Figure 13a. Microwave ablation of a left adrenal metastasis in a 75-year-old woman with a history of previously resected periampullary cancer. (a) Preprocedure T2-weighted magnetic resonance (MR) image shows a cystic metastasis (arrow) at the left adrenal gland. (b) Preprocedure CT scan of the left adrenal gland shows an enlarged metastasis (arrows), now measuring 4 cm in greatest diameter (compared with the MR imaging appearance). (c, d) CT scans show a 15-cm microwave ablation applicator (Trio; Vivant Medical) that was advanced under fluoroscopic guidance into the center of the lesion. The three coiled tines were deployed within the lesion with satisfactory placement. A single 5-minute 60-W treatment was performed. The patient experienced one episode of hypertension during the procedure, which was immediately controlled by beta-blockade. (e, f) Contrast-enhanced CT scans of the adrenal glands obtained immediately after ablation demonstrate a large nonenhancing mass (arrows). The patient was observed after the procedure and discharged home later that same day in stable condition and with no immediate complications.