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Percutaneous Cryoablation of Symptomatic Extraabdominal Metastatic Disease: Preliminary Results

Michael D. Beland1, Damian E. Dupuy1 and William W. Mayo-Smith1

1 All authors: Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.



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  		Fig. 1A. —57-year-old man with metastatic rectal cancer and local presacral recurrence. Prone noncontrast CT image obtained in transaxial plane shows large presacral tumor with bone destruction (arrows).

 


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  		Fig. 1B. —57-year-old man with metastatic rectal cancer and local presacral recurrence. Cryoablation was performed on recurrent presacral rectal cancer. Prone noncontrast CT image obtained in transaxial plane shows round low-density area representing volume of frozen tissue at end of second freeze cycle.

 


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  		Fig. 1C. —57-year-old man with metastatic rectal cancer and local presacral recurrence. Photograph of procedure shows cryoapplicator position under CT fluoroscopy.

 


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  		Fig. 1D. —57-year-old man with metastatic rectal cancer and local presacral recurrence. Axial 18FDG PET image obtained at level of presacral mass before treatment shows increased activity consistent with metabolically active tumor (arrow).

 


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  		Fig. 1E. —57-year-old man with metastatic rectal cancer and local presacral recurrence. Axial 18FDG PET image obtained at same level as D 4 months after procedure shows photopenic defect (arrow) in area of treatment, consistent with necrotic tumor.

 


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  		Fig. 2C. —55-year-old woman with recurrent metastatic breast cancer to left supraclavicular region with infiltration of brachial plexus after failure of local excision, chemotherapy, and radiation therapy. Sagittal T1-weighted fat-saturated contrast-enhanced image in left midaxillary line before treatment shows enhancing mass (arrows) in region of brachial plexus.

 


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  		Fig. 2A. —55-year-old woman with recurrent metastatic breast cancer to left supraclavicular region with infiltration of brachial plexus after failure of local excision, chemotherapy, and radiation therapy. Contrast-enhanced supine transaxial CT scan obtained before treatment shows soft-tissue mass (arrows) in region of left brachial plexus.

 


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  		Fig. 2B. —55-year-old woman with recurrent metastatic breast cancer to left supraclavicular region with infiltration of brachial plexus after failure of local excision, chemotherapy, and radiation therapy. Noncontrast supine transaxial CT image obtained during cryoablation shows applicator placement. Treatment monitoring was difficult secondary to beam hardening and regional fat.

 


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  		Fig. 2D. —55-year-old woman with recurrent metastatic breast cancer to left supraclavicular region with infiltration of brachial plexus after failure of local excision, chemotherapy, and radiation therapy. Coned-down sagittal T1-weighted fat-saturated contrast-enhanced image obtained 7 weeks after treatment at follow-up shows subclavian artery flow void (arrowhead) with area of surrounding enhancing tissue (arrows), which likely represents residual inadequately treated tumor secondary to "cold sink" effect.

 

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