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Early Experience with Percutaneous Radiofrequency Ablation of Small Solid Renal Masses

¹ Department of Radiology, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd., Kingston Upon Hull, HU3 2JZ, United Kingdom.
² Department of Urology, Hull and East Yorkshire Hospitals NHS Trust, Kingston Upon Hull, HU3 2JZ, United Kingdom.
³ Present address: Department of Radiology, Southampton University Hospitals NHS Trust, Tremona Rd., Southampton, SO16 6YD, United Kingdom.

View larger version (140K): [in a new window]   Fig. 1A. —88-year-old man with mass in kidney. Contrast-enhanced axial CT scan shows 3-cm exophytic solid mass (arrow) in upper pole of left kidney.

View larger version (144K): [in a new window]   Fig. 1B. —88-year-old man with mass in kidney. Contrast-enhanced axial CT scan obtained after radiofrequency ablation shows no enhancing mass. On follow-up (not shown), this necrotic mass has since decompressed into perirenal tissues.

View larger version (133K): [in a new window]   Fig. 2B. —80-year-old man with chronic lymphocytic leukemia. Unenhanced CT scan obtained with patient in prone position shows radiofrequency probe placed alongside spleen under fluoroscopic CT guidance to treat lesion.

View larger version (147K): [in a new window]   Fig. 3B. —64-year-old woman with mass in mid pole of right kidney. IV contrast–enhanced CT scan obtained 3 days after radiofrequency ablation shows area of nonenhancement consistent with coagulative necrosis. Thin rim of enhancing mass (arrow) persists.

View larger version (133K): [in a new window]   Fig. 2C. —80-year-old man with chronic lymphocytic leukemia. IV contrast–enhanced CT scan obtained after radiofrequency ablation shows area of high density (arrowhead) within treated area that was present on postprocedure unenhanced scan (not shown). This finding is consistent with hemorrhage and necrosis that occur after radiofrequency ablation. No tumor enhancement is present.

View larger version (178K): [in a new window]   Fig. 4B. —75-year-old man with contralateral nephrectomy caused by hydronephrosis 50 years ago. Axial CT scan obtained after two 12-min radiofrequency ablation sessions shows lack of enhancement. Curvilinear area of high density (arrow) that was thought to be vessel in margin persists on medial aspect.

View larger version (173K): [in a new window]   Fig. 4C. —75-year-old man with contralateral nephrectomy caused by hydronephrosis 50 years ago. Contrast-enhanced CT scan acquired inferior relative to treated lesion shows area of low attenuation consistent with small cortical infarction (arrowhead) that was asymptomatic.

View larger version (168K): [in a new window]   Fig. 4D. —75-year-old man with contralateral nephrectomy caused by hydronephrosis 50 years ago. Contrast-enhanced CT scan obtained at 12-month follow-up shows no change except for slight cortical thinning.

View larger version (162K): [in a new window]   Fig. 2A. —80-year-old man with chronic lymphocytic leukemia. IV contrast–enhanced CT scan obtained before treatment shows border-deforming, biopsy-proven anterior interpolar 3-cm tumor (arrows) in left kidney.

View larger version (170K): [in a new window]   Fig. 2D. —80-year-old man with chronic lymphocytic leukemia. Contrast-enhanced CT scan obtained 22 months after C shows that treated area remains unenhanced and now measures 1.5 cm. Incidental note is made of patient's increasing volume of nodes associated with chronic lymphocytic leukemia.

View larger version (166K): [in a new window]   Fig. 5. —74-year-old man with poor respiratory reserve who was treated with radiofrequency ablation. Contrast-enhanced CT scan shows 3-cm mass (asterisk) in lower pole of right kidney. Thermal injury (arrows) to right psoas major and quadratus lumborum muscles is seen.

View larger version (167K): [in a new window]   Fig. 3D. —64-year-old woman with mass in mid pole of right kidney. Contrast-enhanced CT scan obtained 16 months after C shows that coagulated area now measures 2.8 cm. Slightly reduced attenuation on medial aspect (arrowhead) is suggestive of local infarction that was asymptomatic after retreatment.

View larger version (173K): [in a new window]   Fig. 3A. —64-year-old woman with mass in mid pole of right kidney. Contrast-enhanced CT scan shows 3.5-cm enhancing solid lesion before treatment.

View larger version (176K): [in a new window]   Fig. 3C. —64-year-old woman with mass in mid pole of right kidney. Contrast-enhanced CT scan obtained after repeated treatment to residual area shows no enhancement.

View larger version (140K): [in a new window]   Fig. 4A. —75-year-old man with contralateral nephrectomy caused by hydronephrosis 50 years ago. Contrast-enhanced CT scan shows solid renal sinus mass (arrow) that has grown during observation.

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