DOI: 10.1148/rg.272065119
Sequential Changes after Radiofrequency Ablation and Cryoablation of Renal Neoplasms: Role of CT and MR Imaging1
Satomi Kawamoto, MD,
Sompol Permpongkosol, MD, PhD,
David A. Bluemke, MD, PhD,
Elliot K. Fishman, MD and
Stephen B. Solomon, MD
1 From the Russell H. Morgan Department of Radiology and Radiological Science (S.K., D.A.B., E.K.F., S.B.S.) and the James Buchanan Brady Urological Institute (S.P., S.B.S.), Johns Hopkins Hospital, JHOC 3235A, 601 N Caroline St, Baltimore, MD 21287. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received June 13, 2006; revision requested July 24 and received August 30; accepted August 31. S.B.S. received grant support from Endocare; all remaining authors have no financial relationships to disclose.
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Figure 1a. Clear cell type RCC with no evidence of residual or recurrent RCC seen after RF ablation. (a) Nephrographic phase CT scan shows a solid mass in the right kidney. RF ablation was performed. (b) Excretory phase CT scan obtained 5 months after ablation shows a round mass with soft-tissue attenuation representing the ablated tumor. A curvilinear hyperattenuating area, or "halo" (arrowheads), is seen in the perinephric fat adjacent to the tumor. (c) On an excretory phase CT scan obtained 9 months after ablation, the mass is unenhanced, with fat replacement at the interface between the ablated tumor and the normal kidney (arrow) due to shrinkage of the tumor. Arrowheads indicate the curvilinear hyperattenuating area (cf b). Analysis of attenuation on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 1b. Clear cell type RCC with no evidence of residual or recurrent RCC seen after RF ablation. (a) Nephrographic phase CT scan shows a solid mass in the right kidney. RF ablation was performed. (b) Excretory phase CT scan obtained 5 months after ablation shows a round mass with soft-tissue attenuation representing the ablated tumor. A curvilinear hyperattenuating area, or "halo" (arrowheads), is seen in the perinephric fat adjacent to the tumor. (c) On an excretory phase CT scan obtained 9 months after ablation, the mass is unenhanced, with fat replacement at the interface between the ablated tumor and the normal kidney (arrow) due to shrinkage of the tumor. Arrowheads indicate the curvilinear hyperattenuating area (cf b). Analysis of attenuation on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 1c. Clear cell type RCC with no evidence of residual or recurrent RCC seen after RF ablation. (a) Nephrographic phase CT scan shows a solid mass in the right kidney. RF ablation was performed. (b) Excretory phase CT scan obtained 5 months after ablation shows a round mass with soft-tissue attenuation representing the ablated tumor. A curvilinear hyperattenuating area, or "halo" (arrowheads), is seen in the perinephric fat adjacent to the tumor. (c) On an excretory phase CT scan obtained 9 months after ablation, the mass is unenhanced, with fat replacement at the interface between the ablated tumor and the normal kidney (arrow) due to shrinkage of the tumor. Arrowheads indicate the curvilinear hyperattenuating area (cf b). Analysis of attenuation on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 2a. Exophytic mass in the left kidney. The mass was solid at CT and US; however, biopsy performed at the time of RF ablation was nondiagnostic. No evidence of residual or recurrent tumor was seen after RF ablation. (a) Unenhanced CT scan obtained immediately prior to ablation shows an exophytic left renal mass (arrow). RF ablation of the mass was performed under CT guidance with the patient prone. (b) CT scan obtained during ablation shows minimal perinephric hemorrhage (arrows) and adjacent soft-tissue stranding. (c–e) Contrast-enhanced excretory phase CT scans obtained 1 month (c), 12 months (d), and 49 months (e) after RF ablation show evolution of the ablated lesion with a persistent soft-tissue-attenuation component (arrows in e). A linear circumferential area of high attenuation (arrowheads in e) is seen surrounding the lesion. Analysis of the attenuation of this soft-tissue-attenuation component on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 2b. Exophytic mass in the left kidney. The mass was solid at CT and US; however, biopsy performed at the time of RF ablation was nondiagnostic. No evidence of residual or recurrent tumor was seen after RF ablation. (a) Unenhanced CT scan obtained immediately prior to ablation shows an exophytic left renal mass (arrow). RF ablation of the mass was performed under CT guidance with the patient prone. (b) CT scan obtained during ablation shows minimal perinephric hemorrhage (arrows) and adjacent soft-tissue stranding. (c–e) Contrast-enhanced excretory phase CT scans obtained 1 month (c), 12 months (d), and 49 months (e) after RF ablation show evolution of the ablated lesion with a persistent soft-tissue-attenuation component (arrows in e). A linear circumferential area of high attenuation (arrowheads in e) is seen surrounding the lesion. Analysis of the attenuation of this soft-tissue-attenuation component