Navigated ​Irreversible ​Electroporation of Hepatocellular Carcinoma

Th​is patient presented with ​an 18mm Hepatocellular Carcinoma (HCC) on the posterior aspect of Segment III of the liver. The ablation technique used was ​Irreversible ​Electroporation (IRE) as the tumour ​was in ​close proximity to the stomach. ​​Irreversible ​Electroporation (IRE) is an effective tissue sparing technique which targets the lesion whilst minimising damage to neighbouring structures such as the Stomach, in this particular case. Precise needle positioning ​is crucial for the IRE treatment ​to be effective and this was ​achieved by ​​implementing the CT guidance and navigation ​capabilities of the CAS-One IR workflow. 

Case_Leeds_IRE_Overview-1
 
1. Pre-ablation MR scan of the HCC in Segment III
2. Transverse planning CT reconstruction
3. Needle validation scan showing inserted needles
4. Three months post ablation scan showing the ablation zone (necrosis) in segment III of the liver
 

Name: Prof. Dr. Tze Wah & Dr. James Lenton 


Institution: St. James's Hospital, Leeds, United Kingdom


Patient age and sex:  64 years, male


Initial condition:

  • History of Hemochromatosis
  • Type II diabetes
  • Cirrhosis (secondary to Hemochromatosis)

Treatment: 
  • The IRE treatment was performed under General Anaesthesia with Apnoea
  • 4 needles were planned, 3 well positioned, 1 repositioned
  • 2 overlapping treatments (1cm pull back on superior needles)
  • 90 pulses across each pair of electrode
  • 6 pairs treated in total 

Result:

  • For IRE cases in particular, accurate antenna placement is crucial in order for the treatment to be effective. All trajectories have to be aligned parallel to allow the current pulses to induce tumour cell death
  • Accurate needle placement is difficult when performing the procedure freehand
  • CAS-One IR was used as a navigation system in order to achieve great needle-to-target precision
  • The three month post ablation control scan shows a complete destruction of the HCC.
  • Stomach tissue was spared and left undamaged

Learn more about the stereotactic navigation system CAS-One IR.

 

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