What is the role of CT scanning in the postprocedural follow-up of radiofrequency ablation (RFA) of liver tumors?

Answer

After RFA, patient follow-up normally includes contrast-enhanced CT (CECT). At the authors’ center, a post-RFA CT study is followed by a additional study 3 months later. The usual protocol on a multidetector CT consists of precontrast and dual-phase postcontrast helical scanning. (See the images below.)

CT appearance of a liver lesion before radiofrequency ablation.

View Media Gallery

CT appearance of a liver lesion after radiofrequency ablation.

View Media Gallery

Perihepatic collections and basal consolidation with pleural effusion are common, normal posttreatment changes. Intraperitoneal free fluid may also be seen; this normally resolves within a few days.^[22]Iatrogenic arterioportal shunting and small intralesional air pockets are also seen frequently at immediate follow-up CT.^[51]These usually settle within 1 month after the procedure.

A hypervascular area around the ablation, which represents increased arterial perfusion and possible inflammatory reaction after RFA, is the most common finding in the immediate postablation period.^[52]In one study, this was noted in approximately 90% of patients in the first month and in more than 50% of cases between 1-3 months.^[53]

A lesion with low attenuation and no enhancement after contrast with or without hyperattenuating rim shows a successful ablation.^[52]In contrast, nodular and thick enhancement represents a tumor recurrence.^[54]Another study indicated that lesion shape and nonenhanced CT attenuation are not significant parameters to differentiate between successfully and unsuccessfully treated lesions.^[55]On the other hand, increase in lesion size and nodular enhancement pattern have significant relation to treatment failure.

Catalano et al described four different helical CT patterns of recurrence post RFA, as follows^[56]:

Enhancing tissue within the edge of the ablated nodule (ingrowth)
Enhancing tissue around the treated nodule but continuously to its border (outgrowth)
Enhancing tissue within the same segment of the treated nodule on arterial phase images (spread)
Enhancing tissue within different segments from the treated nodule on arterial phase images (progression)

The postablation area is generally larger than the actual tumor size, for obvious reasons. An ablation area that is smaller than the tumor should be closely followed.^[51]The ablated area gradually decreases in size but may also remain stable over the course of time.

Curvilinear calcification at the edge of the ablated area and fat between the ablated zone and normal parenchyma may also be seen occasionally.^[22]

