--- title: MWA of multiple liver metastases including a segment I tumor description: CAS-One IR guided percutaneous tumor ablation of three metastasis ina patient treated at Sheffield University Hospital. image: https://www.cascination.com/hubfs/Screenshot_21_26_10_000003_Screen0.png --- Monday, 18 May 2026 # MWA of multiple liver metastases including a segment I tumor MWA of multiple liver metastases including a segment I tumor 2:52  A 74-year-old patient initially presented with a primary rectal tumor underwent abdomino-perineal resection in 2025. Adjuvant chemotherapy was not administered due to deranged liver function of unknown aetiology. Six months after surgery, follow-up MRI of the liver demonstrated three small lesions in segment I, IVa and VII-VIII consistent with metastatic disease. The case was reviewed at the multidisciplinary team meeting, where the decision was made to proceed with CAS-One IR guided microwave ablation.  Planning of the three lesions   ![Screenshot Plan Long trajectory](https://www.cascination.com/hs-fs/hubfs/Screenshot%20Plan%20Long%20trajectory.png?width=1240&height=698&name=Screenshot%20Plan%20Long%20trajectory.png) 3D visualization of all three lesions with planned trajectories, including needle-eye–view planning of the long trajectory to the segment I lesion   Verification of all three needles demonstrating minimal (2mm, 1mm, 3mm)  deviation across trajectories   ![Sheffield Ablasure 1](https://www.cascination.com/hs-fs/hubfs/Sheffield%20Ablasure%201.png?width=1920&height=1080&name=Sheffield%20Ablasure%201.png) AblaSure® shows lesion and margin coverage of the caudate lesion  ![Screenshot_21_26_10_000001_Screen0](https://www.cascination.com/hs-fs/hubfs/Screenshot_21_26_10_000001_Screen0.png?width=1920&height=1080&name=Screenshot_21_26_10_000001_Screen0.png) 1st AblaSure result of the second lesion which needed a reablation   ![Screenshot_21_26_10_000003_Screen0](https://www.cascination.com/hs-fs/hubfs/Screenshot_21_26_10_000003_Screen0.png?width=1920&height=1080&name=Screenshot_21_26_10_000003_Screen0.png) Planning of the re-ablation switching to 140W instead of 100W on initial burn to counter the heat-sink from the hepatic branch.   ![Screenshot_21_26_10_000004_Screen0](https://www.cascination.com/hs-fs/hubfs/Screenshot_21_26_10_000004_Screen0.png?width=1920&height=1080&name=Screenshot_21_26_10_000004_Screen0.png) Final AblaSure result   ![Sheffield Ablasure 3](https://www.cascination.com/hs-fs/hubfs/Sheffield%20Ablasure%203.png?width=1920&height=1080&name=Sheffield%20Ablasure%203.png)  AblaSure shows excellent lesion and margin coverage of the third lesion   --- **Name: **Dr. Naomi Hersey --- **Institution:  Sheffield Teaching Hospitals NHS Trust** --- **Patient age and sex:  Male, 74 years-old** --- Initial condition and Imaging: - **May 2025 patient was diagnosed with a primary rectal tumor, T3N1M0** - **Underwent abdomino-perineal resection two months later** - **Not eligible for adjuvant chemotherapy due to deranged liver function of unknown aetiology** - **Six-month follow-up MRI of the liver shows three metastases: 9mm lesion in segment I, 16mm lesion in segment IVa abutting the middle hepatic vein and a 15mm lesion in segment VII-VIII** - **Case was discussed at the MDT meeting and decision was made to perform MWA of all three lesions with CAS-One IR** --- Treatment:  - **The procedure was performed under GA to ensure optimal respiratory control** - **MW was performed using the AngioDynamics Solero probe** - **All three lesions were planned on the initial pre-ablation scan. After each ablation, the ablation zones were assessed using AblaSure® ** - **The challenging segment I lesion was treated first and targeted at a depth of approximately 19cm, with only 2mm of lateral deviation. The remaining two lesions were subsequently treated with millimetric precision. Only the third lesion required a re-ablation, due to heat-sink from hepatic vein, to ensure an optimal outcome.** - **The patient remained well post procedure and was discharged home the same day.** --- Result and Conclusion - One month follow-up MR shows no signs of disease recurrence or complication. - Dr. Naomi Hersey said about this case: "The segment I lesion would have been nearly impossible for us to target without the advantages of the CAS-One IR system.  Ablasure supported us to make real-time treatment decisions which optimised our likelihood of achieving complete ablation " Learn more about [CAS-One IR](https://www.cascination.com/products/cas_one_ir?hsLang=en).     ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Stijn Van Hertem", "url" : "https://www.cascination.com/en/blog/author/stijn-van-hertem" }, "dateModified" : "2026-05-18T15:58:12.362Z", "datePublished" : "2026-05-18T15:43:09.000Z", "headline" : "MWA of multiple liver metastases including a segment I tumor", "image" : [ "https://www.cascination.com/hubfs/Screenshot_21_26_10_000003_Screen0.png" ], "mainEntityOfPage" : { "@id" : "https://www.cascination.com/en/blog/mwa-of-multiple-liver-metastases-includding-a-segment-i-tumor", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://www.cascination.com/hubfs/CASCINATION_Logo_2021_Website.png" }, "name" : "CASCINATION AG" } } ``` ```json { "@context" : "https://schema.org", "@type" : "VideoObject", "contentUrl" : "https://4661825.fs1.hubspotusercontent-na1.net/hubfs/4661825/video_assets/212005833117/inherited/web_optimized.mp4", "dateModified" : "2026-04-30T11:57:56.996Z", "duration" : "PT20S", "height" : 1080, "name" : "Video Planning 3MW", "thumbnailUrl" : "https://api-na1.hubspot.com/filemanager/api/v3/files/thumbnail-redirect/212005833117?portalId=4661825&size=medium", "uploadDate" : "2026-04-30T11:57:41.041Z", "width" : 1920 } ``` ```json { "@context" : "https://schema.org", "@type" : "VideoObject", "contentUrl" : "https://4661825.fs1.hubspotusercontent-na1.net/hubfs/4661825/video_assets/212000277353/inherited/web_optimized.mp4", "dateModified" : "2026-04-30T10:03:57.650Z", "duration" : "PT15S", "height" : 1080, "name" : "Sheffield NeedleVerificationAlllesions", "thumbnailUrl" : "https://api-na1.hubspot.com/filemanager/api/v3/files/thumbnail-redirect/212000277353?portalId=4661825&size=medium", "uploadDate" : "2026-04-30T10:03:46.072Z", "width" : 1920 } ```