) Clinical photograph shows thermal damage to the stomach (open arrow) adjacent to the ablated area (solid arrows). This type of injury could potentially lead to perforation of the gastrointestinal lumen.
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Figure 1b. RF-induced thermal damage to adjacent organs from liver RF ablation in a pig model. (a) Photograph of the gross specimen shows a large area of coagulation (solid arrows) that extends to involve the entire thickness of the gallbladder wall (open arrow). This type of injury could potentially lead to perforation or cholecystitis. (b) Clinical photograph shows thermal damage to the stomach (open arrow) adjacent to the ablated area (solid arrows). This type of injury could potentially lead to perforation of the gastrointestinal lumen.
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Figure 2a. Grounding pad burns following 10 minutes of high-current RF ablation in a pig model. (a) Clinical photograph demonstrates second-degree burns with blister formation along the edge of the pad closest to the electrode, particularly at the corners of the pad (curved arrows). Mild red streaking representing a first-degree burn is seen at the distal edge of the pad (straight arrows). (b) Clinical photograph demonstrates a third-degree burn (solid arrows) with a central eschar (open arrows). This full-thickness skin burn was produced by reducing grounding pad contact to a 2 x 3-cm area during RF ablation at 1,000 mA (50 W).
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Figure 2b. Grounding pad burns following 10 minutes of high-current RF ablation in a pig model. (a) Clinical photograph demonstrates second-degree burns with blister formation along the edge of the pad closest to the electrode, particularly at the corners of the pad (curved arrows). Mild red streaking representing a first-degree burn is seen at the distal edge of the pad (straight arrows). (b) Clinical photograph demonstrates a third-degree burn (solid arrows) with a central eschar (open arrows). This full-thickness skin burn was produced by reducing grounding pad contact to a 2 x 3-cm area during RF ablation at 1,000 mA (50 W).
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Figure 3. Schematic illustrates the correct placement of grounding pads (gray rectangles) in relation to the electrode (left) for RF ablation. To minimize grounding pad burns, multiple pads should be placed horizontally, with their long axes oriented toward the electrode. The electrodes should be equidistant from the RF probe to facilitate a more even heat distribution and minimize deleterious heating along the grounding pad surface.
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Figure 4a. Massive arterial bleeding after liver RF ablation. (a) CT scan obtained prior to RF ablation shows a 2-cm metastatic nodule (arrow). (b) Follow-up CT scan obtained 2 hours after RF ablation shows a large hematoma in the right hepatic lobe (arrows). (c) Emergency angiogram shows brisk arterial bleeding from the hepatic artery (arrow). Embolization was performed to bring the bleeding under control. (d) Follow-up CT scan obtained 2 months after RF ablation shows a liquified subcapsular hematoma (arrows). Note the area of metal attenuation representing the embolization coil (arrowhead).
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Figure 4b. Massive arterial bleeding after liver RF ablation. (a) CT scan obtained prior to RF ablation shows a 2-cm metastatic nodule (arrow). (b) Follow-up CT scan obtained 2 hours after RF ablation shows a large hematoma in the right hepatic lobe (arrows). (c) Emergency angiogram shows brisk arterial bleeding from the hepatic artery (arrow). Embolization was performed to bring the bleeding under control. (d) Follow-up CT scan obtained 2 months after RF ablation shows a liquified subcapsular hematoma (arrows). Note the area of metal attenuation representing the embolization coil (arrowhead).
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Figure 4c. Massive arterial bleeding after liver RF ablation. (a) CT scan obtained prior to RF ablation shows a 2-cm metastatic nodule (arrow). (b) Follow-up CT scan obtained 2 hours after RF ablation shows a large hematoma in the right hepatic lobe (arrows). (c) Emergency angiogram shows brisk arterial bleeding from the hepatic artery (arrow). Embolization was performed to bring the bleeding under control. (d) Follow-up CT scan obtained 2 months after RF ablation shows a liquified subcapsular hematoma (arrows). Note the area of metal attenuation representing the embolization coil (arrowhead).
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Figure 4d. Massive arterial bleeding after liver RF ablation. (a) CT scan obtained prior to RF ablation shows a 2-cm metastatic nodule (arrow). (b) Follow-up CT scan obtained 2 hours after RF ablation shows a large hematoma in the right hepatic lobe (arrows). (c) Emergency angiogram shows brisk arterial bleeding from the hepatic artery (arrow). Embolization was performed to bring the bleeding under control. (d) Follow-up CT scan obtained 2 months after RF ablation shows a liquified subcapsular hematoma (arrows). Note the area of metal attenuation representing the embolization coil (arrowhead).
