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Kulkarni CB, Pullara SK, C S R, Moorthy S. Complications of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Acad Radiol 2024; 31:2987-3003. [PMID: 38092590 DOI: 10.1016/j.acra.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 07/21/2024]
Abstract
Radiofrequency ablation (RFA) is a potentially curative treatment option for early Hepatocellular carcinoma. The RFA is considered safe with a relatively low incidence of complications ranging from 2%-7.9%. Though most of the complications are self-limiting, sometimes they can be life-threatening. The occurrence of the particular complication depends on various factors like tumour location and morphology, underlying disease and ablation technique. A detailed understanding of potential complications along with the associated risk factors will help to employ strategies to prevent them, identify them early and manage them when they occur. This article demonstrates various radiofrequency ablation-related complications and discusses the risk factors and technical strategies to minimise them and achieve complete ablation of the tumour.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
| | - Sreekumar Karumathil Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Rajsekar C S
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
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2
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Ranjbartehrani P, Ramirez DA, Schmidlin F, Etheridge M, Iaizzo PA, Shao Q, Bischof JC. Nerve Protection During Prostate Cryosurgery. Ann Biomed Eng 2023; 51:538-549. [PMID: 36088432 DOI: 10.1007/s10439-022-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022]
Abstract
Cryosurgery is a minimally invasive approach to the treatment of focal prostate cancer (PCa). A major complication is the cryoinjury to the cavernous nerve in the neurovascular bundle (NVB). This nerve cryoinjury halts conduction of action potentials (APs) and can eventually result in erectile dysfunction and therefore diminished quality of life for the patient. Here, we propose the application of cryoprotective agents (CPA) to the regions of the nerves in the NVB, prior to prostate cryosurgery, to minimize non-recoverable loss of AP conduction. We modeled a cryosurgical procedure based on data taken during a clinical case and applied ex-vivo porcine phrenic nerves and rat sciatic nerve with temperature profile of NVB. The APs were measured before and after the CPA exposures and during 3 h of recovery. Comparisons of AP amplitude recovery with various CPA compositions reveal that certain CPAs (e.g., 5% DMSO + 7.5% Trehalose and 5% M22 for porcine and rat nerves, respectively) showed little or no toxicity and effective cryoprotection from freezing (on average 48% and 30% of recovered AP, respectively). In summary, we demonstrate that neural conduction can be preserved after exposure to freezing conditions if CPAs are properly selected and deployed onto the nerve.
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Affiliation(s)
- Pegah Ranjbartehrani
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA
| | - David A Ramirez
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Franz Schmidlin
- Urology Center Hirslanden Grangettes Group, Geneva, Switzerland
| | - Michael Etheridge
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, USA
| | - Qi Shao
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, USA.
| | - John C Bischof
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA. .,Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, USA.
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3
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O'Shea A, Leon D, Arellano RS. Microwave Ablation of Hepatocellular Carcinoma Adjacent to the Esophagus: Value of Hydrodissection for Esophageal Protection. Cardiovasc Intervent Radiol 2023; 46:406-407. [PMID: 36474103 DOI: 10.1007/s00270-022-03328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Aileen O'Shea
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - David Leon
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
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Efficacy and Safety of Angioplasty Balloon Interposition in CT-Guided Percutaneous Thermal Ablation of Hepatic Malignancies to Protect Adjacent Organs. Cardiovasc Intervent Radiol 2022; 45:1401-1407. [PMID: 35794280 PMCID: PMC9458570 DOI: 10.1007/s00270-022-03184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/21/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of placing angioplasty balloons between the liver surface and adjacent organs in CT-guided thermal ablation of subcapsular liver malignancies in case of inadequate success of conventional dissection techniques. MATERIALS AND METHODS A retrospective, single-centre database query identified 327 hepatic malignancies in 153 patients treated in 215 sessions from 2016 to 2018 by thermal ablation. Demographic data, tumour size, distance to adjacent structures, complications and long-term outcomes were assessed when ancillary procedures were performed to protect adjacent organs. RESULTS In 21 of 327 (6.4%) ablations, thermal protection was necessary. Balloon interposition was successfully performed in 9 cases in 8 patients after hydrodissection or gas insufflation failed to separate adherent organs. Median pre- and post-balloon insertion distance was 0 mm [0-2 mm] and 17 mm [8-20 mm]. No balloons were damaged, ruptured or slid away from their initial position. Technical success of MWA and protection of adherent structures were achieved in all procedures. In a median follow-up of 11.5 months [0-49 months], the local control rate was 88.9% as 1 patient was treated twice with an interval of 3 months for local recurrence. Three non-process-related major complications and 1 minor complication occurred. CONCLUSION Balloon interposition is a safe and feasible method to enable thermal ablation to a greater number of patients, even after established thermo-protective techniques fail to separate the colon or stomach from the liver surface.
