CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1773–1778 | Cite as

Evaluation of the Heat Sink Effect After Transarterial Embolization When Performed in Combination with Thermal Ablation of the Liver in a Rabbit Model

  • Charles J. Puza
  • Qi Wang
  • Charles Y. KimEmail author
Laboratory Investigation



To assess the contribution of the heat sink effect when combining thermal ablation with transarterial embolization (TAE).

Materials and Methods

Radiofrequency ablation (RFA) or microwave ablation (MWA) were performed in the liver of non-tumor bearing rabbits. Three perfusion groups were used: rabbits that were killed then immediately ablated (non-perfused liver group to simulate embolized tumor with no heat sink), rabbits that underwent hepatic TAE followed by ablation (embolized liver group), and rabbits that underwent ablation while alive (normally perfused liver control group). For each perfusion group, 8 RFAs and 8 MWAs were performed. Probes were inserted using ultrasound guidance to avoid areas with major blood vessels. During ablation, temperatures were obtained from a thermocouple located 1 cm away from the ablation probe to assess heat conduction. With MWA, temperatures were also measured from the antennae tip.


For RFA, embolization of normal liver did not increase temperature conduction when compared to the control group. However, temperature conduction was significantly increased in the non-perfused group (simulating embolized tumor) compared to controls (p = 0.007). For MWA, neither embolization nor non-perfusion increased temperature conduction compared to controls. With MWA, the probe tip temperature was significantly higher in the non-perfused group compared to the control and embolized group.


In non-perfused tissue simulating tumor, RFA demonstrated modest enhancement of temperature conduction, whereas MWA did not. Embolization of normal liver did not affect RFA or MWA. Findings suggest that heat sink mitigation plays a limited role with combination embolization-ablation therapies, albeit more with RFA than MWA.


Microwave ablation Radiofrequency ablation Heat sink Combination therapy Embolization 



This study was funded by the National Cancer Institute (Grant No. 5R03CA191978), Society of Interventional Radiology (Dr. and Mrs. W.C. Culp Student Research Grant), Radiologic Society of North America (Medical Student Research Grant), and the Duke University Department of Radiology (Charles Putnum Vision Grant).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.


