J Radiol 2009;90:1300-1359© Éditions Françaises de Radiologie, Paris, 2009

édité parElsevier Masson SAS. Tous droits réservés

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Séances thématiques

Séance organisée par la Deutsche Rontgen Gesellschaft DRG

Responsables: Bruno Kastler, Philippe Pereira

Durée: 20 minutes

Durée: 20 minutes

16 h 50

Objectifs: To know advantages and drawbacks of MR and CT gui­dance for liver RFA.Know how to proceed for MR-guided RFA.Know the limitations of CT for monitoring.Messages à retenir: MR guided RFA allows safe needle placement,near on line monitoring and control of the RFA.CT evaluation irnmediately after RFA is not reliable specially forhypovascular liver tumors.Résumé: MR-guided RFA allow a safe, fast and exact placement ofRF applicators by using MR-Fluoroscopy. Monitoring is possiblewith therrnosensiotive sequences as weil as Tlw-Images. Controllingis possible with DWI and standard sequences. CT imaging is limitedfor monitoring of RFA specially for liver metastases.

Mots clés: Foie, tumeur - Radiofréquence, radiologie interven­tionnelle - IRM interventionnelle

17 h 10

IMAGE GUIDED RFA OF THE L1VER: CT MRI?P Pereira (1), C Claussen (2)(1) Heilbronn - Allemagne, (2) Tübingen - AllemagneCorrespondance: philippe.pereira@slk-kliniken,de

Objectifs: To know the limit of tumor staging for RFA attempted as"curative" treatment.To know the limit oftumor staging for RFA attempted as "palliative"or "down staging" treatment.Messages à retenir: Up to 2 cm diameter RFA allows completeablation of almost ail malignant liver tumors.Up to 5 cm diameter, on condition to use proper technology (ei: mul­tipolar), RFA is able to achieve local tumor control similar to partialliver resection.For intermediate tumor stages (T2-T3 in TNM) RFA has the rightprofile of an effective palliative or down staging treatment.Résumé: Up to 5 cm of tumor diameter, RFA has far from partialliver resection the higher feasibility and lower complication rates. Upto 2 cm almost ail tumors can be completely destroy by RFA evenusing routine monopolar technology. Therefore, for such very smalltumor RFA should be regarded as first line therapeutic option. Oncondition to improve tissue destruction capacity of RFA (ei: multipo­lar mode), same results can be obtained in patient with medium sizetumor. In patients with few tumors (= 3) even including large one(= 5 cm), RFA stills provide obvious antitumorous effect withoutsignificant increase of complications. RFA should be regarded con­sequently as an effective palliative option in patients with interme­diate stage of disease.

Mots clés: Foie, tumeur - Radiofréquence, radiologie interven­tionnelle

L1VER RFA: WHAT ARE THE L1MITS OF THE TREATMENT?o SerorBondy - FranceCorrespondance: olivier.seror@jvr,aphp,fr

Durée: 20 minutes

Modérateurs: Bruno Kastler, Philippe Pereira

Objectifs pédagogiquesIndications et limites de la radiofréquence hépatique. Intérêt duguidage IRM. Potentialités du cyberknife.

L1VER RFA: WHAT ARE THE INDICATIONS AT PRESENT?C Aubé (1), J Lebigot (1), J Boursier (1), ELermite (1),P Pereira (2)(1) Angers - France, (2) Heilbronn - AllemagneCorrespondance: chaube@chu-angers,fr

Objectifs: To know the present indications of RF ablation in livertumour.To know the possible evolutions of these indications.To understand the therapeutic schemes using RF ablation in liver.Messages à retenir: In hepatocellular carcinoma (HCC) RF Abla­tion is a curative treatment.In HCC RF ablation is an alternative to surgery.In metastasis RF ablation is a complement to surgery.RF ablation is an oncological treatment that must be decided in mul­tidisciplinary committees.Résumé: Radiofrequency ablation (RFA) is now a weil establishedtreatment for liver tumours. In multidisciplinary cornmittees it mustbe choosed among the different oncological tools and used in a stan­dardised way. Two main indications can be individualised (hepato­cellular carcinoma and metastasis) corresponding to 2 different waysof using the RF tool.-Firstly in case of HCC: RFA is clearly conside­red as a curative treatment and takes place in substitution to surgicalresection. This is currently a fact for small tumours, but following thetechnical evolution of the RF devices (especially multipolar techni­que) this could become true for larger tumours too. The different treat­ments (Chemoembolisation, chemotherapy, surgical treatment,transplantation) will be used in association or alternatively with thetherapeutic scheme following the HCC evolution.-Secondly in caseof metastasis: In this situation RFA could be an isolated treatment,but it is an exception. For the metastatic lesions surgery remains inmost cases the reference and RFA should be used in association withsurgery. The goal of this association is to make a carcinologic resec­tion (i. e. to be able to resect ail liver metastasis), when completeresection could not be possible using surgery alone. This leads tocombined procedures; for the best in one time during the surgicalintervention or in 2 times if we choose to proceed to per cutaneousRF treatment. In other hepatic tumours, like benign tumour or cho­langiocarcinoma, there is no standardised attitude and RFA is used inparticular case always after a collegial decision during a multidisci­plinary committee.

Mots clés: Foie, tumeur - Radiofréquence, radiologie interven­tionnelle

RF ablation of the Liver: "state of the art"

16 h 30

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