Multiple-electrode radiofrequency ablation creates confluent areas of necrosis: in vivo porcine liver results.
ABSTRACT To prospectively evaluate, in vivo in pigs, an impedance-based multiple-electrode radiofrequency (RF) ablation system for creation of confluent areas of hepatic coagulation.
The study was preapproved by the institutional research animal care and use committee. A prototype multiple-electrode RF system that enables switching between three electrically independent electrodes at impedance spikes was created. Forty-two coagulation zones (18 with single, 12 with cluster, and 12 with multiple [three single electrodes spaced 2 cm apart] electrodes) were created at laparotomy in 15 female pigs. Half the ablations were performed for 12 minutes, and half were performed for 16 minutes. The coagulation zones were excised and sliced into approximately 3-mm sections for measurement. Analysis of variance and two-sample t tests (with Bonferroni correction, alpha = .0033) were used to assess for differences between groups.
At 12 minutes, the mean multiple-electrode coagulation was significantly larger than the mean single-electrode coagulation (minimum diameter, 2.8 vs 1.6 cm; maximum diameter, 4.2 vs 2.0 cm; volume, 22.1 vs 6.7 cm(3); P < .0033 for all comparisons). The mean maximum diameter achieved at 12 minutes with multiple electrodes was significantly larger than that achieved with the cluster electrode (4.2 vs 2.9 cm, P = .02). At 16 minutes, the mean multiple-electrode coagulation (minimum diameter, 3.2 cm; maximum diameter, 4.2 cm; volume, 29.1 cm(3)) was significantly larger than the mean single-electrode (minimum diameter, 1.7 cm; maximum diameter, 2.2 cm; volume, 7.1 cm(3); P < .0033 for all comparisons) and cluster-electrode (minimum diameter: 2.3 cm, P = .007; maximum diameter: 3.2 cm, P = .005; volume: 13.1 cm(3), P = .001) coagulations.
Compared with the single and cluster systems used as controls, the multiple-electrode RF ablation system enabled the creation of significantly larger coagulation zones.
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ABSTRACT: To determine the in vivo efficiency of monopolar radiofrequency ablation (RFA) using a dual-switching (DS) system and a separable clustered (SC) electrode to create coagulation in swine liver. Thirty-three ablation zones were created in nine pigs using a DS system and an SC electrode in the switching monopolar mode. The pigs were divided into two groups for two experiments: 1) preliminary experiments (n = 3) to identify the optimal inter-electrode distances (IEDs) for dual-switching monopolar (DSM)-RFA, and 2) main experiments (n = 6) to compare the in vivo efficiency of DSM-RFA with that of a single-switching monopolar (SSM)-RFA. RF energy was alternatively applied to one of the three electrodes (SSM-RFA) or concurrently applied to a pair of electrodes (DSM-RFA) for 12 minutes in in vivo porcine livers. The delivered RFA energy and the shapes and dimensions of the coagulation areas were compared between the two groups. No pig died during RFA. The ideal IEDs for creating round or oval coagulation area using the DSM-RFA were 2.0 and 2.5 cm. DSM-RFA allowed more efficient RF energy delivery than SSM-RFA at the given time (23.0 ± 4.0 kcal vs. 16.92 ± 2.0 kcal, respectively; p = 0.0005). DSM-RFA created a significantly larger coagulation volume than SSM-RFA (40.4 ± 16.4 cm(3) vs. 20.8 ± 10.7 cm(3); p < 0.001). Both groups showed similar circularity of the ablation zones (p = 0.29). Dual-switching monopolar-radiofrequency ablation using an SC electrode is feasible and can create larger ablation zones than SSM-RFA as it allows more RF energy delivery at a given time.Korean journal of radiology: official journal of the Korean Radiological Society 01/2014; 15(2):235-244. · 1.32 Impact Factor
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ABSTRACT: Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. © RSNA, 2014 Online supplemental material is available for this article .Radiology 06/2014; · 6.34 Impact Factor
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ABSTRACT: During the last two decades, various local thermal ablative techniques for the treatment of unresectable hepatocellular carcinoma (HCC) have been developed. According to internationally endorsed guidelines, percutaneous thermal ablation is the mainstay of treatment in patients with small HCC who are not candidates for surgical resection or transplantation. Laser ablation (LA) represents one of currently available loco-ablative techniques. In this article, the general principles, technique, image guidance, and patient selection are reported. Primary effectiveness, long-term outcome, and complications are also discussed. A review of published data suggests that LA is equivalent to the more popular and widespread radiofrequency ablation in both local tumor control and long-term outcome in the percutaneous treatment of early HCC. In addition, the LA technique using multiple thin laser fibres allows improved ablative effectiveness in HCCs greater than 3 cm. Reference centres should be equipped with all the available techniques so as to be able to use the best and the most suitable procedure for each type of lesion for each patient.World journal of hepatology. 10/2014; 6(10):704-15.