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Liver ablation therapy

Department of Medical Imaging, The Middlesex Hospital, Mortimer Street, London W1T 3AA, UK

View larger version (114K): [in a new window]   Figure 1. 73-year-old with multiple colorectal liver metastases previously treated with chemotherapy, referred for ablation after downsizing. (a) Contrast enhanced CT showing two small colorectal metastases (arrows). (b) CT scan just caudal to (a) showing a third metastasis (arrow). (c) Post-ablation CT scan showing three areas of ablation that encompass the whole tumour plus a margin of normal liver. (d) Follow-up CT scan 12 months later showing two of the lesions are reducing in size and healing with no evidence of recurrence. However, inferior to the third lesion there is tumour recurrence adjacent and in the left portal vein branch. Large vessels cool and protect tumour from heating and recurrence is common next to vessels. This case is unusual in that the tumour has invaded the portal vein. This was further downsized by chemotherapy and then ablated. (e) CT scan 23 months after initial ablation treatment showing continuing healing of the two smallest lesions. There is now atrophy of the left lobe of the liver and an area of absent enhancement at the ablation site around the left portal vein. There is currently no evidence of active tumour.

View larger version (105K): [in a new window]   Figure 2. Hepatocellular carcinoma on a background of cirrhosis in an 80-year-old male. The tumour lies adjacent to the branches of the right portal vein branch. (a) Arterial phase CT scan showing a hypervascular lesion in the right lobe (arrow). (b) Post-ablation CT showing complete ablation with no evidence of residual tumour. (c) Follow-up CT scan 15 months later showing healing ablation with no evidence of tumour. (d) Follow-up CT scan 26 months post-ablation shows a nodule of enhancement on the medial border of the tumour inferior to the posterior branch of the right portal vein consistent with recurrent tumour (arrow). This was treated with further radiofrequency ablation. (e) Current CT scan 3 years after the initial ablation; no evidence of active tumour but worsening background cirrhosis.

View larger version (59K): [in a new window]   Figure 3. 39-year-old female with multiple breast metastases (not shown). (a) Ultrasound scan performed during treatment demonstrating "Dextrose isolation". 5% dextrose has been injected through a 19 G needle into the hepatocholecystic space (thin arrow) to displace the gall bladder wall away from the metastasis to be treated (thick arrow). (b) Contrast enhanced CT scans performed the following day showing ablation of the metastasis (arrow) without damage to the gall bladder wall.