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Itou C, Arai Y, Sone M, Sugawara S, Kimura S. Ureteral Displacement Using the Pushing Guidewire Technique to Assist Antegrade Pyeloperfusion in Renal Cryoablation: Report of Two Cases. Cardiovasc Intervent Radiol 2022; 45:1030-1034. [PMID: 35428939 DOI: 10.1007/s00270-022-03146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/31/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shintaro Kimura
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Huang L, Yang S, Bai M, Lin Y, Chen X, Li G, Cui LG, Wang X. Thermal shielding performance of self-healing hydrogel in tumor thermal ablation. Colloids Surf B Biointerfaces 2022; 213:112382. [PMID: 35151993 DOI: 10.1016/j.colsurfb.2022.112382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
Thermal ablation therapy is widely used in the surgical treatment of tumors. Clinically, normal saline is generally used as an insulator to protect adjacent tissues from local high-temperature burns caused by thermal ablation. However, the flow of saline causes fluid loss, requiring frequent injections and complex operation, which is easy to lead to complications such as secondary injury and hematoma. Here, a self-healing chitosan-PEG (CP) hydrogel was proposed as a protective medium to challenge the clinical preparations. Compared with saline and non-self-healing hydrogel F127, CP hydrogel exhibited outstanding thermal shielding performance in the thermal ablation of thyroid nodule in a Beagle dog model. The transient plane source (TPS) method is used to measure thermal properties, including thermal conductivity, thermal diffusivity and specific heat capacity. The thermal shielding mechanism and clinical advantages including operability, biodegradability, and biological safety of self-healing hydrogel are then revealed in-depth. Therefore, self-healing hydrogel can achieve much better thermal management in tumor thermal ablation.
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Affiliation(s)
- Lifei Huang
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Shiyuan Yang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Mingyu Bai
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Yuxuan Lin
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Xue Chen
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Guofeng Li
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China.
| | - Xing Wang
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China.
