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Chelales E, von Windheim K, Banipal AS, Siebeneck E, Benham C, Nief CA, Crouch B, Everitt JI, Sag AA, Katz DF, Ramanujam N. Determining the Relationship between Delivery Parameters and Ablation Distribution for Novel Gel Ethanol Percutaneous Therapy in Ex Vivo Swine Liver. Polymers (Basel) 2024; 16:997. [PMID: 38611255 PMCID: PMC11013462 DOI: 10.3390/polym16070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Ethyl cellulose-ethanol (ECE) is emerging as a promising formulation for ablative injections, with more controllable injection distributions than those from traditional liquid ethanol. This study evaluates the influence of salient injection parameters on forces needed for infusion, depot volume, retention, and shape in a large animal model relevant to human applications. Experiments were conducted to investigate how infusion volume (0.5 mL to 2.5 mL), ECE concentration (6% or 12%), needle gauge (22 G or 27 G), and infusion rate (10 mL/h) impacted the force of infusion into air using a load cell. These parameters, with the addition of manual infusion, were investigated to elucidate their influence on depot volume, retention, and shape (aspect ratio), measured using CT imaging, in an ex vivo swine liver model. Force during injection increased significantly for 12% compared to 6% ECE and for 27 G needles compared to 22 G. Force variability increased with higher ECE concentration and smaller needle diameter. As infusion volume increased, 12% ECE achieved superior depot volume compared to 6% ECE. For all infusion volumes, 12% ECE achieved superior retention compared to 6% ECE. Needle gauge and infusion rate had little influence on the observed depot volume or retention; however, the smaller needles resulted in higher variability in depot shape for 12% ECE. These results help us understand the multivariate nature of injection performance, informing injection protocol designs for ablations using gel ethanol and infusion, with volumes relevant to human applications.
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Affiliation(s)
- Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Katriana von Windheim
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Arshbir Singh Banipal
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Elizabeth Siebeneck
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Claire Benham
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Corrine A. Nief
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Jeffrey I. Everitt
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Alan Alper Sag
- Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - David F. Katz
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
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Chelales E, Morhard R, Nief C, Crouch B, Everitt JI, Sag AA, Ramanujam N. Radiologic-pathologic analysis of increased ethanol localization and ablative extent achieved by ethyl cellulose. Sci Rep 2021; 11:20700. [PMID: 34667252 PMCID: PMC8526742 DOI: 10.1038/s41598-021-99985-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
Ethanol provides a rapid, low-cost ablative solution for liver tumors with a small technological footprint but suffers from uncontrolled diffusion in target tissue, limiting treatment precision and accuracy. Incorporating the gel-forming polymer ethyl cellulose to ethanol localizes the distribution. The purpose of this study was to establish a non-invasive methodology based on CT imaging to quantitatively determine the relationship between the delivery parameters of the EC-ethanol formulation, its distribution, and the corresponding necrotic volume. The relationship of radiodensity to ethanol concentration was characterized with water-ethanol surrogates. Ex vivo EC-ethanol ablations were performed to optimize the formulation (n = 6). In vivo ablations were performed to compare the optimal EC-ethanol formulation to pure ethanol (n = 6). Ablations were monitored with CT and ethanol distribution volume was quantified. Livers were removed, sectioned and stained with NADH-diaphorase to determine the ablative extent, and a detailed time-course histological study was performed to assess the wound healing process. CT imaging of ethanol-water surrogates demonstrated the ethanol concentration-radiodensity relationship is approximately linear. A concentration of 12% EC in ethanol created the largest distribution volume, more than eight-fold that of pure ethanol, ex vivo. In vivo, 12% EC-ethanol was superior to pure ethanol, yielding a distribution volume three-fold greater and an ablation zone six-fold greater than pure ethanol. Finally, a time course histological evaluation of the liver post-ablation with 12% EC-ethanol and pure ethanol revealed that while both induce coagulative necrosis and similar tissue responses at 1-4 weeks post-ablation, 12% EC-ethanol yielded a larger ablation zone. The current study demonstrates the suitability of CT imaging to determine distribution volume and concentration of ethanol in tissue. The distribution volume of EC-ethanol is nearly equivalent to the resultant necrotic volume and increases distribution and necrosis compared to pure ethanol.
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Affiliation(s)
- Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
| | - Robert Morhard
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Corrine Nief
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey I Everitt
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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Cha DI, Lee MW, Jeong WK, Ha SY, Ahn SH, Rhim H, Lim HK. Comparison of ablation performance between dual internally cooled wet tip and conventional dual internally cooled tip radiofrequency electrodes: an experimental study in ex vivo bovine liver. Int J Hyperthermia 2021; 38:332-340. [PMID: 33627017 DOI: 10.1080/02656736.2021.1876255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the performance of dual internally cooled wet tip (ICWT) radiofrequency electrodes in comparison to dual internally cooled tip (ICT) electrodes. METHODS Twenty ablation zones were created for each type of electrodes. Planned procedure time was 6 min. Diameters of the ablation zone along the x-, y-, and z-axes (Dx, Dy, and Dz), ablation zone sphericity, quantitative sphericity measurement, and ablation volume were measured and compared between the two electrode types. Circularity of the ablation zone on the surface with x- and z- axes (zx plane) and amount of energy applied were also compared. RESULTS Dx and Dz were significantly longer with ICWT than those with ICT (Dx: 3.0 vs. 2.8 cm, p = .018; and Dz: 2.7 vs. 2.3 cm, p < .001, respectively). Dy was not significantly different (3.0 vs. 2.9 cm, p = .220). Moreover, 85% (17/20) and 30% (6/20) of ablation zones from ICWT and ICT were spherical (p = .001), respectively. Quantitative measurement showed that ICWT was more spherical compared to ICT (0.962 vs. 0.881, p = .001). The ablation volume was also significantly higher with ICWT (11.55 vs. 9.45 cm3, p = .003). The ablation zone on the zx plane was more circular with ICWT (0.907 vs. 0.883, p = .028). The amount of energy applied was significantly bigger with ICWT (18508 vs. 16998 WS, p = .003). CONCLUSION Dual ICWT electrodes were better able to create more spherical and larger ablation zones than dual ICT electrodes.
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Affiliation(s)
- Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sang Yun Ha
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, Suwon, Republic of Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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De Landro M, Ianniello J, Yon M, Wolf A, Quesson B, Schena E, Saccomandi P. Fiber Bragg Grating Sensors for Performance Evaluation of Fast Magnetic Resonance Thermometry on Synthetic Phantom. SENSORS 2020; 20:s20226468. [PMID: 33198326 PMCID: PMC7696215 DOI: 10.3390/s20226468] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Abstract
The increasing recognition of minimally invasive thermal treatment of tumors motivate the development of accurate thermometry approaches for guaranteeing the therapeutic efficacy and safety. Magnetic Resonance Thermometry Imaging (MRTI) is nowadays considered the gold-standard in thermometry for tumor thermal therapy, and assessment of its performances is required for clinical applications. This study evaluates the accuracy of fast MRTI on a synthetic phantom, using dense ultra-short Fiber Bragg Grating (FBG) array, as a reference. Fast MRTI is achieved with a multi-slice gradient-echo echo-planar imaging (GRE-EPI) sequence, allowing monitoring the temperature increase induced with a 980 nm laser source. The temperature distributions measured with 1 mm-spatial resolution with both FBGs and MRTI were compared. The root mean squared error (RMSE) value obtained by comparing temperature profiles showed a maximum error of 1.2 °C. The Bland-Altman analysis revealed a mean of difference of 0.1 °C and limits of agreement 1.5/−1.3 °C. FBG sensors allowed to extensively assess the performances of the GRE-EPI sequence, in addition to the information on the MRTI precision estimated by considering the signal-to-noise ratio of the images (0.4 °C). Overall, the results obtained for the GRE-EPI fully satisfy the accuracy (~2 °C) required for proper temperature monitoring during thermal therapies.
