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Radiofrequency Ablation of 40 Lung Neoplasms: Preliminary Results

¹ Unità Operativa di Radiologia Interventistica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Oncologico, Via Amendola 209, Bari 70126, Italy.
² Dipartimento di Area Critica e Quartiere Operatorio, IRCCS Oncologico, Bari 70126, Italy.
³ Dipartimento di Oncologia, IRCCS Oncologico, Bari 70126, Italy.
⁴ Unità Operativa di Radiologia, IRCCS Oncologico, Bari 70126, Italy.
⁵ Unità Operativa di Radioterapia, IRCCS Oncologico, Bari 70126, Italy.
⁶ Unità Operativa di Oncologia, Ospedale Generale S. Giuseppe, Via Paladini 40, 50053 Empoli (Firenze), Italy.
⁷ Direzione Scientifica, IRCCS Oncologico, Bari 70126, Italy.

View larger version (101K): [in a new window]   Fig. 1A. —79-year-old man with primary lung carcinoma. CT scan obtained immediately before radiofrequency ablation shows neoplasm (white arrows) with diameter of 3 cm that is located in posterior segment of superior right pulmonary lobe at subapical site. Black arrow indicates tip of electrode needle inserted into dorsal chest wall, immediately before crossing parietal pleura.

View larger version (101K): [in a new window]   Fig. 1B. —79-year-old man with primary lung carcinoma. CT scan obtained during radiofrequency ablation shows wrinkling of edges of lesion; partial emptying, which is likely due to vaporization of tissue; and unchanged diameter.

View larger version (112K): [in a new window]   Fig. 1C. —79-year-old man with primary lung carcinoma. CT scans obtained without contrast enhancement immediately after procedure using parenchymal (C) and mediastinal (D) window settings show thermalablated lesion (single arrow). Double arrows indicate parenchymal tissue around nodule, which is slightly hyperdense with granular appearance; triple arrows indicate vascular hyperdense parenchymal tissue forming envelope around previously described areas.

View larger version (109K): [in a new window]   Fig. 1D. —79-year-old man with primary lung carcinoma. CT scans obtained without contrast enhancement immediately after procedure using parenchymal (C) and mediastinal (D) window settings show thermalablated lesion (single arrow). Double arrows indicate parenchymal tissue around nodule, which is slightly hyperdense with granular appearance; triple arrows indicate vascular hyperdense parenchymal tissue forming envelope around previously described areas.

View larger version (100K): [in a new window]   Fig. 1E. —79-year-old man with primary lung carcinoma. CT scan obtained at end of thermal ablation procedure shows electrode needle (black arrow). White arrows indicate sectorial hyperemia surrounding lesion, conical in shape with apex at hilus.

View larger version (119K): [in a new window]   Fig. 2A. —74-year-old woman with lung metastases from colorectal carcinoma. High-resolution CT scan obtained before radiofrequency ablation shows neoplasm (arrow) with diameter of 1.8 cm located medially in posterior segment of right superior pulmonary lobe.

View larger version (147K): [in a new window]   Fig. 2B. —74-year-old woman with lung metastases from colorectal carcinoma. CT scan obtained 30 min after radiofrequency ablation shows metastatic lung lesions with clear "cockade phenomenon." Thin single arrow indicates treated nodule; double arrows indicate perilesional parenchymal tissue; triple arrows indicate inflamed, hyperemic, hyperdense parenchymal ring; thick arrow indicates minimal pneumothorax. We regard these radiologic finds to be in accordance with histologic descriptions reported by Miao et al. [29].

View larger version (112K): [in a new window]   Fig. 2C. —74-year-old woman with lung metastases from colorectal carcinoma. CT scan shows needle inside tumor during radiofrequency ablation. Neoplasm is located laterally to posterior venous branches (arrows) of posterior segment of superior right pulmonary lobe. Note that more dorsal branch is laterally in contact with lesion and medially in contact with posterior bronchial branch of superior right pulmonary lobe.

View larger version (127K): [in a new window]   Fig. 2D. —74-year-old woman with lung metastases from colorectal carcinoma. CT scan obtained 1 month after radiofrequency ablation shows tumoral lesion to be fully cavitated with reparative hyperemic hyperdense envelope. Areas labeled 1 and 2 were printed during CT process and refer to attenuation. Area 1 indicates the cavitated area with a densitometric value of–886 H. Area 2 indicates surrounding hyperdense ring with a densitometric value of 33 H. Note that envelope encompasses more dorsal branch of right superior pulmonary vein (arrow), which is partially surrounded by necrotic tissue originating from fragmentation of treated nodule.

View larger version (11K): [in a new window]   Fig. 3A. —Diagrams of lung neoplasm before and after radiofrequency ablation. Diagram shows lung neoplasm before treatment.

View larger version (33K): [in a new window]   Fig. 3B. —Diagrams of lung neoplasm before and after radiofrequency ablation. Diagram shows same tumoral lung lesion after radiofrequency ablation. Area of enzymatic necrosis with partially destroyed capillaries, microthrombosis, and lysosomal enzyme activation is labeled D. Peripheral ring of this area (D1) appears to express presence of microhemorrhagic border mixed with outermost layer (E), with edema, inflammatory reaction, and vascular congestion. A = central area intersected by electrode needle; B = partial emptying (dark), likely due to vaporization of lesion, and coagulative necrotic area with destroyed capillaries and "ghost phenomenon" (term used by Miao et al. [29] to describe seemingly intact tissue after sudden thermal coagulation); C = coagulative necrotic area surrounding nodule and containing collapsed alveoli with entrapped air and ghost phenomenon.

View larger version (124K): [in a new window]   Fig. 2E. —74-year-old woman with lung metastases from colorectal carcinoma. MR image obtained with gadolinium 2 months after radiofrequency ablation shows cavitated area appears moderately enlarged; surrounding envelope has less thickness; and necrotic fragments of treated lesion, which adhere to very hyperintense internal surface, are unenhanced. Note that envelope includes more dorsal branch of right superior pulmonary vein (arrow), which is partially surrounded by necrotic fragment of treated lesion. See Miao et al. [29].

View larger version (169K): [in a new window]   Fig. 4A. —69-year-old man with primary lung carcinoma. MR image obtained after marginal relapse 2 months after first treatment shows large hypointense necrotic nodule is surrounded by thin, hyperintense fibrous scar. In peripheral dorsal sector markedly hyperintense tissue (arrow), representing tumoral relapse, is visible.

View larger version (174K): [in a new window]   Fig. 4B. —69-year-old man with primary lung carcinoma. MR image obtained at 5-month check-up after second treatment shows entire hypointense volume of tumor (single arrow), including treated area of relapse. Entire lesion is surrounded by thin hyperintense fibrous scar that has posterior contact with cardiovascular structures. Double arrows point to left inferior pulmonary veins that empty into left atrium.

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