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DOI: 10.1148/rg.272065083
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RadioGraphics 2007;27:325-339
© RSNA, 2007

EDUCATION EXHIBIT

CT and MR Imaging after Imaging-guided Thermal Ablation of Renal Neoplasms1

Geoffrey E. Wile, MD, John R. Leyendecker, MD, Kyle A. Krehbiel, MD, Raymond B. Dyer, MD and Ronald J. Zagoria, MD

1 From the Department of Radiology, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27103. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received May 1, 2006; revision requested July 10 and received August 24; accepted August 28. R.J.Z. is a consultant with and received a research grant from Tyco Healthcare (Valleylab); all remaining authors have no financial relationships to disclose. Address correspondence to J.R.L. (e-mail: jleyende{at}wfubmc.edu).

In recent years, thermal tumor ablation techniques such as percutaneous radiofrequency (RF) ablation and cryoablation have assumed an important role in the management of renal tumors, particularly in patients who may be suboptimal candidates for more invasive surgical techniques. Postablation computed tomography (CT) and magnetic resonance (MR) imaging play an important part in evaluation of the ablation zone, surveillance for residual or recurrent tumor, and identification of procedure-related complications. The appearance of the ablation zone may vary depending on the ablation technique used, initial tumor size, and tumor location and composition. Most ablated tumors demonstrate a gradual decrease in size over time once the acute changes have resolved, although tumor involution is more evident after cryoablation than after RF ablation. Exophytic tumor ablation zones typically have a "bull’s-eye" appearance on CT scans and MR images obtained after RF ablation, with a visible mass often persisting in the absence of viable tumor. Residual or recurrent tumor often manifests as a focus of nodular or crescentic enhancement on postablation contrast material–enhanced CT scans and MR images, although a thin peripheral rim of enhancement often persists for several months following cryoablation. Complications following renal tumor ablation are usually minor but may include hemorrhage, ureteral stricture, urine leak, colonic perforation and colonephric fistula, and pneumothorax. As more patients undergo renal ablation procedures, it will become increasingly important that radiologists be able to recognize typical postablation CT and MR imaging findings to prevent confusing them with other pathologic processes.

© RSNA, 2007


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Invited Commentary
Thomas D. Atwell and Michael A. Farrell
RadioGraphics 2007 27: 339-340. [Full Text] [PDF]





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