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Huo J, Aloia TA, Xu Y, Chung TH, Sheu T, Tina Shih YC. Comparative Effectiveness of Computed Tomography- Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma. Value Health. 2019 Mar. 22 (3):284-292. [Medline].
Shiina S. Japanese experience in ablation therapies for hepatocellular carcinoma. Hepatol Res. 2007 Sep. 37 Suppl 2:S223-9. [Medline].
Howard JH, Tzeng CW, Smith JK, Eckhoff DE, Bynon JS, Wang T, et al. Radiofrequency ablation for unresectable tumors of the liver. Am Surg. 2008 Jul. 74 (7):594-600; discussion 600-1. [Medline].
Wells SA, Hinshaw JL, Lubner MG, Ziemlewicz TJ, Brace CL, Lee FT Jr. Liver Ablation: Best Practice. Radiol Clin North Am. 2015 Sep. 53 (5):933-71. [Medline].
Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. 2005 Mar. 234 (3):961-7. [Medline].
Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, et al. Experience with more than 500 minimally invasive hepatic procedures. Ann Surg. 2008 Sep. 248 (3):475-86. [Medline].
Brunello F, Veltri A, Carucci P, Pagano E, Ciccone G, Moretto P, et al. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scand J Gastroenterol. 2008. 43 (6):727-35. [Medline].
Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology. 1999 Mar. 210 (3):655-61. [Medline].
Ansari D, Andersson R. Radiofrequency ablation or percutaneous ethanol injection for the treatment of liver tumors. World J Gastroenterol. 2012 Mar 14. 18 (10):1003-8. [Medline]. [Full Text].
Cha DI, Lee MW, Rhim H, Choi D, Kim YS, Lim HK. Therapeutic efficacy and safety of percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas in high risk locations. Korean J Radiol. 2013 Mar-Apr. 14 (2):240-7. [Medline]. [Full Text].
Yamagiwa K, Shiraki K, Yamakado K, Mizuno S, Hori T, Yagi S, et al. Survival rates according to the Cancer of the Liver Italian Program scores of 345 hepatocellular carcinoma patients after multimodality treatments during a 10-year period in a retrospective study. J Gastroenterol Hepatol. 2008 Mar. 23 (3):482-90. [Medline].
Patidar Y, Garg L, Mukund A, Sarin SK. Early experience of combination therapy of transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma measuring 3-7 cm. Indian J Radiol Imaging. 2019 Jan-Mar. 29 (1):47-52. [Medline]. [Full Text].
Wang H, Liu B, Long H, Zhang F, Wang S, Li F. Clinical study of radiofrequency ablation combined with TACE in the treatment of breast cancer with liver metastasis. Oncol Lett. 2017 Sep. 14 (3):2699-2702. [Medline].
Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Kawase T, Yoshida K, et al. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinomas. J Gastroenterol Hepatol. 2009 Feb. 24 (2):223-7. [Medline].
Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Kawase T, Yoshida K, et al. Radiofrequency ablation versus percutaneous microwave coagulation therapy for small hepatocellular carcinomas: a retrospective comparative study. Hepatogastroenterology. 2007 Jun. 54 (76):985-9. [Medline].
Glassberg MB, Ghosh S, Clymer JW, Qadeer RA, Ferko NC, Sadeghirad B, et al. Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. Onco Targets Ther. 2019. 12:6407-6438. [Medline]. [Full Text].
Lencioni R, Crocetti L. A critical appraisal of the literature on local ablative therapies for hepatocellular carcinoma. Clin Liver Dis. 2005 May. 9 (2):301-14, viii. [Medline].
Crocetti L, Lencioni R. Thermal ablation of hepatocellular carcinoma. Cancer Imaging. 2008 Feb 27. 8:19-26. [Medline].
Salmi A, Turrini R, Lanzani G, Viviani G, Zappella A, Savio A, et al. Long-term effectiveness of radiofrequency ablation for hepatocellular carcinoma of 3.5 cm or less. Hepatogastroenterology. 2008 Jan-Feb. 55 (81):191-6. [Medline].
