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MR Imaging of the Kidneys After Laparoscopic Cryoablation

¹ Division of Radiology, A21, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.
² Present address: Department of Radiology, Hacettepe University Hospital, Sihhiye, Ankara, Turkey.
³ Department of Urology, Section of Minimally Invasive Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195.

OBJECTIVE. We describe the MR imaging findings of patients who underwent laparoscopic renal lesion cryoablation.

MATERIALS AND METHODS. Twenty-one patients (men, 11; women, 10; age range, 36-84 years; average age, 65.5 years; SD, 11.9) with 23 small renal masses (4 cm) underwent laparoscopic renal lesion cryoablation. Twenty patients (22 masses) underwent followup MR imaging on the first day after surgery, 12 (13 masses) at 1 month, 16 (18 masses) at 3 months, 14 (15 masses) at 6 months, and 12 (12 masses) at 12 months. Three radiologists retrospectively reviewed MR images for the signal intensity, characteristics, and size of cryolesions. CT-guided needle biopsy was performed 6 months after cryoablation (18 patients) and no evidence of malignancy was discovered.

RESULTS. Including all lesions at all times on T1-weighted images, cryolesion signal intensity was isointense to renal parenchyma (47/76, 61.8%) or isointense with hyper- or hypointense foci (7/76, 9.2%). On T2-weighted images, almost all lesions (72/76, 94.7%) were isointense or hypointense, and there was a hypointense rim between the cryolesion and renal parenchyma in 38.2% of lesions (29/76). A thin peripheral rim of enhancement was noted in 19.7% (14/74) of lesions. Cryolesions decreased in size an average of 61.5% (SD, 22.82; n = 12) at 1 month, 78.7% (SD, 13.5; n = 17) at 3 months, 83.5% (SD, 24.3; n = 15) at 6 months, and 94.2% (SD, 8.1; n = 11) at 1 year after cryoablation (one patient was not scanned 1 day after cryoablation and was not included in our calculations).

CONCLUSION. After renal cryoablation, MR imaging revealed common signal characteristics such as low-signal-intensity rims on T2-weighted images, enhancement patterns such as thin peripheral rims, and interval size changes.

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