• Korean Journal of Radiology
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• 제24권8호
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• pp.719-728
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• 2023

Radiofrequency ablation (RFA) has been widely used to manage hepatocellular carcinomas (HCCs) equal to or smaller than 3 cm. No-touch RFA has gained attention and has recently been implemented in local ablation therapy for HCCs, despite its technical complexity, as it provides improved local tumor control compared to conventional tumor-puncturing RFA. This article presents the practice guidelines for performing no-touch RFA for HCCs, which have been endorsed by the Korean Society of Image-Guided Tumor Ablation (KSITA). The guidelines are primarily designed to assist interventional oncologists and address the limitations of conventional tumor-puncturing RFA with describing the fundamental principles, various energy delivery methods, and clinical outcomes of no-touch RFA. The clinical outcomes include technical feasibility, local tumor progression rates, survival outcomes, and potential complications.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5799-5804
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• 2014

Background: Radiofrequency ablation (RFA) is the most widely used and studied method internationally for the local treatment of liver tumors. However, the extension of coagulation necrosis in one RFA procedure is limited and incomplete coverage of the damaged area can lead to a high local recurrence rate. Objective: In this study, we compared the effects of different solutions in enhancing hepatic radiofrequency by establishing a rabbit VX2 liver cancer model. We also determined the optimal solution to maximise effects on the extent of RFA-induced coagulation necrosis. Methods: Thirty VX2 tumor rabbits were randomly assigned to five groups: group A, RFA alone; group B, RFA with anhydrous ethanol injection; group C, RFA with 5% hypertonic saline injection; group D, RFA with lidocaine injection; and group E, RFA with a mixed solution. Routine ultrasound examinations and contrast-enhanced ultrasound (CEUS) of the ablation areas were performed after RFA. Then, we measured the major axis and transverse diameter and compared the areas of coagulation necrosis induced by RFA. Results: The mean ablation area range increased in groups B, C and especially E, and the scopes were greater compared with group A. Preoperative application of anhydrous ethanol, hypertonic saline, lidocaine and the mixed solution (groups B, C, D and E, respectively) resulted in larger coagulation necrosis areas than in group A (p<0.05). Among the groups, the coagulation necrosis areas in group E was largest, and the difference was statistically significant compared with other groups (p<0.05). Pathological findings were consistent with imaging results. Conclusions: A mixture of dehydrated alcohol, hypertonic saline and lidocaine injected with RFA increases the extent of coagulation necrosis in the liver with a single application, and the mixed solution is more effective than any other injection alone.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7897-7903
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• 2015

Background: To explored the value of 3D C-arm CT (CACT) guidance system in performing radiofrequency ablation (RFA) following transarterial chemoembolizationon (TACE) for hepatocellular carcinomas. Materials and Methods: RFA of hepatocellular carcinomas (HCC) were performed on 15 patients (21 lesions) with the assistance of CACT guidance system. Technical success, procedure time, complications and patient radiation exposure were investigated. The puncture performance level was evaluated on a five-point scale (5-1: excellent-poor). Complete ablation rate was evaluated after two months follow-up using enhanced CT scans. Results: The technical success rate of RFA procedure under CACT navigation system was 100 %. Mean total procedure time was $24.24{\pm}6.53min$, resulting in a mean effective exposure dose of $15.4{\pm}5.1mSv$. The mean puncture performance level rated for CACT guided RFA procedure was $4.87{\pm}0.35$. Complete ablation (CA) was achieved in 20 (95.2%) of the treated 21 tumors after the first RFA session. None of patients developed intra-procedural complications. Conclusions: 3D CACT guidance system enables reliable and efficient needle positioning by providing real-time intraoperative guidance for performing RFA on HCCs.

• 대한영상의학회지
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• 제84권5호
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• pp.985-998
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• 2023

고주파절제는 외모상의 문제나 경부 압박 증상을 유발하는 양성갑상선결절에 대한 대표적인 비수술적 치료법으로 시술은 효과적이면서도 안전하게 시행되어야 한다. 이 종설은 갑상선고주파절제에 대한 권고안들과 연구 논문들을 참조하여 대상 환자 선정, 시술 전 평가 및 치료 계획, 치료 원리 및 치료 기구, 시술법, 합병증 등에 대한 정보를 제공하려는 목적으로 작성되었다. 특히 시술법에 많은 부분을 할애해 시술 시행에 실질적인 도움을 주고자 한다.