on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 2c. Exophytic mass in the left kidney. The mass was solid at CT and US; however, biopsy performed at the time of RF ablation was nondiagnostic. No evidence of residual or recurrent tumor was seen after RF ablation. (a) Unenhanced CT scan obtained immediately prior to ablation shows an exophytic left renal mass (arrow). RF ablation of the mass was performed under CT guidance with the patient prone. (b) CT scan obtained during ablation shows minimal perinephric hemorrhage (arrows) and adjacent soft-tissue stranding. (c–e) Contrast-enhanced excretory phase CT scans obtained 1 month (c), 12 months (d), and 49 months (e) after RF ablation show evolution of the ablated lesion with a persistent soft-tissue-attenuation component (arrows in e). A linear circumferential area of high attenuation (arrowheads in e) is seen surrounding the lesion. Analysis of the attenuation of this soft-tissue-attenuation component on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 2d. Exophytic mass in the left kidney. The mass was solid at CT and US; however, biopsy performed at the time of RF ablation was nondiagnostic. No evidence of residual or recurrent tumor was seen after RF ablation. (a) Unenhanced CT scan obtained immediately prior to ablation shows an exophytic left renal mass (arrow). RF ablation of the mass was performed under CT guidance with the patient prone. (b) CT scan obtained during ablation shows minimal perinephric hemorrhage (arrows) and adjacent soft-tissue stranding. (c–e) Contrast-enhanced excretory phase CT scans obtained 1 month (c), 12 months (d), and 49 months (e) after RF ablation show evolution of the ablated lesion with a persistent soft-tissue-attenuation component (arrows in e). A linear circumferential area of high attenuation (arrowheads in e) is seen surrounding the lesion. Analysis of the attenuation of this soft-tissue-attenuation component on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 2e. Exophytic mass in the left kidney. The mass was solid at CT and US; however, biopsy performed at the time of RF ablation was nondiagnostic. No evidence of residual or recurrent tumor was seen after RF ablation. (a) Unenhanced CT scan obtained immediately prior to ablation shows an exophytic left renal mass (arrow). RF ablation of the mass was performed under CT guidance with the patient prone. (b) CT scan obtained during ablation shows minimal perinephric hemorrhage (arrows) and adjacent soft-tissue stranding. (c–e) Contrast-enhanced excretory phase CT scans obtained 1 month (c), 12 months (d), and 49 months (e) after RF ablation show evolution of the ablated lesion with a persistent soft-tissue-attenuation component (arrows in e). A linear circumferential area of high attenuation (arrowheads in e) is seen surrounding the lesion. Analysis of the attenuation of this soft-tissue-attenuation component on both unenhanced CT scans and arterial phase and excretory phase CT scans showed no evidence of tumoral contrast enhancement.
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Figure 3a. Recurrence of clear cell type RCC after RF ablation. (a) Contrast-enhanced excretory phase CT scan shows a 2.2 x 1.6-cm enhancing mass (arrow) in the right kidney. RF ablation was performed. (b) Contrast-enhanced excretory phase CT scan obtained 4 months after ablation shows a partially exophytic hypoattenuating lesion with peripheral linear circumferential hyperattenuation in the perirenal fat (arrowheads). (c) On a contrast-enhanced corticomedullary phase CT scan obtained 8 months after ablation, the lesion has a stable appearance. (d) Contrast-enhanced corticomedullary phase CT scan obtained 20 months after ablation shows a nodular enhancing component (arrow) in the medial portion of the ablation zone. (e) Contrast-enhanced CT scan obtained 31 months after ablation shows an interval increase in the size of the mass, a finding that represents recurrent RCC. A region of interest (circled) was placed to measure CT attenuation. (Fig 3 reprinted, with permission, from reference 12.)
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Figure 3b. Recurrence of clear cell type RCC after RF ablation. (a) Contrast-enhanced excretory phase CT scan shows a 2.2 x 1.6-cm enhancing mass (arrow) in the right kidney. RF ablation was performed. (b) Contrast-enhanced excretory phase CT scan obtained 4 months after ablation shows a partially exophytic hypoattenuating lesion with peripheral linear circumferential hyperattenuation in the perirenal fat (arrowheads). (c) On a contrast-enhanced corticomedullary phase CT scan obtained 8 months after ablation, the lesion has a stable appearance. (d) Contrast-enhanced corticomedullary phase CT scan obtained 20 months after ablation shows a nodular enhancing component (arrow) in the medial portion of the ablation zone. (e) Contrast-enhanced CT scan obtained 31 months after ablation shows an interval increase in the size of the mass, a finding that represents recurrent RCC. A region of interest (circled) was placed to measure CT attenuation. (Fig 3 reprinted, with permission, from reference 12.)