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Affiliation(s)
- Martina De Landro
- Department of Mechanical Engineering, Politecnico di Milano, via Giuseppe La Masa 1, 20156 Milan, Italy;
- Correspondence: ; Tel.: +39-02-2399-8571
| | - Jacopo Ianniello
- Unit of Measurements and Biomedical Instrumentation, Departmental Faculty of Engineering, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128 Rome, Italy; (J.I.); (E.S.)
| | - Maxime Yon
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Avenue du Haut Lévêque, 33600 Pessac, France; (M.Y.); (B.Q.)
| | - Alexey Wolf
- Laboratory of Fiber Optics, Institute of Automation and Electrometry of the SB RAS, 1 Acad. Koptyug Ave., 630090 Novosibirsk, Russia;
| | - Bruno Quesson
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Avenue du Haut Lévêque, 33600 Pessac, France; (M.Y.); (B.Q.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Departmental Faculty of Engineering, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128 Rome, Italy; (J.I.); (E.S.)
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico di Milano, via Giuseppe La Masa 1, 20156 Milan, Italy;
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Bullone M, Garberoglio R, Pregel P, Cannizzo FT, Gagliardo A, Martano M, Bollo E, Scaglione FE. Characterization of the ablation zones produced by three commercially available systems from a single vendor for radiofrequency thermoablation in an ex vivo swine liver model. Vet Med Sci 2020; 6:1041-1048. [PMID: 32613738 PMCID: PMC7738736 DOI: 10.1002/vms3.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/24/2020] [Accepted: 06/11/2020] [Indexed: 12/25/2022] Open
Abstract
Background Radiofrequency Ablation (RFA) is rarely performed in veterinary medicine. A rationale exists for its use in selected cases of canine liver tumours. RFA induces ablation zones of variable size and geometry depending on the technique used and on the impedance of the targeted organ. Objectives (a) to describe the geometry and reproducibility of the ablation zones produced by three commercially available systems from a single company, using isolated swine liver parenchyma as a model for future veterinary applications in vivo; (b) to study the effects of local saline perfusion into the ablated parenchyma through the electrode tip and of single versus double passage of the electrode on size, geometry and reproducibility of the ablation zones produced. Methods Size, and geometry of ablation zones reproduced in six livers with one cooled and perfused (saline) and two cooled and non‐perfused systems, after single or double passage (n = 6/condition), were assessed macroscopically on digitalized images by a blinded operator. Longitudinal and transverse diameters, equivalent diameter, estimated volume and roundness index were measured. Reproducibility was assessed as coefficient of variation. Results and Conclusions Ablation zone reproducibility was higher when expressed in terms of ablation zone diameters than estimated volume. Local saline perfusion of the parenchyma through the electrode tip during RFA increased the ablation zone longitudinal diameter. Ablation zone estimated volume increased with saline perfusion only when double passage was performed. These data may provide useful information for those clinicians who intend to include RFA as an additive tool in veterinary interventional radiology.
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Affiliation(s)
- Michela Bullone
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Roberto Garberoglio
- Division of endocrinology, diabetology and metabolism - Department of Medical Sciences, University of Turin, Torino, Italy
| | - Paola Pregel
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | | | - Arianna Gagliardo
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Marina Martano
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Enrico Bollo
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Frine E Scaglione
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
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Radiofrequency ablation with four electrodes as a building block for matrix radiofrequency ablation: Ex vivo liver experiments and finite element method modelling. Influence of electric and activation mode on coagulation size and geometry. Surg Oncol 2020; 33:145-157. [PMID: 32561081 DOI: 10.1016/j.suronc.2020.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 02/07/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Radiofrequency ablation (RFA) is increasingly being used to treat unresectable liver tumors. Complete ablation of the tumor and a safety margin is necessary to prevent local recurrence. With current electrodes, size and shape of the ablation zone are highly variable leading to unsatisfactory local recurrence rates, especially for tumors >3 cm. In order to improve predictability, we recently developed a system with four simple electrodes with complete ablation in between the electrodes. This rather small but reliable ablation zone is considered as a building block for matrix radiofrequency ablation (MRFA). In the current study we explored the influence of the electric mode (monopolar or bipolar) and the activation mode (consecutive, simultaneous or switching) on the size and geometry of the ablation zone. MATERIALS AND METHODS The four electrode system was applied in ex vivo bovine liver. The electric and the activation mode were changed one by one, using constant power of 50 W in all experiments. Size and geometry of the ablation zone were measured. Finite element method (FEM) modelling of the experiment was performed. RESULTS In ex vivo liver, a complete and predictable coagulation zone of a 3 × 2 × 2 cm block was obtained most efficiently in the bipolar simultaneous mode due to the combination of the higher heating efficacy of the bipolar mode and the lower impedance by the simultaneous activation of four electrodes, as supported by the FEM simulation. CONCLUSIONS In ex vivo liver, the four electrode system used in a bipolar simultaneous mode offers the best perspectives as building block for MRFA. These results should be confirmed by in vivo experiments.
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Lee DH, Lee JM. Recent Advances in the Image-Guided Tumor Ablation of Liver Malignancies: Radiofrequency Ablation with Multiple Electrodes, Real-Time Multimodality Fusion Imaging, and New Energy Sources. Korean J Radiol 2018; 19:545-559. [PMID: 29962861 PMCID: PMC6005950 DOI: 10.3348/kjr.2018.19.4.545] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/27/2018] [Indexed: 02/06/2023] Open
Abstract
Radiofrequency ablation (RFA) has emerged as an effective loco-regional treatment modality for malignant hepatic tumors. Indeed, studies have demonstrated that RFA of early stage hepatocellular carcinomas can provide comparable overall survival to surgical resection. However, the incidence of local tumor progression (LTP) after RFA is significantly higher than that of surgical resection. Thus, to overcome this limitation, multiple electrode radiofrequency (RF) systems that use a multi-channel RF generator have been developed, and they demonstrate better efficiency in creating larger ablation zones than that using the conventional RFA with a single electrode. Furthermore, RFA with multiple electrodes can allow the “no-touch” ablation technique which may also help to reduce LTP. Another technique that would be helpful in this regard is multi-modality-ultrasound fusion imaging, which helps to not only more accurately determine the target lesion by enabling the RFA of small, poorly visible or invisible tumors, but also improve the monitoring of procedures and determine the appropriateness of the ablation margin. In addition, new energy sources, including microwave and cryoablation, have been introduced in imaging-guided tumor ablation. In this review, these recently introduced ablation techniques and the results of the most current animal and clinical studies are discussed.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
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Seror O, Hocquelet A, Sutter O. Could Monopolar Mode be a Suitable Strategy of Energy Deposition for Performing No-Touch Radiofrequency Ablation of Liver Tumor ≤ 5 cm? Cardiovasc Intervent Radiol 2018; 41:1630-1631. [PMID: 29594478 DOI: 10.1007/s00270-018-1946-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Olivier Seror
- Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 Juillet, 93140, Bondy, France. .,Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France. .,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Bobigny, France.