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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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Wang Z, Lu J, Huang W, Wu Z, Gong J, Wang Q, Liu Q, Wang C, Zhu Y, Ding X, Wang Z. A retrospective study of CT-guided percutaneous irreversible electroporation (IRE) ablation: clinical efficacy and safety. BMC Cancer 2021; 21:124. [PMID: 33546635 PMCID: PMC7866876 DOI: 10.1186/s12885-021-07820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background To evaluate the clinical efficacy and safety of ablating renal cell carcinoma (RCC) by irreversible electroporation (IRE). Methods Fifteen patients (19 lesions) with RCC who underwent IRE were retrospectively reviewed. Seven patients had solitary kidneys. Two lesions were located in the renal hilus. One patient had chronic renal insufficiency. Percutaneous biopsy for histopathology was performed. The best puncture path plan was evaluated before CT-guided IRE. The estimated glomerular filtration rate (eGFR) was compared vs baseline at 1–2 months after the ablation. Contrast-enhanced computed tomography imaging changes were evaluated immediately after IRE. Contrast-enhanced computed tomography/magnetic resonance was performed 1 month, 3 months, 6 months, 12 months and every year thereafter. The complications after treatment were also reviewed. Results The success rate of the procedure was 100%. The median tumor size was 2.4 (IQR 1.3–2.9) cm, with an median score of 6 (IQR 5.5–8) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). Two cases (3 lesions) were punctured through the liver. In other cases, puncture was performed through the perirenal space. There were no severecomplications in interventional therapy. Transient gross hematuria occurred in 2 patients (centrally located). Self-limiting perinephric hematomas occurred in 1 patient. Needle puncture path metastasis was found in 1 patient 2.5 years after IRE. The subcutaneous metastasis was surgically removed, and there was no evidence of recurrence. There was no significant change in eGFR levels in terms of short- term clinical outcomes (t = 0.348, P = 0.733). At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 15) was noted to have experienced needle tract metastasis and accepted salvage radiofrequency ablation (RFA) therapy. Conclusions IRE appears to be a safe and effective treatment for RCC that may offer a tissue-sparing method and complete ablation as an alternative therapy for RCC.
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Affiliation(s)
- Ziyin Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Jian Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Ju Gong
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Qingbing Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Qin Liu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Cangyi Wang
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Yu Zhu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China.
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China.
| | - Zhongmin Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China. .,Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China.
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Abstract
Renal cell carcinoma is most commonly diagnosed in the sixth or seventh decade of life. Historically, surgical extirpation was the gold standard treatment option for small renal masses. However, given the comorbidities in this elderly population, not all patients are candidates for surgery. The development of minimally invasive ablative therapies has solved the surgical dilemma in this patient population. Furthermore, the 2017 American Urological Association guidelines recommends consideration of percutaneous image guided thermal ablation as a treatment option for masses smaller than 3 cm even in healthy individuals. Percutaneous image guided thermal ablation is an attractive treatment option providing excellent local tumor control, fewer complications, better preservation of the renal functions, faster recovery and shorter hospital stay. Various ablative modalities are available in clinical practice. This includes radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, high intensity focused ultrasound, and laser ablation. In this review, we focus on the most commonly used modalities including radiofrequency ablation and cryoablation and to a lesser extent microwave ablation and irreversible electroporation.
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Affiliation(s)
- Mohamed E Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Auloge P, Cazzato RL, Chiang JB, Caudrelier J, Weiss J, De Marini P, Koch G, Garnon J, Gangi A. Performance of a New Blunt-Tip Needle for the Displacement of Critical Structure in Thermal Ablation. Cardiovasc Intervent Radiol 2020; 43:924-930. [PMID: 32342162 DOI: 10.1007/s00270-020-02472-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To ascertain the performance of a new blunt-tip needle (HydroGuard®), which allows injection of fluids during needle advancement in order to safely approach, displace and insulate nearby critical structures during thermal ablation (TA). MATERIALS AND METHODS This study included 27 consecutive patients treated by TA [cryoablation (CA), radiofrequency (RFA), and microwave MWA)] between April 2018 and January 2019. During TA, hydro- or gas dissection was performed with HydroGuard® needle to displace and protect critical structures close to the tumor (< 10 mm). Technical and clinical success, distance between critical structure and tumor before and after hydro/gas dissection and complications were recorded. RESULTS Eighteen patients were treated by CA (66.7%), 7 by MWA (25.9%) and 2 by RFA (7.4%). Majority of patients were treated with a curative intent (24/27; 88.8%). Adjacent critical structures include vessels (n = 3), nerves (n = 10), ureter/renal pelvis (n = 3), bowel/rectum (n = 10), stomach: (n = 3), diaphragm (n = 2), and pleura (n = 1). Technical success was 100%. Clinical success was 88% (24/27). Median minimum distance to adjacent critical structures before hydro/gas dissection was 1 mm (range 0-9 mm; IQR: 0-3 mm) versus 10.5 mm (range 4-47 mm; IQR: 9.7-18 mm) after displacement. Of the 27 patients treated, four developed complications (14.8%; 95% CI: 1.4-28.2): 1 major (3.7%; 95% CI: 0-10.8) and 3 minors (11.1%; 95% CI: 0-23). Only one minor complication was related to inadequate hydro-dissection, resulting in close proximity of the critical structure to the ablation zone. CONCLUSION HydroGuard® is a safe and effective needle when used to approach, displace and insulate nearby critical structures during TA.