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Figure 3c. Recurrence of clear cell type RCC after RF ablation. (a) Contrast-enhanced excretory phase CT scan shows a 2.2 x 1.6-cm enhancing mass (arrow) in the right kidney. RF ablation was performed. (b) Contrast-enhanced excretory phase CT scan obtained 4 months after ablation shows a partially exophytic hypoattenuating lesion with peripheral linear circumferential hyperattenuation in the perirenal fat (arrowheads). (c) On a contrast-enhanced corticomedullary phase CT scan obtained 8 months after ablation, the lesion has a stable appearance. (d) Contrast-enhanced corticomedullary phase CT scan obtained 20 months after ablation shows a nodular enhancing component (arrow) in the medial portion of the ablation zone. (e) Contrast-enhanced CT scan obtained 31 months after ablation shows an interval increase in the size of the mass, a finding that represents recurrent RCC. A region of interest (circled) was placed to measure CT attenuation. (Fig 3 reprinted, with permission, from reference 12.)
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Figure 3d. Recurrence of clear cell type RCC after RF ablation. (a) Contrast-enhanced excretory phase CT scan shows a 2.2 x 1.6-cm enhancing mass (arrow) in the right kidney. RF ablation was performed. (b) Contrast-enhanced excretory phase CT scan obtained 4 months after ablation shows a partially exophytic hypoattenuating lesion with peripheral linear circumferential hyperattenuation in the perirenal fat (arrowheads). (c) On a contrast-enhanced corticomedullary phase CT scan obtained 8 months after ablation, the lesion has a stable appearance. (d) Contrast-enhanced corticomedullary phase CT scan obtained 20 months after ablation shows a nodular enhancing component (arrow) in the medial portion of the ablation zone. (e) Contrast-enhanced CT scan obtained 31 months after ablation shows an interval increase in the size of the mass, a finding that represents recurrent RCC. A region of interest (circled) was placed to measure CT attenuation. (Fig 3 reprinted, with permission, from reference 12.)
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Figure 3e. Recurrence of clear cell type RCC after RF ablation. (a) Contrast-enhanced excretory phase CT scan shows a 2.2 x 1.6-cm enhancing mass (arrow) in the right kidney. RF ablation was performed. (b) Contrast-enhanced excretory phase CT scan obtained 4 months after ablation shows a partially exophytic hypoattenuating lesion with peripheral linear circumferential hyperattenuation in the perirenal fat (arrowheads). (c) On a contrast-enhanced corticomedullary phase CT scan obtained 8 months after ablation, the lesion has a stable appearance. (d) Contrast-enhanced corticomedullary phase CT scan obtained 20 months after ablation shows a nodular enhancing component (arrow) in the medial portion of the ablation zone. (e) Contrast-enhanced CT scan obtained 31 months after ablation shows an interval increase in the size of the mass, a finding that represents recurrent RCC. A region of interest (circled) was placed to measure CT attenuation. (Fig 3 reprinted, with permission, from reference 12.)
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Figure 4a. Bilateral RCC with no evidence of residual or recurrent RCC seen after cryoablation. (a) Contrast-enhanced CT scan shows bilateral solid renal masses (arrows). The masses proved to be RCCs at biopsy. Cryoablation was performed. (b–d) Contrast-enhanced CT scans obtained 6 weeks (b), 4 months (c), and 8 months (d) after percutaneous cryoablation of the left renal mass show a gradual decrease in the size of the mass with no contrast enhancement. (e–g) Contrast-enhanced CT scans obtained 1 month (e), 2 months (f), and 6 months (g) after laparoscopic cryoablation of the right renal mass show a gradual decrease in the size of the mass with no contrast enhancement (cf b–d).
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Figure 4b. Bilateral RCC with no evidence of residual or recurrent RCC seen after cryoablation. (a) Contrast-enhanced CT scan shows bilateral solid renal masses (arrows). The masses proved to be RCCs at biopsy. Cryoablation was performed. (b–d) Contrast-enhanced CT scans obtained 6 weeks (b), 4 months (c), and 8 months (d) after percutaneous cryoablation of the left renal mass show a gradual decrease in the size of the mass with no contrast enhancement. (e–g) Contrast-enhanced CT scans obtained 1 month (e), 2 months (f), and 6 months (g) after laparoscopic cryoablation of the right renal mass show a gradual decrease in the size of the mass with no contrast enhancement (cf b–d).