Kim GA, Shim JH, Kim MJ, Kim SY, Won HJ, Shin YM, et al. Radiofrequency ablation as an alternative to hepatic resection for single small hepatocellular carcinomas. Br J Surg. 2016 Jan. 103 (1):126-35. [Medline].
Jansen MC, van Hillegersberg R, Chamuleau RA, van Delden OM, Gouma DJ, van Gulik TM. Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review. Eur J Surg Oncol. 2005 May. 31 (4):331-47. [Medline].
Smith S, Gillams A. Imaging appearances following thermal ablation. Clin Radiol. 2008 Jan. 63 (1):1-11. [Medline].
Grundmann RT, Hermanek P, Merkel S, Germer CT, Grundmann RT, Hauss J, et al. [Diagnosis and treatment of colorectal liver metastases - workflow]. Zentralbl Chir. 2008 Jun. 133 (3):267-84. [Medline].
Lawes D, Chopada A, Gillams A, Lees W, Taylor I. Radiofrequency ablation (RFA) as a cytoreductive strategy for hepatic metastasis from breast cancer. Ann R Coll Surg Engl. 2006 Nov. 88 (7):639-42. [Medline].
Wertenbroek MW, Links TP, Prins TR, Plukker JT, van der Jagt EJ, de Jong KP. Radiofrequency ablation of hepatic metastases from thyroid carcinoma. Thyroid. 2008 Oct. 18 (10):1105-10. [Medline].
Gillams A, Cassoni A, Conway G, Lees W. Radiofrequency ablation of neuroendocrine liver metastases: the Middlesex experience. Abdom Imaging. 2005 Jul-Aug. 30 (4):435-41. [Medline].
Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ, Bilchik AJ. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol. 2000 Sep. 7 (8):593-600. [Medline].
Chen S, Peng Z, Xiao H, Lin M, Chen Z, Jiang C, et al. Combined Radiofrequency Ablation and Ethanol Injection Versus Repeat Hepatectomy for Elderly Patients with Recurrent Hepatocellular Carcinoma after Initial Hepatic Surgery. Int J Hyperthermia. 2017 Oct 4. 1-34. [Medline].
Shiina S, Sato K, Tateishi R, Shimizu M, Ohama H, Hatanaka T, et al. Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery. Can J Gastroenterol Hepatol. 2018. 2018:4756147. [Medline]. [Full Text].
van Duijnhoven FH, Jansen MC, Junggeburt JM, van Hillegersberg R, Rijken AM, van Coevorden F, et al. Factors influencing the local failure rate of radiofrequency ablation of colorectal liver metastases. Ann Surg Oncol. 2006 May. 13 (5):651-8. [Medline].
Seror O, Haddar D, N'Kontchou G, Ajavon Y, Trinchet JC, Beaugrand M, et al. Radiofrequency ablation for the treatment of liver tumors in the caudate lobe. J Vasc Interv Radiol. 2005 Jul. 16 (7):981-90. [Medline].
Hatanaka T, Kakizaki S, Yuhei S, Takeuchi S, Shimada Y, Takizawa D, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma located in the caudate lobe of the liver. Acta Gastroenterol Belg. 2015 Jul-Sep. 78 (3):267-73. [Medline].
Bilchik AJ, Wood TF, Allegra DP. Radiofrequency ablation of unresectable hepatic malignancies: lessons learned. Oncologist. 2001. 6 (1):24-33. [Medline].
Huang GT, Liang JD, Sheu JC. Current role of local ablative treatments for hepatocellular carcinoma. J Formos Med Assoc. 2004 Jun. 103 (6):403-10. [Medline].
Lencioni R, Cioni D, Crocetti L, Bartolozzi C. Percutaneous ablation of hepatocellular carcinoma: state-of-the-art. Liver Transpl. 2004 Feb. 10 (2 Suppl 1):S91-7. [Medline].
Lencioni R, Della Pina C, Bartolozzi C. Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma. Abdom Imaging. 2005 Jul-Aug. 30 (4):401-8. [Medline].
Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg. 2006 Feb. 141 (2):181-90. [Medline].
Penka I, Kaplan Z, Sefr R, Sirotek L, Eber Z, Ondrák M. Use of radiofrequency ablation in the treatment of malignant liver lesions. Hepatogastroenterology. 2008 Mar-Apr. 55 (82-83):562-7. [Medline].
Toshimori J, Nouso K, Nakamura S, Wada N, Morimoto Y, Takeuchi Y, et al. Local Recurrence and Complications after Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma: A Retrospective Cohort Study Focused on Tumor Location. Acta Med Okayama. 2015 Aug. 69 (4):219-26. [Medline].
