Computed tomography findings after radiofrequency ablation in locally advanced pancreatic cancer

• Published in: Abdominal imaging Vol. 43; no. 10; pp. 2702 - 2711
• Main Authors: Rombouts, Steffi J. E., Derksen, Tyche C., Nio, Chung Y., van Hillegersberg, Richard, van Santvoort, Hjalmar C., Walma, Marieke S., Molenaar, Izaak Q., van Leeuwen, Maarten S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2018; Springer Nature B.V
• Subjects: Ablation; Aged; Arteries; Cancer; Computation; Computed tomography; Feasibility Studies; Female; Gastroenterology; Hepatology; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Netherlands; Occlusion; Pancreas; Pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Patients; Postoperative Complications - diagnostic imaging; Prospective Studies; Radio frequency; Radiofrequency Ablation; Radiology; Thromboembolism; Thrombosis; Tomography, X-Ray Computed; Netherlands; Radiofrequency ablation; Computed tomography; Imaging findings; Locally advanced pancreatic cancer
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-018-1519-y

Purpose The purpose of the study was to provide a systematic evaluation of the computed tomography(CT) findings after radiofrequency ablation (RFA) in locally advanced pancreatic cancer(LAPC). Methods Eighteen patients with intra-operative RFA-treated LAPC were included in a prospective case series. All CT-scans performed prior to RFA and 1 week and 3 months of post-RFA, according to standard regimen, were assessed by two radiologists in consensus, using standardized radiological scoring lists. Results 51 CT-scans were assessed. One week after RFA, the ablation zone was visible in all patients as a (partially) sharply defined (83%), heterogeneous area (94%). At 3 months of follow-up, the ablation zone was completely invaded by tumor in 67% of patients and still present, but decreased in 33%. In two patients (11%), local thrombosis and/or occlusion of the superior mesenteric vein occurred. The occlusions persisted without clinical consequences and the thrombosis disappeared. A peripancreatic fluid collection was visible 1 week after RFA in 3 patients, wherein the ablation zone extended ventrally outside of the pancreas. Conclusions Directly after RFA for LAPC, a well-defined ablation zone is visible on CT-imaging. This ablation zone is usually replaced by tumor ingrowth after 3 months. Moreover, the ablation zone regularly included vascular structures, with rare asymptomatic venous occlusion or thrombosis and without adverse effects on arteries.