EDUCATION EXHIBIT - Continuing Medical Education

Major Complications after Radio-frequency Thermal Ablation of Hepatic Tumors: Spectrum of Imaging Findings

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Although radio-frequency (RF) ablation has been accepted as a promising and safe technique for treatment of unresectable hepatic tumors, investigation of its complications has been limited. According to the multicenter (1,139 patients in 11 institutions) survey data of the Korean Study Group of Radiofrequency Ablation, a spectrum of complications occurred after RF ablation of hepatic tumors. The prevalence of major complications was 2.43%. The most common complications were hepatic abscess (0.66%), peritoneal hemorrhage (0.46%), biloma (0.20%), ground pad burn (0.20%), pneumothorax (0.20%), and vasovagal reflex (0.13%). Other complications were biliary stricture, diaphragmatic injury, gastric ulcer, hemothorax, hepatic failure, hepatic infarction, renal infarction, sepsis, and transient ischemic attack. One procedure-related death (0.09%) occurred (due to peritoneal hemorrhage). Three important strategies for decreasing the rate of complications are prevention, early detection, and proper management. A physician who performs RF ablation of hepatic malignancies should be aware of the broad spectrum of major complications so that these strategies can be used.

© RSNA, 2003


  • 1 Dodd GD, III, Soulen M, Kane R, et al. Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. RadioGraphics 2000; 20:9-27. LinkGoogle Scholar
  • 2 Rhim H, Goldberg SN, Dodd GD, III, et al. Essential techniques for successful radio-frequency thermal ablation of hepatic tumors. RadioGraphics 2001; 21:S17-S39. LinkGoogle Scholar
  • 3 Gazelle GS, Goldberg SN, Solbiati L, Livraghi T. Tumor ablation with radio-frequency energy. Radiology 2001; 217:633-646. Google Scholar
  • 4 McGahan JP, Dodd GD, III. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 2001; 176:3-16. Crossref, MedlineGoogle Scholar
  • 5 Goldberg SN, Dupuy DE. Image-guided radiofrequency tumor ablation: challenges and opportunities—part I. J Vasc Interv Radiol 2001; 12:1020-1032. Google Scholar
  • 6 Dupuy DE, Goldberg SN. Image-guided radiofrequency tumor ablation: challenges and opportunities—part II. J Vasc Interv Radiol 2001; 12:1135-1148. Crossref, MedlineGoogle Scholar
  • 7 Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. AJR Am J Roentgenol 1996; 167:759-768. Crossref, MedlineGoogle Scholar
  • 8 Solbiati L, Goldberg SN, Ierace T, et al. Hepatic metastases: percutaneous radiofrequency ablation with cool-tip electrodes. Radiology 1997; 205:367-373. LinkGoogle Scholar
  • 9 Rhim H, Dodd GD, III. Radiofrequency thermal ablation of liver tumors. J Clin Ultrasound 1999; 27:221-229. Crossref, MedlineGoogle Scholar
  • 10 Goldberg SN, Solbiati L, Hahn PF, et al. Large-volume tissue ablation with radio frequency by using a clustered, internally cooled electrode technique: laboratory and clinical experience in liver metastases. Radiology 1998; 209:371-379. LinkGoogle Scholar
  • 11 Goldberg SN, Gazelle SG, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174:323-331. Crossref, MedlineGoogle Scholar
  • 12 Livraghi T, Goldberg SN, Lazzaroni S, et al. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 2000; 214:761-768. LinkGoogle Scholar
  • 13 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; 210:655-661. LinkGoogle Scholar
  • 14 Solbiati L, Ierace T, Goldberg SN, et al. Percutaneous US-guided RF tissue ablation of liver metastases: results of treatment and follow-up in 16 patients. Radiology 1997; 202:195-203. LinkGoogle Scholar
  • 15 LeVeen RF. Laser hyperthermia and radiofrequency ablation of hepatic lesions. Semin Interv Radiol 1997; 14:313-324. Google Scholar
  • 16 Rossi S, Buscarini E, Garbagnati F, et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 1998; 170:1015-1022. Crossref, MedlineGoogle Scholar
  • 17 Livraghi TL, Solbiati L, Meloni F, Ierace T, Goldberg SN. Complications after cool-tip RF ablation of liver cancer: initial report of the Italian Multicenter Cooled-Tip RF Study Group (abstr). Radiology 2000; 217(P):27. Google Scholar