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Figure 4c. Bilateral RCC with no evidence of residual or recurrent RCC seen after cryoablation. (a) Contrast-enhanced CT scan shows bilateral solid renal masses (arrows). The masses proved to be RCCs at biopsy. Cryoablation was performed. (b–d) Contrast-enhanced CT scans obtained 6 weeks (b), 4 months (c), and 8 months (d) after percutaneous cryoablation of the left renal mass show a gradual decrease in the size of the mass with no contrast enhancement. (e–g) Contrast-enhanced CT scans obtained 1 month (e), 2 months (f), and 6 months (g) after laparoscopic cryoablation of the right renal mass show a gradual decrease in the size of the mass with no contrast enhancement (cf b–d).
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Figure 4d. Bilateral RCC with no evidence of residual or recurrent RCC seen after cryoablation. (a) Contrast-enhanced CT scan shows bilateral solid renal masses (arrows). The masses proved to be RCCs at biopsy. Cryoablation was performed. (b–d) Contrast-enhanced CT scans obtained 6 weeks (b), 4 months (c), and 8 months (d) after percutaneous cryoablation of the left renal mass show a gradual decrease in the size of the mass with no contrast enhancement. (e–g) Contrast-enhanced CT scans obtained 1 month (e), 2 months (f), and 6 months (g) after laparoscopic cryoablation of the right renal mass show a gradual decrease in the size of the mass with no contrast enhancement (cf b–d).
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Figure 4e. Bilateral RCC with no evidence of residual or recurrent RCC seen after cryoablation. (a) Contrast-enhanced CT scan shows bilateral solid renal masses (arrows). The masses proved to be RCCs at biopsy. Cryoablation was performed. (b–d) Contrast-enhanced CT scans obtained 6 weeks (b), 4 months (c), and 8 months (d) after percutaneous cryoablation of the left renal mass show a gradual decrease in the size of the mass with no contrast enhancement. (e–g) Contrast-enhanced CT scans obtained 1 month (e), 2 months (f), and 6 months (g) after laparoscopic cryoablation of the right renal mass show a gradual decrease in the size of the mass with no contrast enhancement (cf b–d).
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Figure 4f. Bilateral RCC with no evidence of residual or recurrent RCC seen after cryoablation. (a) Contrast-enhanced CT scan shows bilateral solid renal masses (arrows). The masses proved to be RCCs at biopsy. Cryoablation was performed. (b–d) Contrast-enhanced CT scans obtained 6 weeks (b), 4 months (c), and 8 months (d) after percutaneous cryoablation of the left renal mass show a gradual decrease in the size of the mass with no contrast enhancement. (e–g) Contrast-enhanced CT scans obtained 1 month (e), 2 months (f), and 6 months (g) after laparoscopic cryoablation of the right renal mass show a gradual decrease in the size of the mass with no contrast enhancement (cf b–d).
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Figure 4g. Bilateral RCC with no evidence of residual or recurrent RCC seen after cryoablation. (a) Contrast-enhanced CT scan shows bilateral solid renal masses (arrows). The masses proved to be RCCs at biopsy. Cryoablation was performed. (b–d) Contrast-enhanced CT scans obtained 6 weeks (b), 4 months (c), and 8 months (d) after percutaneous cryoablation of the left renal mass show a gradual decrease in the size of the mass with no contrast enhancement. (e–g) Contrast-enhanced CT scans obtained 1 month (e), 2 months (f), and 6 months (g) after laparoscopic cryoablation of the right renal mass show a gradual decrease in the size of the mass with no contrast enhancement (cf b–d).
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Figure 5a. Residual or recurrent RCC of the right kidney after cryoablation in a patient who had undergone right partial nephrectomy for RCC 4 years earlier. (a) Axial contrast-enhanced T1-weighted MR image shows an intensely enhancing mass (arrow) in the right kidney. Cryoablation was performed. (b) CT scan obtained during cryoablation performed with the patient prone demonstrates the cryoprobe tip in the tumor surrounded by ice ball formation. (c) Arterial phase CT scan obtained 4 months after cryoablation shows an area of hypoattenuation representing the ablated lesion, along with a curvilinear hyperattenuating area in the perinephric fat surrounding the lesion. A small nodular enhancing focus (arrow) is seen in the right kidney at the periphery of the ablated lesion. (d) Arterial phase CT scan obtained 12 months after cryoablation shows an interval increase in the size of the nodular enhancing focus (arrow), a finding that indicates viable tumor. (e) Excretory phase CT scan shows washout of contrast material from the enhancing nodule (arrow). Excreted contrast material is seen in the upper pole calix (arrowhead).