| | - Arnaud Hocquelet
- Department of Radiology and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olivier Sutter
- Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 Juillet, 93140, Bondy, France
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de Baere T, Tselikas L, Yevich S, Boige V, Deschamps F, Ducreux M, Goere D, Nguyen F, Malka D. The role of image-guided therapy in the management of colorectal cancer metastatic disease. Eur J Cancer 2017; 75:231-242. [DOI: 10.1016/j.ejca.2017.01.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 11/29/2016] [Accepted: 01/14/2017] [Indexed: 02/07/2023]
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Liver Metastases From Noncolorectal Malignancies (Neuroendocrine Tumor, Sarcoma, Melanoma, Breast). Cancer J 2016; 22:381-386. [DOI: 10.1097/ppo.0000000000000232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Assessment of Early Treatment Response With DWI After CT-Guided Radiofrequency Ablation of Functioning Adrenal Adenomas. AJR Am J Roentgenol 2016; 207:804-810. [DOI: 10.2214/ajr.16.16207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Olutoye OO, Gay AN, Sheikh F, Akinkuotu AC, Sundararajan M, Lazar DA, Zamora IJ, Naik-Mathuria BJ, Cass DL, Yu L. In-utero radiofrequency ablation in fetal piglets: Lessons learned. J Pediatr Surg 2016; 51:554-8. [PMID: 26309094 PMCID: PMC4728058 DOI: 10.1016/j.jpedsurg.2015.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is increasingly utilized in minimally invasive fetal intervention. However, the response of different fetal tissues to RFA is poorly characterized. We sought to determine the extent of RFA damage in a fetal environment. METHODS 90Day gestation Yorkshire piglets (term 115days) were subjected to RFA of the chest and abdominal viscera under various temperatures and wattages. The extent of tissue damage was determined by NADPH diaphorase histochemistry. RESULTS Tyne temperature was widely variable and displayed varying responses between lung and liver tissue. Tyne exposure to amniotic fluid resulted in an increase in amniotic fluid temperature. Collateral damage, even across the diaphragm, was readily seen, and ultrasonography did not always reflect this injury. CONCLUSIONS Utilization of extracorporeal tynes heats fluid at a greater rate than solid tissue and reliance on temperature sensitive probes may result in overheating. The extent of injury may extend beyond damage observed by ultrasound examination and varies for different tissues. Additional studies on the use of devices that regulate tyne temperature are needed to define optimal conditions and better define the extent of adjacent tissue injury.
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Affiliation(s)
- Oluyinka O Olutoye
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Andre N Gay
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Fariha Sheikh
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Adesola C Akinkuotu
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Miel Sundararajan
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David A Lazar
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Irving J Zamora
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bindi J Naik-Mathuria
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Darrell L Cass
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ling Yu
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
Although a surgical procedure is performed by visual inspection with histopathological assessment of the excised tumor and margins, percutaneous and noninvasive thermal ablation is performed strictly with the aid of imaging. Applicator guidance into the target zone, treatment monitoring and verification, and clinical follow-up rely on effective imaging. Detailed discussion of imaging is beyond the scope of this article, but the influence of imaging on the choice of thermal ablation or procedural approach will be discussed as needed. More information on imaging for interventional therapies can be found in other articles in this issue of IEEE Pulse.
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Mulier S, Jiang Y, Jamart J, Wang C, Feng Y, Marchal G, Michel L, Ni Y. Bipolar radiofrequency ablation with 2 × 2 electrodes as a building block for matrix radiofrequency ablation:Ex vivoliver experiments and finite element method modelling. Int J Hyperthermia 2015; 31:649-65. [DOI: 10.3109/02656736.2015.1046194] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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de Baere T, Tselikas L, Pearson E, Yevitch S, Boige V, Malka D, Ducreux M, Goere D, Elias D, Nguyen F, Deschamps F. Interventional oncology for liver and lung metastases from colorectal cancer: The current state of the art. Diagn Interv Imaging 2015; 96:647-54. [DOI: 10.1016/j.diii.2015.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023]
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Aubé C, Bouvier A, Lebigot J, Vervueren L, Cartier V, Oberti F. Radiological treatment of HCC: Interventional radiology at the heart of management. Diagn Interv Imaging 2015; 96:625-36. [DOI: 10.1016/j.diii.2015.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 02/07/2023]
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Park HJ, Lee MW, Song KD, Cha DI, Rhim H, Kang TW, Lim S, Lim HK. Comparison of therapeutic efficacy and safety of radiofrequency ablation of hepatocellular carcinomas between internally cooled 15-G and 17-G single electrodes. Br J Radiol 2014; 87:20130534. [PMID: 24646182 DOI: 10.1259/bjr.20130534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To compare the ablation volume, local tumour progression rate and complication rate of radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) using 15-G and 17-G single electrodes. METHODS This retrospective study was approved by the institutional review board and informed consent was waived. We reviewed percutaneous RFA cases for HCCs using 15-G or 17-G electrodes without multiple overlapping ablations. A total of 36 pairs of HCCs matched according to tumour size and active tip length were included. We compared ablation volume and complication rate between the two electrode groups. Cumulative local tumour progression rates were estimated using the Kaplan–Meier method and compared using the log-rank test. RESULTS Tumour size and ablation time were not significantly different between the 15-G and 17-G groups (p50.661 and p50.793, respectively). However, ablation volume in the 15-G electrode group was larger than that in the 17-G group (14.465.4cm3 vs 8.762.5cm3; p,0.001). No statistical difference in complication rates between the two electrode groups was found. The 10- and 20-month local tumour progression rates were not significantly different between the two groups (2.8% and 5.6% vs 11.1% and 19.3%; p50.166). CONCLUSION Ablation volume by the 15-G electrode was larger than that by the 17-G electrode. However, local tumour progression rate and complication rate were not significantly different between the two electrode groups. ADVANCES IN KNOWLEDGE RFA of HCC using a 15-G electrode is useful to create larger ablation volumes than a 17-G electrode.
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KIM JEEYOUNG, AHN HUIJEONG, WOO HEUNGMYONG, LEE EUNSONG, LEE GEUNSHIK. Generation of liver-specific TGF-α and c-Myc-overexpressing fibroblasts for future creation of a liver cancer porcine model. Mol Med Rep 2014; 10:329-35. [DOI: 10.3892/mmr.2014.2217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/28/2014] [Indexed: 11/05/2022] Open
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SOONAWALLA ZF, ANDERSON EM. Hepatic resection and radiofrequency ablation for metastatic liver tumours: an update. IMAGING 2013. [DOI: 10.1259/imaging/39521156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Furse A, Miller BJ, McCann C, Kachura JR, Jewett MA, Sherar MD. Radiofrequency coil for the creation of large ablations: ex vivo and in vivo testing. J Vasc Interv Radiol 2013; 23:1522-8. [PMID: 23101925 DOI: 10.1016/j.jvir.2012.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 07/31/2012] [Accepted: 08/13/2012] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Various radiofrequency (RF) ablation electrode designs have been developed to increase ablation volume. Multiple heating cycles and electrode positions are often required, thereby increasing treatment time. The objective of this study was to evaluate the performance of a high-frequency monopolar induction coil designed to produce large thermal lesions (>3 cm) with a single electrode insertion in a treatment time of less than 10 minutes. MATERIALS AND METHODS A monopolar nitinol interstitial coil operated at 27.12 MHz and 200 W was evaluated. Ex vivo performance was tested in excised bovine liver (n = 22). In vivo testing (n = 10) was conducted in livers of seven Yorkshire pigs. Visual inspection, contrast-enhanced computed tomography (CT), and pathologic evaluation of ablation zones were performed. RESULTS Average ablation volumes in ex vivo and in vivo tests were 60.5 cm(3) ± 14.1 (5.9 × 4.4 × 4.4 cm) and 57.1cm(3) ± 13.8 (6.1 × 4.5 × 4.1cm), with average treatment times of 9.0 minutes ± 3.0 and 8.4 minutes ± 2.7, respectively. Contrast-enhanced CT ablation volume measurements corresponded with findings of gross inspection. Pathologic analysis showed morphologic and enzymatic changes suggestive of tissue death within the ablation zones. CONCLUSIONS The RF ablation coil device successfully produced large, uniform ablation volumes in ex vivo and in vivo settings in treatment times of less than 10 minutes. Ex vivo and in vivo lesion sizes were not significantly different (P = .53), suggesting that the heating efficiency of this higher-frequency coil device may help to minimize the heat-sink effect of perfusion.
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Affiliation(s)
- Alex Furse
- Division of Biophysics and Bioimaging, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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Mahnken AH, Pereira PL, de Baère T. Interventional oncologic approaches to liver metastases. Radiology 2013; 266:407-30. [PMID: 23362094 DOI: 10.1148/radiol.12112544] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metastatic liver disease is the most common cause of death in cancer patients. Complete surgical resection is currently considered the only curative treatment, with only about 25% of patients being amenable to surgery. Therefore, a variety of interventional oncologic techniques have been developed for treating secondary liver malignancies. The aim of these therapies is either to allow patients with unresectable tumors to become surgical candidates, provide curative treatment options in nonsurgical candidates, or improve survival in a palliative or even curative approach. Among these interventional therapies are transcatheter therapies such as portal vein embolization, hepatic artery infusion chemotherapy, transarterial chemoembolization, and radioembolization, as well as interstitial techniques, particularly radiofrequency ablation as the most commonly applied technique. The rationale, application and clinical results of each of these techniques are reviewed on the basis of the current literature. Future prospects such as gene therapy and immunotherapy are introduced.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Aachen, Germany
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Ishikawa T, Kubota T, Horigome R, Kimura N, Honda H, Iwanaga A, Seki K, Honma T, Yoshida T. Radiofrequency ablation during continuous saline infusion can extend ablation margins. World J Gastroenterol 2013; 19:1278-1282. [PMID: 23483097 PMCID: PMC3587485 DOI: 10.3748/wjg.v19.i8.1278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/24/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether fluid injection during radiofrequency ablation (RFA) can increase the coagulation area.
METHODS: Bovine liver (1-2 kg) was placed on an aluminum tray with a return electrode affixed to the base, and the liver was punctured by an expandable electrode. During RFA, 5% glucose; 50% glucose; or saline fluid was infused continuously at a rate of 1.0 mL/min through the infusion line connected to the infusion port. The area and volume of the thermocoagulated region of bovine liver were determined after RFA. The Joule heat generated was determined from the temporal change in output during the RFA experiment.
RESULTS: No liquid infusion was 17.3 ± 1.6 mL, similar to the volume of a 3-cm diameter sphere (14.1 mL). Mean thermocoagulated volume was significantly larger with continuous infusion of saline (29.3 ± 3.3 mL) than with 5% glucose (21.4 ± 2.2 mL), 50% glucose (16.5 ± 0.9 mL) or no liquid infusion (17.3 ± 1.6 mL). The ablated volume for RFA with saline was approximately 1.7-times greater than for RFA with no liquid infusion, representing a significant difference between these two conditions. Total Joule heat generated during RFA was highest with saline, and lowest with 50% glucose.
CONCLUSION: RFA with continuous saline infusion achieves a large ablation zone, and may help inhibit local recurrence by obtaining sufficient ablation margins. RFA during continuous saline infusion can extend ablation margins, and may be prevent local recurrence.
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Mulier S, Jiang Y, Wang C, Jamart J, Marchal G, Michel L, Ni Y. Bipolar radiofrequency ablation with four electrodes: Ex vivo liver experiments and finite element method analysis. Influence of inter-electrode distance on coagulation size and geometry. Int J Hyperthermia 2012; 28:686-97. [DOI: 10.3109/02656736.2012.706729] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cao W, Li J, Wu ZQ, Zhou CX, Liu X, Wan Y, Duan YY. Changes in hepatic blood flow during transcatheter arterial infusion with heated saline in hepatic VX2 tumor. Cardiovasc Intervent Radiol 2012; 36:764-72. [PMID: 22869046 DOI: 10.1007/s00270-012-0459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/15/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE This study evaluates the influence of transcatheter arterial infusion with heated saline on hepatic arterial and portal venous blood flows to tumor and normal hepatic tissues in a rabbit VX2 tumor model. METHODS All animal experiments were approved by the institutional animal care and use committee. Twenty rabbits with VX2 liver tumors were divided into the following two groups: (a) the treated group (n = 10), which received a 60 mL transarterial injection of 60 °C saline via the hepatic artery; (b) the control group (n = 10), which received a 60 mL injection of 37 °C saline via the hepatic artery. Using ultrasonography, the blood flows in both the portal vein and hepatic artery were measured, and the changes in the hemodynamic indices were recorded before and immediately after the injection. The changes in the tumor and normal liver tissues of the two groups were histopathologically examined by hematoxylin and eosin staining after the injection. RESULTS After the transcatheter arterial heated infusion, there was a decrease in the hepatic arterial blood flow to the tumor tissue, a significant decrease in the hepatic artery mean velocity (P < 0.05), and a significant increase in the resistance index (P < 0.05). On hematoxylin and eosin staining, there were no obvious signs of tissue destruction in the normal liver tissue or the tumor tissue after heated perfusion, and coagulated blood plasma was observed in the cavities of intratumoral blood vessels in the treated group. CONCLUSIONS The changes in tumor blood flow in the rabbit VX2 tumor model were presumably caused by microthrombi in the tumor vessels, and the portal vein likely mediated the heat loss in normal liver tissue during the transarterial heated infusion.
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Affiliation(s)
- Wei Cao
- Department of Interventional Radiology, Tangdu Hospital, The Fourth Military Medical University, No. 1 Xinshi Road, Xi'an 710038, Shaanxi Province, China.
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Tiong LU, Field JBF, Maddern GJ. Bimodal electric tissue ablation (BETA) compared with the Cool-Tip RFA system. ANZ J Surg 2012; 82:269-74. [PMID: 22510186 DOI: 10.1111/j.1445-2197.2011.05990.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bimodal electric tissue ablation (BETA) incorporates the process of electrolysis into radiofrequency ablation (RFA) to increase the size of tissue ablation. This study investigated whether BETA could increase the efficacy of the Cool-Tip RF system (Covidien, Boulder, CO, USA) to produce larger ablations. It also investigated whether applying electrolysis only during the pretreatment phase (called electrochemical treatment (ECT)/RFA group) is as effective as BETA (where electrolysis was used during both the pretreatment and RFA phases). METHODS A Cool-Tip RF system (Covidien) was used to test three types of ablations (RFA, BETA, and ECT/RFA) in a pig liver model. In BETA, 9 V of direct current was provided for 10 min, after which the RF generator was started and both electrical circuits were allowed to run concurrently. In ECT/RFA, however, the direct current circuit was switched off after 10 min of pretreatment and only RFA was performed as described above. Ablation sizes were measured in three dimensions. RESULTS The size of ablations (transverse diameter A and B) produced by BETA and ECT/RFA was significantly larger compared with standard RFA (P < 0/001). BETA also created larger ablations compared with ECT/RFA (P < 0.001). CONCLUSION BETA could improve the efficacy of the Cool-Tip RF system (Covidien) to achieve larger ablations. The increased tissue hydration improved delivery of electrical energy to the tissues and delayed the process of desiccation, thus allowing the ablation process to continue for longer periods of time to produce larger ablations. BETA could be used to treat larger liver tumours more effectively than standard RFA.
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Affiliation(s)
- Leong Ung Tiong
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Bipolar radio frequency ablation of spinal neoplasms in late stage cancer disease: a report of three cases. Spine (Phila Pa 1976) 2012; 37:E64-8. [PMID: 21508889 DOI: 10.1097/brs.0b013e31821cc57e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To avoid neuronal damage by using the bipolar radio frequency ablation of spinal tumors. SUMMARY OF BACKGROUND DATA Radio frequency ablation of tumorous masses is an established procedure and is increasingly used as pain therapy of unresectable spine tumors. Ablation of lesions adjacent to vulnerable structures remains a challenging task because flow of current is insufficiently controlled by monopolar probes. Using this technique, a prediction of the induced necrosis accurate to the millimeter is not feasible. METHODS Three patients with metastases of the spine were treated using the bipolar radio frequency ablation. RESULTS In all 3 cases collateral damage of neuronal structures could be avoided even though tumorous masses touched the cauda equina or were very close to vulnerable structures, respectively. The induction of necrosis was predictable to the millimeter. CONCLUSION Ablation of tumorous masses adjacent to neural structures by bipolar technique, is feasible and predictable. Spinal cord damage can be avoided by exact planning of the induced necrosis.
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Cao W, Lu Q, Li JH, Zhou CX, Zhu J, Wan Y, Liu YF. Transcatheter arterial infusion with heated saline changes the vascular permeability of rabbit hepatic tumors. Acad Radiol 2011; 18:1569-76. [PMID: 21968263 DOI: 10.1016/j.acra.2011.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/14/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
RATIONALE AND OBJECTIVES The vascular permeability of tumors can be changed by transarterial infusion heat, but the mechanisms remain unknown. The aim of this study was to analyze the underlying causes of changes in tumor vascular permeability after heated perfusion via two different modes. MATERIALS AND METHODS Thirty rabbits with VX2 hepatic tumors were randomly divided into three groups of 10 rabbits each. The hepatic artery was selectively catheterized via a femoral approach, and unheated saline (control group) or heated saline (60°C) was then injected in either a continuous (transcatheter arterial continuous perfusion [TACP]) or a pulsed (transcatheter arterial pulsed perfusion [TAPP]) manner. Changes in vascular permeability in the tumors were assessed using the following markers and methods: (1) qualitative assessment by visual estimation on digital subtraction angiography performed after the heat infusion procedure on live animals and quantitative assessment by spectrophotometry using Evans blue dye extravasation on tumor and liver tissue after animals were sacrificed and (2) kinase domain receptor or vascular endothelial growth factor (VEGF), expressed in vascular endothelial cells, assessed by immunohistochemical staining, Western blot analysis, and reverse transcription polymerase chain reaction. RESULTS Tumor staining increased in the TAPP group more than in the TACP group, but not in the control group, assessed on digital subtraction angiography. Extracted dye was higher in tumors in the TAPP group than in those in the TACP group; extracted dye in both groups was higher than in the control group. Kinase domain receptor protein and messenger ribonucleic acid expression were both higher in the TAPP group than in the TACP and control groups. VEGF protein expression was lower in the TAPP and TACP groups than in the control group, but VEGF messenger ribonucleic acid expression was higher in the TACP group than in the TAPP and control groups, and VEGF messenger ribonucleic acid expression was lower in the TAPP group than in the control group. CONCLUSIONS The vascular permeability of rabbit VX2 tumors significantly increased after arterial pulsed heated infusion, and the protein kinase domain receptor may play a key role in this increase of tumor vascular permeability.
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Park MJ, Kim YS, Rhim H, Lim HK, Lee MW, Choi D. A comparison of US-guided percutaneous radiofrequency ablation of medium-sized hepatocellular carcinoma with a cluster electrode or a single electrode with a multiple overlapping ablation technique. J Vasc Interv Radiol 2011; 22:771-9. [PMID: 21616430 DOI: 10.1016/j.jvir.2011.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/07/2011] [Accepted: 02/04/2011] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare ablation zone, local therapeutic efficacy, and complications of ultrasound (US)-guided percutaneous radiofrequency (RF) ablation of medium-sized hepatocellular carcinomas (HCCs) with a cluster electrode versus a single electrode with multiple overlapping ablations. MATERIALS AND METHODS From February 2005 to January 2009, a total of 79 consecutive patients (57 men, 22 women; mean age, 58.6 y) with 79 HCCs (range, 2.5-4.0 cm) underwent percutaneous RF ablation with a cluster electrode (n = 37) or a single electrode with multiple overlapping ablations (n = 42). These methods were compared in terms of ablation zone size on immediate follow-up computed tomography and the rates of technique effectiveness and cumulative local tumor progression on further follow-up (range, 12.0-46.2 mo; median, 24.3 mo). RESULTS Baseline characteristics did not differ between groups. The ablation zone in the cluster group was significantly smaller in the longitudinal dimension (43.7 mm ± 4.8 vs 46.5 mm ± 5.9; P = .03), but greater in the short axial dimension (30.7 mm ± 3.9 vs 27.3 mm ± 5.5; P = .03), compared with that in the overlapping ablation group. Technique effectiveness rates in the cluster and overlap groups were 100% and 92.9% (39 of 42), respectively (P = .24). The cumulative local tumor progression rate was significantly lower in the cluster group than in the overlapping group (1- and 3- year follow-up: 8.1 and 18.8% vs 23.8 and 42.2%, P = .04). Complications were more frequent in the cluster group than in the overlapping group (27.0% vs 7.1%; P = .03). CONCLUSIONS In US-guided percutaneous RF ablation of medium-sized HCCs, the cluster electrode showed better local therapeutic efficacy than the single electrode with multiple overlapping ablations, probably because of the favorable shape of the ablation zone; however, complications occurred more frequently.
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Affiliation(s)
- Min Jung Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, 135-710, Seoul, Korea
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Koda M, Tokunaga S, Matono T, Sugihara T, Nagahara T, Murawaki Y. Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study. Exp Ther Med 2011; 2:1215-1220. [PMID: 22977647 DOI: 10.3892/etm.2011.347] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/24/2011] [Indexed: 11/06/2022] Open
Abstract
The purpose of the present study was to compare the size and configuration of the ablation zones created by SuperSlim and CoAccess electrodes, using various ablation algorithms in ex vivo bovine liver and in clinical cases. In the experimental study, we ablated explanted bovine liver using 2 types of electrodes and 4 ablation algorithms (combinations of incremental power supply, stepwise expansion and additional low-power ablation) and evaluated the ablation area and time. In the clinical study, we compared the ablation volume and the shape of the ablation zone between both electrodes in 23 hepatocellular carcinoma (HCC) cases with the best algorithm (incremental power supply, stepwise expansion and additional low-power ablation) as derived from the experimental study. In the experimental study, the ablation area and time by the CoAccess electrode were significantly greater compared to those by the SuperSlim electrode for the single-step (algorithm 1, p=0.0209 and 0.0325, respectively) and stepwise expansion algorithms (algorithm 2, p=0.0002 and <0.0001, respectively; algorithm 3, p= 0.006 and 0.0407, respectively). However, differences were not significant for the additional low-power ablation algorithm. In the clinical study, the ablation volume and time in the CoAccess group were significantly larger and longer, respectively, compared to those in the SuperSlim group (p=0.0242 and 0.009, respectively). Round ablation zones were acquired in 91.7% of the CoAccess group, while irregular ablation zones were obtained in 45.5% of the SuperSlim group (p=0.0428). In conclusion, the CoAccess electrode achieves larger and more uniform ablation zones compared with the SuperSlim electrode, though it requires longer ablation times in experimental and clinical studies.
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Affiliation(s)
- Masahiko Koda
- Second Department of Internal Medicine, School of Medicine, Tottori University, Yonago 683-8504, Japan
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Seror O. [Percutaneous radiofrequency and other liver ablation techniques: 2011 update]. JOURNAL DE RADIOLOGIE 2011; 92:763-773. [PMID: 21944235 DOI: 10.1016/j.jradio.2011.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
Percutaneous ablation of liver tumors was initially limited to patients that were not surgical candidates and with a limited number of relatively small liver lesions. Because of the diversification of techniques and technologies, percutaneous liver ablation has progressively been integrating to more and more complex therapeutic strategies available to a wider group of patients. Local knowledge and expertise with these techniques, largely dominated by radiofrequency ablation, often dictate the role of these techniques in the management of patients with liver tumors. We will review the clinical indications of percutaneous ablation techniques for liver tumors based on clinical considerations as well as ablation techniques.
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Affiliation(s)
- O Seror
- Service de radiologie, hôpital Jean-Verdier, avenue du 14-Juillet, 93143 Bondy, France.
