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Introduction: The effectiveness of percutaneous radiofrequency ablation (RFA) in intrahepatic cholangiocarcinomas (iCCA) remains insufficiently studied. Methods: We conducted a retrospective study including patients with histologically proven iCCA within Milan criteria treated by percutaneous RFA from 2000 to 2022. The primary outcome was overall survival in treatment‐naive patients and secondary outcomes included ablation completeness, adverse events, local and distant recurrence. A total of 494 patients with hepatocellular carcinoma (HCC) on cirrhosis treated by RFA were included as a comparison group. Oncological events were analysed using Kaplan–Meier, log‐rank and univariate/multivariate Cox models. Results: The main population included 71 patients, mostly cirrhotic (80%) with solitary tumours (66%) of a median size of 24 mm. Local recurrence was 45% at 5 years, lower in multibipolar versus monopolar RFA (22% vs. 55%, p =.007). In treatment‐naive patients (n = 45), median overall and recurrence‐free survivals were 26 and 11 months, respectively. Tumour size (p =.01) and Child‐Pugh B (p =.001) were associated with death. The rate of distant recurrence was 59% at 5 years significantly lower for single tumours of less than 2 (p =.002) or 3 cm (p =.02). In cirrhotic patients naïve of previous treatment (n = 40), overall survival was shorter than in HCC (26 vs 68 months, p <.0001), with more local recurrences (p <.0001). Among distant recurrences, 50% were extrahepatic metastases compared to 12% in HCC (p <.001). Conclusion: Multibipolar RFA provides better results in terms of tumour recurrence than monopolar RFA and could be used to treat small iCCA (<3 cm). Adjuvant chemotherapy should be discussed due to the frequent extra‐hepatic metastasis at recurrence. [ABSTRACT FROM AUTHOR]

Background & Aims: Long‐term outcomes after percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in patients with non‐alcoholic fatty liver disease (NAFLD) have been poorly studied. We aim to determine the outcomes after multibipolar RFA in these patients compared to other aetiologies as well as the prognostic impact of metabolic syndrome (MS). Methods: Patients who underwent multibipolar RFA as the first treatment for HCC within Milan criteria (2008‐2018) were enrolled in this multicentre retrospective cohort from four tertiary centres in France. The association of MS and NAFLD with adverse events and outcomes after percutaneous RFA were assessed using Kaplan Meier method, log‐rank test and uni/multivariate analysis with the Cox models. Results: Among 520 patients, 390 patients (75%) had at least one component of MS including obesity (30%) and 95% had cirrhosis. Sixty‐two patients (12.6%) had NAFLD‐HCC, 225 (45.5%) had alcohol‐related‐HCC, 36 (7.3%) had HBV‐HCC and 171 (34.6%) had HCV‐HCC. Patients with NAFLD‐HCC were significantly older (median age 72.6 years, P <.001), more obese (median BMI 30.3 kg/m2, P <.001) and had more components of MS. Patients with NAFLD‐HCC achieved a median overall survival (OS) of 79 months (1‐year, 3‐year and 5‐year OS of 90%, 71% and 59%). There were no differences in morbidity, tumour recurrence and OS among patients with NAFLD‐HCC vs other aetiologies as well as no prognostic impact of metabolic components. Conclusions: Percutaneous multibipolar RFA is an efficient treatment in HCC patients with NAFLD or metabolic syndrome and achieved similar long‐term oncological outcomes compared to other aetiologies. [ABSTRACT FROM AUTHOR]

In Europe and North America, hepatocellular adenomas (HCA) occur, classically, in middle-aged woman taking oral contraceptives. Twenty percent of women, however, are not exposed to oral contraceptives; HCA can more rarely occur in men, children, and women over 65 years. HCA have been observed in many pathological conditions such as glycogenosis, familial adenomatous polyposis,MODY3, after male hormone administration, and in vascular diseases. Obesity is frequent particularly in inflammatory HCA. The background liver is often normal, but steatosis is a frequent finding particularly in inflammatory HCA. The diagnosis of HCA is more difficult when the background liver is fibrotic, notably in vascular diseases. HCA can be solitary, or multiple or in great number (adenomatosis). When nodules are multiple, they are usually of the same subtype. HNF1α-inactivated HCA occur almost exclusively in woman. The most important point of the classification is the identification of β-catenin mutated HCA, a strong argument to identify patients at risk of malignant transformation. Some HCA already present criteria indicating malignant transformation. When the whole nodule is a hepatocellular carcinoma, it is extremely difficult to prove that it is the consequence of a former HCA. It is occasionally difficult to identify HCA remodeled by necrosis or hemorrhage. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the feasibility and precision of magnetic resonance imaging (MRI) thermometry for monitoring radiofrequency (RF) liver ablation in vivo and predicting the size of the ablation zone. Materials and Methods At 1.5T, respiratory-triggered real-time MR temperature mapping (the proton resonance frequency (PRF) method) was used to monitor RF ablation in rabbit liver ( N = 6) under free breathing. The size of the ablation zones, as assessed by histological analyses, was compared with that predicted from MR thermal dose (TD) maps or derived from conventional T1-weighted (T1w), T2-weighted (T2w), and T1w gadolinium (Gd)-enhanced (T1w-Gd) images acquired immediately after the ablation, and on days 4 and 8 postprocedure. Results MR temperature uncertainty remained under 1-2°C even during RF deposition. The TD maps were shown to be more predictive and precise than the other MR images, with an average predictive precision for the final ablation zone size of about 1 mm as compared to the histologically proven lesion on day 8. Conclusion Quantitative temperature MRI during RF ablation is feasible and offered a precise indication of the ablation zone size in this preclinical study based on the lethal dose threshold. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose To determine the stability and quality of MR temperature mapping using the proton resonance frequency (PRF) method in the liver of hepatic tumor patients. Materials and Methods The standard deviation (SD) of a series of temperature maps was determined in 30 patients (21 patients with cirrhotic livers with carcinoma, and nine patients with noncirrhotic livers with metastasis or angioma) and in five volunteers at normal body temperature under free breathing. A respiratory-gated segmented echo-planar imaging (EPI) sequence (three slices in one expiration phase) was performed with sensitivity encoding (SENSE) acceleration on a 1.5 T scanner. Motion-corrupted images were identified by calculation of the cross-correlation coefficient, and discarded. Results A T2* range of 10-33 msec was found, with especially low values in advanced cirrhotic livers. The mean temperature SD in patients was 2.3°C (range = 1.5-5.0°C). The stability in healthy livers was slightly better than that in cirrhotic livers, and it was higher in the right liver than in the left liver. The gating failed in 4% of the images when the respiratory cycle was irregular, leading to motion artifacts and errors in the temperature maps. Conclusion The achieved temperature stability and image quality makes real-time quantitative monitoring of thermal ablation of liver tumors feasible on a clinical scanner. J. Magn. Reson. Imaging 2004;19:438-446. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]