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CT Imaging Findings of Pulmonary Neoplasms After Treatment with Radiofrequency Ablation: Results in 32 Tumors

¹ All authors: Department of Diagnostic Imaging, Rhode Island Hospital, Brown Medical School, 593 Eddy St., Providence, RI 02903.

Abstract

OBJECTIVE. The purpose of this study is to describe the CT appearance of thoracic neoplasms after treatment with radiofrequency ablation (RFA).

MATERIALS AND METHODS. Thirty-two thoracic neoplasms in 26 patients had pulmonary RFA and imaging follow-up. Fourteen neoplasms were primary lung cancer and 18 were metastases. The mean pretreatment neoplasm size was 3.1 cm (range, 1.0–7.0 cm), and the average number of neoplasms treated per patient was 1.2 (range, 1–3). The mean follow-up was 10.1 months (range, 1–30 months). Imaging findings on CT were evaluated by three radiologists and documented by consensus.

RESULTS. The most common finding immediately after treatment was peripheral ground-glass opacity surrounding the treated neoplasm, seen in 27 of 32 tumors (84%). This rapidly resolved in all but one patient by the end of the first month. Cavitation was seen in 10 of 32 tumors (31%) on follow-up CT and was most common in neoplasms in the inner two thirds of the lung and adjacent to a segmental bronchus. Sixty percent of the cavitations decreased in size on follow-up scans. Ten of 32 tumors (31%) that did not develop cavitation developed bubble lucencies on follow-up CT. Pleural thickening was found in 12 of 22 (55%) parenchymal neoplasms, and linear opacifications were seen between the treated lesion and adjacent pleura in 14 of 22 parenchymal tumors (64%). Pleural effusions were seen in four patients (15%). Fourteen of 22 tumors (64%) with follow-up imaging at 1 month enlarged from pretreatment CT scans. At 3 and 6 months after RFA, the majority remained stable in size.

CONCLUSION. Peripheral ground-glass opacity, cavitation, bubble lucencies, and pleural changes are common findings on CT after RFA. Many treated neoplasms increase in size from baseline on 1- to 3-month follow-up CT scans and then remain stable thereafter. Enlargement of a treated tumor after 6 months is felt to represent local recurrence. Stability of a treated lesion beyond 6 months does not guarantee continued stability.

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