1. Percutaneous Liver Tumour Ablation: Image Guidance, Endpoint Assessment, and Quality Control 
Robbert S. Puijk, MD, Alette H. Ruarus, MD, Hester J. Scheffer, MD, PhD, Laurien G.P.H. Vroomen, MD, Aukje A.J.M. van Tilborg, MD, PhD, Jan J.J. de Vries, MD, Ferco H. Berger, MD, Petrousjka M.P. van den Tol, MD, PhD, Martijn R. Meijerink, MD, PhD 
Canadian Association of Radiologists Journal 
Volume 69, Issue 1, Pages (February 2018)
DOI: /j.carj
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

2. Figure 1
Ultrasound (US) of a small segment VI colorectal liver metastasis treated with radiofrequency ablation. (A) Hypoechoic lesion (white arrows) depicted on B-mode US. (B) The same hypoechoic lesion (white arrows). US during deployment of the tines with the needle electrode (asterisk) clearly visible. (C) Directly after radiofrequency ablation the ablation zone can be depicted as a hyperechoic area due to substantial vaporization and hence gas formation.
Canadian Association of Radiologists Journal  , 51-62DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

3. Figure 2
Real-time ultrasound during liver tumour irreversible electroporation (IRE) procedure. Patient with a small segment I colorectal liver metastasis directly adjacent to the inferior caval vein treated with IRE. (A) Hypoechoic lesion (white arrows) depicted on B-mode ultrasound. (B) During IRE the active tip of the needle electrode becomes hyperechoic (asterisk), presumably caused by electrolysis (splitting of H2O molecules in H2 and O2). (C) Contrary to thermal ablation, with IRE the ablation zone can be depicted as a hypoechoic tumour-free area (dotted line) surrounding the lesion (line).
Canadian Association of Radiologists Journal  , 51-62DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

4. Figure 3
Contrast-enhanced computed tomography (CECT) plus CT fluoroscopy in percutaneous liver tumour microwave ablation (MWA). (A) Patient with a segment I-VI colorectal liver metastasis (white arrows) in between the inferior caval vein and main portal vein. (B) Using CT fluoroscopy the lesion was successfully targeted using an MWA antenna. (C) Post-MWA CECT shows a clear shrinkage of the metastasis (line) surrounded by a nonenhancing tumour-free ablation zone (dotted line). Naturally, there is no tumour-free margin between the ablated lesion and the directly abutting inferior caval vein and main portal vein.
Canadian Association of Radiologists Journal  , 51-62DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

5. Figure 4
Three-dimensional computer assisted navigation in percutaneous liver tumour microwave ablation. Patient with a local site recurrence of a previously ablated colorectal liver metastasis in the hepatic dome. To avoid traversing the lung an angulated approach was chosen. (A) Using computer assisted navigation software (CAScination, Bern, Switzerland) with a mechanical arm and infrared markers on the patient's skin, (B) a microwave antenna was inserted using 3-dimensional computer-assisted navigation. (C) The tumour target volume (red line) and estimated ablation volume (green line) were drawn semiautomatically before advancing the probe. (D) The actual nonenhancing ablation zone, typically surrounded by a hyperemic rim, accurately matches the estimated ablation zone volume (green line). This figure is available in colour online at
Canadian Association of Radiologists Journal  , 51-62DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

6. Figure 5
Schematic drawing of the transcatheter computed tomography (CT) hepatic arteriography technique. After injection of 40 cm3 of a 1:1 mixed bolus of contrast medium and saline through a catheter in the common hepatic artery (CHA) 2 CT series are acquired at 6 and 22 seconds, respectively, after start of injection (flow rate 5 cm3/s) to obtain an arterial phase CT and a mixed late arterial to early portal venous phase CT. Contrast will flow directly into the liver via the proper hepatic artery (PHA) and indirectly via the gastroduodenal artery (GDA) to the pancreatic, duodenal, and gastric circulation into the superior mesenteric vein (SMV) and hence the portal vein (PV) [27,56]. GEA = gastroepiploic artery; SV = splenic vein.
Canadian Association of Radiologists Journal  , 51-62DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

7. Figure 6
Computed tomography hepatic arteriography (CTHA) in percutaneous liver tumour ablation. (A) Typical incomplete-ring sign (white arrows) on CT hepatic angiography indicating ablation site recurrence. (B) Transcatheter CT fluoroscopy allows for real-time delineation of the ablation zone and the vital recurrence after injecting minimal amounts of diluted (20 cm3 contrast medium + 20 cm3 saline; 4 cm3/s) contrast. (C) The hypoattenuating ablation zone clearly encompasses the target tumour volume (white line).
Canadian Association of Radiologists Journal  , 51-62DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

8. Figure 7
Algorithm for quality control after liver tumour ablation. 18F-FDG PET-CT = 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography computed tomography; CECT = contrast-enhanced computed tomography; CEMRI = contrast-enhanced magnetic resonance imaging; CRLM = colorectal liver metastasis; HCC = hepatocellular carcinoma.
Canadian Association of Radiologists Journal  , 51-62DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions