1. Irreversible Electroporation in Hepatopancreaticobiliary Tumours
A.H. Ruarus, MD, L.G.P.H. Vroomen, MD, R.S. Puijk, MD, PhD, H.J. Scheffer, MD, PhD, B.M. Zonderhuis, MD, G. Kazemier, MD, PhD, M.P. van den Tol, MD, PhD, F.H. Berger, MD, M.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
The NanoKnife system (AngioDynamics, Latham, NY). (A) NanoKnife generator with 6 probe connections. (B) The 19-gauge monopolar probes covered in a retractable sheath allowing for adjustment of the active tip length. (C) AccuSync (AccuSync Medical Research Corporation, Milford, CT) device allowing for electrocardiogram-synchronized pulse delivery. (D) Pulse delivery (p) within the cardiac refractory period.
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Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

3. Figure 2
Hepatic irreversible electroporation (IRE) for centrally located colorectal liver metastasis: transcatheter computed tomography fluoroscopy guidance. (A) Computed tomography hepatic angiography shows a typical ring-enhancing metastasis that encases the middle hepatic vein (arrow). (B) Computed tomography arterial portography confirms the final location of the needles just before IRE. (C) Immediate post-IRE computed tomography arterial portography reveals a patent middle hepatic vein (arrow) within a hypoattenuating ablation zone with intralesional gas pockets (caused by electrolysis of H2O into H2 and O2 gas).
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4. Figure 3
Pancreatic irreversible electroporation for locally advanced pancreatic adenocarcinoma: transcatheter computed tomography fluoroscopy guidance. (A) Unenhanced computed tomography not delineating pancreatic mass from the superior mesenteric artery. (B) Contrast-enhanced computed tomography fluoroscopy after injecting 80 cm3 of contrast (diluted 1:1 with saline) through a flush catheter within the abdominal aorta clearly demarcates the enhancing superior mesenteric artery (red asterisk), allowing for a safe positioning of the needle electrode. (C) Contrast-enhanced computed tomography confirms the final location of the needle electrodes just before irreversible electroporation, enclosing the entire tumour while evading the superior mesenteric artery (red asterisk). This figure is available in colour online at
Canadian Association of Radiologists Journal  , 38-50DOI: ( /j.carj )
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5. Figure 4
Ultrasound, macroscopic, and microscopic images of an irreversibly electroporated and later resected colorectal liver metastasis. (A) Ultrasound pre–irreversible electroporation (IRE) showing 2 electrodes positioned in the periphery of the hypoechoic colorectal liver metastasis. (B) Ultrasound during IRE showing gas formation directly around the electrodes. (C) Ultrasound 15 minutes post-IRE showing a hypoechoic ablation zone as compared with surrounding liver tissue broadly encapsulating the lesion. (D) The resected specimen after vitality staining (5-triphenyl tetrazolium chloride [TTC]) shows an nonviable (grey, TTC–) ablation zone, surrounded by vital (red, TTC+) untreated liver parenchyma. (E–G) Photomicrograph of the transition between TTC– and TTC+ tissue (D, box) at 20× magnification (E) Hematoxylin and Eosin (HE) stain showing congestion of erythrocytes with widening of the sinusoids with an abrupt abortion in the vital zone (F) Complement-3d activity in the nonviable zone with sharp demarcation from the viable zone (G) Caspase-3 is activated in the nuclei in the TTC– zone, quickly diminishing in the TTC+ zone. Reprinted, with permission, from Scheffer et al [13]. This figure is available in colour online at
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6. Figure 5
A patient from the COLDFIRE-2 trial with a 5-cm centrally located colorectal liver metatasis treated with percutaneous irreversible electroporation (IRE). (A, B) Pre-IRE: contrast-enhanced computed tomography (CECT) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)-CT showing a status after left hemihepatectomy and a 5-cm centrally located solitary avid colorectal liver metatasis (white arrow) that was chemorefractory and rapidly enlarging. (C, D) IRE: axial and sagittal plane CECT with 11 needles required to cover the tumour. (E, F) Post-IRE coronal and axial plane CECT showing a large hypodense ablation zone with patent hepatic and portal veins plus typical intralesional gas pockets. (G, H) 18F-FDG PET-CT showing shrinkage of the nonenhancing ablation zone with absence of tracer uptake of the treated lesion (red asterisk: intra- and extrahepatic hematoma caused by percutaneous biopsy). This figure is available in colour online at
Canadian Association of Radiologists Journal  , 38-50DOI: ( /j.carj )
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7. Figure 6
Pancreatic irreversible electroporation (IRE). (A) Pre-IRE contrast-enhanced computed tomography (CECT) showing an isoattenuating tumour encasing the portal vein (arrow). (B) CT fluoroscopy with 2 needles in situ surrounding the tumour, catheter in the portal vein. (C) CT confirming correct electrode placement during IRE before pulse delivery. (D) Hypoattenuating ablation zone with intralesional gas pockets and reactive and reversible vessel spasm directly after IRE. (E) Preventively CT-guided placement of a portal vein stent directly after IRE, as the patient is prone to portal vein occlusion due to the preexistent narrowed portal vein. (F) CECT 3 months after IRE showing a hypoattenuating ablation zone and portal vein stent in situ.
Canadian Association of Radiologists Journal  , 38-50DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions

8. Figure 7
Patient with pathology proven unresectable Bismuth-Corlette stage IV perihilar cholangiocarcinoma (Klatskin tumour). (A) Pre–irreversible electroporation contrast-enhanced computed tomography clearly shows wall thickening surrounding 2 “kissing” self-expandable metal Wallstents (self-expanding metal biliary stent; black arrow) in the left and right main bile duct (blue dashed line surrounds the tumour). (B) Thick maximum intensity projection reconstruction of 4 needle electrodes surrounding the stents. (C) Directly after irreversible electroporation a typical hypoattenuating ablation zone (red dashed line) with gas pockets (white arrows) surrounded by marginal hyperenhancement can be appreciated. One and a half years later the patient is still alive without signs for local tumour progression. This figure is available in colour online at
Canadian Association of Radiologists Journal  , 38-50DOI: ( /j.carj )
Copyright © 2017 Canadian Association of Radiologists Terms and Conditions