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Affiliation(s)
- Pierre Auloge
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France.
| | - Roberto L Cazzato
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Jeanie Betsy Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Jean Caudrelier
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Julia Weiss
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Pierre De Marini
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Guillaume Koch
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Julien Garnon
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Afshin Gangi
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
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11
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Leshen M, Butani D. Management of small renal masses: An interventional radiologist's perspective. Eur J Intern Med 2019; 64:15-20. [PMID: 31029546 DOI: 10.1016/j.ejim.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 11/25/2022]
Abstract
Renal cell carcinoma is relatively common malignancy. Its imaging features are often non-specific and can present a diagnostic dilemma for clinicians. Historically, all patients with a renal mass underwent radical nephrectomy. Advances in technology have allowed for an increase in partial nephrectomies and percutaneous ablations. This essay briefly describes some of the imaging findings of renal cell carcinoma and several of its mimics followed by an in-depth review of procedural management with a particular focus on recent advancements.
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Affiliation(s)
- Michael Leshen
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Devang Butani
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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12
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Yamagami T, Yoshimatsu R, Kajiwara K, Yamanishi T, Minamiguchi H, Karashima T, Inoue K. Protection from injury of organs adjacent to a renal tumor during percutaneous cryoablation. Int J Urol 2019; 26:785-790. [PMID: 31094038 DOI: 10.1111/iju.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/07/2019] [Indexed: 01/20/2023]
Abstract
Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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13
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Bittman RW, Friedberg EB, Fleishon HB, Prologo JD. Global Approach to the Patient with Pain in Interventional Radiology. Semin Intervent Radiol 2018; 35:342-349. [PMID: 30402017 DOI: 10.1055/s-0038-1673362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ross W Bittman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Eric B Friedberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Howard B Fleishon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Radiology, Emory Johns Creek Hospital, Johns Creek, Georgia
| | - J David Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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14
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Garnon J, Cazzato RL, Caudrelier J, Nouri-Neuville M, Rao P, Boatta E, Ramamurthy N, Koch G, Gangi A. Adjunctive Thermoprotection During Percutaneous Thermal Ablation Procedures: Review of Current Techniques. Cardiovasc Intervent Radiol 2018; 42:344-357. [DOI: 10.1007/s00270-018-2089-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
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15
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Mauri G, Nicosia L, Della Vigna P, Varano GM, Maiettini D, Bonomo G, Giuliano G, Orsi F, Solbiati L, De Fiori E, Papini E, Pacella CM, Sconfienza LM. Percutaneous laser ablation for benign and malignant thyroid diseases. Ultrasonography 2018; 38:25-36. [PMID: 30440161 PMCID: PMC6323312 DOI: 10.14366/usg.18034] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.
