---
title: "Two challenging CRLMs in segment VIII: close to the liver dome, and close to the middle hepatic vein"
description: Two challenging CRLMs treated with CAS-One IR. One in the liver dome, and one close to the middle hepatic vein. AI-driven segmentation helped treat both lesions safely and 100% margin coverage was achieved.
image: https://www.cascination.com/hubfs/Ablasure-jpg-1.jpeg
---

 Tuesday, 21 November 2023

# Two challenging CRLMs in segment VIII: close to the liver dome, and close to the middle hepatic vein

Two challenging CRLMs in segment VIII: close to the liver dome, and close to the middle hepatic vein

2:58

 

A 77-year-old patient diagnosed in 2014 with metastatic colorectal cancer underwent resection of two liver metastases in 2014 and another resection in 2017 and RFA in 2019. A new lesion was treated by MWA in 2021. In 2023 PET-CT showed 2 new lesions hardly seen on CT or MRI and invisible on US.

MWA with CAS-One IR was chosen as a treatment option because of its ability to fuse the planning CT with MRI and partially with PET-CT. The dome lesion was challenging due to its mandatory ascending access, and AI-driven segmentation proved very useful for the second lesion adjacent to the middle hepatic vein and portal branch. Sub-millimeter accuracy was achieved in needle placement, as well as 100% tumor and margin coverage in the post-ablation scan. No complications were observed.

 

 

Planning scan video showing the two challenging trajectories close to the liver dome and hepatic/portal veins with PET-CT showing the lesions.

![](https://www.cascination.com/hs-fs/hubfs/Verify%201st%20lesion-png.png?width=1200&height=675&name=Verify%201st%20lesion-png.png)

Verification CT showing a 0.1mm lateral displacement with an ascending trajectory avoiding the lung.

![](https://www.cascination.com/hs-fs/hubfs/Ablasure-jpg-1.jpeg?width=1213&height=682&name=Ablasure-jpg-1.jpeg) AI-Driven AblaSure images showing the full treatment (100% of tumor, 100% of margin) of both lesions.

---

Name: Dr. Jose Maria Abadal, Dra. Esther Galvez

---

Institution: Hospital Universitario Severo Ochoa, Madrid, Spain

---

Patient age, sex:  77, Female 

---

Initial condition:

- 77 years old woman with metastatic colorectal cancer diagnosed in 2014.
- Resection of 2 liver metastases in 2014.
- Hepatic progression in 2017 and 2019 treated with surgery and RFA. New lesion in 2021 treated with MWA.
- PET-CT in 2023 revealed 2 new lesions, one 20mm in segment VIII adjacent to middle hepatic vein. Second 18mm lesion in the dome of segment VIII.

Treatment: 

- MWA with CAS-One IR was chosen because of the poor visibility of the lesion and challenging trajectories with mandatory double obliquity for the dome lesion.
- Procedure was performed under general anesthesia and apnea was done for CT scans and needle positioning.
- Each lesion was treated with MWA using Medtronic Emprint system.
- AI-driven AblaSure was used after treatment to assess the success of the ablation. 
- There were no complications on post procedural CT and patient was released the next day.

---

Result:

- Complete ablation, including clinical margins were observed after treatment.
- No complications observed due to the ablation.
- The patient will remain under routine control, follow-up images are due in January.
- At the end of the case the physician said: " without CAS-One IR it would have been very difficult to perform the procedure and to guarantee coverage of the lesion with oncological margins".

Learn more about the stereotactic navigation system [CAS-One IR](https://www.cascination.com/products/cas_one_ir?hsLang=en).

[![Subscribe to our newsletter](https://no-cache.hubspot.com/cta/default/4661825/741ee7e3-4f56-4ba9-9f5e-b9e9e3395c13.png)](https://cta-redirect.hubspot.com/cta/redirect/4661825/741ee7e3-4f56-4ba9-9f5e-b9e9e3395c13)

```json
{
  "@context" : "https://schema.org",
  "@type" : "BlogPosting",
  "author" : {
    "@type" : "Person",
    "name" : "Melissa Golin",
    "url" : "https://www.cascination.com/en/blog/author/melissa-golin"
  },
  "dateModified" : "2024-03-21T09:14:57.641Z",
  "datePublished" : "2023-11-21T14:18:37.000Z",
  "headline" : "Two challenging CRLMs in segment VIII: close to the liver dome, and close to the middle hepatic vein",
  "image" : [ "https://www.cascination.com/hubfs/Ablasure-jpg-1.jpeg" ],
  "mainEntityOfPage" : {
    "@id" : "https://www.cascination.com/en/blog/two-challenging-crlms-in-segment-viii",
    "@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/Top%20Case%20November.mp4",
  "dateModified" : "2023-11-16T10:42:10.774Z",
  "duration" : "PT35S",
  "height" : 1080,
  "name" : "Top Case November",
  "thumbnailUrl" : "https://api-na1.hubapi.com/filemanager/api/v3/files/thumbnail-redirect/145745826908?portalId=4661825&size=medium",
  "uploadDate" : "2023-11-16T10:42:02.563Z",
  "width" : 1920
}
```