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Radiological findings of porcine liver after electrochemotherapy with bleomycin

Maja Brloznik
Maja Brloznik
, 
Nina Boc
Nina Boc
, 
Gregor Sersa
Gregor Sersa
, 
Jan Zmuc
Jan Zmuc
, 
Gorana Gasljevic
Gorana Gasljevic
, 
Alenka Seliskar
Alenka Seliskar
, 
Rok Dezman
Rok Dezman
, 
Ibrahim Edhemovic
Ibrahim Edhemovic
, 
Nina Milevoj
Nina Milevoj
, 
Tanja Plavec
Tanja Plavec
, 
Vladimira Erjavec
Vladimira Erjavec
, 
Darja Pavlin
Darja Pavlin
, 
Masa Bosnjak
Masa Bosnjak
, 
Erik Brecelj
Erik Brecelj
, 
Ursa Lampreht Tratar
Ursa Lampreht Tratar
, 
Bor Kos
Bor Kos
, 
Jani Izlakar
Jani Izlakar
, 
Marina Stukelj
Marina Stukelj
, 
Damijan Miklavcic
Damijan Miklavcic
 and 
Maja Cemazar
Maja Cemazar
   | Oct 10, 2019
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Article Category: Research Article
Published Online: Oct 10, 2019
Page range: 415 - 426
Received: Aug 15, 2019
Accepted: Sep 12, 2019
DOI: https://doi.org/10.2478/raon-2019-0049
© 2019 Maja Brloznik, Nina Boc, Gregor Sersa, Jan Zmuc, Gorana Gasljevic, Alenka Seliskar, Rok Dezman, Ibrahim Edhemovic, Nina Milevoj, Tanja Plavec, Vladimira Erjavec, Darja Pavlin, Masa Bosnjak, Erik Brecelj, Ursa Lampreht Tratar, Bor Kos, Jani Izlakar, Marina Stukelj, Damijan Miklavcic, Maja Cemazar, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

B-mode ultrasonography. (A) Position of the variable linear geometry electrode in the left middle hepatic vein (arrow). (B) Hyperechogenic microbubbles (arrows) observed immediately after electrochemotherapy (ECT) along the track of the linear electrode. (C) Hyperechogenic microbubbles observed immediately after ECT along the tracks of hexagonal geometry electrodes (arrows). (D) In the next minutes, the hepatic parenchyma of the treated area becomes hypoechogenic (yellow arrow), and hyperechogenic microbubbles (red arrow) start to diffuse.
B-mode ultrasonography. (A) Position of the variable linear geometry electrode in the left middle hepatic vein (arrow). (B) Hyperechogenic microbubbles (arrows) observed immediately after electrochemotherapy (ECT) along the track of the linear electrode. (C) Hyperechogenic microbubbles observed immediately after ECT along the tracks of hexagonal geometry electrodes (arrows). (D) In the next minutes, the hepatic parenchyma of the treated area becomes hypoechogenic (yellow arrow), and hyperechogenic microbubbles (red arrow) start to diffuse.

Figure 2

Doppler and contrast-enhanced ultrasonography. (A) Color Doppler in the left middle hepatic vein (blue) immediately after electrochemotherapy (ECT). Hyperechogenic microbubbles (arrow) can be noted. (B) Contrast enhanced ultrasound (CEUS) immediately after ECT and at 13 seconds after contrast administration; the position of the electrode is circled. (C) CEUS at 4 minutes after ECT and at 24 seconds after contrast; the larger vessel can be recognized (arrows). (D) CEUS at 5 minutes after ECT and at 14 seconds after contrast; a perfusion curve is shown.
Doppler and contrast-enhanced ultrasonography. (A) Color Doppler in the left middle hepatic vein (blue) immediately after electrochemotherapy (ECT). Hyperechogenic microbubbles (arrow) can be noted. (B) Contrast enhanced ultrasound (CEUS) immediately after ECT and at 13 seconds after contrast administration; the position of the electrode is circled. (C) CEUS at 4 minutes after ECT and at 24 seconds after contrast; the larger vessel can be recognized (arrows). (D) CEUS at 5 minutes after ECT and at 14 seconds after contrast; a perfusion curve is shown.

Figure 3

Dynamic CT study, area treated with hexagonal electrodes is circled; note that hypoenhancing areas are most clearly seen 30 seconds after arterial phase. (A) Pre-contrast. (B) Arterial phase. (C) At 30 seconds after arterial phase. (D) At 60 seconds after arterial phase. (E) At 90 seconds after arterial phase.
Dynamic CT study, area treated with hexagonal electrodes is circled; note that hypoenhancing areas are most clearly seen 30 seconds after arterial phase. (A) Pre-contrast. (B) Arterial phase. (C) At 30 seconds after arterial phase. (D) At 60 seconds after arterial phase. (E) At 90 seconds after arterial phase.

