CT mapping of the distribution of saline during radiofrequency ablation with perfusion electrodes

Purpose: During radiofrequency (RF) ablation, adjunctive saline increases the size of the ablation zone and therefore electrodes that simultaneously deliver current and saline have been developed, but the addition of saline also results in an irregular ablation zone. Our aim was to study the distribution of saline during RF ablation. Methods: Four patients were treated: 3 with liver metastases and 1 with hepatocellular carcinoma (HCC). Two different perfusion electrodes were used: a high-perfusion-rate, straight electrode (Berchtold, Germany) and a low-perfusion-rate, expandable electrode (RITA Medical Systems, USA). The saline perfusate was doped with non-ionic contrast medium to render it visible on CT and the electrical conductivity was measured. CT scans were obtained of each electrode position prior to ablation and repeated after ablation. Contrast-enhanced CT was performed 18-24 hr later to demonstrate the ablation zone. All treatments were carried out according to the manufacturer's recommended protocol. Results: The addition of a small quantity of non-ionic contrast did not alter the electrical conductivity of the saline. Contrast-doped saline extravasated beyond the tumor in all 3 patients with metastases but was limited in the patient with HCC. In some areas where saline had extravasated there was reduced enhancement on contrast-enhanced CT consistent with tissue ablation. One patient treated with the high-perfusion-rate system sustained a jejunal perforation requiring surgery. Conclusion: Saline can extravasate beyond the tumor and with the high-perfusion-rate system this resulted in an undesirable extension of the ablation zone and a complication.