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Percutaneous MR-Guided Radiofrequency Ablation of Recurrent Sacrococcygeal Chordomas

Volker Teichgräber1,2, Christophe Aubé1, Diethard Schmidt1, Ekkehard Jehle3, Claudius König1, Claus D. Claussen1 and Philippe L. Pereira1

1 Department of Radiology, University of Tübingen, Hoppe-Seyler-Strasse 3, 70276 Tübingen, Germany.
2 Present address: Department of Medical Oncology/Tumor Research, West German Cancer Center, Essen, Germany.
3 Department of Surgery, University of Tübingen, Tübingen, Germany.


Figure 1
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  		Fig. 1A —66-year-old woman with recurrent sacrococcygeal chordomas. A-C are T2-weighted transverse images. Follow-up images D-F are T1-weighted fat-saturated contrast-enhanced with high-field-strength MRI. For radiofrequency treatment, patient was placed in prone position on left side. (These images have been rotated to resemble regular supine scanning position.) Before procedure, location of paraanal sacrococcygeal chordoma was determined (arrow, A). Using multiplanar reconstruction in MRI, radiofrequency applicator (arrow, B) could be exactly placed in center of tumor (only transverse section is shown). After treatment, hyperintense signal of tumor is replaced by hypointense coagulated material (arrow, C).

 

Figure 2
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  		Fig. 1B —66-year-old woman with recurrent sacrococcygeal chordomas. A-C are T2-weighted transverse images. Follow-up images D-F are T1-weighted fat-saturated contrast-enhanced with high-field-strength MRI. For radiofrequency treatment, patient was placed in prone position on left side. (These images have been rotated to resemble regular supine scanning position.) Before procedure, location of paraanal sacrococcygeal chordoma was determined (arrow, A). Using multiplanar reconstruction in MRI, radiofrequency applicator (arrow, B) could be exactly placed in center of tumor (only transverse section is shown). After treatment, hyperintense signal of tumor is replaced by hypointense coagulated material (arrow, C).

 

Figure 3
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  		Fig. 1C —66-year-old woman with recurrent sacrococcygeal chordomas. A-C are T2-weighted transverse images. Follow-up images D-F are T1-weighted fat-saturated contrast-enhanced with high-field-strength MRI. For radiofrequency treatment, patient was placed in prone position on left side. (These images have been rotated to resemble regular supine scanning position.) Before procedure, location of paraanal sacrococcygeal chordoma was determined (arrow, A). Using multiplanar reconstruction in MRI, radiofrequency applicator (arrow, B) could be exactly placed in center of tumor (only transverse section is shown). After treatment, hyperintense signal of tumor is replaced by hypointense coagulated material (arrow, C).

 

Figure 4
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  		Fig. 1D —66-year-old woman with recurrent sacrococcygeal chordomas. A-C are T2-weighted transverse images. Follow-up images D-F are T1-weighted fat-saturated contrast-enhanced with high-field-strength MRI. In longitudinal study 4 weeks after thermal ablation therapy, pararectal ablation area (arrow) shows thermal-induced necrosis and peripheral inflammation. Surrounding muscular structures show slight alterations, but no damages such as abscesses can be observed.

 

Figure 5
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  		Fig. 1E —66-year-old woman with recurrent sacrococcygeal chordomas. A-C are T2-weighted transverse images. Follow-up images D-F are T1-weighted fat-saturated contrast-enhanced with high-field-strength MRI. In second control 4 months after ablation, region shows scarring and residual edema (arrow). Necrotic areas are no longer detectable in pararectal region. Alterations of surrounding structures are regressive in obturator muscle.

 

Figure 6
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  		Fig. 1F —66-year-old woman with recurrent sacrococcygeal chordomas. A-C are T2-weighted transverse images. Follow-up images D-F are T1-weighted fat-saturated contrast-enhanced with high-field-strength MRI. Regeneration (arrow) continues after 10 months. No signs of tumor relapse and complete regression of clinical symptoms are indicators of successful ablation.

 

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