Computer modeling of the combined effects of perfusion, electrical conductivity, and thermal conductivity on tissue heating patterns in radiofrequency tumor ablation

Purpose. To use an established computer simulation model of radiofrequency (RF) ablation to characterize the combined effects of varying perfusion, and electrical and thermal conductivity on RF heating. Methods. Two-compartment computer simulation of RF heating using 2-D and 3-D finite element analysis (ETherm) was performed in three phases (n = 88 matrices, 144 data points each). In each phase, RF application was systematically modeled on a clinically relevant template of application parameters (i.e., varying tumor and surrounding tissue perfusion: 0-5 kg/m3-s) for internally cooled 3 cm single and 2.5 cm cluster electrodes for tumor diameters ranging from 2-5 cm, and RF application times (6-20 min). In the first phase, outer thermal conductivity was changed to reflect three common clinical scenarios: soft tissue, fat, and ascites (0.5, 0.23, and 0.7 W/m-C, respectively). In the second phase, electrical conductivity was changed to reflect different tumor electrical conductivities (0.5 and 4.0 S/m, representing soft tissue and adjuvant saline injection, respectively) and background electrical conductivity representing soft tissue, lung, and kidney (0.5, 0.1, and 3.3 S/m, respectively). In the third phase, the best and worst combinations of electrical and thermal conductivity characteristics were modeled in combination. Tissue heating patterns and the time required to heat the entire tumor a 5 mm margin to 50C were assessed. Results. Increasing background tissue thermal conductivity increases the time required to achieve a 50C isotherm for all tumor sizes and electrode types, but enabled ablation of a given tumor size at higher tissue perfusions. An inner thermal conductivity equivalent to soft tissue (0.5 W/m-C) surrounded by fat (0.23 W/m-C) permitted the greatest degree of tumor heating in the shortest time, while soft tissue surrounded by ascites (0.7 W/m-C) took longer to achieve the 50C isotherm, and complete ablation could not be achieved at higher inner/outer perfusions (4 kg/m3-s). For varied electrical conductivities in the setting of varied perfusion, greatest RF heating occurred for inner electrical conductivities simulating injection of saline around the electrode with an outer electrical conductivity of soft tissue, and the least amount of heating occurring while simulating renal cell carcinoma in normal kidney. Characterization of these scenarios demonstrated the role of electrical and thermal conductivity interactions, with the greatest differences in effect seen in the 3-4 cm tumor range, as almost all 2 cm tumors and almost no 5 cm tumors could be treated. Conclusion. Optimal combinations of thermal and electrical conductivity can partially negate the effect of perfusion. For clinically relevant tumor sizes, thermal and electrical conductivity impact which tumors can be successfully ablated even in the setting of almost non-existent perfusion.