HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Test (opens in a new window) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Akahane, M. Articles by Ohtomo, K. Search for Related Content PubMed PubMed Citation Articles by Akahane, M. Articles by Ohtomo, K. Related Collections Vascular and/or Interventional Radiology Gastrointestinal Radiology

Complications of Percutaneous Radiofrequency Ablation for Hepato-cellular Carcinoma: Imaging Spectrum and Management¹

¹ From the Departments of Radiology (M.A., H.K., N.K., H.Y., K.U., K.O.) and Gastroenterology (R.T., T.T., S.S.), Graduate School of Medicine, University of Tokyo, 7–3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received February 7, 2005; revision requested April 18 and received May 27; accepted June 3. All authors have no financial relationships to disclose.

View larger version (149K): [in a new window]   Figure 1.  Portal vein thrombosis in a 58-year-old woman with hepatocellular carcinoma in segment II. Follow-up CT scan, obtained immediately after RF ablation, shows loss of enhancement in the umbilical portion of the left portal vein (arrow) and strong segmental enhancement of the left lobe (arrowheads).

 

View larger version (144K): [in a new window]   Figure 2a.  Hepatic vein thrombosis in a 68-year-old man with hepatocellular carcinoma in segment VIII. Follow-up CT scans obtained immediately after RF ablation (a and b at approximately the same level but with different rotation due to different degrees of inspiration) show a wedge-shaped area with decreased enhancement (arrowheads) in the hepatic arterial phase (a) and loss of enhancement in a tributary of the right hepatic vein (arrow) adjacent to the ablated lesion in the equilibrium phase (b).

 

View larger version (154K): [in a new window]   Figure 2b.  Hepatic vein thrombosis in a 68-year-old man with hepatocellular carcinoma in segment VIII. Follow-up CT scans obtained immediately after RF ablation (a and b at approximately the same level but with different rotation due to different degrees of inspiration) show a wedge-shaped area with decreased enhancement (arrowheads) in the hepatic arterial phase (a) and loss of enhancement in a tributary of the right hepatic vein (arrow) adjacent to the ablated lesion in the equilibrium phase (b).

 

View larger version (144K): [in a new window]   Figure 3a.  Hepatic infarction in a 55-year-old woman with hepatocellular carcinoma in segment III. (a) Follow-up CT scan, obtained immediately after RF ablation, shows a well-defined wedge-shaped infarcted area with low attenuation (arrowheads), as well as branching areas with attenuation similar to that of air (arrow), considered to be tributaries of the portal vein. (b) Follow-up CT scan (obtained 3 cm caudad to a) shows that the area of low attenuation (arrows) extends to the liver surface.

 

View larger version (147K): [in a new window]   Figure 3b.  Hepatic infarction in a 55-year-old woman with hepatocellular carcinoma in segment III. (a) Follow-up CT scan, obtained immediately after RF ablation, shows a well-defined wedge-shaped infarcted area with low attenuation (arrowheads), as well as branching areas with attenuation similar to that of air (arrow), considered to be tributaries of the portal vein. (b) Follow-up CT scan (obtained 3 cm caudad to a) shows that the area of low attenuation (arrows) extends to the liver surface.

 

View larger version (170K): [in a new window]   Figure 4a.  Subcapsular hematoma in a 64-year-old man with hepatocellular carcinoma in segment IV. (a) Follow-up CT scan, obtained immediately after RF ablation, shows a biconvex lesion (arrows) with attenuation higher than that of water, located along the hepatic surface. (b) CT scan at a level lower than a shows that the hematoma extends to the subserosal space of the stomach (arrow).

 

View larger version (186K): [in a new window]   Figure 4b.  Subcapsular hematoma in a 64-year-old man with hepatocellular carcinoma in segment IV. (a) Follow-up CT scan, obtained immediately after RF ablation, shows a biconvex lesion (arrows) with attenuation higher than that of water, located along the hepatic surface. (b) CT scan at a level lower than a shows that the hematoma extends to the subserosal space of the stomach (arrow).