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Figure 5b. Residual or recurrent RCC of the right kidney after cryoablation in a patient who had undergone right partial nephrectomy for RCC 4 years earlier. (a) Axial contrast-enhanced T1-weighted MR image shows an intensely enhancing mass (arrow) in the right kidney. Cryoablation was performed. (b) CT scan obtained during cryoablation performed with the patient prone demonstrates the cryoprobe tip in the tumor surrounded by ice ball formation. (c) Arterial phase CT scan obtained 4 months after cryoablation shows an area of hypoattenuation representing the ablated lesion, along with a curvilinear hyperattenuating area in the perinephric fat surrounding the lesion. A small nodular enhancing focus (arrow) is seen in the right kidney at the periphery of the ablated lesion. (d) Arterial phase CT scan obtained 12 months after cryoablation shows an interval increase in the size of the nodular enhancing focus (arrow), a finding that indicates viable tumor. (e) Excretory phase CT scan shows washout of contrast material from the enhancing nodule (arrow). Excreted contrast material is seen in the upper pole calix (arrowhead).
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Figure 5c. Residual or recurrent RCC of the right kidney after cryoablation in a patient who had undergone right partial nephrectomy for RCC 4 years earlier. (a) Axial contrast-enhanced T1-weighted MR image shows an intensely enhancing mass (arrow) in the right kidney. Cryoablation was performed. (b) CT scan obtained during cryoablation performed with the patient prone demonstrates the cryoprobe tip in the tumor surrounded by ice ball formation. (c) Arterial phase CT scan obtained 4 months after cryoablation shows an area of hypoattenuation representing the ablated lesion, along with a curvilinear hyperattenuating area in the perinephric fat surrounding the lesion. A small nodular enhancing focus (arrow) is seen in the right kidney at the periphery of the ablated lesion. (d) Arterial phase CT scan obtained 12 months after cryoablation shows an interval increase in the size of the nodular enhancing focus (arrow), a finding that indicates viable tumor. (e) Excretory phase CT scan shows washout of contrast material from the enhancing nodule (arrow). Excreted contrast material is seen in the upper pole calix (arrowhead).
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Figure 5d. Residual or recurrent RCC of the right kidney after cryoablation in a patient who had undergone right partial nephrectomy for RCC 4 years earlier. (a) Axial contrast-enhanced T1-weighted MR image shows an intensely enhancing mass (arrow) in the right kidney. Cryoablation was performed. (b) CT scan obtained during cryoablation performed with the patient prone demonstrates the cryoprobe tip in the tumor surrounded by ice ball formation. (c) Arterial phase CT scan obtained 4 months after cryoablation shows an area of hypoattenuation representing the ablated lesion, along with a curvilinear hyperattenuating area in the perinephric fat surrounding the lesion. A small nodular enhancing focus (arrow) is seen in the right kidney at the periphery of the ablated lesion. (d) Arterial phase CT scan obtained 12 months after cryoablation shows an interval increase in the size of the nodular enhancing focus (arrow), a finding that indicates viable tumor. (e) Excretory phase CT scan shows washout of contrast material from the enhancing nodule (arrow). Excreted contrast material is seen in the upper pole calix (arrowhead).
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Figure 5e. Residual or recurrent RCC of the right kidney after cryoablation in a patient who had undergone right partial nephrectomy for RCC 4 years earlier. (a) Axial contrast-enhanced T1-weighted MR image shows an intensely enhancing mass (arrow) in the right kidney. Cryoablation was performed. (b) CT scan obtained during cryoablation performed with the patient prone demonstrates the cryoprobe tip in the tumor surrounded by ice ball formation. (c) Arterial phase CT scan obtained 4 months after cryoablation shows an area of hypoattenuation representing the ablated lesion, along with a curvilinear hyperattenuating area in the perinephric fat surrounding the lesion. A small nodular enhancing focus (arrow) is seen in the right kidney at the periphery of the ablated lesion. (d) Arterial phase CT scan obtained 12 months after cryoablation shows an interval increase in the size of the nodular enhancing focus (arrow), a finding that indicates viable tumor. (e) Excretory phase CT scan shows washout of contrast material from the enhancing nodule (arrow). Excreted contrast material is seen in the upper pole calix (arrowhead).