Shady W, Petre EN, Gonen M, Erinjeri JP, Brown KT, Covey AM, et al. Percutaneous Radiofrequency Ablation of Colorectal Cancer Liver Metastases: Factors Affecting Outcomes--A 10-year Experience at a Single Center. Radiology. 2016 Feb. 278 (2):601-11. [Medline].
Yamao T, Imai K, Yamashita YI, Kaida T, Nakagawa S, Mima K, et al. Surgical treatment strategy for hepatocellular carcinoma in patients with impaired liver function: hepatic resection or radiofrequency ablation?. HPB (Oxford). 2018 Mar. 20 (3):244-250. [Medline].
Weissleder R, Wittenberg J, Harisinghani MG, Chen JW. Gastrointestinal imaging. Primer of Diagnostic Imaging. 5th ed. St Louis: Elsevier Mosby; 2011. 150-61.
Mulier S, Ni Y, Miao Y, Rosière A, Khoury A, Marchal G, et al. Size and geometry of hepatic radiofrequency lesions. Eur J Surg Oncol. 2003 Dec. 29 (10):867-78. [Medline].
Hänsler J, Frieser M, Tietz V, Uhlke D, Wissniowski TT, Bernatik T, et al. Percutaneous ultrasound-guided radiofrequency ablation (RFA) using saline-perfused (wet) needle electrodes for the treatment of hepatocellular carcinoma--long term experience. Ultraschall Med. 2007 Dec. 28 (6):604-11. [Medline].
Panpikoon T, Treesit T, Thapaneeyakorn J, Wedsart B, Inman T. Efficacy of percutaneous radiofrequency ablation of hepatic malignant tumors using a perfused-cooled electrode. J Med Assoc Thai. 2013 Jan. 96 (1):77-82. [Medline].
Curley SA. Radiofrequency ablation of malignant liver tumors. Ann Surg Oncol. 2003 May. 10 (4):338-47. [Medline].
Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003 Feb. 226 (2):441-51. [Medline].
Carrafiello G, Laganà D, Ianniello A, Dionigi G, Novario R, Recaldini C, et al. Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours: one centre experience and review of published works. Australas Radiol. 2007 Dec. 51 (6):550-4. [Medline].
Giorgio A, Tarantino L, de Stefano G, Coppola C, Ferraioli G. Complications after percutaneous saline-enhanced radiofrequency ablation of liver tumors: 3-year experience with 336 patients at a single center. AJR Am J Roentgenol. 2005 Jan. 184 (1):207-11. [Medline].
Giovannini M, Moutardier V, Danisi C, Bories E, Pesenti C, Delpéro JR. Treatment of hepatocellular carcinoma using percutaneous radiofrequency thermoablation: results and outcomes in 56 patients. J Gastrointest Surg. 2003 Sep-Oct. 7 (6):791-6. [Medline].
Kim SK, Lim HK, Kim YH, Lee WJ, Lee SJ, Kim SH, et al. Hepatocellular carcinoma treated with radio-frequency ablation: spectrum of imaging findings. Radiographics. 2003 Jan-Feb. 23 (1):107-21. [Medline].
Lim HK, Choi D, Lee WJ, Kim SH, Lee SJ, Jang HJ, et al. Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology. 2001 Nov. 221 (2):447-54. [Medline].
Tsuda M, Majima K, Yamada T, Saitou H, Ishibashi T, Takahashi S. Hepatocellular carcinoma after radiofrequency ablation therapy: dynamic CT evaluation of treatment. Clin Imaging. 2001 Nov-Dec. 25 (6):409-15. [Medline].
Nghiem HV, Francis IR, Fontana R, Hussain H, Platt JF, Higgins E, et al. Computed tomography appearances of hypervascular hepatic tumors after percutaneous radiofrequency ablation therapy. Curr Probl Diagn Radiol. 2002 May-Jun. 31 (3):105-11. [Medline].
Filippone A, Iezzi R, Di Fabio F, Cianci R, Grassedonio E, Storto ML. Multidetector-row computed tomography of focal liver lesions treated by radiofrequency ablation: spectrum of findings at long-term follow-up. J Comput Assist Tomogr. 2007 Jan-Feb. 31 (1):42-52. [Medline].
Catalano O, Lobianco R, Esposito M, Siani A. Hepatocellular carcinoma recurrence after percutaneous ablation therapy: helical CT patterns. Abdom Imaging. 2001 Jul-Aug. 26 (4):375-83. [Medline].
Chen MH, Wu W, Yang W, Dai Y, Gao W, Yin SS, et al. The use of contrast-enhanced ultrasonography in the selection of patients with hepatocellular carcinoma for radio frequency ablation therapy. J Ultrasound Med. 2007 Aug. 26 (8):1055-63. [Medline].