Figure 4

(A) Electrochemotherapy (ECT) of the liver with linear electrodes. Left Figure is a CT image, where a distance between the hypoenhancing tracks of 2 cm can be noted. Right Figure is numerical model of electric field distribution in linear electrodes. Middle Figure shows electric field distribution superimposed on the CT image. (B) ECT of the liver with hexagonal electrodes. Left Figure is a CT image and right Figure is numerical model of electric field distribution in hexagonal electrodes. Middle image shows electric field distribution superimposed on the CT image. (C) Multiplanar reconstruction (MPR) of Figure 4A .The hypoenhancing area is circled. Note the larger vessel in the middle of the hypoenhancing area in coronal reconstruction.
(A) Electrochemotherapy (ECT) of the liver with linear electrodes. Left Figure is a CT image, where a distance between the hypoenhancing tracks of 2 cm can be noted. Right Figure is numerical model of electric field distribution in linear electrodes. Middle Figure shows electric field distribution superimposed on the CT image. (B) ECT of the liver with hexagonal electrodes. Left Figure is a CT image and right Figure is numerical model of electric field distribution in hexagonal electrodes. Middle image shows electric field distribution superimposed on the CT image. (C) Multiplanar reconstruction (MPR) of Figure 4A .The hypoenhancing area is circled. Note the larger vessel in the middle of the hypoenhancing area in coronal reconstruction.

Figure 5

Computed tomography. Hypoenhancing areas after electrochemotherapy (ECT). (A) Variable linear geometry electrodes. Hypoenhancing track to the caudal vena cava (yellow arrow), hepatic vein (green arrow), portal vein (red arrow) and treated hepatic parenchyma of the left liver lobe (blue arrow). (B) Fixed hexagonal geometry electrodes. Hypoenhancing tracks toward the caudal vena cava (yellow circle), hepatic vein (green circle), portal vein (red circle) and when inserted only into hepatic parenchyma (blue circle).
Computed tomography. Hypoenhancing areas after electrochemotherapy (ECT). (A) Variable linear geometry electrodes. Hypoenhancing track to the caudal vena cava (yellow arrow), hepatic vein (green arrow), portal vein (red arrow) and treated hepatic parenchyma of the left liver lobe (blue arrow). (B) Fixed hexagonal geometry electrodes. Hypoenhancing tracks toward the caudal vena cava (yellow circle), hepatic vein (green circle), portal vein (red circle) and when inserted only into hepatic parenchyma (blue circle).

Figure 6

Computed tomography. (A) Left middle hepatic vein, three successive slices, hypoenhancing tracks in contiguity with the treated vessel (circled) and the vessel wall and patency were not affected. (B) Delineation of nonenhancing regions (white) and computer program determination of the area (in mm2) and attenuation (in Hounsfield units or HU) of the region. The red circle indicates untreated hepatic parenchyma, excluding large vessels. (C) One week after electrochemotherapy (ECT) with linear electrodes, narrow hypoenhancing tracks were observed (red arrow).
Computed tomography. (A) Left middle hepatic vein, three successive slices, hypoenhancing tracks in contiguity with the treated vessel (circled) and the vessel wall and patency were not affected. (B) Delineation of nonenhancing regions (white) and computer program determination of the area (in mm2) and attenuation (in Hounsfield units or HU) of the region. The red circle indicates untreated hepatic parenchyma, excluding large vessels. (C) One week after electrochemotherapy (ECT) with linear electrodes, narrow hypoenhancing tracks were observed (red arrow).

Figure 7

Histology of hepatic parenchyma immediately after electrochemotherapy (ECT). Fibrin thrombus in the lumen of a small venule (arrow). (A) H&E, 10x. (B) H&E, 20x.
Histology of hepatic parenchyma immediately after electrochemotherapy (ECT). Fibrin thrombus in the lumen of a small venule (arrow). (A) H&E, 10x. (B) H&E, 20x.

Area and attenuation of hypoenhancing regions for each animal

Number of measured hypo- enhancing regionsTotal area (in mm2)Median area (in mm2), IQRA Attenuation of total area (in HU) Σ ((area x attenuation) / total area)B Attenuation of untreated parenchyma (in HU), ± SE 15 measurements in each animalDifference in attenuation (B – A)Corrected difference in attenuation (B–A)/B*100
48845494.5, 46–16872118 ± 24639
ECT66317831.5, 19–5386114 ± 22825
Linear91514639, 25–7582123 ± 14133
electrodesEP61453851, 30–10475108 ± 13330
55356332, 18–92122165 ± 34326
25750*21, 11.5–32*98124 ± 22621
Hexagonal electrodesECT462328*39.5, 25–72*80101 ± 121*21*
1 week after ECT1199**8, 5–11**7499 ± 124**25**
with electrodes linear13300**19, 12–27.5**76101 ± 125**25**
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