• Clinical Endoscopy
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• 제56권2호
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• pp.155-163
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• 2023

Malignant hilar biliary obstruction (MHO), an aggressive perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment for biliary malignancies. However, the majority of patients with MHO cannot undergo surgery on presentation because of an advanced inoperable state or a poor performance state due to old age or comorbid diseases. Therefore, palliative biliary drainage is mandatory to improve symptomatic jaundice and the quality of life. Among the drainage methods, endoscopic biliary drainage is the current standard for palliation of unresectable advanced MHO. In addition, combined with endoscopic drainage, additional local ablation therapies, such as photodynamic therapy or radiofrequency ablation (RFA), have been introduced to prolong stent patency and survival. Currently, RFA is commonly used as palliative therapy, even for advanced MHO. This literature review summarizes recent studies on RFA for advanced MHO.

• Investigative Magnetic Resonance Imaging
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• 제20권4호
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• pp.231-240
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• 2016

Purpose: To determine whether liver stiffness (LS) measured by magnetic resonance elastography (MRE) can predict the outcome of radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients. Materials and Methods: A total of 107 patients with Child-Pugh class A liver function who were treated with RFA for single HCC and who had undergone a gradient-echo MRE within 6 months before RFA were included. We evaluated the relationship between the LS values and the ablation volume, local tumor progression (LTP), and intrahepatic distant recurrence (IDR). We also constructed receiver operating characteristic (ROC) curves to examine the role of LS in predicting liver function deterioration, which was defined as an increase of Child-Pugh score by one point or more at 1 year after RFA. Results: There was no significant correlation between LS and ablation volume, and neither time to LTP nor IDR was associated with LS. Among the 66 patients who did not have recurrence 1 year after RFA, 5 patients (7.6%) developed liver function deterioration. A high LS value was significantly associated with development of liver function deterioration after RFA and the area under the ROC curve was 0.764 (95% CI 0.598-0.929, P = 0.003). Conclusion: LS measured by MRE could not predict ablation volume and tumor recurrence. However, high LS values were significantly associated with development of liver function deterioration.

• Korean Journal of Radiology
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• 제22권2호
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• pp.179-188
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• 2021

Objective: This study aimed to prospectively compare the efficacy, safety, and mid-term outcomes of dual-switching monopolar (DSM) radiofrequency ablation (RFA) to those of conventional single-switching monopolar (SSM) RFA in the treatment of hepatocellular carcinoma (HCC). Materials and Methods: This single-center, two-arm, parallel-group, randomized controlled study was approved by the Institutional Review Board. Written informed consent was obtained from all patients upon enrollment. A total of 80 patients with 94 HCC nodules were randomized into either the DSM-RFA group or SSM-RFA group in a 1:1 ratio, using a blocked randomization method (block size 2). The primary endpoint was the minimum diameter of the ablation zone per unit time. The secondary endpoints included other technical parameters, complication rate, technique efficacy, and 2-year clinical outcomes. Results: Significantly higher ablation energy per unit time was delivered to the DSM-RFA group than to the SSM-RFA group (1.7 ± 0.2 kcal/min vs. 1.2 ± 0.3 kcal/min; p < 0.001). However, no significant differences were observed between the two groups for the analyzed variables, including primary endpoint, regarding size of the ablation zone and ablation time. Major complication rates were 4.9% in the DSM-RFA group and 2.6% in the SSM-RFA group (p = 1.000). The 2-year local tumor progression (LTP) rates of the HCC nodules treated using DSM-RFA and SSM-RFA were 8.5% and 4.7%, respectively (p = 0.316). The 2-year LTP-free survival rates of patients in the DSM-RFA and SSM-RFA groups were 90.0% and 94.4%, respectively (p = 0.331), and the 2-year recurrence-free survival rates were 54.9% and 75.7%, respectively (p = 0.265). Conclusion: Although DSM-RFA using a separable clustered electrode delivers higher ablation energy than SSM-RFA, its effectiveness failed to show superiority over SSM-RFA in the treatment of HCC.