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de Baere T, Robinson JM, Rao P, Teriitehau C, Deschamps F. Radiofrequency Ablation of Lung Metastases Close to Large Vessels during Vascular Occlusion: Preliminary Experience. J Vasc Interv Radiol 2011; 22:749-54. [DOI: 10.1016/j.jvir.2011.02.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 02/22/2011] [Accepted: 02/22/2011] [Indexed: 02/01/2023] Open
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Microwave Ablation of Porcine Kidneys in vivo: Effect of two Different Ablation Modes (“Temperature Control” and “Power Control”) on Procedural Outcome. Cardiovasc Intervent Radiol 2011; 35:653-60. [DOI: 10.1007/s00270-011-0171-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 04/18/2011] [Indexed: 12/22/2022]
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Feasibility of Noninvasive Temperature Assessment During Radiofrequency Liver Ablation on Computed Tomography. J Comput Assist Tomogr 2011; 35:356-60. [DOI: 10.1097/rct.0b013e318217121d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cao W, Li JH, Feng DY, Wan Y, Liu YF, Yang QF, Cheng JW, Zhao SY, Zhang HX. Effect of transarterial pulsed perfusion with heated saline on tumor vascular permeability in a rabbit VX2 liver tumor model. Eur J Radiol 2011; 81:e209-16. [PMID: 21345630 DOI: 10.1016/j.ejrad.2011.01.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 01/23/2011] [Accepted: 01/28/2011] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the effect of transarterial pulsed perfusion with 60 °C saline on vascular permeability of tumor tissue, as well as its hepatic and renal toxicity, in a rabbit VX2 liver model. MATERIALS AND METHODS VX2 carcinomas were grown in rabbit livers, forty male New Zealand white tumor-bearing rabbits were randomly divided into four groups, followed by transarterial perfusion with 37 °C saline 60 ml (n=10) (control 1 group), transarterial pulsed perfusion with 37 °C saline 60 ml (n=10) (control 2 group), transarterial continuous perfusion with 60 °C saline 60 ml (n=10) (TCP group), transarterial pulsed perfusion with 60 °C saline 60 ml (n=10) (TPP group), the duration of time for tumor tissues in the range 43-45 °C of the treated groups was measured with needle thermometer during perfusion. Vascular permeability was assessed using the extravasation of Evans blue (EB) dye in the tumor or normal liver tissues of the four groups separately, the tumor or normal liver tissues of the four groups were estimated by histopathologic examination, and hepatic and renal toxicity was evaluated by means of blood biochemical analysis. The vascular endothelial cells in the tumor were observed by transmission electron microscopy (TEM). RESULTS The duration of time for tumor tissues in the range 43-45 °C of TPP group showed significantly longer than that of TCP group (12.3±3.3 min vs. 5.7±2.5 min) (P<0.01). After perfusion, the EB content of tumor tissue in TPP group showed significantly higher than that in TCP group (15.21±0.94 μg/100 mg vs. 10.71±0.84 μg/100 mg) (P<0.01), and also showed significantly higher than that in the two control group (3.42±0.87 μg/100 mg, 3.57±0.64 μg/100 mg) (P<0.01). Blood chemical analysis indicating there was an increase (P<0.05) in the serum ALT, AST levels in the two heated perfusion groups at 1, 2, 4, 8 h after infusion when compared to that in the two control group, but there was no significant difference in the serum ALT, AST levels among the four groups at 24 h after perfusion (P>0.05), and there was no significant difference in the serum BUN, Cr levels among the four groups at 1, 2, 4, 8, 24 h after perfusion. Observed by hematoxylin and eosin staining, there were no obvious signs of tissue destruction in liver tissue and tumor tissue. TEM indicating the endothelial cell gap was broadened and the endothelial cells' microvillus was decreased after heated perfusion. CONCLUSIONS The vascular permeability of the rabbit VX2 tumor was significantly increased after transarterial pulsed perfusion with 60°C saline without significant increase in hepatic and renal toxicity.
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Affiliation(s)
- Wei Cao
- Department of Interventional Radiology, Tangdu Hospital, The Fourth Military Medical University, No. 1 Xinshi Road, Shaanxi Province, Xi'an 710038, China.
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Hess A, Palussière J, Goyers JF, Guth A, Aupérin A, de Baère T. Pulmonary Radiofrequency Ablation in Patients with a Single Lung: Feasibility, Efficacy, and Tolerance. Radiology 2011; 258:635-42. [DOI: 10.1148/radiol.10100771] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Renal Artery Embolization Combined With Radiofrequency Ablation in a Porcine Kidney Model: Effect of Small and Narrowly Calibrated Microparticles as Embolization Material on Coagulation Diameter, Volume, and Shape. Cardiovasc Intervent Radiol 2010; 34:156-65. [DOI: 10.1007/s00270-010-9908-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 05/20/2010] [Indexed: 12/18/2022]
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Tissue contraction caused by radiofrequency and microwave ablation: a laboratory study in liver and lung. J Vasc Interv Radiol 2010; 21:1280-6. [PMID: 20537559 DOI: 10.1016/j.jvir.2010.02.038] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 02/09/2010] [Accepted: 02/21/2010] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine the amount of tissue contraction during radiofrequency (RF) and microwave ablation. MATERIALS AND METHODS Markers were inserted into explanted bovine liver and lung 10 mm (inner), 20 mm (middle; not used in lung), and 30 mm (peripheral) diametrically around an ablation applicator. Aside from unablated controls, RF and microwave ablations 25-30 mm in diameter were then created and sectioned to measure the distance between markers (n = 12, liver RF; n = 8, other). Total contraction was calculated by subtracting postablation measurements from controls at each position. Relative contraction was calculated by subtracting the nearest more central measurement. Sample water content was measured to determine the relationship between dehydration and relative contraction. A mixed-effects model tested for differences in diameters, total and relative contraction, and water content with energy, tissue, and marker position as independent variables. RESULTS Total contractions at the inner, middle, and peripheral positions in liver were 2.9 mm (31%), 4.8 mm (24%), and 4.5 mm (15%) for RF and 3.6 mm (38%), 6.6 mm (33%), and 9.0 mm (30%) for microwave, respectively. Significantly more contraction was noted in lung (P < .001): 5.1 mm (55%) and 14.2 mm (49%) for RF and 4.8 mm (52%) and 13.7 mm (47%) for microwave at the inner and peripheral positions, respectively. Microwaves produced more contraction than RF in liver (P < .05) but not in lung. A positive correlation between dehydration and relative contraction was observed in all cases. CONCLUSIONS Ablation-induced tissue contraction is substantial and influenced by dehydration. Contraction should be considered when testing devices and computer models or comparing pre- and postablation images.
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Crocetti L, Bozzi E, Faviana P, Cioni D, Della Pina C, Sbrana A, Fontanini G, Lencioni R. Thermal Ablation of Lung Tissue: In Vivo Experimental Comparison of Microwave and Radiofrequency. Cardiovasc Intervent Radiol 2010; 33:818-27. [DOI: 10.1007/s00270-010-9869-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 04/08/2010] [Indexed: 02/08/2023]
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Appelbaum L, Sosna J, Pearson R, Perez S, Nissenbaum Y, Mertyna P, Libson E, Goldberg SN. Algorithm optimization for multitined radiofrequency ablation: comparative study in ex vivo and in vivo bovine liver. Radiology 2010; 254:430-40. [PMID: 20093515 DOI: 10.1148/radiol.09090207] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To prospectively optimize multistep algorithms for largest available multitined radiofrequency (RF) electrode system in ex vivo and in vivo tissues, to determine best energy parameters to achieve large predictable target sizes of coagulation, and to compare these algorithms with manufacturer's recommended algorithms. MATERIALS AND METHODS Institutional animal care and use committee approval was obtained for the in vivo portion of this study. Ablation (n = 473) was performed in ex vivo bovine liver; final tine extension was 5-7 cm. Variables in stepped-deployment RF algorithm were interrogated and included initial current ramping to 105 degrees C (1 degrees C/0.5-5.0 sec), the number of sequential tine extensions (2-7 cm), and duration of application (4-12 minutes) for final two to three tine extensions. Optimal parameters to achieve 5-7 cm of coagulation were compared with recommended algorithms. Optimal settings for 5- and 6-cm final tine extensions were confirmed in in vivo perfused bovine liver (n = 14). Multivariate analysis of variance and/or paired t tests were used. RESULTS Mean RF ablation zones of 5.1 cm +/- 0.2 (standard deviation), 6.3 cm +/- 0.4, and 7 cm +/- 0.3 were achieved with 5-, 6-, and 7-cm final tine extensions in a mean of 19.5 min +/- 0.5, 27.9 min +/- 6, and 37.1 min +/- 2.3, respectively, at optimal settings. With these algorithms, size of ablation at 6- and 7-cm tine extension significantly increased from mean of 5.4 cm +/- 0.4 and 6.1 cm +/- 0.6 (manufacturer's algorithms) (P <.05, both comparisons); two recommended tine extensions were eliminated. In vivo confirmation produced mean diameter in specified time: 5.5 cm +/- 0.4 in 18.5 min +/- 0.5 (5-cm extensions) and 5.7 cm +/- 0.2 in 21.2 min +/- 0.6 (6-cm extensions). CONCLUSION Large zones of coagulation of 5-7 cm can be created with optimized RF algorithms that help reduce number of tine extensions compared with manufacturer's recommendations. Such algorithms are likely to facilitate the utility of these devices for RF ablation of focal tumors in clinical practice.
