Radiofrequency Ablation Combined with CO2 Injection for Treatment of Retroperitoneal Tumor: Protecting Surrounding Organs Against Thermal Injury
Shuji Kariya1,
Noboru Tanigawa1,
Hiroyuki Kojima1,
Atsushi Komemushi1,
Yuzo Shomura1,
Yasuhiro Ueno1,
Tomokuni Shiraishi2 and
Satoshi Sawada1
1 Department of Radiology, Kansai Medical University, 10-15 Fumizono, Moriguchi,
Osaka, Japan 570-8507.
2 Department of Radiology, Ishikiri Seiki Hospital, Osaka, Japan 579-8026.
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Fig. 1A —62-year-old man with metastatic adrenal tumor originating
from primary lung cancer. Preoperative unenhanced CT image shows left adrenal
gland swollen (black arrow) and adjacent to splenic vein (white
arrow) and pancreas.
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Fig. 1B —62-year-old man with metastatic adrenal tumor originating
from primary lung cancer. Intraoperative unenhanced CT image (prone position)
after injection of 400 mL CO2 (asterisks) into perirenal
space shows left adrenal gland physically separated from splenic vein and
pancreas. In left adrenal gland, 3-cm single-tip active electrode (black
arrowhead) is seen.
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Fig. 1C —62-year-old man with metastatic adrenal tumor originating
from primary lung cancer. Contrast-enhanced CT performed 2 days after ablation
shows no enhancement in left adrenal gland (black arrow) or area of
left adrenal gland adjacent to splenic vein (white arrow), confirming
absence of heat-sink effect from splenic vein.
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Fig. 1D —62-year-old man with metastatic adrenal tumor originating
from primary lung cancer. Contrast-enhanced CT performed 2 days after ablation
reveals nothing of concern in left adrenal gland (black arrow) or
area of left adrenal gland adjacent to splenic artery (white
arrowhead), confirming absence of heat-sink effect from splenic
artery.
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Fig. 2A —72-year-old man with renal cell carcinoma. Intraoperative
unenhanced CT image before CO2 injection shows tumor (white
arrow) protruding on dorsal side from superior pole of left kidney and
electrode (white arrowhead) placed at center of tumor. 20-gauge percutaneous
transhepatic cholangiodrainage (PTCD) needle (black arrow) was placed
on right side of tumor for CO2 injection.
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Fig. 2B —72-year-old man with renal cell carcinoma. Multiplanar
reconstruction of intraoperative unenhanced CT findings before CO2
injection shows tumor (white arrow) adjacent to spleen (black
arrowhead). 20-gauge PTCD needle (black arrow) and electrode
(white arrowhead) placed at center of tumor was placed. Tip is out of
image.
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Fig. 2C —72-year-old man with renal cell carcinoma. Intraoperative
unenhanced CT image (prone position) immediately after injection of 400 mL
CO2 into the perirenal space shows tumor (white arrow)
separated from surrounding organs by CO2 (asterisks)
injected in perirenal space.
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Fig. 2D —72-year-old man with renal cell carcinoma. Multiplanar
reconstruction of intraoperative unenhanced CT shows tumor (white
arrow) and left kidney separated from spleen (black arrowhead)
and surrounding organs after CO2 (asterisk) injection into
perirenal space.
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Copyright © 2005 by the American Roentgen Ray Society.
