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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]

Purpose: To describe and evaluate an image fusion technique for the portal vein puncture guidance during TIPS procedure: a three-dimensional (3D) virtual target fluoroscopic display obtained with an automated 3D carbon dioxide wedged hepatic vein portography (3D CO2-WHVP).Materials and Methods: All the 37 TIPS creations performed in our institution between 3/2017 and 12/2018 were retrospectively reviewed. Seventeen procedures were guided using the 3D CO2-WHVP technique (group 1) and were compared with the other 20 procedures performed under conventional 2D fluoroscopic guidance (group 2). Image acquisition for the 3D CO2-WHVP consisted of combining a CBCT acquisition and an automatic CO2 injection. Once located on the multiplanar reformatted images of the CBCT acquisition, the portal bifurcation was manually segmented to create a virtual target that was overlaid onto live fluoroscopy allowing a real-time 3D guidance during portal vein puncture.Results: Primary success was 100% in group1 and 95% in group2. Median intervention length, fluoroscopy time and dose area product (DAP) were, respectively, 124 min [IQR 94-137], 40 min [IQR 26-52] and 12140 cGy.cm2 [IQR 10147-18495] in group 1 and 146 min [IQR 118-199], 40 min [IQR 36-60] and 13290 cGy.cm2 [IQR 10138-19538] in group 2. No technical parameter was significantly different between the two groups. Intraprocedural complication rate was 0% in group 1 and 20% in group 2 (p = 0.05).Conclusion: Three-dimensional virtual target fluoroscopic display using a CBCT-acquired CO2 wedged portography is an effective and safe technique to ease intrahepatic puncture of the portal vein during TIPS procedures. [ABSTRACT FROM AUTHOR]