• International Journal of Computer Science & Network Security
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• 제23권2호
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• pp.183-192
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• 2023

Radiofrequency ablation (RFA) is an alternative treatment for liver cancer to the surgical intervention preferred by surgeons. However, the main challenge remains the use of RF for the ablation of large tumours (i.e., tumours with a diameter of >3 cm). For large tumours, RFA takes a large duration in the ablation process compared with surgery, which increases patient pain. Therefore, RFA for large tumours is not preferred by surgeons. The currently materials used in RF electrodes, such as the nickeltitanium alloy (nitinol), are characterized by low thermal and electrical conductivities. On the other hand, the use of materials that have high thermal and electrical conductivities, such as titanium aluminide alloy (gamma titanium), produces more thermal energy for tumours. In this paper, we developed a cool-tip RF electrode model that uses nickel-titanium alloy and replaced it with titanium aluminide alloy by using the finite element model (FEM). The aim of this paper is to study the effect of the thermal and electrical conductivities of gamma titanium on the ablation volume. Results showed that the proposed design of the electrode increased the ablation rate by 1 cm³ /minute and 6.3 cm³/10 minutes, with a decrease in the required time ablation. Finally, the proposed model reduces the ablation time and damages healthy tissue while increasing the ablation volume from 22.5% cm³ to 62.5% cm³ in ten minutes compared to recent studies.

• Korean Journal of Radiology
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• 제24권2호
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• pp.86-94
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• 2023

Objective: To compare Octopus multipurpose (MP) electrodes, which are capable of saline instillation and direct tissue temperature measurement, and conventional electrodes for radiofrequency ablation (RFA) in porcine livers in vivo. Materials and Methods: Sixteen pigs were used in this study. In the first experiment, RFA was performed in the liver for 6 minutes using Octopus MP electrodes (n = 15 ablation zones) and conventional electrodes (n = 12 ablation zones) to investigate the effect of saline instillation. The ablation energy, electrical impedance, and ablation volume of the two electrodes were compared. In the second experiment, RFA was performed near the gallbladder (GB) and colon using Octopus MP electrodes (n = 12 ablation zones for each) with direct tissue temperature monitoring and conventional electrodes (n = 11 ablation zones for each). RFA was discontinued when the temperature increased to > 60℃ in the Octopus MP electrode group, whereas RFA was performed for a total of 6 minutes in the conventional electrode group. Thermal injury was assessed and compared between the two groups by pathological examination. Results: In the first experiment, the ablation volume and total energy delivered in the Octopus MP electrode group were significantly larger than those in the conventional electrode group (15.7 ± 4.26 cm³ vs. 12.5 ± 2.14 cm³, p = 0.027; 5.48 ± 0.49 Kcal vs. 5.04 ± 0.49 Kcal, p = 0.029). In the second experiment, thermal injury to the GB and colon was less frequently noted in the Octopus MP electrode group than that in the conventional electrode group (16.7% [2/12] vs. 90.9% [10/11] for GB and 8.3% [1/12] vs. 90.9% [10/11] for colon, p < 0.001 for all). The total energy delivered around the GB (2.65 ± 1.07 Kcal vs. 5.04 ± 0.66 Kcal) and colon (2.58 ± 0.57 Kcal vs. 5.17 ± 0.90 Kcal) were significantly lower in the Octopus MP electrode group than that in the conventional electrode group (p < 0.001 for all). Conclusion: RFA using the Octopus MP electrodes induced a larger ablation volume and resulted in less thermal injury to the adjacent organs compared with conventional electrodes.

• Korean Journal of Radiology
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• 제19권6호
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• pp.1053-1065
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• 2018

Objective: To evaluate the clinical impact of using registration software for ablative margin assessment on pre-radiofrequency ablation (RFA) magnetic resonance imaging (MRI) and post-RFA computed tomography (CT) compared with the conventional side-by-side MR-CT visual comparison. Materials and Methods: In this Institutional Review Board-approved prospective study, 68 patients with 88 hepatocellulcar carcinomas (HCCs) who had undergone pre-RFA MRI were enrolled. Informed consent was obtained from all patients. Pre-RFA MRI and post-RFA CT images were analyzed to evaluate the presence of a sufficient safety margin (${\geq}3mm$) in two separate sessions using either side-by-side visual comparison or non-rigid registration software. Patients with an insufficient ablative margin on either one or both methods underwent additional treatment depending on the technical feasibility and patient's condition. Then, ablative margins were re-assessed using both methods. Local tumor progression (LTP) rates were compared between the sufficient and insufficient margin groups in each method. Results: The two methods showed 14.8% (13/88) discordance in estimating sufficient ablative margins. On registration software-assisted inspection, patients with insufficient ablative margins showed a significantly higher 5-year LTP rate than those with sufficient ablative margins (66.7% vs. 27.0%, p = 0.004). However, classification by visual inspection alone did not reveal a significant difference in 5-year LTP between the two groups (28.6% vs. 30.5%, p = 0.79). Conclusion: Registration software provided better ablative margin assessment than did visual inspection in patients with HCCs who had undergone pre-RFA MRI and post-RFA CT for prediction of LTP after RFA and may provide more precise risk stratification of those who are treated with RFA.