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Figure 6a. Residual RCC of the left kidney after cryoablation in a patient who had undergone right nephrectomy for clear cell RCC 5 years earlier and had subsequently developed a 1.5-cm left renal RCC. (a) Contrast-enhanced CT scan shows a partially exophytic enhancing mass (arrow) in the left kidney. Cryoablation was performed. (b, c) Axial (b) and coronal (c) contrast-enhanced arterial phase CT scans obtained 9 days after cryoablation show a hypoattenuating ablation zone, along with minimal adjacent stranding and perinephric hemorrhage. Subtle linear and punctate nodular contrast enhancement is also seen (arrow), a finding that is compatible with residual tumor. (d) Contrast-enhanced excretory phase CT scan also shows ill-defined areas of enhancement (arrow). (e) Contrast-enhanced arterial phase CT scan obtained 3 months after cryoablation shows an interval decrease in the extent of hypoattenuation in the ablation zone. However, the area of nodular contrast enhancement (arrow) within the ablation zone has increased, a finding that indicates residual tumor.
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Figure 6b. Residual RCC of the left kidney after cryoablation in a patient who had undergone right nephrectomy for clear cell RCC 5 years earlier and had subsequently developed a 1.5-cm left renal RCC. (a) Contrast-enhanced CT scan shows a partially exophytic enhancing mass (arrow) in the left kidney. Cryoablation was performed. (b, c) Axial (b) and coronal (c) contrast-enhanced arterial phase CT scans obtained 9 days after cryoablation show a hypoattenuating ablation zone, along with minimal adjacent stranding and perinephric hemorrhage. Subtle linear and punctate nodular contrast enhancement is also seen (arrow), a finding that is compatible with residual tumor. (d) Contrast-enhanced excretory phase CT scan also shows ill-defined areas of enhancement (arrow). (e) Contrast-enhanced arterial phase CT scan obtained 3 months after cryoablation shows an interval decrease in the extent of hypoattenuation in the ablation zone. However, the area of nodular contrast enhancement (arrow) within the ablation zone has increased, a finding that indicates residual tumor.
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Figure 6c. Residual RCC of the left kidney after cryoablation in a patient who had undergone right nephrectomy for clear cell RCC 5 years earlier and had subsequently developed a 1.5-cm left renal RCC. (a) Contrast-enhanced CT scan shows a partially exophytic enhancing mass (arrow) in the left kidney. Cryoablation was performed. (b, c) Axial (b) and coronal (c) contrast-enhanced arterial phase CT scans obtained 9 days after cryoablation show a hypoattenuating ablation zone, along with minimal adjacent stranding and perinephric hemorrhage. Subtle linear and punctate nodular contrast enhancement is also seen (arrow), a finding that is compatible with residual tumor. (d) Contrast-enhanced excretory phase CT scan also shows ill-defined areas of enhancement (arrow). (e) Contrast-enhanced arterial phase CT scan obtained 3 months after cryoablation shows an interval decrease in the extent of hypoattenuation in the ablation zone. However, the area of nodular contrast enhancement (arrow) within the ablation zone has increased, a finding that indicates residual tumor.
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Figure 6d. Residual RCC of the left kidney after cryoablation in a patient who had undergone right nephrectomy for clear cell RCC 5 years earlier and had subsequently developed a 1.5-cm left renal RCC. (a) Contrast-enhanced CT scan shows a partially exophytic enhancing mass (arrow) in the left kidney. Cryoablation was performed. (b, c) Axial (b) and coronal (c) contrast-enhanced arterial phase CT scans obtained 9 days after cryoablation show a hypoattenuating ablation zone, along with minimal adjacent stranding and perinephric hemorrhage. Subtle linear and punctate nodular contrast enhancement is also seen (arrow), a finding that is compatible with residual tumor. (d) Contrast-enhanced excretory phase CT scan also shows ill-defined areas of enhancement (arrow). (e) Contrast-enhanced arterial phase CT scan obtained 3 months after cryoablation shows an interval decrease in the extent of hypoattenuation in the ablation zone. However, the area of nodular contrast enhancement (arrow) within the ablation zone has increased, a finding that indicates residual tumor.
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Figure 6e. Residual RCC of the left kidney after cryoablation in a patient who had undergone right nephrectomy for clear cell RCC 5 years earlier and had subsequently developed a 1.5-cm left renal RCC. (a) Contrast-enhanced CT scan shows a partially exophytic enhancing mass (arrow) in the left kidney. Cryoablation was performed. (b, c) Axial (b) and coronal (c) contrast-enhanced arterial phase CT scans obtained 9 days after cryoablation show a hypoattenuating ablation zone, along with minimal adjacent stranding and perinephric hemorrhage. Subtle linear and punctate nodular contrast enhancement is also seen (arrow), a finding that is compatible with residual tumor. (d) Contrast-enhanced excretory phase CT scan also shows ill-defined areas of enhancement (arrow). (e) Contrast-enhanced arterial phase CT scan obtained 3 months after cryoablation shows an interval decrease in the extent of hypoattenuation in the ablation zone. However, the area of nodular contrast enhancement (arrow) within the ablation zone has increased, a finding that indicates residual tumor.
