Radiofrequency Ablation of Hepatic Lesions: A Review

Venkataramu N. Krishnamurthy, MD; V. Javier Casillas, MD; Lina Latorre, MD


Appl Radiol. 2003;32(10) 

In This Article

Preprocedural Evaluation

Complete evaluation of the patient, including clinical history and directed physical examination, is required. Table 2 gives a summary of the required preprocedural investigations and their significance. Any active infection, uncorrectable coagulopathy, untreatable extrahepatic tumor spread, and extreme debility are contraindications. Histopathologic confirmation of malignancy by biopsy is essential in all patients. Written and informed consent should be obtained.

Imaging studies form the basis for treatment. Triple-phase computed tomography (CT) scanning or contrast-enhanced magnetic resonance imaging (MRI) scanning is usually required. The number of lesions, their size, location, relationship to adjacent viscera (eg, intestines, diaphragm, gallbladder), and proximity to major intrahepatic vessels (eg, hepatic and portal veins) should be carefully recorded. Ideal tumors for RF ablation are <3 cm in diameter, completely surrounded by hepatic parenchyma, >=1 cm deep to the liver capsule, >=2 cm away from large hepatic or portal veins, and <5 in number. Patients with too much of a tumor burden (>5 cm in diameter and >5 lesions) are not good candidates. Extrahepatic tumor spread should be evaluated with a bone scan or chest CT scan, if clinically appropriate.