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Affiliation(s)
- Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luca Nicosia
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Paolo Della Vigna
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Gianluca Maria Varano
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Daniele Maiettini
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Guido Bonomo
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | | | - Franco Orsi
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luigi Solbiati
- Department of Radiology, Humanitas University, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Elvio De Fiori
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Enrico Papini
- Endocrinology Department, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Rome, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
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16
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Percutaneous radiofrequency and microwave ablation in the treatment of renal tumors - 10 years of experience. Wideochir Inne Tech Maloinwazyjne 2017; 12:394-402. [PMID: 29362655 PMCID: PMC5776489 DOI: 10.5114/wiitm.2017.72322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023] Open
Abstract
Introduction The standard radical treatment of renal cell carcinoma is surgical resection, but it is not suitable for patients with serious medical comorbidities and solitary kidney tumors. Minimally invasive ablation techniques could be an appropriate therapeutic alternative. Aim To retrospectively evaluate the technical success, mid-term and long-term efficacy and safety of radiofrequency and microwave ablation in patients with small renal tumors. Material and methods Over the course of 10 years, 91 ablation procedures in 64 patients for 68 tumors, of size 12–60 mm, were performed using only conscious sedation. These ablations were done under the guidance of computed tomography. We treated 41 males and 23 females with solitary kidney tumors (14 cases) and tumors in non-surgical candidates (54 cases). Results In 50 (73.5%) tumors single treatment was successful; in 13 (19.1%) cases a second procedure was used successfully, and in the 5 largest tumors (sizes 45–60 mm, 7.4%) a third treatment was necessary. Within the follow-up 10 (15.6%) patients died, but none due to metastatic renal cell carcinoma. Only 1 serious complication was observed – retroperitoneal and psoatic hematoma. Early recurrence occurred in 18 (26.5%) tumors. Late recurrence was detected in 5 (7.4%) cases. In all cases complete local control of the renal tumors was reached. Conclusions Percutaneous ablation is a very effective treatment for patients with small renal tumors of the T1a group with a minimal complication rate.
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17
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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18
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Chan P, Vélasco S, Vesselle G, Boucebci S, Herpe G, Debaene B, Ingrand P, Irani J, Tasu JP. Percutaneous microwave ablation of renal cancers under CT guidance: safety and efficacy with a 2-year follow-up. Clin Radiol 2017; 72:786-792. [PMID: 28545682 DOI: 10.1016/j.crad.2017.03.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the safety and efficiency of percutaneous microwave ablation (MWA) of renal cell carcinomas (RCC) carried out under computed tomography (CT) guidance. MATERIALS AND METHODS A retrospective study was performed on RCC that was either histologically proven or diagnosed at imaging (Bosniak IV cyst) and treated by MWA under general anaesthesia with CT guidance. Indications for percutaneous ablation were based on the American Urological Association recommendations. Twenty-four months post-procedure follow-up was performed. RESULTS Sixty-two patients presenting one or more RCC (84 tumours ranging from 10-48 mm in diameter; mean diameter: 25.6 mm) were included. Technical success was achieved for 78 tumours (58 patients). For four patients, the treatment was stopped due to gas dissection failure. At 3 months, six residual tumours were observed (8%). At 6 months, two recurrences and one residual tumour (3.8%) were observed; all were retreated with complete success. At 12 months, local control of the disease was achieved in 94% of cases (100% in cases where treatment was performed). Two cases of distal metastasis were observed after 12 and 24 months. At 24 months, one patient presented with a contralateral tumour. The complication rate was 4.8% including one grade III complication and two grade II complications according to the Clavien-Dindo classification. At 2 years, the cumulative disease-free survival rate and overall survival were 95% and 97%, respectively. CONCLUSION MWA ablation under CT guidance to treat RCC is safe and provides a high rate of effectiveness at 24 months.
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Affiliation(s)
- P Chan
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - S Vélasco
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - G Vesselle
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - S Boucebci
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - G Herpe
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - B Debaene
- Anesthesiology Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - P Ingrand
- Inserm U619, CHU de Poitiers et University of Poitiers, rue de la milétrie, 86000 CHU de Poitiers, France
| | - J Irani
- Inserm U619, CHU de Poitiers et University of Poitiers, rue de la milétrie, 86000 CHU de Poitiers, France; Urology Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - J-P Tasu
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France.
