Flat-Panel Cone-Beam Ct-Guided Radiofrequency Ablation of Very Small (aparts per thousandcurrency sign1.5 cm) Liver Tumors: Technical Note on a Preliminary Experience

The aim of the present study was to investigate the technical feasibility of flat-panel cone-beam CT (CBCT)-guided radiofrequency ablation (RFA) of very small (< 1.5 cm) liver tumors. Patients included were candidates for hepatic percutaneous RFA as they had single biopsy-proven hepatic tumors sized a parts per thousand currency sign1.5 cm and poorly defined on ultrasonography. Following apnea induction, unenhanced CBCT scans were acquired and used to deploy the RF electrode with the aid of a virtual navigation system. If the tumor was not clearly identified on the unenhanced CBCT scan, a right retrograde arterial femoral access was established to carry out hepatic angiography and localize the tumor. Patients' lesions and procedural variables were recorded and analyzed. Three patients (2 male and 1 female), aged 68, 76, and 87 years were included; 3 lesions (2 hepato-cellular carcinoma and 1 metastasis from colorectal cancer) were treated. One patient required hepatic angiography. Cycles of apnea used to acquire CBCT images and to deploy the electrode lasted < 120 s. Mean fluoroscopic time needed to deploy the electrode was 36.6 +/- A 5.7 min. Mean overall procedural time was 66.0 +/- A 22.9 min. No peri- or post-procedural complications were noted. No cases of incomplete ablation were noted at 1-month follow-up. Percutaneous CBCT-guided liver RFA with or without arterial hepatic angiography is technically feasible.