Evaluation of Patients Referred for Percutaneous Ablation of Renal Tumors: Importance of a Preprocedural Diagnosis
Kemal Tuncali1,
Eric vanSonnenberg1,2,
Sridhar Shankar2,3,
Koenraad J. Mortele1,
Edmund S. Cibas4 and
Stuart G. Silverman1
1 Department of Radiology, Division of Abdominal Imaging and Intervention,
Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.
2 Department of Radiology, Brigham and Women's Hospital and Dana Farber Cancer
Institute, 44 Binney St., Boston, MA 02115.
3 Present address: Department of Radiology, University of Massachusetts, 5 Lake
Ave., Worcester, MA.
4 Department of Pathology, Division of Cytology, Brigham and Women's Hospital,
Boston, MA 02115.
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Fig. 1A. —58-year-old man with cirrhosis referred for percutaneous ablation of
right renal mass suspicious for renal cell carcinoma. Preprocedural axial
T1-weighted enhanced MR image shows 1.5-cm enhancing mass (arrowhead)
in upper pole of right kidney.
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Fig. 1B. —58-year-old man with cirrhosis referred for percutaneous ablation of
right renal mass suspicious for renal cell carcinoma. Preprocedural unenhanced
axial CT scan shows no evidence of fat attenuation in mass
(arrowhead).
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Fig. 1C. —58-year-old man with cirrhosis referred for percutaneous ablation of
right renal mass suspicious for renal cell carcinoma. MRI-guided biopsy of
mass (arrowhead) was performed during cryotherapy procedure, just
before treatment. Axial T2-weighted image obtained with patient in prone
position shows right kidney (curved arrow) and 22-gauge needle
(straight arrow) in mass. Final biopsy result was angiomyolipoma. S =
spine, L = liver, GB = gallbladder.
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Fig. 2A. —67-year-old woman referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. Preprocedural axial T1-weighted enhanced
MR image shows 1.6-cm enhancing left renal mass (arrowhead).
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Fig. 2B. —67-year-old woman referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. Preprocedural axial unenhanced CT scan
shows no evidence of fat attenuation in mass (arrowhead).
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Fig. 2C. —67-year-old woman referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. CT-guided biopsy of mass was performed
before day of planned ablation procedure. Axial unenhanced CT image with
patient in prone position shows 22-gauge needle (arrow) in mass
(arrowhead). Biopsy revealed angiomyolipoma.
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Fig. 3A. —83-year-old man with solitary kidney referred for percutaneous
ablation of renal mass suspicious for renal cell carcinoma. Axial enhanced CT
scan shows 2-cm enhancing mass (arrowhead) in right kidney.
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Fig. 3B. —83-year-old man with solitary kidney referred for percutaneous
ablation of renal mass suspicious for renal cell carcinoma. Follow-up axial
T1-weighted enhanced MR image obtained 2 weeks after A shows subtle
reduction in size of now wedge-shaped mass (arrowhead) to 1.7 cm.
Diagnosis of focal bacterial pyelonephritis was made, and patient was treated
with antibiotics.
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Fig. 3C. —83-year-old man with solitary kidney referred for percutaneous
ablation of renal mass suspicious for renal cell carcinoma. Follow-up axial
enhanced CT scan obtained 12 weeks after B shows near-complete
resolution of mass (arrowhead).
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Fig. 4A. —61-year-old woman referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. Axial enhanced CT scan shows 2-cm left
renal hyperdense mass (arrowhead) with equivocal enhancement.
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Fig. 4B. —61-year-old woman referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. Follow-up axial enhanced CT scan obtained
6 months after A shows marked reduction in size of mass
(arrowhead). No enhancement was detected at this time. Diagnosis was
hyperdense cyst.
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Fig. 4C. —61-year-old woman referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. Follow-up axial enhanced CT scan obtained
14 months after B shows almost complete resolution of mass
(arrowhead).
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Fig. 5A. —71-year-old man referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. Preprocedural axial T1-weighted enhanced
MR image shows 2.4-cm enhancing right renal mass (arrowhead).
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Fig. 5B. —71-year-old man referred for percutaneous ablation of renal mass
suspicious for renal cell carcinoma. CT-guided biopsy of mass
(arrowhead) was performed before day of planned ablation procedure.
Axial unenhanced CT scan with patient in prone position shows 22-gauge needle
(arrow) in mass. Biopsy revealed papillary renal cell carcinoma.
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Copyright © 2004 by the American Roentgen Ray Society.