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19
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Mauri G, Nicosia L, Varano GM, Bonomo G, Della Vigna P, Monfardini L, Orsi F. Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation. Insights Imaging 2017; 8:357-363. [PMID: 28500486 PMCID: PMC5438321 DOI: 10.1007/s13244-017-0555-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/08/2017] [Accepted: 04/13/2017] [Indexed: 12/17/2022] Open
Abstract
Abstract Image-guide thermal ablations are nowadays increasingly used to provide a minimally invasive treatment to patients with renal tumours, with reported good clinical results and low complications rate. Different ablative techniques can be applied, each with some advantages and disadvantages according to the clinical situation. Moreover, percutaneous ablation of renal tumours might be complex in cases where there is limited access for image guidance or a close proximity to critical structures, which can be unintentionally injured during treatment. In the present paper we offer an overview of the most commonly used ablative techniques and of the most important manoeuvres that can be applied to enhance the safety and effectiveness of percutaneous image-guided renal ablation. Emphasis is given to the different technical aspects of cryoablation, radiofrequency ablation, and microwave ablation, on the ideal operating room setting, optimal image guidance, application of fusion imaging and virtual navigation, and contrast enhanced ultrasound in the guidance and monitoring of the procedure. Moreover, a series of protective manoeuvre that can be used to avoid damage to surrounding sensitive structures is presented. A selection of cases of image-guided thermal ablation of renal tumours in which the discussed technique were used is presented and illustrated. Teaching points • Cryoablation, radiofrequency and microwave ablation have different advantages and disadvantages. • US, CT, fusion imaging, and CEUS increase an effective image-guidance. • Different patient positioning and external compression may increase procedure feasibility. • Hydrodissection and gas insufflation are useful to displace surrounding critical structures. • Cold pyeloperfusion can reduce the thermal damage to the collecting system.
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Affiliation(s)
- Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy. .,Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, Italy.
| | - L Nicosia
- Scuola di specializzazione in Radiodiagnostica, Università degli studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - G M Varano
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
| | - G Bonomo
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
| | - P Della Vigna
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
| | - L Monfardini
- Dipartimento di radiologia e diagnostica per immagini, Poliambulazna di Brescia, Via Leonida Bissolati 57, Brescia, Italy
| | - F Orsi
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
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20
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Abstract
Small renal masses (SRMs) have been traditionally managed with surgical resection. Minimally invasive nephron-sparing treatment methods are preferred to avoid harmful consequences of renal insufficiency, with partial nephrectomy (PN) considered the gold standard. With increase in the incidence of the SRMs and evolution of ablative technologies, percutaneous ablation is now considered a viable treatment alternative to surgical resection with comparable oncologic outcomes and better nephron-sparing property. Traditional thermal ablative techniques suffer from unique set of challenges in treating tumors near vessels or critical structures. Irreversible electroporation (IRE), with its non-thermal nature and connective tissue-sparing properties, has shown utility where traditional ablative techniques face challenges. This review presents the role of IRE in renal tumors based on the most relevant published literature on the IRE technology, animal studies, and human experience.
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21
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Liu C, Wu B, Huang P, Ding Q, Xiao L, Zhang M, Zhou J. US-Guided Percutaneous Microwave Ablation for Primary Hyperparathyroidism with Parathyroid Nodules: Feasibility and Safety Study. J Vasc Interv Radiol 2016; 27:867-75. [DOI: 10.1016/j.jvir.2016.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/06/2016] [Accepted: 02/10/2016] [Indexed: 02/08/2023] Open
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Abstract
Renal cell carcinoma is a common malignancy with increasing incidence due to the incidental detection of non-symptomatic small renal masses on imaging. Management of these small tumors has evolved toward minimally invasive nephron-sparing techniques which include partial nephrectomy and image-guided ablation. Cryoablation and radiofrequency ablation are the most utilized ablation modalities with the former more suited for larger and central renal masses due to intra-procedural visualization of the ablation zone and reduced pelvicalyceal injury. In this article, we review the epidemiology and natural history of renal cell carcinoma, the role of biopsy, and the management options available-surgery, image-guided ablation, and active surveillance-with a focus on cryoablation. The clinical outcomes of the longer term maturing cryoablation data are discussed with reference to partial nephrectomy and radiofrequency ablation. Image-guided ablation has often been the management choice in patients deemed unfit for surgery; however, growing evidence from published series demonstrates image-guided ablation as a sound alternative treatment with equivalent oncological outcomes and minimal patient impact.
