Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: Frequency of diaphragmatic injury

Hayden W. Head, Gerald D. Dodd, Neal C. Dalrymple, Srinivas R. Prasad, Fadi M. El-Merhi, Michael W. Freckleton, Linda G. Hubbard

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Purpose: To retrospectively determine the frequency of diaphragmatic injury when percutaneous hepatic radiofrequency (RF) ablation is performed adjacent to the diaphragm. Materials and Methods: Institutional Review Board approval was obtained for our HIPAA-compliant study. Informed consent for the ablation procedure and for use of related data for future research was obtained from each patient. A retrospective review was conducted of 215 patients undergoing percutaneous RF ablation of hepatic tumors. Twenty-nine patients (21 men and eight women; age, 41-89 years) were identified with tumors abutting the diaphragm. Episodes of right shoulder pain were recorded. A panel of radiologists blinded to the patients' clinical histories reviewed their imaging for evidence of diaphragmatic injury and ablation success. A generalized estimating equation model and the Fisher exact test were used for statistical analysis. Results: The 29 patients had a total of 33 tumors abutting the diaphragm. Tumor size was 1.3-5.5 cm (mean, 3.2 cm ± 1.1). After ablation, five (17%) patients reported right shoulder pain. In four, pain was mild or moderate, with symptoms lasting 2-14 days (median, 5.5 days). Three of these showed diaphragmatic thickening on postablation computed tomographic (CT) scans. One patient had severe pain lasting 2 weeks, followed by milder pain for 2 months. This patient's postablation CT images showed focal nodular diaphragmatic thickening. This patient was treated with a multitined device; the other four, with straight-needle devices. Local tumor progression was seen in 14 tumors (42.4%). Tumors 3 cm or smaller had a much lower local progression rate than tumors larger than 3 cm (12.5% vs 70.6%). Conclusion: Of 29 patients who had ablation of hepatic tumors adjacent to the diaphragm, five (17%) had diaphragmatic injury, which was clinically apparent with right shoulder pain.

Original languageEnglish (US)
Pages (from-to)877-884
Number of pages8
JournalRadiology
Volume243
Issue number3
DOIs
StatePublished - Jun 1 2007

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Head, H. W., Dodd, G. D., Dalrymple, N. C., Prasad, S. R., El-Merhi, F. M., Freckleton, M. W., & Hubbard, L. G. (2007). Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: Frequency of diaphragmatic injury. Radiology, 243(3), 877-884. https://doi.org/10.1148/radiol.2433060157