  1. 1.
    Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer. 2005;103(6):1201–9. Scholar
  2. 2.
    Benson AB 3rd, D’Angelica MI, Abbott DE, Abrams TA, Alberts SR, Saenz DA, et al. NCCN guidelines insights: hepatobiliary cancers, version 1.2017. J Natl Compr Canc Netw. 2017;15(5):563–73.CrossRefGoogle Scholar
  3. 3.
    Yamanaka T, Yamakado K, Takaki H, Nakatsuka A, Shiraki K, Hasegawa H, et al. Ablative zone size created by radiofrequency ablation with and without chemoembolization in small hepatocellular carcinomas. Jpn J Radiol. 2012;30(7):553–9. Scholar
  4. 4.
    Mostafa EM, Ganguli S, Faintuch S, Mertyna P, Goldberg SN. Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J Vasc Interv Radiol. 2008;19(12):1740–8. Scholar
  5. 5.
    Peng ZW, Zhang YJ, Chen MS, Xu L, Liang HH, Lin XJ, et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol. 2013;31(4):426–32. Scholar
  6. 6.
    Peng ZW, Zhang YJ, Liang HH, Lin XJ, Guo RP, Chen MS. Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: a prospective randomized trial. Radiology. 2012;262(2):689–700. Scholar
  7. 7.
    Kim JH, Won HJ, Shin YM, Kim SH, Yoon HK, Sung KB, et al. Medium-sized (3.1–5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol. 2011;18(6):1624–9. Scholar
  8. 8.
    Kang SG, Yoon CJ, Jeong SH, Kim JW, Lee SH, Lee KH, et al. Single-session combined therapy with chemoembolization and radiofrequency ablation in hepatocellular carcinoma less than or equal to 5 cm: a preliminary study. J Vasc Interv Radiol. 2009;20(12):1570–7. Scholar
  9. 9.
    Yan S, Xu D, Sun B. Combination of radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: a meta-analysis. Dig Dis Sci. 2012;57(11):3026–31. Scholar
  10. 10.
    Lu Z, Wen F, Guo Q, Liang H, Mao X, Sun H. Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: a meta-analysis of randomized-controlled trials. Eur J Gastroenterol Hepatol. 2013;25(2):187–94.CrossRefGoogle Scholar
  11. 11.
    Lee HJ, Kim JW, Hur YH, Shin SS, Heo SH, Cho SB, et al. Combined therapy of transcatheter arterial chemoembolization and radiofrequency ablation versus surgical resection for single 2–3 cm hepatocellular carcinoma: a propensity-score matching analysis. J Vasc Interv Radiol. 2017. Scholar
  12. 12.
    Takuma Y, Takabatake H, Morimoto Y, Toshikuni N, Kayahara T, Makino Y, et al. Comparison of combined transcatheter arterial chemoembolization and radiofrequency ablation with surgical resection by using propensity score matching in patients with hepatocellular carcinoma within Milan criteria. Radiology. 2013;269(3):927–37. Scholar
  13. 13.
    Ginsburg M, Zivin SP, Wroblewski K, Doshi T, Vasnani RJ, Van Ha TG. Comparison of combination therapies in the management of hepatocellular carcinoma: transarterial chemoembolization with radiofrequency ablation versus microwave ablation. J Vasc Interv Radiol. 2015;26(3):330–41. Scholar
  14. 14.
    Vasnani R, Ginsburg M, Ahmed O, Doshi T, Hart J, Te H, et al. Radiofrequency and microwave ablation in combination with transarterial chemoembolization induce equivalent histopathologic coagulation necrosis in hepatocellular carcinoma patients bridged to liver transplantation. Hepatobiliary Surg Nutr. 2016;5(3):225–33. Scholar
  15. 15.
    Tsochatzis E, Garcovich M, Marelli L, Papastergiou V, Fatourou E, Rodriguez-Peralvarez ML, et al. Transarterial embolization as neo-adjuvant therapy pretransplantation in patients with hepatocellular carcinoma. Liver Int. 2013;33(6):944–9. Scholar
  16. 16.
    Riaz A, Lewandowski RJ, Kulik L, Ryu RK, Mulcahy MF, Baker T, et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with chemoembolization. Cardiovasc Interv Radiol. 2010;33(6):1143–52. Scholar
  17. 17.
    Higgins MC, Soulen MC. Combining locoregional therapies in the treatment of hepatocellular carcinoma. Semin Intervent Radiol. 2013;30(1):74–81. Scholar
  18. 18.
    Stone MJ, Wood BJ. Emerging local ablation techniques. Semin Intervent Radiol. 2006;23(1):85–98. Scholar
  19. 19.
    Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DS. Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol. 2008;19(7):1087–92. Scholar
  20. 20.
    Bierman HR, Byron RL Jr, Kelley KH, Grady A. Studies on the blood supply of tumors in man. III. Vascular patterns of the liver by hepatic arteriography in vivo. J Natl Cancer Inst. 1951;12(1):107–31.PubMedGoogle Scholar
  21. 21.
    Bhardwaj N, Strickland AD, Ahmad F, Atanesyan L, West K, Lloyd DM. A comparative histological evaluation of the ablations produced by microwave, cryotherapy and radiofrequency in the liver. Pathology. 2009;41(2):168–72. Scholar
  22. 22.
    Pillai K, Akhter J, Chua TC, Shehata M, Alzahrani N, Al-Alem I, et al. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine (Baltimore). 2015;94(9):e580. Scholar
  23. 23.
    Primavesi F, Swierczynski S, Klieser E, Kiesslich T, Jager T, Urbas R, et al. Thermographic real-time-monitoring of surgical radiofrequency and microwave ablation in a perfused porcine liver model. Oncol Lett. 2018;15(3):2913–20. Scholar
  24. 24.
    Parvinian A, Casadaban LC, Gaba RC. Development, growth, propagation, and angiographic utilization of the rabbit VX2 model of liver cancer: a pictorial primer and “how to” guide. Diagn Interv Radiol. 2014;20(4):335–40. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Division of Interventional RadiologyDuke University Medical CenterDurhamUSA
  2. 2.Department of Radiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China

Personalised recommendations