Microwave ablation of a single hepatocellular carcinoma metastasis. The trajectory was planned in the very small space between kidney and liver, going through fat tissue only until reaching the lesion adjacent to the right adrenal gland.
Preoperative CT showing hypervascular lesion in arterial phase
Planning scan in MPR view
3D needle eye view nicely showing the small window between kidney and liver for the trajectory
Follow-up scan November 2021 arterial phase
Name: Dr. Johan Lindeberg and Dr. Niklas Fahlberg
Institution: Danderyd Hospital, Stockholm (Sweden)
Patient age and sex: 67 years, male
Initial condition:
- Patient was first diagnosed with HCC in 2016
- He has a non-cirrhotic liver
- First surgery in September 2016
- Patient developed several new lesions that were treated with a combination of resection and ablation in 2017, 2018 and 2019
- In 2020 diagnosis of growing hyper vascular lesion (i.e. HCC metastasis) adjacent to the right adrenal gland and the diaphragm
- Multi-disciplinary team conference in January 2021 advocated ablation as surgery was not an option
Treatment:
- Intra costal, oblique access was chosen
- Planning involved not puncturing either the liver nor the kidney capsule and only passing intra-abdominal fat tissue
- The needle verification scan shows a highly precise placement with an exact execution of the plan
- The patient was then treated with a short pause in the burning phase (3min at 60 watts) due to rising blood pressure
Conclusion:
- Control scan showed a retracted lesion with follow up scan in November 2021 shows stable conditions without signs of regrowth
- Trajectory would have been extremely challenging without CAS-One IR navigation (over 13cm, double angulated, steep caudo-cranial, only small space between liver and kidney
- Ablation zone expectation was very useful for a gentle treatment
