Case Study: Managing RF Ablation with contast-enhanced ultrasound
Case: Gastrointestinal stromal tumor with RFA and intraoperative monitoring
(Bjørn Skjoldbye, MD BSc, Senior Consultant, Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark)
52-yr-old female with gastrointestinal stromal tumor (GIST). Primary tumor in the small intestine removed radically. New metastasis was detected in the liver and treated with percutaneous RF ablation 9 months later. Disease stabilized on systemic therapy with Gilvec®.
However, a new solitary metastasis was detected in the liver two years later. IOUS with CEUS (8815 transducer) visualized a small new metastasis on the edge of the previously ablated volume (Fig A). The recurrence was not seen on CT but was seen with CEUS. The previously ablated area appears empty of contrast activity as opposed to the active vascular appearance of the new metastasis. IOUS-guided RFA is performed (Fig B), and IOUS with CEUS after ablation (Fig C) shows a successful and complete ablation without contrast activity.
* In the USA, contrast-enhanced ultrasound has not been market cleared by the FDA, with the exception of only select cardiac imaging applications. |