Cholecystokinin-Assisted Hydrodissection of the Gallbladder Fossa during FDG PET/CT-guided Liver Ablation

Cholecystokinin to Enhance the Safety of Ablation of Liver Tumors Adjacent to the Gallbladder

This retrospective case review describes the potential for intravenous cholecystokinin (CCK) to improve the safety margin between the hepatic tumor and gallbladder (GB) for hepatic tumor ablation. Eight patients with primary hepatic neoplasms adjacent to the GB underwent CCK administration before ablation. GB volume and contact area measurements were performed before and after CCK administration to assess the degree of contraction. The planned ablation was successful in 7 patients (88%) after CCK administration, although 5 patients (63%) also had hydrodissection. After CCK, the median GB volume reduction was 22%, and tumor contact area with the GB was reduced by 20%. There was no evidence for CCK-related adverse events. CCK administration before ablation of hepatic neoplasms abutting the GB is a safe and simple method that may be an adjunct to needle decompression or hydrodissection of the GB.

Evaluation of the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation for hepatocellular carcinoma and liver metastases adjacent to the gallbladder

OBJECTIVE

To evaluate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC) and liver metastases adjacent to the gallbladder (GB).

MATERIALS AND METHODS

A total of 113 patients with 118 liver lesions (63 HCC lesions and 55 liver metastases) adjacent to the gallbladder underwent RFA between March 2011 and June 2019. Gallbladder-related complications and technique effectiveness rates were evaluated based on the classification of liver tumors and the distance between the lesion and the gallbladder.

RESULTS

Gallbladder-related complications were observed in 13 patients. Among the patients with HCC, there was no significant difference between the ≤0.5 cm and >0.5 cm groups (p = .282). However, among the patients with liver metastases, the incidence of gallbladder-related complications in the ≤0.5 cm group was significantly higher than that in the >0.5 cm group (p = .025). The overall incidence of complications was significantly higher in the ≤0.5 cm group than in the >0.5 cm group (p = .020). Among the patients with lesions ≤3 cm, the technical effectiveness rate in the HCC group was significantly higher than in the liver metastasis group (p = .036).

CONCLUSION

RFA is a safe and effective treatment option for liver tumors adjacent to the gallbladder. Patients with lesions ≤0.5 cm from the gallbladder had higher gallbladder-related complications, especially patients with liver metastases. Among patients with lesions ≤3 cm, RFA showed greater technical effectiveness for treating HCC than for treating liver metastases.

Hydrodissection of the Gallbladder Bed: A Technique for Ablations Located Close to the Gallbladder

OBJECTIVE

To report the technique of hydrodissection of the gallbladder bed, in order to separate the gallbladder wall from the liver surface during microwave ablation of liver malignancies located in segment V.

MATERIALS AND METHODS

Between January 2018 and March 2018, percutaneous hydrodissection of the gallbladder fossa was performed during four microwave ablation procedures in three patients (One patient was treated twice for the same lesion, making a total of four procedures for three lesions.) All treated lesions were located in segment V and abutting the gallbladder. Number of hydrodissection needles, volume of hydrodissection, repartition of hydrodissection, separation of tumour from the gallbladder post-hydrodissection, technical success of hydrodissection/ablation, and complications were recorded and evaluated.

RESULTS

Hydrodissection of the gallbladder fossa was technically feasible in all four procedures, and microwave ablation was performed at maximum power without any early interruption. Time to perform hydrodissection was 11.3 min on average (range 7-18 min). Minimal distance between the ablation area and the GB increased from virtual to 10 mm on average (range 6-13), with a mean volume of dissection of 65 ml (range 40-100). Technical success was 75%. There was no complication related to the hydrodissection itself, and no acute or delayed gallbladder complication.

CONCLUSION

Hydrodissection of the gallbladder bed is a feasible technique to separate the gallbladder from the liver surface. This could potentially decrease the risk of thermal injuries to the gallbladder wall when ablating tumours located in segment V.

Automatic segmentation of liver tumors from multiphase contrast-enhanced CT images based on FCNs

This paper presents a novel, fully automatic approach based on a fully convolutional network (FCN) for segmenting liver tumors from CT images. Specifically, we designed a multi-channel fully convolutional network (MC-FCN) to segment liver tumors from multiphase contrast-enhanced CT images. Because each phase of contrast-enhanced data provides distinct information on pathological features, we trained one network for each phase of the CT images and fused their high-layer features together. The proposed approach was validated on CT images taken from two databases: 3Dircadb and JDRD. In the case of 3Dircadb, using the FCN, the mean ratios of the volumetric overlap error (VOE), relative volume difference (RVD), average symmetric surface distance (ASD), root mean square symmetric surface distance (RMSD) and maximum symmetric surface distance (MSSD) were 15.6±4.3%, 5.8±3.5%, 2.0±0.9%, 2.9±1.5mm, 7.1±6.2mm, respectively. For JDRD, using the MC-FCN, the mean ratios of VOE, RVD, ASD, RMSD, and MSSD were 8.1±4.5%, 1.7±1.0%, 1.5±0.7%, 2.0±1.2mm, 5.2±6.4mm, respectively. The test results demonstrate that the MC-FCN model provides greater accuracy and robustness than previous methods.