Wu J, Yang W, Yin S, Wu J, Wu W, Yan K, et al. Role of contrast-enhanced ultrasonography in percutaneous radiofrequency ablation of liver metastases and efficacy evaluation. Chin J Cancer Res. 2013 Apr. 25 (2):143-54. [Medline]. [Full Text].
Nicolau C, Vilana R, Bianchi L, Brú C. Early-stage hepatocellular carcinoma: the high accuracy of real-time contrast-enhanced ultrasonography in the assessment of response to percutaneous treatment. Eur Radiol. 2007 Dec. 17 Suppl 6:F80-8. [Medline].
Meloni MF, Livraghi T, Filice C, Lazzaroni S, Calliada F, Perretti L. Radiofrequency ablation of liver tumors: the role of microbubble ultrasound contrast agents. Ultrasound Q. 2006 Mar. 22 (1):41-7. [Medline].
Bruenn K, Beyer L, Haimerl M, Pregler B, Stroszczynski C, Jung EM, et al. Comparison of computed tomography (CT) and contrast-enhanced ultrasound (CEUS) for the quantitative evaluation of an ablation defect following radiofrequency ablation of malignant liver lesions. Clin Hemorheol Microcirc. 2017. 67 (3-4):445-451. [Medline].
Wen YL, Kudo M, Zheng RQ, Minami Y, Chung H, Suetomi Y, et al. Radiofrequency ablation of hepatocellular carcinoma: therapeutic response using contrast-enhanced coded phase-inversion harmonic sonography. AJR Am J Roentgenol. 2003 Jul. 181 (1):57-63. [Medline].
Nishigori S, Numata K, Irie K, Fukuda H, Chuma M, Maeda S. Fusion imaging with contrast-enhanced ultrasonography for evaluating the early therapeutic efficacy of radiofrequency ablation for small hypervascular hepatocellular carcinomas with iso-echoic or unclear margins on conventional ultrasonography. J Med Ultrason (2001). 2018 Jul. 45 (3):405-415. [Medline].
Bartolozzi C, Lencioni R, Caramella D, Mazzeo S, Ciancia EM. Treatment of hepatocellular carcinoma with percutaneous ethanol injection: evaluation with contrast-enhanced MR imaging. AJR Am J Roentgenol. 1994 Apr. 162 (4):827-31. [Medline].
Sironi S, Livraghi T, Meloni F, De Cobelli F, Ferrero C, Del Maschio A. Small hepatocellular carcinoma treated with percutaneous RF ablation: MR imaging follow-up. AJR Am J Roentgenol. 1999 Nov. 173 (5):1225-9. [Medline].
Dromain C, de Baere T, Elias D, Kuoch V, Ducreux M, Boige V, et al. Hepatic tumors treated with percutaneous radio-frequency ablation: CT and MR imaging follow-up. Radiology. 2002 Apr. 223 (1):255-62. [Medline].
Vossen JA, Buijs M, Kamel IR. Assessment of tumor response on MR imaging after locoregional therapy. Tech Vasc Interv Radiol. 2006 Sep. 9 (3):125-32. [Medline].
Travaini LL, Trifirò G, Ravasi L, Monfardini L, Della Vigna P, Bonomo G, et al. Role of [18F]FDG-PET/CT after radiofrequency ablation of liver metastases: preliminary results. Eur J Nucl Med Mol Imaging. 2008 Jul. 35 (7):1316-22. [Medline].
Kuehl H, Antoch G, Stergar H, Veit-Haibach P, Rosenbaum-Krumme S, Vogt F, et al. Comparison of FDG-PET, PET/CT and MRI for follow-up of colorectal liver metastases treated with radiofrequency ablation: initial results. Eur J Radiol. 2008 Aug. 67 (2):362-71. [Medline].
Donckier V, Van Laethem JL, Goldman S, Van Gansbeke D, Feron P, Ickx B, et al. [F-18] fluorodeoxyglucose positron emission tomography as a tool for early recognition of incomplete tumor destruction after radiofrequency ablation for liver metastases. J Surg Oncol. 2003 Dec. 84 (4):215-23. [Medline].

Media Gallery

Ultrasound image of liver after radiofrequency ablation.
CT appearance of a liver lesion before radiofrequency ablation.
CT appearance of a liver lesion after radiofrequency ablation.
Electrodes for radiofrequency ablation.
Umbrella-type electrodes for radiofrequency ablation.

of 5

What is the role of CT scanning in the postprocedural follow-up of radiofrequency ablation (RFA) of liver tumors?

Related Questions:

References

Tables

Contributor Information and Disclosures