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Affiliation(s)
- Liat Appelbaum
- Applied Radiology Research Laboratory, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel.
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Abbas G, Pennathur A, Landreneau RJ, Luketich JD. Radiofrequency and microwave ablation of lung tumors. J Surg Oncol 2010; 100:645-50. [PMID: 20017162 DOI: 10.1002/jso.21334] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is the most common cause of cancer-related mortality in the United States. Surgical resection remains the standard treatment for early stage, non-small cell lung cancer, and limited pulmonary metastases. However, many patients with resectable disease have significant co-morbidities which preclude surgical resection. Radiofrequency and microwave ablation are emerging modalities of treatment for these high-risk patients. Here, we review the principles, common devices in use, and treatment results of ablative therapy for lung tumors.
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Affiliation(s)
- Ghulam Abbas
- Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Frieser M, Strobel D, Schaber S, Wissniowski TT, Bernatik T, Adis S, Hahn EG, Hänsler JM. Getaktete Dreifachapplikation mit perfundierten Nadelapplikatoren bei Radiofrequenzablation: In-vitro-Versuch an der Rinderleber / Pulsed radiofrequency ablation using perfused needle applicators in an in vitro trial on bovine liver. ACTA ACUST UNITED AC 2010; 55:101-7. [DOI: 10.1515/bmt.2010.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Radiofrequency ablation of large size liver tumours using novel plan-parallel expandable bipolar electrodes: initial clinical experience. Eur J Radiol 2009; 77:167-71. [PMID: 19616911 DOI: 10.1016/j.ejrad.2009.06.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/22/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE Although radiofrequency ablation (RFA) is a promising method for local treatment of liver malignancies, with conventional monopolar systems recurrence rates for large size tumours (≥3.5 cm) remain high. The objective of this study was to evaluate the safety, feasibility and local effectiveness of a novel bipolar plan-parallel expandable system for these larger tumours. METHODS AND MATERIALS Eight consecutive patients with either unresectable colorectal liver metastases (CRLM in 6 patients), carcinoid liver metastases (1 patient) and hepatocellular carcinoma (HCC in 1 patient) of ≥3.5 cm were treated with bipolar RFA during laparotomy with ultrasound guidance. Early and late, major and minor complications were recorded. Local success was determined on 3-8 month follow-up CT scans of the upper abdomen. RESULTS Nine CRLM, one carcinoid liver metastases and one HCC (3.5-6.6 cm) were ablated with bipolar RFA. Average ablation time was 16 min (range 6-29 min.). Two patients developed a liver abscess which required re-laparotomy. In both cases bowel surgery during the same session probably caused bacterial spill. There were no mortalities. The patients were released from hospital between 5 and 29 days after the procedure (median 12 days). The 6-12 month follow-up PET-CT scans showed signs for marginal RFA-site tumour recurrence in three patients with CRLM (3/11 lesions). CONCLUSION Preliminary results suggest bipolar RFA to be a reasonably safe, fast and feasible technique which seems to improve local control for large size hepatic tumour ablations.
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Eisele RM, Neumann U, Neuhaus P, Schumacher G. Open surgical is superior to percutaneous access for radiofrequency ablation of hepatic metastases. World J Surg 2009; 33:804-11. [PMID: 19184639 DOI: 10.1007/s00268-008-9905-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was designed to determine the best approach to radiofrequency ablation (RFA) in the liver. METHODS From a total of 41 procedures, 37 patients with 47 tumors were treated with RFA for metastatic disease. Indications included colorectal cancer (n=28, 68%), neuroendocrine tumors (n=2, 5%), gynecological primaries (n=4, 10%), pancreatic/duodenal cancer (n=2, 5%), and miscellaneous entities (n=5, 12%). Mean follow-up period was 18 (median, 18) months. All ways of approach to RFA were applied: percutaneous was chosen in 17 (41.5%), laparoscopic and hand-assisted laparoscopic in 5 (12.2%), and open surgical in 19 cases (46.3%), and in 10 cases, RFA was combined with hepatic resection. The average maximum tumor size was 2.3 (range, 0.8-6) cm, and the mean number of nodules treated per patient in a single session was 1.3 (range, 1-3). RESULTS Overall survival was 59.5% at 2 years, recurrence-free 2-year survival was 12.6%, local tumor recurrence rate was 34%, and overall recurrence was 75.6%. Local tumor recurrence and disease-free survival were significantly improved in the open surgically treated patients compared with the percutaneous treatment group (15.8% [n=3] vs. 58.8% [n=10] and 11.5 vs. 7.9 months, p<0.01 [chi2 test] and p<0.05 [log-rank test], respectively). CONCLUSIONS Open surgical approach is superior to percutaneous access for RFA in metastatic hepatic disease.
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Affiliation(s)
- Robert M Eisele
- Department of General, Visceral, and Transplantation Surgery, Charité Virchow-Clinic, Augustenburger Pl. 1, 13353, Berlin, Germany.
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Cao W, Wan Y, Liang ZH, Duan YY, Liu X, Wang ZM, Liu YY, Zhu J, Liu XT, Zhang HX. Heated lipiodol as an embolization agent for transhepatic arterial embolization in VX2 rabbit liver cancer model. Eur J Radiol 2008; 73:412-9. [PMID: 19091502 DOI: 10.1016/j.ejrad.2008.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 11/04/2008] [Accepted: 11/05/2008] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the therapeutic effect of heated (60 degrees C) lipiodol via hepatic artery administration in a rabbit model of VX2 liver cancer. MATERIALS AND METHODS Thirty male New Zealand white rabbits were randomly divided into three groups with 10 rabbits assigned to each group. VX2 carcinoma cells were surgically implanted into the left hepatic lobe. The tumors were allowed to grow for 2 weeks, and studies were performed until the diameter of the tumors detected by ultrasonograph reached 2-3cm. Under anesthesia, trans-catheter hepatic arterial embolization was performed and doxorubicin-lipiodol (37 degrees C) (1mL), lipiodol (60 degrees C) (1mL) or control (physiological saline (37 degrees C) (1mL)) solution was injected into the hepatic arteries of animals in the three groups. One week later, the volume of the tumor was measured by ultrasonograph again. The serum of all rabbits was collected before injection and at 4 and 7 days after injection, and the level of aspartate aminotransferase (AST) was checked. The survival period of the three groups of rabbits after treatment was also recorded. During the last course of their disease, the rabbits were given analgesics to relieve suffering. RESULTS The tumor growth rate in the lipiodol (60 degrees C) group (0.92+/-0.21, tumor volume from 1811+/-435 to 1670+/-564mm(3)) was significantly lower than that in the control group (3.48+/-1.17, tumor volume from 1808+/-756 to 5747+/-1341mm(3)) (P<0.05) and in the doxorubicin-lipiodol (37 degrees C) group (1.69+/-0.26, tumor volume from 1881+/-641 to 2428+/-752mm(3)) (P<0.05). Consequently, the survival period of the animals in the lipiodol (60 degrees C) group (41.0+/-3.0 days) was significantly greater than that in the doxorubicin-lipiodol (37 degrees C) group (38.0+/-2.5 days) (P<0.05). On the other hand, there was no statistically significant difference in serum AST levels between the lipiodol (60 degrees C) group (148.2+/-11.3UL(-1)) and the doxorubicin-lipiodol (37 degrees C) group (139.7+/-12.3UL(-1)) (P>0.05). However, the serum AST level in the lipiodol (60 degrees C) group was significantly higher at 4 days after injection (P<0.05) than in the control group (68.6+/-6.6UL(-1)). CONCLUSIONS Treatment with lipiodol (60 degrees C) resulted in an effect on serum AST levels similar to that caused by treatment with doxorubicin-lipiodol (37 degrees C). Thus, lipiodol (60 degrees C) treatment could greatly prolong the survival period of rabbits with VX2 cancer by inhibiting tumor growth.