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Figure 7a. Oncocytoma of the left kidney with no evidence of residual or recurrent tumor after RF ablation. (a) Axial contrast-enhanced T1-weighted MR image shows a 1.5-cm enhancing mass (arrow) in the lateral aspect of the left kidney, which also contains multiple cysts. RF ablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 3 months after ablation shows an area of hyperintensity (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 3 months after ablation shows a hypointense area (arrow) in the ablation zone. (d) Axial contrast-enhanced T1-weighted MR image obtained 3 months after ablation shows no contrast enhancement in the ablation zone (arrow). (e) Axial contrast-enhanced T1-weighted MR image obtained 17 months after ablation shows a decrease in the size of the ablation zone, which demonstrates no contrast enhancement.
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Figure 7b. Oncocytoma of the left kidney with no evidence of residual or recurrent tumor after RF ablation. (a) Axial contrast-enhanced T1-weighted MR image shows a 1.5-cm enhancing mass (arrow) in the lateral aspect of the left kidney, which also contains multiple cysts. RF ablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 3 months after ablation shows an area of hyperintensity (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 3 months after ablation shows a hypointense area (arrow) in the ablation zone. (d) Axial contrast-enhanced T1-weighted MR image obtained 3 months after ablation shows no contrast enhancement in the ablation zone (arrow). (e) Axial contrast-enhanced T1-weighted MR image obtained 17 months after ablation shows a decrease in the size of the ablation zone, which demonstrates no contrast enhancement.
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Figure 7c. Oncocytoma of the left kidney with no evidence of residual or recurrent tumor after RF ablation. (a) Axial contrast-enhanced T1-weighted MR image shows a 1.5-cm enhancing mass (arrow) in the lateral aspect of the left kidney, which also contains multiple cysts. RF ablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 3 months after ablation shows an area of hyperintensity (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 3 months after ablation shows a hypointense area (arrow) in the ablation zone. (d) Axial contrast-enhanced T1-weighted MR image obtained 3 months after ablation shows no contrast enhancement in the ablation zone (arrow). (e) Axial contrast-enhanced T1-weighted MR image obtained 17 months after ablation shows a decrease in the size of the ablation zone, which demonstrates no contrast enhancement.
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Figure 7d. Oncocytoma of the left kidney with no evidence of residual or recurrent tumor after RF ablation. (a) Axial contrast-enhanced T1-weighted MR image shows a 1.5-cm enhancing mass (arrow) in the lateral aspect of the left kidney, which also contains multiple cysts. RF ablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 3 months after ablation shows an area of hyperintensity (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 3 months after ablation shows a hypointense area (arrow) in the ablation zone. (d) Axial contrast-enhanced T1-weighted MR image obtained 3 months after ablation shows no contrast enhancement in the ablation zone (arrow). (e) Axial contrast-enhanced T1-weighted MR image obtained 17 months after ablation shows a decrease in the size of the ablation zone, which demonstrates no contrast enhancement.
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Figure 7e. Oncocytoma of the left kidney with no evidence of residual or recurrent tumor after RF ablation. (a) Axial contrast-enhanced T1-weighted MR image shows a 1.5-cm enhancing mass (arrow) in the lateral aspect of the left kidney, which also contains multiple cysts. RF ablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 3 months after ablation shows an area of hyperintensity (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 3 months after ablation shows a hypointense area (arrow) in the ablation zone. (d) Axial contrast-enhanced T1-weighted MR image obtained 3 months after ablation shows no contrast enhancement in the ablation zone (arrow). (e) Axial contrast-enhanced T1-weighted MR image obtained 17 months after ablation shows a decrease in the size of the ablation zone, which demonstrates no contrast enhancement.
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Figure 8a. Papillary type RCC with no evidence of residual or recurrent RCC after cryoablation. (a) Axial contrast-enhanced T1-weighted MR image shows a small, hypointense mass (arrow) in the left kidney. Biopsy revealed papillary type RCC, and cryoablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 2 months after cryoablation shows a hyperintense area (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 2 months after cryoablation shows an area of hypointensity (arrow) in the ablation zone. There is also a small cyst in the left kidney. (d, e) Axial contrast-enhanced T1-weighted (d) and subtraction (e) MR images obtained 2 months after cryoablation show no contrast enhancement in the ablation zone. (f) Axial contrast-enhanced T1-weighted MR image obtained 13 months after cryoablation shows a decrease in the size of the ablated lesion. No contrast enhancement is detected in the ablation zone.
