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Objectives To assess the safety and efficacy of radiofrequency ablation (RFA) guidance software that incorporated patient-specific physics-based simulation of each ablation volume.Materials and methods Patients referred for curative ablation of hepatocellular carcinoma (HCC) of 2–5 cm diameter were prospectively enrolled. RFA was performed under general anesthesia. Procedure planning and intraprocedural modifications were guided by computer simulation of each ablation. The segmented target (tumor with 5 mm margin) was registered to and superimposed on subsequent 3D multiplanar images. The applied RF energy was used to calculate a simulated ablation volume which was displayed relative to the electrode and segmented target, to depict any untreated target tissue. After each additional ablation, the software updated the accumulated simulated ablation volume in relation to the target. The primary endpoints were technical efficacy and rate of local tumor progression (LTP).Results Sixty-eight tumors were ablated during 57 procedures in 52 patients (68.3 ± 9.2 years old, 78.8% male); 15 (26.3%) had multiple lesions and 23 (39.1%) had prior HCC treatment. The mean tumor diameter was 2.73 (±0.64) cm. The intraprocedural simulation directed additional overlapping ablations in 75.9% of tumors. Technical success and efficacy were 100% at 3-month contrast enhanced CT or MRI follow-up after the single treatment session. Cumulative incidence function estimates for 1- and 2-year LTP were 3.9% and 20.2%, respectively.Conclusion This prospective study found computer-assisted guidance that simulated each ablation was both safe and efficacious. The low rate of LTP was similar to studies that employed stereotactic guidance and ablation confirmation, without requiring a second contrast enhanced study.

Gelfoam® is a temporary embolization agent often used in trauma where permanent arterial occlusion is not desired. Gelfoam occlusions have been shown to resolve by 2 weeks, but shorter intervals have not been studied. We report a case of spontaneous arterial hemorrhage due to ruptured hepatic malignancy where treatment was Gelfoam slurry occlusion of the right hepatic artery. Repeat hemorrhage resulted in repeat CT and hepatic arteriography, which showed that recanalization of the occluded artery had occurred in less than 48 hours. Gelfoam arterial occlusion in some cases may last less than 2 weeks.