Assessment of liver tissue after radiofrequency ablation: Findings with different imaging procedures

Our goal was to assess the typical appearance of normal liver tissue immediately after radiofrequency ablation (RF-ablation) when imaged with contrast-enhanced ultrasound, CT, MRI, F-18-FDG PET, and PET/CT. Methods: Nineteen RF-ablation sessions were performed on nontumorous liver tissue of 10 Gottingen Mini Pigs. CT, ultrasound, MRI, 18F-FDG PET, and PET/CT were performed immediately after the intervention. All imaging procedures were evaluated qualitatively for areas of increased contrast enhancement (morphologic imaging) and regions of elevated tracer uptake (functional imaging). Images were assessed quantitatively by determination of ratios (r(p/p)) comparing contrast enhancement/tracer uptake in the periphery of the necrosis with contrast enhancement/tracer uptake of normal liver parenchyma. Results: On morphologic imaging, an increase in contrast enhancement surrounding the ablative necrosis was detected in all lesions. Quantification of this area of increased contrast enhancement revealed ratios of r(p/p) 1.57 +/- 0.2 for CT and r(p/p) 1.57 +/- 0.19 for MRI. On PET and PET/CT, homogeneous tracer utilization was found surrounding all lesions. There were no areas of a focal or rim-like increase in glucose metabolism. The ratio rp/p was found to be 1.05 +/- 0.08 for functional data. Histologic examination revealed pooling of blood in the sinusoids of the lesion's periphery that was caused by outflow obstruction due to the central necrosis. Conclusion: On morphologic imaging, a rim-like increase of contrast enhancement was found immediately after RF-ablation resembling peripheral hyperperfusion. This area of contrast enhancement may hamper detection of residual tumor. On the basis of homogeneous tracer distribution surrounding the area of necrosis, PET and PET/CT may serve for early assessment of patients after RF-ablation.