Radiology: Radiofrequency ablation

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, and occurs in the setting of cirrhosis in 80% of cases.  With appropriate screening methods, including ultrasound and alpha fetoprotein (AFP) measurements at six-month intervals for patients with cirrhosis, many more HCC are detected at a treatable stage.

Treatment options are severalfold.  The only curative options are surgical in nature; resection and transplantation should always be considered unless contraindications exist.  If a tumor cannot be addressed surgically, the next set of options include locoregional therapy, like radiofrequency ablation (RFA).

RFA is generally preferred in HCC less than 3 cm in greatest diameter.  Caveats include tumors that are adjacent to other organs, like the gallbladder or diaphragm, or large caliber blood vessels that act as a heat sink and lead to incomplete ablation.  In the image below, a RFA probe reaches the HCC in a transcutaneous approach; high temperatures cause necrosis of the lesion and immediate surrounding  parenchyma.  Follow up imaging is usually performed one month later to determine procedure efficacy, after local edema has had time to disappear.

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