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Affiliation(s)
- Nirav Patel
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - Alexander J King
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - David J Breen
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
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23
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Jiang L, Krishnasamy V, Varano GM, Wood BJ. Hyponatremia Following High-Volume D5W Hydrodissection During Thermal Ablation. Cardiovasc Intervent Radiol 2015; 39:146-9. [PMID: 26246216 DOI: 10.1007/s00270-015-1195-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Liwei Jiang
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Building 10, Room 1C351, 10 Center Dr, Bethesda, MD, 20892-1182, USA. .,Johns Hopkins University School of Medicine, Edward D. Miller Research Building, Suite 137, 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Venkatesh Krishnasamy
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Building 10, Room 1C351, 10 Center Dr, Bethesda, MD, 20892-1182, USA.
| | - Gianluca M Varano
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Building 10, Room 1C351, 10 Center Dr, Bethesda, MD, 20892-1182, USA.
| | - Bradford J Wood
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Building 10, Room 1C351, 10 Center Dr, Bethesda, MD, 20892-1182, USA.
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24
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Thermal Ablative Techniques in Renal Cell Carcinoma. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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26
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Pua BB, Li D, Sullivan BW, Madoff DC. Virtually no thoracic lesion inaccessible: a pictorial case review. Semin Intervent Radiol 2014; 30:206-14. [PMID: 24436538 DOI: 10.1055/s-0033-1342963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Access route considerations in percutaneous intrathoracic biopsy or ablation offers its own unique set of challenges, with special consideration toward reducing the rate of pneumothorax. This review highlights several novel and atypical methods to improve access to intrathoracic lesions through a series of representative cases. These methods include patient positioning, curved needles, hydrodissection, induced/artificial pneumothorax, and use of specialized equipment functions. No intrathoracic lesion should be considered "inaccessible" either for biopsy or treatment by percutaneous approaches without consideration of performing these adjunctive techniques.
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Affiliation(s)
- Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David Li
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Brian W Sullivan
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
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27
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Iannuccilli JD, Grand DJ, Dupuy DE, Mayo-Smith WW. Percutaneous ablation for small renal masses-imaging follow-up. Semin Intervent Radiol 2014; 31:50-63. [PMID: 24596440 DOI: 10.1055/s-0033-1363843] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Image-guided percutaneous thermal ablation is a safe and effective nephron-sparing alternative to surgical resection for the treatment of small renal tumors. Assessment of treatment efficacy relies heavily on interval follow-up imaging after treatment. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) both play a pivotal role in evaluating the treatment zone, identifying residual tumor, and detecting early and delayed procedure-related complications. This article discusses a surveillance imaging protocol for patients who undergo percutaneous thermal ablation of renal tumors, and also illustrates the typical appearances of both successfully treated tumors and residual disease on contrast-enhanced CT or MRI. In addition, it discusses the imaging appearance of potential early and delayed treatment-related complications to facilitate their prompt detection and management.
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Affiliation(s)
- Jason D Iannuccilli
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
| | - David J Grand
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Damian E Dupuy
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
| | - William W Mayo-Smith
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
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28
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 2014; 273:241-60. [PMID: 24927329 DOI: 10.1148/radiol.14132958] [Citation(s) in RCA: 806] [Impact Index Per Article: 80.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article .
