135 - Hepatic Histotripsy of Central Tumors; Retrospective Analysis of the First 10 Cases for Safety

Monday, April 13, 2026

3:54 PM - 4:03 PM ET

Presenting Author(s)

GF

Gretchen Foltz, MD, FSIR (she/her/hers)

Associate Professor
Madison Radiologists, United States

Author/Co-author(s)

FL

Fred T. Lee, Jr., MD

Professor
University Of Wisconsin, United States
Paul F. Laeseke, MD, PhD

Assistant Professor
University of Wisconsin, United States
Timothy J. Ziemlewicz, MD

Professor of Radiology
University of Wisconsin Hospital and Clinics, United States
Katrina Falk, MS

MD-PhD Student
University of Wisconsin-Madison, United States
Lexiana L. Poe (she/her/hers)

Research Intern
University of Wisconsin-Madison, United States
Adrienne L. Kisting, MS (she/her/hers)

Research Intern
University of Wisconsin-Madison, United States
AM

Ali Mutlu, MD

Research Intern
University of Wisconsin-Madison, United States
LH

Louis Hinshaw, MD

Professor
University of Wisconsin School of Medicine and Public Health, United States
JS

John F. Swietlik, MD

Assistant Professor
University of Wisconsin, United States
EG

Edwarda Golden, MD

Assistant Professor
The Johns Hopkins Hospital, United States
Erica M. Knavel Koepsel, MD (she/her/hers)

Associate Professor
University of Wisconsin, United States

Purpose: Treatment of central hepatic malignancies with thermal ablation modalities can be challenging or contraindicated due to the risk of injuring central bile ducts or hilar vessels. Histotripsy is a nonthermal ablation modality that destroys tumors but spares the biliary and vascular architecture at the treatment site. Animal studies have shown it is safe to target central locations in the liver prompting many providers to offer Histotripsy to patients with central tumors who traditionally would not have been candidates for percutaneous thermal ablation. The purpose of this study is to retrospectively evaluate the treatment safety of Histotrispy used for ablation of centrally located tumors.

Materials and Methods: Patient charts and images were retrospectively reviewed to identify patients who underwent histotripsy treatment of a hepatic tumor within 1 cm of a central bile duct between January 2024 to July 2025. All patients provided preprocedural written informed consent for the procedure and the retrospective review was performed under a waiver of informed consent provided by the institutional IRB and was HIPPA compliant. The treatment plan, post procedural imaging, follow up imaging, clinic notes and periprocedural labs were evaluated.

Results: 10 patients with central hepatic lesions treated with Histotripsy (8 Male, 2 Female; average age 60.7 years). A variety of tumor types were treated; 4 HCC, 4 mCRC, 1 metastatic ocular melanoma, 1 mNET. Average tumor size was 3.8 cm (range 1.8 - 5.6 cm). 4 of the lesions were treated with one planned treatment volume (PTV), 4 of the lesions were treated with two overlapping PTV’s, 1 lesion was treated with 3 overlapping PTV’s and 1 lesion was treated with 4 overlapping PTV’s. None of the patients had biliary injuries on the post procedural or follow up imaging. Two patients had non occlusive portal venous thrombus on post procedure imaging requiring anticoagulation treatment. One of the patients had a liver transplant prior to acquiring follow up imaging and the second patient had resolution of the thrombus on the follow up scan.

Conclusion: Treatment of central hepatic lesions with histotripsy was generally safe with minimal complications.