 

View larger version (140K): [in a new window]   Figure 5a.  Bile duct stenosis and biloma in a 67-year-old woman with hepatocellular carcinoma in segment III. (a) Follow-up CT scan, obtained 6 months after RF ablation, shows mild dilatation of the intrahepatic bile duct (arrows) in the lateral segment of the liver. (b) Follow-up CT scan, obtained 11 months after RF ablation and at approximately the same level as a, shows biloma formation (arrow) as well as exacerbation of dilatation of the bile duct (arrowheads). (c) US image shows an anechoic lesion that corresponds to the biloma (arrowhead) and dilated duct (arrow).

 

View larger version (169K): [in a new window]   Figure 5b.  Bile duct stenosis and biloma in a 67-year-old woman with hepatocellular carcinoma in segment III. (a) Follow-up CT scan, obtained 6 months after RF ablation, shows mild dilatation of the intrahepatic bile duct (arrows) in the lateral segment of the liver. (b) Follow-up CT scan, obtained 11 months after RF ablation and at approximately the same level as a, shows biloma formation (arrow) as well as exacerbation of dilatation of the bile duct (arrowheads). (c) US image shows an anechoic lesion that corresponds to the biloma (arrowhead) and dilated duct (arrow).

 

View larger version (131K): [in a new window]   Figure 5c.  Bile duct stenosis and biloma in a 67-year-old woman with hepatocellular carcinoma in segment III. (a) Follow-up CT scan, obtained 6 months after RF ablation, shows mild dilatation of the intrahepatic bile duct (arrows) in the lateral segment of the liver. (b) Follow-up CT scan, obtained 11 months after RF ablation and at approximately the same level as a, shows biloma formation (arrow) as well as exacerbation of dilatation of the bile duct (arrowheads). (c) US image shows an anechoic lesion that corresponds to the biloma (arrowhead) and dilated duct (arrow).

 

View larger version (131K): [in a new window]   Figure 6a.  Hepatic abscess in a 72-year-old man with hepatocellular carcinoma in segment VIII. (a) CT scan, obtained 4 months after RF ablation, shows an abscess with the typical target sign (arrow). (b) Follow-up CT scan, obtained after percutaneous drainage, shows improvement of the abscess (arrow).

 

View larger version (110K): [in a new window]   Figure 6b.  Hepatic abscess in a 72-year-old man with hepatocellular carcinoma in segment VIII. (a) CT scan, obtained 4 months after RF ablation, shows an abscess with the typical target sign (arrow). (b) Follow-up CT scan, obtained after percutaneous drainage, shows improvement of the abscess (arrow).

 

View larger version (137K): [in a new window]   Figure 7a.  Bleeding from a pseudoaneurysm into a hepatic abscess in a 70-year-old man. The patient had a history of Billroth II–type gastrectomy, right hepatic lobectomy, and radiation therapy for a portal vein tumor thrombus. RF ablation was performed for recurrent hepatocellular carcinoma in segment III. (a) US image, obtained soon after RF ablation, shows an inhomogeneous and relatively hyperechoic area that corresponds to the ablated area (arrowheads). (b, c) Follow-up US image (b) and CT scan (c), obtained 5 months after RF ablation, show a biloma (arrow) in the ablated area just anterior to the proper hepatic artery (arrowhead in c), with no evidence of pseudoaneurysm. (d) Unenhanced CT scan, obtained when the patient was admitted to the hospital for fever and melena 13 months after RF ablation, shows an area of high attenuation (arrow) suggestive of hemorrhage in an abscess derived from the biloma. (e) Subsequent angiogram helps to confirm a pseudoaneurysm of the proper hepatic artery (arrow). (f ) Follow-up angiogram obtained immediately after isolation of the pseudoaneurysm with fibered platinum embolization coils (arrowheads) shows that bleeding has stopped. No complication associated with embolization was documented. The abscess was controlled with antibiotics, without drainage.

