title: In vivo determination of a modified heat capacity of small hepatocellular carcinomas prior to radiofrequency ablation: correlation with adjacent vasculature and tumour recurrence.
abstract: OBJECTIVE
  To calculate a modified heat capacity (mHC) of small hepatocellular carcinomas (HCCs) in vivo during radio frequency ablation (RFA) and to determine if mHC correlates with tumour vascularity, adjacent vessels or local recurrence.
  
  
  METHODS
  This study was IRB approved and informed consent was obtained from all patients. Before formal RFA, ambient HCC temperature and temperature 1 min after heating at constant wattage were measured in 29 patients. From temperature change and wattage, individual mHCs (joules required to increase tumour temperature by 1° Celsius) were calculated. Pre-RFA, three-phase computerised tomography (CT) scans were reviewed blindly for hepatic arteries, hepatic veins and portal veins abutting or within 3 mm of tumour edge from which twelve vascular parameters were quantified. Tumour enhancement (homogeneous or heterogeneous on arterial phase) was also assessed. Multiple regression was used to correlate mHC with vascular parameters and tumour enhancement. Cox proportional hazard model was used to examine the relationship of mHC to local recurrence.
  
  
  RESULTS
  There was significant correlation of mHC with lesion enhancement (P = 0.0018), length of hepatic arteries (P < 0.0001) and total hepatic vein volume in contact with tumour (P = 0.016). No correlation was found with any non-abutting vessel or portal vein parameter. The chance of local recurrence increased with increasing mHC.
  
  
  CONCLUSIONS
  Because the modified heat capacity of small HCCs in our study population correlated with HCC enhancement, abutting hepatic arteries, the volume of abutting hepatic veins and local recurrence, it may be an indicator of the heat sink effect (HSE) and supports the HSE as a risk factor for local recurrence.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215, USA. rsheiman@caregroup.harvard.edu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sheiman
authors.forename: Charles
authors.initials: C
authors.lastname: Mullan
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006358:Hot Temperature; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000503:physiopathology*; D011859:Radiography