title: Radiofrequency ablation for viable hepatocellular carcinoma around retained iodized oil after transcatheter arterial chemoembolization: usefulness of biplane fluoroscopy plus ultrasound guidance.
abstract: OBJECTIVE
  To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE).
  
  
  METHODS
  Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT.
  
  
  RESULTS
  Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients.
  
  
  CONCLUSIONS
  When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Min
authors.forename: Min Woo
authors.initials: MW
authors.lastname: Lee
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Rhim
authors.forename: Dongil
authors.initials: D
authors.lastname: Choi
authors.forename: Young-Sun
authors.initials: YS
authors.lastname: Kim
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Cha
authors.forename: Hyo K
authors.initials: HK
authors.lastname: Lim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D045424:Complex Mixtures; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage*; D007472:Iohexol / Q000031:analogs & derivatives; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018084:Ultrasonography, Interventional
chemical_list: C078881:CT-102 activated platelet supernatant; D045424:Complex Mixtures; D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D007459:Iodized Oil
keywords: Biplane fluoroscopy; Guidance; Hepatocellular carcinoma; Liver; Radiofrequency ablation; Transcatheter arterial chemoembolization, iodized oil; Ultrasonography