 

View larger version (156K): [in a new window]   Figure 7b.  Bleeding from a pseudoaneurysm into a hepatic abscess in a 70-year-old man. The patient had a history of Billroth II–type gastrectomy, right hepatic lobectomy, and radiation therapy for a portal vein tumor thrombus. RF ablation was performed for recurrent hepatocellular carcinoma in segment III. (a) US image, obtained soon after RF ablation, shows an inhomogeneous and relatively hyperechoic area that corresponds to the ablated area (arrowheads). (b, c) Follow-up US image (b) and CT scan (c), obtained 5 months after RF ablation, show a biloma (arrow) in the ablated area just anterior to the proper hepatic artery (arrowhead in c), with no evidence of pseudoaneurysm. (d) Unenhanced CT scan, obtained when the patient was admitted to the hospital for fever and melena 13 months after RF ablation, shows an area of high attenuation (arrow) suggestive of hemorrhage in an abscess derived from the biloma. (e) Subsequent angiogram helps to confirm a pseudoaneurysm of the proper hepatic artery (arrow). (f ) Follow-up angiogram obtained immediately after isolation of the pseudoaneurysm with fibered platinum embolization coils (arrowheads) shows that bleeding has stopped. No complication associated with embolization was documented. The abscess was controlled with antibiotics, without drainage.

 

View larger version (154K): [in a new window]   Figure 7c.  Bleeding from a pseudoaneurysm into a hepatic abscess in a 70-year-old man. The patient had a history of Billroth II–type gastrectomy, right hepatic lobectomy, and radiation therapy for a portal vein tumor thrombus. RF ablation was performed for recurrent hepatocellular carcinoma in segment III. (a) US image, obtained soon after RF ablation, shows an inhomogeneous and relatively hyperechoic area that corresponds to the ablated area (arrowheads). (b, c) Follow-up US image (b) and CT scan (c), obtained 5 months after RF ablation, show a biloma (arrow) in the ablated area just anterior to the proper hepatic artery (arrowhead in c), with no evidence of pseudoaneurysm. (d) Unenhanced CT scan, obtained when the patient was admitted to the hospital for fever and melena 13 months after RF ablation, shows an area of high attenuation (arrow) suggestive of hemorrhage in an abscess derived from the biloma. (e) Subsequent angiogram helps to confirm a pseudoaneurysm of the proper hepatic artery (arrow). (f ) Follow-up angiogram obtained immediately after isolation of the pseudoaneurysm with fibered platinum embolization coils (arrowheads) shows that bleeding has stopped. No complication associated with embolization was documented. The abscess was controlled with antibiotics, without drainage.

 

View larger version (147K): [in a new window]   Figure 7d.  Bleeding from a pseudoaneurysm into a hepatic abscess in a 70-year-old man. The patient had a history of Billroth II–type gastrectomy, right hepatic lobectomy, and radiation therapy for a portal vein tumor thrombus. RF ablation was performed for recurrent hepatocellular carcinoma in segment III. (a) US image, obtained soon after RF ablation, shows an inhomogeneous and relatively hyperechoic area that corresponds to the ablated area (arrowheads). (b, c) Follow-up US image (b) and CT scan (c), obtained 5 months after RF ablation, show a biloma (arrow) in the ablated area just anterior to the proper hepatic artery (arrowhead in c), with no evidence of pseudoaneurysm. (d) Unenhanced CT scan, obtained when the patient was admitted to the hospital for fever and melena 13 months after RF ablation, shows an area of high attenuation (arrow) suggestive of hemorrhage in an abscess derived from the biloma. (e) Subsequent angiogram helps to confirm a pseudoaneurysm of the proper hepatic artery (arrow). (f ) Follow-up angiogram obtained immediately after isolation of the pseudoaneurysm with fibered platinum embolization coils (arrowheads) shows that bleeding has stopped. No complication associated with embolization was documented. The abscess was controlled with antibiotics, without drainage.

 

View larger version (134K): [in a new window]   Figure 7e.  Bleeding from a pseudoaneurysm into a hepatic abscess in a 70-year-old man. The patient had a history of Billroth II–type gastrectomy, right hepatic lobectomy, and radiation therapy for a portal vein tumor thrombus. RF ablation was performed for recurrent hepatocellular carcinoma in segment III. (a) US image, obtained soon after RF ablation, shows an inhomogeneous and relatively hyperechoic area that corresponds to the ablated area (arrowheads). (b, c) Follow-up US image (b) and CT scan (c), obtained 5 months after RF ablation, show a biloma (arrow) in the ablated area just anterior to the proper hepatic artery (arrowhead in c), with no evidence of pseudoaneurysm. (d) Unenhanced CT scan, obtained when the patient was admitted to the hospital for fever and melena 13 months after RF ablation, shows an area of high attenuation (arrow) suggestive of hemorrhage in an abscess derived from the biloma. (e) Subsequent angiogram helps to confirm a pseudoaneurysm of the proper hepatic artery (arrow). (f ) Follow-up angiogram obtained immediately after isolation of the pseudoaneurysm with fibered platinum embolization coils (arrowheads) shows that bleeding has stopped. No complication associated with embolization was documented. The abscess was controlled with antibiotics, without drainage.

 

View larger version (98K): [in a new window]   Figure 7f.  Bleeding from a pseudoaneurysm into a hepatic abscess in a 70-year-old man. The patient had a history of Billroth II–type gastrectomy, right hepatic lobectomy, and radiation therapy for a portal vein tumor thrombus. RF ablation was performed for recurrent hepatocellular carcinoma in segment III. (a) US image, obtained soon after RF ablation, shows an inhomogeneous and relatively hyperechoic area that corresponds to the ablated area (arrowheads). (b, c) Follow-up US image (b) and CT scan (c), obtained 5 months after RF ablation, show a biloma (arrow) in the ablated area just anterior to the proper hepatic artery (arrowhead in c), with no evidence of pseudoaneurysm. (d) Unenhanced CT scan, obtained when the patient was admitted to the hospital for fever and melena 13 months after RF ablation, shows an area of high attenuation (arrow) suggestive of hemorrhage in an abscess derived from the biloma. (e) Subsequent angiogram helps to confirm a pseudoaneurysm of the proper hepatic artery (arrow). (f ) Follow-up angiogram obtained immediately after isolation of the pseudoaneurysm with fibered platinum embolization coils (arrowheads) shows that bleeding has stopped. No complication associated with embolization was documented. The abscess was controlled with antibiotics, without drainage.

 

View larger version (129K): [in a new window]   Figure 8a.  Hemobilia in a 68-year-old man with hepatocellular carcinoma in segment VII who was readmitted for abdominal pain 3 days after RF ablation. (a) CT scan shows an area of high attenuation (arrow) that represents hemobilia in the common bile duct. (b) Endoscopic retrograde cholangiopancreatographic image helps to confirm hemobilia (arrows). The clot was removed and drainage was performed endoscopically. Bleeding was controlled without arterial embolization.

 

View larger version (139K): [in a new window]   Figure 8b.  Hemobilia in a 68-year-old man with hepatocellular carcinoma in segment VII who was readmitted for abdominal pain 3 days after RF ablation. (a) CT scan shows an area of high attenuation (arrow) that represents hemobilia in the common bile duct. (b) Endoscopic retrograde cholangiopancreatographic image helps to confirm hemobilia (arrows). The clot was removed and drainage was performed endoscopically. Bleeding was controlled without arterial embolization.

