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Inflammatory Nodules Mimic Applicator Track Seeding After Percutaneous Ablation of Renal Tumors

R. Peter Lokken1, Debra A. Gervais2, Ronald S. Arellano2, Kemal Tuncali1, Paul R. Morrison1, Servet Tatli1, Peter R. Mueller2 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, Massachusetts General Hospital, Boston, MA 02114.


Figure 1
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  		Fig. 1A —42-year-old man with von Hippel-Lindau disease referred for CT-guided percutaneous radiofrequency ablation of 3.4-cm renal cell carcinoma. Axial CT scan before ablation shows enhancing tumor (arrows) in left mid to lower pole.

 

Figure 2
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  		Fig. 1B —42-year-old man with von Hippel-Lindau disease referred for CT-guided percutaneous radiofrequency ablation of 3.4-cm renal cell carcinoma. CT scan 1 month after ablation shows soft-tissue stranding (arrow) adjacent to applicator track. Dense arterial enhancement (arrowhead) is seen within treated tumor, consistent with residual disease.

 

Figure 3
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  		Fig. 1C —42-year-old man with von Hippel-Lindau disease referred for CT-guided percutaneous radiofrequency ablation of 3.4-cm renal cell carcinoma. CT scan 7 months after ablation procedure. A new, enhancing 4.9 x 4.1 cm nodule (arrows) is located in perinephric space and abdominal wall along applicator track. Percutaneous biopsy of nodule showed chronic inflammation with histiocytes, granulation tissue, and fibrosis, with no evidence of malignancy. Arrowhead indicates residual disease within treated tumor.

 

Figure 4
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  		Fig. 1D —42-year-old man with von Hippel-Lindau disease referred for CT-guided percutaneous radiofrequency ablation of 3.4-cm renal cell carcinoma. CT scan 2 months later shows applicator track nodule decreased in size to 4.0 x 3.2 cm.

 

Figure 5
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  		Fig. 2A —71-year-old woman referred for percutaneous cryoablation of 5.0-cm renal cell carcinoma. Axial T1-weighted, fat-suppressed, dynamic sequence image (TR/TE, 310/4.2) shows heterogeneously enhancing tumor (arrows) before cryoablation.

 

Figure 6
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  		Fig. 2B —71-year-old woman referred for percutaneous cryoablation of 5.0-cm renal cell carcinoma. Axial gradient-recalled echo image (51/10) shows cryoprobes and ice ball formation during cryoablation.

 

Figure 7
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  		Fig. 2C —71-year-old woman referred for percutaneous cryoablation of 5.0-cm renal cell carcinoma. Axial unenhanced T1-weighted, fat-suppressed image (260/4.2) acquired 9 months after cryoablation procedure shows new 1.3-cm nodule (arrow) within applicator track.

 

Figure 8
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  		Fig. 2D —71-year-old woman referred for percutaneous cryoablation of 5.0-cm renal cell carcinoma. Axial gadolinium-enhanced T1-weighted, fat-suppressed image (260/4.2) shows enhancement (34.8%) of nodule (arrow). Percutaneous biopsy revealed fibroadipose tissue with mild perivascular lymphoplasmacytic infiltrate and no evidence of malignancy.

 

Figure 9
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  		Fig. 2E —71-year-old woman referred for percutaneous cryoablation of 5.0-cm renal cell carcinoma. On axial fast-acquisition multiple-excitation image (4.4/1.9) acquired 13 months after tumor cryoablation, discrete applicator track nodule detected 4 months earlier is not visible. Enhancing tram-tracking pattern of soft-tissue stranding (arrows) now follows ablation track.

 

Figure 10
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  		Fig. 2F —71-year-old woman referred for percutaneous cryoablation of 5.0-cm renal cell carcinoma. Axial fast-acquisition multiple-excitation image (4.4/1.9) acquired 17 months after tumor cryoablation shows tram-tracking enhancement (arrows) is stable along applicator track. It has remained stable at 34 months.

 

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