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Percutaneous CT-Guided Radiofrequency Ablation of Renal Neoplasms: Factors Influencing Success

¹ Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157.
² Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157.

View larger version (9K): [in a new window]   Fig. 1. —Scatterplot shows correlation of tumor size and months of follow-up. Black circles = complete ablation, white circles = residual tumor.

View larger version (159K): [in a new window]   Fig. 2A. —79-year-old man with renal cell carcinoma in right kidney. T1-weighted MR image (TR/TE 150/4.2) shows solid mass in upper pole of right kidney.

View larger version (131K): [in a new window]   Fig. 2B. —79-year-old man with renal cell carcinoma in right kidney. T1-weighted MR image (150/4.2) obtained at same level as A after IV injection of gadolinium shows marked enhancement in mass.

View larger version (179K): [in a new window]   Fig. 2C. —79-year-old man with renal cell carcinoma in right kidney. CT scan 1 month later during first ablation session with patient in prone position shows radiofrequency electrode in renal cell carcinoma.

View larger version (92K): [in a new window]   Fig. 2D. —79-year-old man with renal cell carcinoma in right kidney. T1-weighted MR images, obtained 4 months after ablation session, before (D) (150/4.2) and after (E) (600/15, with fat saturation) IV injection of gadolinium show enhancement only in small area of tumor (arrow, E). This enhancement was interpreted as indicating residual viable tumor.

View larger version (121K): [in a new window]   Fig. 2E. —79-year-old man with renal cell carcinoma in right kidney. T1-weighted MR images, obtained 4 months after ablation session, before (D) (150/4.2) and after (E) (600/15, with fat saturation) IV injection of gadolinium show enhancement only in small area of tumor (arrow, E). This enhancement was interpreted as indicating residual viable tumor.

View larger version (110K): [in a new window]   Fig. 2F. —79-year-old man with renal cell carcinoma in right kidney. CT scan with patient prone 2 months later during second ablation session shows electrode placed in area of residual viable tumor. Radiofrequency ablation was performed at this site.

View larger version (117K): [in a new window]   Fig. 2G. —79-year-old man with renal cell carcinoma in right kidney. Fast acquisition with multiphase 3D enhanced fast gradient-echo T1-weighted MR images (6/0.94) before (G) and after (H) IV injection of gadolinium obtained 10 months after second ablation session show absence of enhancement throughout renal tumor, interpreted as indicating complete tumor ablation.

View larger version (137K): [in a new window]   Fig. 2H. —79-year-old man with renal cell carcinoma in right kidney. Fast acquisition with multiphase 3D enhanced fast gradient-echo T1-weighted MR images (6/0.94) before (G) and after (H) IV injection of gadolinium obtained 10 months after second ablation session show absence of enhancement throughout renal tumor, interpreted as indicating complete tumor ablation.

View larger version (160K): [in a new window]   Fig. 3A. —Technique and expected results for radiofrequency ablations of renal cell carcinoma in 73-year-old woman. Contrast-enhanced CT scan shows 1.5-cm enhancing renal cell carcinoma (arrow) in right kidney.

View larger version (165K): [in a new window]   Fig. 3B. —Technique and expected results for radiofrequency ablations of renal cell carcinoma in 73-year-old woman. One month later, unenhanced CT scan with patient in prone position shows tip of ablation electrode (arrow) in renal tumor for second ablation. Small amount of gas has been released from first ablation, performed moments earlier, and is seen in tumor.

View larger version (136K): [in a new window]   Fig. 3C. —Technique and expected results for radiofrequency ablations of renal cell carcinoma in 73-year-old woman. Contrast-enhanced CT scan obtained immediately after ablation shows no enhancement of tumor and normal enhancement of adjacent kidney parenchyma. Small amount of perinephric stranding and foci of gas caused by thermal damage are present.

View larger version (155K): [in a new window]   Fig. 3D. —Technique and expected results for radiofrequency ablations of renal cell carcinoma in 73-year-old woman. Contrast-enhanced CT scan obtained 1 year after radiofrequency ablation shows no evidence of residual or recurrent tumor. Some atrophy has occurred, and sharp line of demarcation (arrow) is present between normal kidney and area of ablation. No enhancement in area of treatment is apparent, indicating complete tumor eradication.

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