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. 2012 Oct 12;13(6):784–794. doi: 10.3348/kjr.2012.13.6.784

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Copyright © 2012 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fig. 3 — 57-year-old man with viable hepatocellular carcinoma (HCC) in left hepatic dome after repeated transcatheter arterial chemoembolization (TACE).

A. Arterial phase axial CT scan obtained one month after four TACE sessions shows enhancing lesion with maximum diameter of 2.2 cm (arrowheads), located around incomplete accumulation of iodized oil (black asterisk) in hepatic segment III. Patient had previous history of radiofrequency ablation (RFA) for another HCC (white asterisk) in segment VIII of liver. B. Delayed phase CT scan shows wash-out (arrowheads) suggestive of viable HCC, in site corresponding to enhancing lesion in A. C. Fluoroscopic images demonstrate accumulation of iodized oil (arrowheads) around viable HCC on magnified anteroposterior (C) and lateral (D) projection images, which were not visualized by US. Biplane fluoroscopy using retained iodized oil as radio-opaque anatomic landmark was chosen as main guiding modality for percutaneous RFA. D. Fluoroscopic images demonstrate accumulation of iodized oil (arrowheads) around viable HCC on magnified anteroposterior (C) and lateral (D) projection images, which were not visualized by US. Biplane fluoroscopy using retained iodized oil as radio-opaque anatomic landmark was chosen as main guiding modality for percutaneous RFA. E. Representative anteroposterior (AP) and lateral (Lat) fluoroscopic images obtained during six overlapping radiofrequency ablation (RFA) procedures. We inserted electrode to lateral aspect of retained iodized oil, where viable HCC was considered to be present (left column). Multiple overlapping ablations were facilitated using steep oblique approach based on biplane fluoroscopic images in which retained iodized oil remained almost unchanged over 6 overlapping ablations. On sixth overlapping (right column), electrode was positioned in anterior side of retained iodized oil. Although not shown here, US was used for monitoring purposes during each ablation cycle. Total ablation time of six overlapping treatments was 26 minutes. F. Transverse portal phase CT image obtained immediately after single RFA session reveals partial intratumoral deposition of iodized oil, with sufficient non-enhancing ablative zone (arrowheads), with maximum diameter of 4.5 cm.