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Perfusion-Modulated MR Imaging—Guided Radiofrequency Ablation of the Kidney in a Porcine Model

Andrik J. Aschoff1,2, Aaron Sulman3, Michael Martinez1, Jeffrey L. Duerk1,4, Martin I. Resnick3, Gregory T. MacLennan5 and Jonathan S. Lewin1,6

1 Department of Radiology, Division of MR Imaging, University Hospitals of Cleveland/Case Western Reserve University, 1110 Euclid Ave., Cleveland, OH 44106.
2 Department of Diagnostic Radiology, University of Ulm, Ulm 89075, Germany.
3 Department of Urology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH 44106.
4 Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106.
5 Department of Pathology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH 44106.
6 Department of Oncology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH 44106.



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  		Fig. 1. —One of series of sequential fast low-angle shot images shows inflation of balloon catheter (arrows) in aorta above renal arteries.

 


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  		Fig. 2. —Graph shows average radiofrequency current versus time during radiofrequency ablation in six pig kidneys with normal perfusion and six pig kidneys with reduced perfusion during ablation. Note continuous decrease of radiofrequency current during interstitial thermotherapy; kidneys with reduced perfusion required less radiofrequency current. Average for perfused kidneys = {diamondsuit}; average for nonperfused kidneys = {blacksquare}.

 


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  		Fig. 3. —Graph shows average impedance versus time during radiofrequency ablation in six pig kidneys with normal perfusion and six pig kidneys with reduced perfusion during ablation. Note impedance drop in first min of ablation; kidneys with reduced perfusion showed higher impedance throughout whole experiment. Average for perfused kidneys = {diamondsuit}; average for nonperfused kidneys = {blacksquare}.

 


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  		Fig. 4. —Graph shows average maximum lesion diameter as measured on gross pathologic specimens perpendicular to electrode. Error bars represent standard deviations. Difference is statistically significant (one-tailed t test, p = 0.00002).

 


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  		Fig. 5A. —MR images obtained immediately after thermal ablation. Right kidney is perfused, and left kidney is nonperfused. Axial contrast-enhanced T1-weighted spin-echo MR image. Note difference in lesion size (arrows) between perfused and nonperfused kidneys.

 


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  		Fig. 5B. —MR images obtained immediately after thermal ablation. Right kidney is perfused, and left kidney is nonperfused. Coronal contrast-enhanced T1-weighted spin-echo MR image. Note difference in lesion size (arrows) between perfused and nonperfused kidneys.

 


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  		Fig. 5C. —MR images obtained immediately after thermal ablation. Right kidney is perfused, and left kidney is nonperfused. Axial T2-weighted turbo spin-echo MR image. Note difference in lesion size (arrows) between perfused and nonperfused kidneys.

 


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  		Fig. 5D. —MR images obtained immediately after thermal ablation. Right kidney is perfused, and left kidney is nonperfused. Coronal T2-weighted turbo spin-echo MR image. Note difference in lesion size (arrows) between perfused and nonperfused kidneys.

 


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  		Fig. 5E. —MR images obtained immediately after thermal ablation. Right kidney is perfused, and left kidney is nonperfused. Axial short tau inversion recovery (STIR) sequence MR image. Note difference in lesion size (arrows) between perfused and nonperfused kidneys.

 


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  		Fig. 5F. —MR images obtained immediately after thermal ablation. Right kidney is perfused, and left kidney is nonperfused. Coronal STIR sequence MR image. Note difference in lesion size (solid arrows) between perfused and nonperfused kidneys. Also note small subcapsular hematoma at insertion site of right kidney (arrowhead) and larger hematoma adjacent to left kidney (dotted arrows).

 


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  		Fig. 6A. —Gross pathologic and histologic sections in comparison. Photograph of gross section of perfused kidney with thermal lesion surrounded by darker sharply delineated rim.

 


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  		Fig. 6B. —Gross pathologic and histologic sections in comparison. Photograph of gross section of nonperfused kidney with thermal lesion. Note that rim appears wider and darker.

 


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  		Fig. 6C. —Gross pathologic and histologic sections in comparison. Low-power image of histologic slide reveals zone of evolving cell damage (arrows) around central cavity (asterisk) caused by radiofrequency electrode.

 


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  		Fig. 6D. —Gross pathologic and histologic sections in comparison. Higher magnification of histologic slide shows interface (arrows) between normal and damaged tissue with inflammatory and edematous changes. Asterisk marks central cavity. (H and E, x20)

 


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  		Fig. 6E. —Gross pathologic and histologic sections in comparison. High-power magnification of histologic slide shows normal glomerulus (arrowheads) outside zone of cell destruction. (H and E, x200)

 


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  		Fig. 6F. —Gross pathologic and histologic sections in comparison. High-power magnification of histologic slide shows edematous hemorrhagic glomerulus (arrowheads) in zone of thermal damage. Also note areas of interstitial hemorrhage between tubulus (arrow). (H and E, x400)

 

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