Percutaneous radiofrequency tissue ablation: Does perfusion-mediated tissue cooling limit coagulation necrosis?

S. Nahum Goldberg, Peter F. Hahn, Kenneth K. Tanabe, Peter R. Mueller, Wolfgang Schima, Christos A. Athanasoulis, Carolyn C. Compton, Luigi Solbiati, G. Scott Gazelle

Research output: Contribution to journalArticle

457 Scopus citations

Abstract

PURPOSE: To determine, by decreasing hepatic perfusion during radiofrequency (RF) ablation, whether perfusion-mediated tissue cooling can explain the reduced coagulation observed in in vivo studies compared to that seen with RF application in ex vivo tissue. MATERIALS AND METHODS: RF was applied in vivo with use of cooled-tip electrodes to normal porcine liver without (n = 8) and with balloon occlusion of the portal vein (n = 8), celiac artery (n = 3), or hepatic artery (n = 2), and to ex vivo calf liver (n = 10). In vivo trials of vasopressin (0.3-0.6 U/min) infusion during RF application with (n = 10) and without (n = 2) arterial balloon occlusion were also performed. Intraoperative RF was subsequently performed in seven patients with hepatic colorectal metastases with and without portal inflow occlusion. Remote thermometry was performed in four patients. RESULTS: RF application (12 minutes) during portal venous occlusion produced larger areas of coagulation necrosis than RF with unaltered blood flow (2.9 cm ± 0.1 vs 2.4 cm ± 0.2 diameter; P < .01). With celiac and hepatic artery occlusion, coagulation diameter measured 2.7 cm ± 0.2 and 2.5 cm ± 0.1, respectively. Infusion of vasopressin without vascular occlusion reduced coagulation diameter to 1.1 cm. However, different methods of hepatic or celiae arterial balloon occlusion with simultaneous vasopressin infusion produced a mean 3.4 cm ± 0.2 of necrosis. Coagulation in ex vivo liver was 2.9 cm ± 0.1 in diameter. Clinical studies demonstrated greater coagulation diameter for metastases treated during portal inflow occlusion (4.0 cm ± 1.3) than for tumors treated with normal blood flow (2.5 cm ± 0.8; P < .05). Thermometry documented a 10°C increase compared to baseline at 10 mm and 20 mm from the electrode after 5 minutes of portal inflow occlusion during constant RF application. CONCLUSIONS: Perfusion-mediated tissue cooling reduces coagulation necrosis achievable with RF ablation. Reduction of blood flow during RF application increases coagulation in both an animal model and human liver metastases.

Original languageEnglish (US)
Pages (from-to)101-111
Number of pages11
JournalJournal of Vascular and Interventional Radiology
Volume9
Issue number1 I
DOIs
StatePublished - Jan 1 1998
Externally publishedYes

Keywords

  • Liver tumors, secondary
  • Liver, blood supply
  • Radiofrequency ablation
  • Tumor ablation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Goldberg, S. N., Hahn, P. F., Tanabe, K. K., Mueller, P. R., Schima, W., Athanasoulis, C. A., Compton, C. C., Solbiati, L., & Gazelle, G. S. (1998). Percutaneous radiofrequency tissue ablation: Does perfusion-mediated tissue cooling limit coagulation necrosis? Journal of Vascular and Interventional Radiology, 9(1 I), 101-111. https://doi.org/10.1016/S1051-0443(98)70491-9