  • 18 Choi H, Loyer EM, DuBrow RA, et al. Radio-frequency ablation of liver tumors: assessment of therapeutic response and complications. RadioGraphics 2001; 21:S41-S54. LinkGoogle Scholar
  • 19 Zagoria RJ, Chen MY, Shen P, Levine EA. Complications from radiofrequency ablation of liver metastases. Am Surg 2002; 68:204-209. MedlineGoogle Scholar
  • 20 Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 1999; 230:1-6. Crossref, MedlineGoogle Scholar
  • 21 Lees WR, Gilliam AR. Complications of radiofrequency and laser ablation of liver metastases: incidence and management (abstr). Radiology 1999; 213(P):122. Google Scholar
  • 22 Choi JB, Rhim H, Kim Y, et al. Radiofrequency thermal ablation of malignant hepatic tumors: post-ablation syndrome. J Korean Radiol Soc 2000; 43:63-68. CrossrefGoogle Scholar
  • 23 Napier DH, Dodd GD, III, Hubbard LG, Chintapalli KN, Chopra S, Medina D. Post-ablation syndrome following radiofrequency ablation of liver tumors. Presented at the 29th Annual Meeting and Postgraduate Course of the Society of Gastrointestinal Radiologists, Kauai, Hawaii, March 12–17 2000. Google Scholar
  • 24 Llovet JM, Vilana R, Bru C, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001; 33:1124-1129. Crossref, MedlineGoogle Scholar
  • 25 Lencioni R, Cioni D, Bartolozzi C. Percutaneous radiofrequency thermal ablation of liver malignancies: techniques, indications, imaging findings, and clinical results. Abdom Imaging 2001; 26:345-360. Crossref, MedlineGoogle Scholar
  • 26 Song SY, Chung JW, Han JK, et al. Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome. J Vasc Interv Radiol 2001; 12:313-320. Crossref, MedlineGoogle Scholar
  • 27 O’Connor MJ, Schwartz ML, McQuarrie DG, Sumner HW. Cholangitis due to malignant obstruction of biliary outflow. Ann Surg 1981; 193:341-345. Crossref, MedlineGoogle Scholar
  • 28 Lim HK, Choi D, Lee WJ, et al. Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology 2001; 221:447- 454. LinkGoogle Scholar
  • 29 Lu DS, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the “heat sink” effect. AJR Am J Roentgenol 2002; 178:47-51. Crossref, MedlineGoogle Scholar
  • 30 Rossi S, Garbagnati F, Lencioni R, et al. Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply. Radiology 2000; 217:119-126. LinkGoogle Scholar
  • 31 Goldberg SN, Saldinger PF, Gazelle GS, et al. Percutaneous tumor ablation: increased coagulation necrosis with combined radiofrequency and percutaneous doxorubicin injection (abstr). AJR Am J Roentgenol 2000; 174:34. Google Scholar
  • 32 Patterson EJ, Scudamore CH, Owen DA, Nagy AG, Buczkowski AK. Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size. Ann Surg 1998; 227:559-565. Crossref, MedlineGoogle Scholar
  • 33 Goldberg SN, Solbiati L, Halpern EF, Gazelle GS. Variables affecting proper system grounding for radiofrequency ablation in an animal model. J Vasc Interv Radiol 2000; 11:1069-1075. Crossref, MedlineGoogle Scholar
  • 34 Goldberg SN, Hahn PF, Halpern EF, Fogle RM, Gazelle GS. Radio-frequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter. Radiology 1998; 209:761-767. LinkGoogle Scholar
  • 35 Hansen PD, Rogers S, Corless CL, Swanstrom LL, Siperstien AE. Radiofrequency ablation lesions in a pig liver model. J Surg Res 1999; 87:114-121. Crossref, MedlineGoogle Scholar
  • 36 Bilchik AJ, Wood TF, Allegra DP. Radiofrequency ablation of unresectable hepatic malignancies: lessons learned. Oncologist 2001; 6:24-33. CrossrefGoogle Scholar
  • 37 Wood TF, Rose M, Chung M, et al. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 2000; 7:593-600. Crossref, MedlineGoogle Scholar
  • 38 Curley S, Izzo F, Ellis EM, Vauthey JN, Vallone P. Radiofrequency ablation of hepatocellular carcinoma in 110 patients with cirrhosis. Ann Surg 2000; 232:381-391. Crossref, MedlineGoogle Scholar
  • 39 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; 210:655-661. LinkGoogle Scholar
  • 40 Rossi S, Garbagnati F, Lencioni R, et al. Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply. Radiology 2000; 217:119-126. LinkGoogle Scholar

Article History

Published in print: Jan 2003