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Figure 5a. Diaphragmatic injury after liver RF ablation. (a) Follow-up CT scan obtained 1 day after RF ablation demonstrates two ablated lesions representing metastatic nodules in the right hepatic lobe (arrows). The patient experienced right shoulder pain for 3 months. (b) Follow-up CT scan obtained 1 month after RF ablation shows focal thickening of the diaphragm adjacent to the ablated area (arrow).
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Figure 5b. Diaphragmatic injury after liver RF ablation. (a) Follow-up CT scan obtained 1 day after RF ablation demonstrates two ablated lesions representing metastatic nodules in the right hepatic lobe (arrows). The patient experienced right shoulder pain for 3 months. (b) Follow-up CT scan obtained 1 month after RF ablation shows focal thickening of the diaphragm adjacent to the ablated area (arrow).
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Figure 6a. Hepatic abscess formation after liver RF ablation. (a) US image obtained prior to RF ablation shows a hypoechoic mass (cursors and arrows) in the left lateral segment of the liver. The patient complained of prolonged fever for 1 week after undergoing ablation. (b) Follow-up CT scan shows a gas-containing abscess (arrows). The patient’s condition improved after aspiration of pus from the abscess cavity.
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Figure 6b. Hepatic abscess formation after liver RF ablation. (a) US image obtained prior to RF ablation shows a hypoechoic mass (cursors and arrows) in the left lateral segment of the liver. The patient complained of prolonged fever for 1 week after undergoing ablation. (b) Follow-up CT scan shows a gas-containing abscess (arrows). The patient’s condition improved after aspiration of pus from the abscess cavity.
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Figure 7. Tumor seeding after RF ablation of a metastatic liver nodule. CT scan shows a focal enhancing nodule in the subcutaneous area near the abdominal wall (arrow), a location that corresponds to the puncture site of the RF electrode.
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Figure 8a. Tumor seeding in the peritoneal cavity after RF ablation of a metastatic liver nodule. (a) Follow-up CT scan obtained 1 day after RF ablation shows the ablated area with peritumoral hyperemia (arrow) in the left lateral segment of the liver. (b) Follow-up CT scan obtained 6 months later shows multiple extrahepatic and intraperitoneal tumor nodules (arrows) just below the site of ablation.
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Figure 8b. Tumor seeding in the peritoneal cavity after RF ablation of a metastatic liver nodule. (a) Follow-up CT scan obtained 1 day after RF ablation shows the ablated area with peritumoral hyperemia (arrow) in the left lateral segment of the liver. (b) Follow-up CT scan obtained 6 months later shows multiple extrahepatic and intraperitoneal tumor nodules (arrows) just below the site of ablation.
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Figure 9. Real-time imaging-guided monitoring. US image obtained during ablation of a renal tumor shows how imaging-guided monitoring can prevent injury to adjacent bowel loops.
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Figure 10. Hematuria after laparoscopic RF ablation of a renal tumor. CT scan demonstrates an ablated central tumor (arrow) that touches the collecting system. Hematuria developed but was self-limiting and transient, resolving 2 hours after the procedure. Although postprocedural hematuria is uncommon, central lesions carry greater risk than peripheral lesions for this complication.
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Figure 11a. Perinephric hematoma after renal RF ablation. (a, b) Unenhanced (a) and contrast material-enhanced (b) CT scans obtained shortly after RF ablation demonstrate a large perinephric hematoma (arrow). (c) Follow-up CT scan obtained 5 months later shows the hematoma with mild interval shrinkage and a second tumor on the contralateral kidney (arrow).
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Figure 11b. Perinephric hematoma after renal RF ablation. (a, b) Unenhanced (a) and contrast material-enhanced (b) CT scans obtained shortly after RF ablation demonstrate a large perinephric hematoma (arrow). (c) Follow-up CT scan obtained 5 months later shows the hematoma with mild interval shrinkage and a second tumor on the contralateral kidney (arrow).
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Figure 11c. Perinephric hematoma after renal RF ablation. (a, b) Unenhanced (a) and contrast material-enhanced (b) CT scans obtained shortly after RF ablation demonstrate a large perinephric hematoma (arrow). (c) Follow-up CT scan obtained 5 months later shows the hematoma with mild interval shrinkage and a second tumor on the contralateral kidney (arrow).
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Figure 12. Abscess formation after adrenal RF ablation. MR image obtained 11 weeks after ablation shows an abscess (arrow) in the focal area of coagulation in a paraspinal metastatic lesion from adrenocortical carcinoma.
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Copyright © 2004 by the Radiological Society of North America.
