Percutaneous ablation for perivascular hepatocellular carcinoma: Refining the current status based on emerging evidence and future perspectives

Figure 1 Images demonstrating aggressive intrasegmental recurrence after radiofrequency ablation for perivascular hepatocellular carcinoma. A: Axial computed tomography image obtained during hepatic arterial phase shows viable hepatocellular carcinoma (HCC) within the partially lipiodolized nodule (asterisk) in segment V before radiofrequency (RF) ablation. The index tumor is in contact with the right portal vein (black arrow); B: On planning ultrasonography (US), using fusion imaging with color Doppler US and magnetic resonance imaging (MRI), the low echogenic incident tumor (asterisk) is in contact with a right portal vein (black arrow); C: During RF ablation with the US fusion system, the ablation zone (A) is covered with viable enhancing tumor foci, indicating T marker on real time US/fused MR image; D: MRI scan obtained during the hepatic arterial phase 9 mo after RF ablation shows multiple small arterial enhancing nodules (white arrows) of consistent size, representing recurrent tumors. These recurrent tumors developed simultaneously in a peripheral area of the treated segment, fed by the previous peritumoral portal vein; E: The patient underwent transarterial chemoembolization for tumor control considering tumor multiplicity. Multiple small nodular tumors were detected along the portal tract on hepatic angiogram.