PMC3022176_01
(a) A hypodense lesion with maximum diameter of 4.5 cm located in the IVth segment of the liver (arrow), with signs of early arterial enhancement, consistent with HCC characteristics. (b) The tip of the electrode is seen inside the lesion during the first RFA session.
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fig1
C virus infection, presented about 12 years ago with elevation of a-fetoprotein (AFP) levels up to 110 ng/mL during routine laboratory tests. Computed tomography (CT) scan performed at that time demonstrated a hypodense lesion, 4.5 cm in maximum diameter, located in the IVth segment of the liver, with signs of early arterial enhancement consistent with HCC characteristics (Figure 1(a)). A cool-tip electrode was used [RADIONICS (Burlington, MA)] and a pulsed RF energy was applied for 15 min (Figure 1(b)).
(a) After 18 months, a new CT scan depicted a local tumor progression at the ablation site. Note the unenhanced area of the lesion corresponding to the ablated site (long arrow) and the local tumor progression seen as an adjacent hypodense area (short arrow). (b) Similar to findings on the MRI scan, the ablated area shows no signal (long arrow), whereas the local tumor progression appears as a low signal area (short arrow).
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fig2
 For a 18-month follow-up period the patient presented excellent clinical status with normal levels of AFP and stable appearance of the lesion on CT and magnetic resonance imaging (MRI) scans, when a new rise of the AFP levels to 80 ng/mL prompted us to repeat a new CT and MRI scan (Figures 2(a) and 2(b)); the CT images shown depict the local tumor progression as a slightly hypodense area adjacent to the unenhanced area of the lesion corresponding to the ablated site (short and long arrows, resp. on Figure 2(a)). Similar to the findings on the MRI scan (Figure 2(b)), the ablated area shows no signal (long arrow), whereas the local tumor progression appears as a low signal area (short arrow).
Latest CT scan, 12 years after the initial RF procedure; both lesions (arrows) are hardly visualized and might be misdiagnosed as cystic formations in the liver.
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fig3
In the latest CT scan, performed at the same period (12 years after the initial RF procedure), both lesions were hardly visualized and could have been misdiagnosed as cystic formations in the liver (Figures 3(a) and 3(b)).