PMC4689746_01
A Coronal ceCT image pre IRE with a hilar cholangiocarcinoma (arrow) surrounding a metallic Wallstent present in the common bile duct. B ceMRI image demonstrating an enhancing mass in the liver hilum surrounding the common bile duct. C Axial CT image of two electrodes placed alongside the Wallstent. D Coronal CT view demonstrating all six electrodes and eight electrode pairs during the ablation (red lines). E ceCT immediately after IRE demonstrating patent vessels and gas bubbles in the ablated area (arrow). F ceMRI 1 day post-IRE with no signs of complications. G, H ceCT 6 months and 1 year after IRE demonstrating no tumor progression
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Fig1
Computed tomography (CT) imaging showed a 30 x 30 x 38 mm mass in the liver hilum surrounding the common and the left and right main bile ducts (Bismuth-Corlette type IV) (Fig. 1A, B). With the patient under general anesthesia in the supine position, a total of six monopolar needle electrodes (NanoKnife; AngioDynamics, Latham, New York) were placed alongside the metallic Wallstent under CT-fluoroscopy guidance, three on each side (Figs. 1C, D, 2). Eight vectors for pulse delivery were chosen with a minimum and maximum interprobe distance of 1.6 and 2.5 cm (Fig. 1D). A, so subsequently 80 treatment pulses were delivered along each vector. After removal of all six needles, contrast-enhanced CT (ceCT) demonstrated a hypodense ablation zone containing gas bubbles (Fig. 1E). No complications to the blood vessels or bile ducts were noticed (Fig. 1F). At six, 9 months, and 1-year follow-up, ceCT still showed no local tumor progression or metastatic disease (Fig. 1G, H).
3D reconstruction with a catheter in the common hepatic artery (asterisk) and six electrodes placed alongside the metallic Wallstent
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Fig2
First, to allow repeated and real-time visualization of both the tumor and the vessels within the celiac trunk, a catheter was placed within the common hepatic artery (Fig. 2). With the patient under general anesthesia in the supine position, a total of six monopolar needle electrodes (NanoKnife; AngioDynamics, Latham, New York) were placed alongside the metallic Wallstent under CT-fluoroscopy guidance, three on each side (Figs. 1C, D, 2).