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Figure 8b. Papillary type RCC with no evidence of residual or recurrent RCC after cryoablation. (a) Axial contrast-enhanced T1-weighted MR image shows a small, hypointense mass (arrow) in the left kidney. Biopsy revealed papillary type RCC, and cryoablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 2 months after cryoablation shows a hyperintense area (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 2 months after cryoablation shows an area of hypointensity (arrow) in the ablation zone. There is also a small cyst in the left kidney. (d, e) Axial contrast-enhanced T1-weighted (d) and subtraction (e) MR images obtained 2 months after cryoablation show no contrast enhancement in the ablation zone. (f) Axial contrast-enhanced T1-weighted MR image obtained 13 months after cryoablation shows a decrease in the size of the ablated lesion. No contrast enhancement is detected in the ablation zone.
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Figure 8c. Papillary type RCC with no evidence of residual or recurrent RCC after cryoablation. (a) Axial contrast-enhanced T1-weighted MR image shows a small, hypointense mass (arrow) in the left kidney. Biopsy revealed papillary type RCC, and cryoablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 2 months after cryoablation shows a hyperintense area (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 2 months after cryoablation shows an area of hypointensity (arrow) in the ablation zone. There is also a small cyst in the left kidney. (d, e) Axial contrast-enhanced T1-weighted (d) and subtraction (e) MR images obtained 2 months after cryoablation show no contrast enhancement in the ablation zone. (f) Axial contrast-enhanced T1-weighted MR image obtained 13 months after cryoablation shows a decrease in the size of the ablated lesion. No contrast enhancement is detected in the ablation zone.
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Figure 8d. Papillary type RCC with no evidence of residual or recurrent RCC after cryoablation. (a) Axial contrast-enhanced T1-weighted MR image shows a small, hypointense mass (arrow) in the left kidney. Biopsy revealed papillary type RCC, and cryoablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 2 months after cryoablation shows a hyperintense area (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 2 months after cryoablation shows an area of hypointensity (arrow) in the ablation zone. There is also a small cyst in the left kidney. (d, e) Axial contrast-enhanced T1-weighted (d) and subtraction (e) MR images obtained 2 months after cryoablation show no contrast enhancement in the ablation zone. (f) Axial contrast-enhanced T1-weighted MR image obtained 13 months after cryoablation shows a decrease in the size of the ablated lesion. No contrast enhancement is detected in the ablation zone.
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Figure 8e. Papillary type RCC with no evidence of residual or recurrent RCC after cryoablation. (a) Axial contrast-enhanced T1-weighted MR image shows a small, hypointense mass (arrow) in the left kidney. Biopsy revealed papillary type RCC, and cryoablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 2 months after cryoablation shows a hyperintense area (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 2 months after cryoablation shows an area of hypointensity (arrow) in the ablation zone. There is also a small cyst in the left kidney. (d, e) Axial contrast-enhanced T1-weighted (d) and subtraction (e) MR images obtained 2 months after cryoablation show no contrast enhancement in the ablation zone. (f) Axial contrast-enhanced T1-weighted MR image obtained 13 months after cryoablation shows a decrease in the size of the ablated lesion. No contrast enhancement is detected in the ablation zone.
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Figure 8f. Papillary type RCC with no evidence of residual or recurrent RCC after cryoablation. (a) Axial contrast-enhanced T1-weighted MR image shows a small, hypointense mass (arrow) in the left kidney. Biopsy revealed papillary type RCC, and cryoablation was performed. (b) Axial fat-suppressed T1-weighted MR image obtained 2 months after cryoablation shows a hyperintense area (arrow) in the ablation zone. (c) Axial T2-weighted MR image obtained 2 months after cryoablation shows an area of hypointensity (arrow) in the ablation zone. There is also a small cyst in the left kidney. (d, e) Axial contrast-enhanced T1-weighted (d) and subtraction (e) MR images obtained 2 months after cryoablation show no contrast enhancement in the ablation zone. (f) Axial contrast-enhanced T1-weighted MR image obtained 13 months after cryoablation shows a decrease in the size of the ablated lesion. No contrast enhancement is detected in the ablation zone.
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Copyright © 2007 by the Radiological Society of North America.