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Affiliation(s)
- Wei Cao
- Department of Interventional Radiology, Tangdu Hospital, The Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi'an 710038, China.
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Schutt DJ, Haemmerich D. Effects of variation in perfusion rates and of perfusion models in computational models of radio frequency tumor ablation. Med Phys 2008; 35:3462-70. [PMID: 18777906 DOI: 10.1118/1.2948388] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Finite element method (FEM) models are commonly used to simulate radio frequency (RF) tumor ablation. Prior FEM models of RF ablation have either ignored the temperature dependent effect of microvascular perfusion, or implemented the effect using simplified algorithms to reduce computational complexity. In this FEM modeling study, the authors compared the effect of different microvascular perfusion algorithms on ablation zone dimensions with two commercial RF electrodes in hepatic tissue. They also examine the effect of tissue type and inter-patient variation of perfusion on ablation zone dimensions. METHODS AND MATERIALS The authors created FEM models of an internally cooled and multi-tined expandable electrode. RF voltage was applied to both electrodes (for 12 or 15 min, respectively) such that the maximum temperature in the model was 105 degrees C. Temperature dependent microvascular perfusion was implemented using three previously reported methodologies: cessation above 60 degrees C, a standard first-order Arrhenius model with decreasing perfusion with increasing degree of vascular stasis, and an Arrhenius model that included the effects of increasing perfusion at the ablation zone boundary due to hyperemia. To examine the effects of interpatient variation, simulations were performed with base line and +/-1 standard deviation values of perfusion. The base line perfusion was also varied to simulate the difference between normal and cirrhotic liver tissue. RESULTS The ablation zone volumes with the cessation above 60 degrees C perfusion algorithm and with the more complex Arrhenius model were up to 70% and 25% smaller, respectively, compared to the standard Arrhenius model. Ablation zone volumes were up to 175% and approximately 100% different between the simulations where -1 and +1 standard deviation values of perfusion were used in normal and cirrhotic liver tissue, respectively. CONCLUSIONS The choice of microvascular perfusion algorithm has significant effects on final ablation zone dimensions in FEM models of RF ablation. The authors also found that both interpatient variation in base line tissue perfusion and the reduction in perfusion due to cirrhosis have considerable effect on ablation zone dimensions.
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Affiliation(s)
- David J Schutt
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Pennathur A, Abbas G, Schuchert M, Landreneau RJ, Luketich JD. Radiofrequency ablation for the treatment of lung neoplasm. Expert Rev Med Devices 2008; 5:613-21. [PMID: 18803472 DOI: 10.1586/17434440.5.5.613] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung cancer is the most common cause of cancer-related mortality in the USA. Surgical resection is the standard treatment for resectable disease; however, a significant percentage of patients with otherwise resectable lung cancer may have other comorbidities, precluding surgical resection. In patients with Stage I non-small-cell lung cancer, conventional external-beam radiotherapy is typically offered as treatment in medically inoperable, high-risk patients with reported 5-year survival rates of 10-30%. An emerging technology in the treatment of lung tumors is radiofrequency ablation, which is a thermal ablative technique and may be applicable in high-risk patients with lung cancer. In this article we will review the principles of radiofrequency ablation, the common devices in use, the experimental background, the results of 'ablate and resect' studies and the clinical experience with radiofrequency ablation in the treatment of lung neoplasm.
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Affiliation(s)
- Arjun Pennathur
- The Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Frich L, Halvorsen PS, Skulstad H, Damås JK, Gladhaug IP. Microbubbles in the pulmonary artery generated during experimental hepatic radiofrequency ablation is correlated with increased pulmonary arterial pressure. J Vasc Interv Radiol 2008; 18:437-42. [PMID: 17377191 DOI: 10.1016/j.jvir.2006.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Microbubbles in hepatic veins during hepatic radiofrequency (RF) ablation is a well-known observation. In this experimental study, we examined the association between microbubbles in the pulmonary artery and alterations in mean pulmonary arterial pressure (MPAP) during hepatic RF ablation with a perfusion electrode system. MATERIALS AND METHODS Sixteen domestic pigs were included in the study. Twelve animals were randomly assigned to RF ablation with maintained (n = 6) or interrupted (n = 6) hepatic inflow. Four animals were assigned to a control group where interruption of hepatic inflow but no RF ablation was performed. Microbubbles in the pulmonary artery were recorded by transesophageal echocardiography and scored according to the number of bubbles per heart cycle. Mean pulmonary arterial pressure was continuously registered by a pulmonary artery catheter. The association between the microbubble score and increase in MPAP during ablation was examined using Spearman's rank correlation coefficient. RESULTS Echocardiographic recordings were acquired in 9 of 12 animals in the two treatment groups. Microbubbles in the pulmonary artery were present in four animals in each treatment group. Mean pulmonary arterial pressure increased from a baseline value of 17.7 mm Hg +/- 2.3 to a maximum value of 29.7 mm Hg +/- 7.7 during ablation (P = .018). A significant association was found between the microbubble score and increase in MPAP (P = .001). CONCLUSIONS Microbubbles were detected in the pulmonary artery during hepatic RF ablation both during maintained and interrupted hepatic inflow. A strong association was found between microbubbles in the pulmonary artery and increased MPAP. The clinical implications of our findings are to be determined.
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Affiliation(s)
- Lars Frich
- Interventional Centre, Rikshospitalet University Hospital, N-0027 Oslo, Norway.
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Jin GY, Han YM, Lee YS, Lee YC. Radiofrequency ablation using a monopolar wet electrode for the treatment of inoperable non-small cell lung cancer: a preliminary report. Korean J Radiol 2008; 9:140-7. [PMID: 18385561 PMCID: PMC2627221 DOI: 10.3348/kjr.2008.9.2.140] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective To assess the technical feasibility and complications of radiofrequency ablation (RFA) using a monopolar wet electrode for the treatment of inoperable non-small cell lung malignancies. Materials and Methods Sixteen patients with a non-small cell lung malignancy underwent RFA under CT guidance. All the patients were non-surgical candidates, with mean maximum tumor diameters ranging from 3 to 6 cm (mean: 4.6 ± 1.1 cm). A single 16-gauge open-perfused electrode with a 2 cm exposed tip was used for the procedure. A 0.9% NaCl saline solution was used as the perfusion liquid with the flow adjusted to 30 mL/h. The radiofrequency energy was applied for 10-40 minutes. The response to RFA was evaluated by performing contrast-enhanced CT immediately after RFA, one month after treatment and then every three months thereafter. Results Technical failure was observed in six (37.5%) of 16 patients: intractable pain (n = 2) and non-stop coughing (n = 4). The mean follow-up interval was 15 ± 8 months (range: 9-31 months). The mean maximum ablated diameter in the technically successful group of patients ranged from 3.5 to 7.5 cm (mean 5.1 ± 1.3 cm). Complete necrosis was attained for eight (80%) of 10 lesions, and partial necrosis was achieved for two lesions. There were two major complications (2/10, 20%) encountered: a hemothorax (n = 1) and a bronchopleural fistula (n = 1). Conclusion Although RFA using a monopolar wet electrode can create a large ablation zone, it is associated with a high rate of technical failure when used to treat inoperable non-small cell lung malignancies.
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Affiliation(s)
- Gong Yong Jin
- Department of Radiology, Chonbuk National University Medical School, Research Institute for Medical Science, Chonbuk, Korea.
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de Baere T, Deschamps F, Briggs P, Dromain C, Boige V, Hechelhammer L, Abdel-Rehim M, Aupérin A, Goere D, Elias D. Hepatic Malignancies: Percutaneous Radiofrequency Ablation during Percutaneous Portal or Hepatic Vein Occlusion. Radiology 2008; 248:1056-66. [DOI: 10.1148/radiol.2483070222] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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