3 - Diagnostic imaging pre- and post-ablation

Summary

Introduction

Hepatic malignant tumors are common worldwide. Surgical resection and, in rare instances, liver transplantation represent the gold standard of management, offering a chance of cure in selected patients. The overall 3-year survival rate in patients with hepatocellular carcinoma (HCC) who undergo surgical resection is between 47.2% and 83.9%, and the overall 5-year survival rate in patients with colorectal liver metastases who undergo surgical resection is between 35% and 58%. However, curative resection is frequently precluded because of medical comorbidities that render patients inoperable. Less than 25% of patients with either primary HCC or colorectal liver metastases are candidates for surgical resection.

Since the 1990s, radiofrequency ablation (RFA) of primary and secondary hepatic malignancies has had promising results in local control of tumors. With advances in imaging modalities and refinements of ablation technique, as well as more powerful generators, the outcome of RFA for hepatic tumors has improved significantly in the past several years. RFA can achieve complete necrosis of the tumor without adverse effects on liver function. To date, RFA is considered a reasonable alternative for patients with four or fewer hepatic tumors that are less than 3–5 cm in diameter. The absolute contraindications of RFA include extrahepatic disease, life expectancy less than 6 months, other active malignant disease, cirrhosis or hepatic insufficiency, portal hypertension or portal vein thrombosis, altered mental status, age less than 18 years, pregnancy, severe pulmonary disease, active infection, and refractory coagulopathy.