PMC8337056_01
(A) Computed tomography showed a S5 lesion ( ) with hyper-enhancement in arterial phase and near the gallbladder( ). (B) Color Doppler ultrasound showed the feeding artery ( ). (C) Contrast-enhanced ultrasound showed the lesion had hyper-enhancement in arterial phase ( ) and only 1mm away from the gallbladder( ).
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F1
Enhanced computed tomography (CT) showed hyperenhancement of the lesion in the arterial phase, which was 17mm x 18mm in size, with a hypodense central stellate scar visible inside the region (Figure 1A). Color Doppler ultrasound revealed spoke-wheel blood flow, with the feeding artery being from the S5 hepatic artery branch (Figure 1B). Contrast-enhanced ultrasound (CEUS) indicated a radiant artery and hyperenhancement of the lesion, which was 29mm x 25mm in size, in the arterial phase (Figure 1C), portal phase and delayed phase.
Normal saline and SonoVue (100:1) were infused into abdominal cavity. Contrast-enhanced ultrasound (A), along with B-mode ultrasound (B) showed that SonoVue distribution between the gallbladder( ) and the liver ( ), suggesting that ascites could separate the gallbladder wall away from the liver to avoid thermal injury.
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F2
Under CEUS, we observed hyperechoic contrast agent distribution between the gallbladder and the hepatic margin close to the lesion, indicating that this fluid could provide a cooling effect during thermal ablation (Figure 2).
(A) Microwave antenna( ) punctured at the feeding artery and the hyperechoic caused by ablation( ). (B) After ablation of the feeding artery, contrast-enhanced ultrasound showed no blood supply ( ) inside the tumor.
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F3
Under color Doppler ultrasound guidance, the microwave antenna was inserted directly to the site of the feeding artery (Figure 3A), and after 2 min of ablation at 60 W, CEUS showed no blood flow perfusion in the tumor (Figure 3B).
(A) After ablation, contrast-enhanced ultrasound showed blood supply in gallbladder wall ( ), suggesting the gallbladder wall had no necrosis. (B) Magnetic resonance imaging 1 month later showed the lesion was completely ablated ( ) and the gallbladder( ) was not injured.
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F4
Additionally, the gallbladder wall showed blood perfusion, indicating that the thermal ablation procedure did not cause necrosis in the gallbladder wall (Figure 4A). Examination by magnetic resonance imaging (MRI) 1 month later showed that the tumor was completely ablated and that the gallbladder was not injured (Figure 4B).