 

View larger version (153K): [in a new window]   Figure 9a.  Perforation of the colon in a 70-year-old man with hepatocellular carcinoma in segment VI. (a) CT scan, obtained 2 days after RF ablation, shows scattered air bubbles (arrow) and fat stranding (arrowheads). (b) Follow-up CT scan, obtained 2 weeks after RF ablation, shows an abscess (arrowheads) in the ablated area, and, between the colon and the abscess, a fistula (arrow) that developed despite management with fasting and antibiotic therapy. (c) CT scan, obtained 5 months after endoscopic aspiration and closure of the fistula, shows the absence of the abscess (arrow).

 

View larger version (159K): [in a new window]   Figure 9b.  Perforation of the colon in a 70-year-old man with hepatocellular carcinoma in segment VI. (a) CT scan, obtained 2 days after RF ablation, shows scattered air bubbles (arrow) and fat stranding (arrowheads). (b) Follow-up CT scan, obtained 2 weeks after RF ablation, shows an abscess (arrowheads) in the ablated area, and, between the colon and the abscess, a fistula (arrow) that developed despite management with fasting and antibiotic therapy. (c) CT scan, obtained 5 months after endoscopic aspiration and closure of the fistula, shows the absence of the abscess (arrow).

 

View larger version (160K): [in a new window]   Figure 9c.  Perforation of the colon in a 70-year-old man with hepatocellular carcinoma in segment VI. (a) CT scan, obtained 2 days after RF ablation, shows scattered air bubbles (arrow) and fat stranding (arrowheads). (b) Follow-up CT scan, obtained 2 weeks after RF ablation, shows an abscess (arrowheads) in the ablated area, and, between the colon and the abscess, a fistula (arrow) that developed despite management with fasting and antibiotic therapy. (c) CT scan, obtained 5 months after endoscopic aspiration and closure of the fistula, shows the absence of the abscess (arrow).

 

View larger version (155K): [in a new window]   Figure 10a.  Injury to the gallbladder and colon in a 70-year-old man with a history of anterior segmentectomy and percutaneous microwave coagulation therapy for hepatocellular carcinoma in segment VI 2 years earlier. (a) CT scan, obtained 2 days after RF ablation of hepatocellular carcinoma in segment IV, shows gas in the biliary tract (arrowheads) and fat stranding that surrounds a fistula (arrow) between the colon and the ablated area. (b) Cholangiogram obtained with contrast material injection via the drainage tube helps to confirm injury of the gallbladder (arrow) and colon (arrowhead).

 

View larger version (132K): [in a new window]   Figure 10b.  Injury to the gallbladder and colon in a 70-year-old man with a history of anterior segmentectomy and percutaneous microwave coagulation therapy for hepatocellular carcinoma in segment VI 2 years earlier. (a) CT scan, obtained 2 days after RF ablation of hepatocellular carcinoma in segment IV, shows gas in the biliary tract (arrowheads) and fat stranding that surrounds a fistula (arrow) between the colon and the ablated area. (b) Cholangiogram obtained with contrast material injection via the drainage tube helps to confirm injury of the gallbladder (arrow) and colon (arrowhead).

 

View larger version (95K): [in a new window]   Figure 11.  Pneumothorax in a 61-year-old man with hepatocellular carcinoma in segment VIII. CT scan obtained immediately after RF ablation shows pneumothorax (arrow), which resolved without drainage.

 

View larger version (150K): [in a new window]   Figure 12.  Tumor seeding in a 59-year-old woman with hepatocellular carcinoma in segment VI. Contrast-enhanced CT scan, obtained 2 years after RF ablation, shows a flat enhanced lesion (arrowhead) along the hypochondriac wall, near the ablated area (arrow).

 

---

HOME

HELP

FEEDBACK

SUBSCRIPTIONS

ARCHIVE

SEARCH

TABLE OF CONTENTS

RADIOGRAPHICS

RADIOLOGY

RSNA JOURNALS ONLINE

Copyright © 2005 by the Radiological Society of North America.