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

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

Research output: Contribution to journalArticle

67 Citations (Scopus)

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

Fingerprint

Diaphragm
Liver
Wounds and Injuries
Neoplasms
Shoulder Pain
Pain
Health Insurance Portability and Accountability Act
Equipment and Supplies
Research Ethics Committees
Patient Rights
Informed Consent
Needles

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Head, H. W., Dodd, G. D., Dalrymple, N. C., Prasad, S., 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

Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm : Frequency of diaphragmatic injury. / Head, Hayden W.; Dodd, Gerald D.; Dalrymple, Neal C.; Prasad, Srinivasa; El-Merhi, Fadi M.; Freckleton, Michael W.; Hubbard, Linda G.

In: Radiology, Vol. 243, No. 3, 01.06.2007, p. 877-884.

Research output: Contribution to journalArticle

Head, HW, Dodd, GD, Dalrymple, NC, Prasad, S, El-Merhi, FM, Freckleton, MW & Hubbard, LG 2007, 'Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: Frequency of diaphragmatic injury', Radiology, vol. 243, no. 3, pp. 877-884. https://doi.org/10.1148/radiol.2433060157
Head, Hayden W. ; Dodd, Gerald D. ; Dalrymple, Neal C. ; Prasad, Srinivasa ; El-Merhi, Fadi M. ; Freckleton, Michael W. ; Hubbard, Linda G. / Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm : Frequency of diaphragmatic injury. In: Radiology. 2007 ; Vol. 243, No. 3. pp. 877-884.
@article{6eb870a79b95469984aff8850961323e,
title = "Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: Frequency of diaphragmatic injury",
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.",
author = "Head, {Hayden W.} and Dodd, {Gerald D.} and Dalrymple, {Neal C.} and Srinivasa Prasad and El-Merhi, {Fadi M.} and Freckleton, {Michael W.} and Hubbard, {Linda G.}",
year = "2007",
month = "6",
day = "1",
doi = "10.1148/radiol.2433060157",
language = "English (US)",
volume = "243",
pages = "877--884",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "3",

}

TY - JOUR

T1 - Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm

T2 - Frequency of diaphragmatic injury

AU - Head, Hayden W.

AU - Dodd, Gerald D.

AU - Dalrymple, Neal C.

AU - Prasad, Srinivasa

AU - El-Merhi, Fadi M.

AU - Freckleton, Michael W.

AU - Hubbard, Linda G.

PY - 2007/6/1

Y1 - 2007/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=34249087788&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34249087788&partnerID=8YFLogxK

U2 - 10.1148/radiol.2433060157

DO - 10.1148/radiol.2433060157

M3 - Article

C2 - 17517940

AN - SCOPUS:34249087788

VL - 243

SP - 877

EP - 884

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 3

ER -