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US findings after irreversible electroporation ablation: radiologic-pathologic correlation.

Liat Appelbaum1, Eliel Ben-David, Jacob Sosna

  • 1Department of Radiology, Hadassah Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel. liata@hadassah.org.il

Radiology
|November 23, 2011
PubMed
Summary

Ultrasonography (US) can assess irreversible electroporation (IRE) ablation margins. A hyperechoic rim appearing 90-120 minutes post-IRE accurately predicts the ablation zone size.

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Area of Science:

  • Medical Imaging
  • Interventional Radiology
  • Hepatobiliary Surgery

Background:

  • Irreversible electroporation (IRE) is an ablation technique used in liver cancer treatment.
  • Accurate assessment of ablation margins is crucial for treatment efficacy and preventing recurrence.
  • Current imaging modalities may have limitations in precisely defining IRE-treated zones.

Purpose of the Study:

  • To characterize the dynamic ultrasonographic (US) findings following irreversible electroporation (IRE) in a liver model.
  • To evaluate the utility of these US findings in accurately assessing the margins of the ablation zone.

Main Methods:

  • In vivo IRE liver ablations (n=58) were performed in 16 pigs using specific electrode configurations and energy settings.
  • Ablations were guided by US, with imaging acquired during and up to 2 hours post-procedure.

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  • Ablation zones were histopathologically confirmed, and US findings were correlated with gross and microscopic pathology.

    • Main Results:

    • The ablation zone initially appeared hypoechoic with well-defined margins, decreasing in size and becoming isoechoic over 8-15 minutes.
    • A peripheral hyperechoic rim developed 25-90 minutes post-IRE, measuring 2-7 mm.
    • The external margin of this hyperechoic rim showed the highest accuracy (1.7 mm ± 0.2) and correlation (r²=0.89) with gross pathologic findings.

    Conclusions:

    • Ultrasonographic findings post-IRE are dynamic and evolve over time.
    • The external hyperechoic rim, observed 90-120 minutes after IRE, is the most reliable indicator of the ablation zone.
    • This rim is likely due to hemorrhagic infiltration within widened sinusoids.