Pulmonary Ablation: A Primer

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Presentation transcript:

Pulmonary Ablation: A Primer Benjamin J. Roberton, MBChB, MRCP, FRCR, David Liu, MD, FRCPC, ABR(D), CAQ(IR), FSIR, Mark Power, MD, John M.C. Wan, MBBS(Singapore), FRCR(UK), Sam Stuart, FRCR, Darren Klass, MBChB, MD, MRCS, FRCR, John Yee, MD, FRCS Canadian Association of Radiologists Journal Volume 65, Issue 2, Pages 177-185 (May 2014) DOI: 10.1016/j.carj.2013.01.003 Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 1 Radiofrequency ablation probes. From the top, the LeVeen multi-tine electrode (Boston Scientific Corp, Marlborough, MA), the RITA multi-tine electrode (RITA Medical Systems, Fremont, CA), a cluster array electrode (3 parallel internally cooled probes; Covidien, Mansfield, MA), and a single internally cooled electrode (Covidien). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2014 65, 177-185DOI: (10.1016/j.carj.2013.01.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 2 The popsicle stick technique. The lesion has been targeted with a cryoprobe and freeze-stick mode activated (A). An iatrogenic pneumothorax was then created (B), and, with leverage on the cryoprobe, the lesion was steered away from the adjacent right heart border before the treatment cycle was initiated (C). Canadian Association of Radiologists Journal 2014 65, 177-185DOI: (10.1016/j.carj.2013.01.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 3 The double cluster technique with iatrogenic pneumothorax. This right upper lobe lesion has been treated with the deployment of 2 cluster array needles and maneuvered away from the adjacent right heart border after the creation of a pneumothorax. Canadian Association of Radiologists Journal 2014 65, 177-185DOI: (10.1016/j.carj.2013.01.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 4 Radiofrequency ablation (RFA) of a cystic lesion after fluid instillation. A coronal computed tomography image, demonstrating a cystic right lower lobe metastasis (A), treated with an internally cooled RFA electrode by using a posterior approach after the intralesional injection of normal saline solution (B). Canadian Association of Radiologists Journal 2014 65, 177-185DOI: (10.1016/j.carj.2013.01.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 5 Ground glass surrounding an ablated pulmonary nodule. This osteosarcoma metastasis was ablated with a LeVeen electrode, panel (A) shows the multi-tined electrode deployed within the right lower lobe lesion. The immediate postablation computed tomography image (B), showing a rim of ground-glass opacification surrounding the lesion, which suggests an adequate ablation zone. This image was reproduced courtesy of Steven Rose, MD, University of California, San Diego, CA. Canadian Association of Radiologists Journal 2014 65, 177-185DOI: (10.1016/j.carj.2013.01.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 6 Computed tomography (CT) imaging after thermal ablation. The baseline scan (left image), showing a lingula segment non–small-cell lung cancer (NSCLC) metastasis treated with radiofrequency ablation. The subsequent imaging (from left to right), showing a transient increase in lesion size at 1 month; the 3- and 6-month follow-up CT images, showing the lesion receding in size; by 12 months, the parenchyma is distorted with scarring and retraction. This image was reproduced courtesy of Robert Suh, MD, University of California, Los Angeles, CA. Canadian Association of Radiologists Journal 2014 65, 177-185DOI: (10.1016/j.carj.2013.01.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 7 Fused-axial positron-emission tomography–computed tomography images before (A), and 6 months after undergoing radiofrequency ablation (B). The lesion at the apex of the right lower lobe is no longer fluorodeoxyglucose avid on the follow-up imaging, which indicates successful treatment. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2014 65, 177-185DOI: (10.1016/j.carj.2013.01.003) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions