CT-guided Thermal Ablation of Postoperative Isolated Bile Leakages—Evaluation of Safety and Therapeutic Effectiveness

Safety and Effectiveness of Image-Guided Therapies for Giant Hepatic Hemangiomas: A Systematic Review and Meta-Analysis of 2,617 Patients.

Osteoid Osteoma: CT-guided Percutaneous Radiofrequency Ablation and Follow-up in 47 Patients

Percutaneous microwave ablation of renal parenchymal tumors using a 2.4 GHz gas-cooled probe: initial results and technique

New frontiers in liver resection for hepatocellular carcinoma.

Purpose:To evaluate the technical and clinical success of radiofrequency ablation of osteoid osteoma and analyze the factors responsible for clinical success. We also tried to investigate the role of follow-up computed tomography (CT) imaging.Materials and Methods:This is a prospective study approved by the institute's ethics committee involving 87 patients with appendicular osteoid osteoma. CT-guided radio frequency ablation was performed using a bipolar ablation system. Patients were followed up over 15.4 (4–24) months for pain, and clinical success/failure was determined using established criteria. Patients with clinical failure were taken for repeat ablation. Follow-up CT was obtained at 6 months and correlated with clinical success. Procedural scans were later reviewed for technical success in a blinded manner and correlated with clinical success along with other imaging and patient characteristics.Results:Mean pre-procedure visual analog scale (VAS) score was 7.0 ± 0.8. Primary success rate after single session was 86.2%(75/87 patients), and overall success rate after one/two sessions was 96.6%(84/87). No major complications were noted. Technical success rate was 89.7%(78/87). All 9 patients who had a suboptimal needle positioning had recurrence where as three patients had recurrence despite technical success. None of the imaging characteristics or history of prior intervention was significantly associated with clinical success. Follow-up CT showed advanced bone healing in 48 lesions, and was confined to the treatment success group. Alternately, minimal/absent bone healing was seen in all (12) patients of primary treatment failure and 27 patients with treatment success.Conclusions:CT-guided percutaneous radio frequency ablation is a safe and highly effective treatment for osteoid osteomas even in recurrent and residual cases. Technical success is the most important parameter affecting the outcome. Post radio frequency ablation CT findings have a good positive but a poor negative predictive value in prognostication.

To compare technical success, complications, and long-term clinical success following radiofrequency ablation of osteoid osteomas in pediatric and adult patients. Ninety-two patients underwent percutaneous computed tomography-guided radiofrequency ablation for osteoid osteomas including 54 pediatric (mean age 12.9years) and 38 adult (mean age 24.1years) patients. Presenting indication, osteoma location, ablation method, technical success, complications, visual analog score, radiographic follow-up, clinical success, reintervention rate, and total follow-up were reported. Technical success was defined as placement of the probe in the radiolucent nidus with ablation. Clinical success was defined as resolution of symptoms. Ablation indications included: pain localized to the lesion, night pain, and an osteoma on imaging in all patients. Majority of osteoid osteomas were localized to the femur (pediatric [n = 22, 40.7%]; adult [n = 12, 34.2%]) and tibia (pediatric [n = 21, 38.9%]; adult [n = 10, 26.3%]). Mean lesion size was 9.6mm in pediatric patients and 9.0mm in adults. Technical success was achieved in all pediatric patients (100%) and 97.4% of adults. Two complications occurred. Primary clinical success was achieved in 49 (90.7%) pediatric and 35 (92.1%) adult patients. Five (9.3%) pediatric and 3 (7.9%) adult patients sought reintervention for residual symptoms, and all had secondary clinical success. Mean total follow-up was 95.2 ± 58.7months in pediatric and 90.0 ± 61.6months in adult patients. No differences in outcomes were identified between pediatric and adult patients. Radiofrequency ablation of osteoid osteomas is safe with excellent technical and clinical success rates in pediatric and adult patients.

Background: Osteoid osteoma (OO) is a benign osteogenic tumor that causes severe pain despite its small size. Minimally invasive image-guided thermal ablation has replaced surgery as the treatment of choice. While radiofrequency ablation (RFA) is considered the gold standard, microwave ablation (MWA) offers faster and more homogeneous heating, though comparative evidence remains limited. Methods: We retrospectively analyzed 53 patients with OO treated with RFA (n = 27) or MWA (n = 26) between 2014 and 2023. All procedures were CT-guided. Technical success, clinical success, recurrence, complications, and prognostic factors—including the nidus diameter and eccentricity index—were evaluated over a minimum 24-month follow-up period. Results: Technical success was achieved in all cases. Overall clinical success was 94.3% (96.2% MWA vs. 92.6% RFA, p = 1.000). Two recurrences (4%) occurred, unrelated to device type. One major complication (1.9%, third-degree skin burn after MWA) was noted. Median nidus diameter was 7 mm; lesions ≥10 mm were significantly linked to failure (p = 0.009). Logistic regression identified nidus size as the strongest outcome predictor, with the eccentricity index showing a borderline effect. Conclusions: Both RFA and MWA are safe and effective for OO, with comparable outcomes and low recurrence rates. Treatment selection should prioritize lesion-specific factors—particularly nidus size ≥ 10 mm and geometry—rather than device type. Lesion size (≥10 mm) and geometry—not ablation modality—were the principal determinants of treatment success. Individualized modality selection based on these features may optimize outcomes.

Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation

Endoscopic radiofrequency ablation for ingrowth occlusion after bilateral metal stent placement for malignant hilar biliary obstruction: a prospective pilot study

This meta-analysis aims to evaluate thermal ablation for giant hepatic hemangiomas (GHHs) and compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA). A systematic review and meta-analysis followed the Cochrane Collaboration Handbook and PRISMA 2020 guidelines. Eligible studies reporting on patients with GHHs (≥ 4cm) treated with MWA or RFA were identified through Medline, Scopus, and Web of Science databases. Primary outcomes included technical success (complete and accurate execution of the intended MWA or RFA procedure as per the study protocol), safety outcomes, clinical success, and radiological success. Statistical analyses were performed using a random-effects model, with heterogeneity assessed via the I2 statistic. Fourteen studies (925 patients; 33.6% men; mean age: 46.6years) with 1,010 GHHs were included. The overall technical success rate for thermal ablation was 99.95%, with a major complication rate of 2.21%. Clinical success, defined as symptom resolution or significant improvement, was achieved in 99.85% of patients, while radiological success, defined as at least a 50% reduction in lesion size, was observed in 89.81%. Minor complications were reported in 48.88%, and total complications in 52.43%, while procedure-related morbidity was low at 0.34%. In the subgroup analysis, radiological success was 95.6% in the MWA group and 86.3% in the RFA group (p = 0.073). Major complication rates were 1.99% for MWA and 2.08% for RFA (p = 0.93), while total complication rates were 46.0% and 58.1%, respectively (p = 0.43). MWA and RFA are highly effective and safe options for treating GHHs, with excellent technical and clinical success rates. MWA may offer advantages in radiological success and lower complication rates.

Percutaneous radiofrequency (RF) ablation of osteoid osteoma has high technical and clinical success rates. However, there are limited data on its use in the treatment of osteoid osteoma in children. To assess the safety and efficacy of CT-guided percutaneous RF ablation of osteoid osteoma in children and compare the outcomes with published data on its use in patients unselected for age. From January 2003 to July 2006, 23 children with osteoid osteoma were treated with CT-guided RF ablation using a straight rigid electrode. Their mean age was 11 years (range 3.5-16 years) and there were 15 boys and 8 girls. The procedures were carried out under general anaesthesia. Follow-up was performed to assess technical and clinical outcome. The mean follow-up period was 2.5 years (range 13-49 months). Technical success was achieved in 21 children (91.3%). Failure occurred in two children, in one due to failure to adequately localize the nidus within the dense sclerosis and in the other because of a short ablation time (2 min) because he developed hyperthermia. Clinical success was achieved in 18 patients within 2-5 days (primary clinical success rate 78.2%).These patients were allowed to fully weight-bear and function without limitation 1 week after the procedure. Pain recurrence was observed in two patients; one was treated successfully with a second ablation after 6 months (secondary clinical success rate 82.6%). Hyperthermia was observed in two patients during the procedure. Three other minor complications were observed: wound infection in one child and skin burn in two children. No major immediate or delayed complications were observed. Percutaneous CT-guided RF ablation is an effective and safe minimally invasive procedure for the treatment of osteoid osteoma in children. It has high technical and clinical success rates that are slightly lower than those of patients with a wider range of ages.

Image-Guided Radiofrequency Ablation for Adrenocortical Adenoma with Cushing Syndrome: Outcomes After Mean Follow-up of 33 Months

Combined liver resection and radiofrequency ablation for bilobar multiple colorectal liver metastasis

This study evaluated technical efficacy and safety of stent angioplasty of the inferior vena cava (IVC) after liver transplantation or liver resection and analysis of changes in creatinine levels and patients' weight. Between October 2004 and February 2011, 16 patients (mean age, 52.6years) with symptomatic IVC stenoses after liver transplantation (n=10) or liver resection (n=6) were subjected to stent angioplasty. Enrollment criteria included edema and/or ascites. The smallest diameter of the IVC, serum creatinine values, and patients' weight were assessed before and after stent placement and respective values were compared. Technical and clinical success, patency rates, related complications, and patients' survival were analyzed. Stent placement was technically successful in 16 patients (100%). Clinical success was achieved in 13 patients (81.25%), reflecting two patients with early restenosis and one patient suffering from thrombosis distal to the stent. Mean follow-up was 372days. Primary patencies were 75% (n=12). Primary assisted patencies were 93.75% (n=15). Serum creatinine levels decreased significantly (p=0.01) from 1.68mg/dl before to 1.08mg/dl after stent placement. Patients' weight decreased (mean 2.1%). No angioplasty-related complications occurred. Stent angioplasty of the IVC is an effective and safe treatment of stenoses after liver transplantation and resection and has a positive effect on creatinine levels.

Aim. To analyze the results of a multidisciplinary approach to the treatment of patients with hepatocellular cancer in a multidisciplinary oncology clinic.Materials and Methods. From 2007 to 2021, 259 patients with hepatocellular cancer were surgically treated in the Department of Liver and Pancreas Surgery of the city clinical hospital named after S.P. Botkin. Liver resections of different extent were performed in 74 (28.6%) patients, radiofrequency ablation – in 19 (7.3%), microwave ablation – in 20 (7.7%), hepatic artery chemoembolization with radiofrequency ablation – in 34 (13.1%), regional chemotherapy – in 104 (40.2%), liver transplantation – in 8 (3.1%) patients.Results. The overall five- and ten-year survival after liver resection was 51.4% and 31.1% respectively. The poor prognostic factors following liver resection were age >70 years (p = 0.03), postoperative complications (p = 0.04), lymph node metastases (p = 0.01), and a body mass index >30 kg/m2 (p = 0.045). Complications that developed after radiofrequency (microwave) ablation and chemoembolization of the hepatic artery with radiofrequency ablation were 5.1% and 5.8%. Within 90 days after liver resection, three (1.1%) patients died. Complications after resection developed in 18 (24.3%) cases during the same period. With metastases measuring ≤3 cm, the overall five-year survival after radiofrequency and microwave ablation was 36.8% and 35% respectively. With neoplasms measuring 3–5 cm, the best five-year survival was after hepatic artery chemoembolization and radiofrequency ablation (44.1%). The overall fiveyear survival after hepatic artery chemoembolization was 11.5%. No complications or deaths resulted from liver transplantation. With an average follow-up period of 12.5 months, none of the patients experienced disease recurrence or died.Conclusion. Using a multidisciplinary approach in a multidisciplinary oncology clinic improves the results of treating patients with hepatocellular cancer.