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215 (M.A.); Department of Radiology, Ospedale Generale, Busto Arsizio, Italy (L.S.); Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.L.B.); Department of Radiology, Southampton University Hospitals, Southampton, England (D.J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.R.C., J.W.C.); Department of Ultrasound, School of Oncology, Peking University, Beijing, China (M.H.C.); Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea (B.I.C.); Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France (T.d.B.); Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (G.D.D.); Department of Diagnostic Radiology, Rhode Island Hospital, Providence, RI (D.E.D.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.A.G.); Medical Imaging, University Health Network, Laval, Quebec, Canada (D.G.); Imaging Department, the London Clinic, London, England (A.R.G.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (F.T.L.); Department of Radiology, Royal Infirmary, Glasgow, Scotland (E.L.); Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy (R.L.); Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Mich (P.J.L.); Busto Arsizio, Italy (T.L.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.S.L.); Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, Calif (J.P.M.); Department of Radiology, Ospedale Valduce, Como, Italy (M.F.M.); Department of Radiology, Albert Einstein Medical Center, Phil
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Knuttinen MG, Van Ha TG, Reilly C, Montag A, Straus C. Unintended thermal injuries from radiofrequency ablation: organ protection with an angioplasty balloon catheter in an animal model. J Clin Imaging Sci 2014; 4:1. [PMID: 24678433 PMCID: PMC3952378 DOI: 10.4103/2156-7514.126018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/04/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate a novel approach of using a balloon catheter as a protective device to separate liver from the diaphragm or nearby bowel during radiofrequency ablation (RFA) of hepatic dome tumors in an animal model. MATERIALS AND METHODS All experimental procedures were approved by animal Institutional Review Board. Using a 3 cm RF needle electrode, 70 hepatic ablation zones were created using ultrasound in 7 pigs. 50 lesions were created using balloon interposition between liver and diaphragm; 20 lesions were created using the balloon device interposed posteriorly between liver and bowel. Additional 21 control lesions were performed. Animals were sacrificed immediately; diaphragm and bowel were then visually inspected and sectioned. Diaphragmatic and bowel injury was then classified according to the depth of thickness. RESULTS Control lesions caused full thickness injury, either to diaphragm or bowel. During ablation of lesions with balloon interposition, there was significantly less diaphragmatic injury, P < 0.001 and less bowel injury, P < 0.01. CONCLUSION Using balloon interposition as a protective device has advantages over previous saline infusion or CO2 insufflation, providing a safe way to expand percutaneous RFA of liver tumors located on the undersurface of the diaphragm. In addition, this method may be used in protection of other organs adjacent to areas being ablated.
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Affiliation(s)
- Martha-Grace Knuttinen
- Department of Vascular and Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois 60612, USA
| | - Thuong G Van Ha
- Department of Interventional Radiology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
| | - Christopher Reilly
- Department of Interventional Radiology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
| | - Anthony Montag
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
| | - Christopher Straus
- Department of Interventional Radiology, University of Chicago Medical Center, Chicago, Illinois 60637, USA
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Maurice MJ, Haaga JR, Nakamoto DA, Ponsky LE. Pneumodissection: an alternative protective technique for the percutaneous cryoablation of small renal masses. Urol Int 2013; 90:381-3. [PMID: 23594736 DOI: 10.1159/000346332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Percutaneous cryoablation is an emerging treatment option for the small renal mass. It poses a risk of thermal injury to adjacent tissues, limiting its application. We describe pneumodissection, a novel technique for preventing thermal injury during percutaneous cryoablation. MATERIALS AND METHODS The cases of 4 patients who underwent percutaneous renal cryoablation and pneumodissection were retrospectively reviewed. RESULTS Pneumodissection mechanically separated four tumors from overlying bowel segments (mean distance 1.2 ± 0.4 cm), permitting successful cryoablation. There were no complications or recurrences with 7.5 months of follow-up. CONCLUSIONS Pneumodissection is a feasible displacement technique that facilitates percutaneous cryoablation in at-risk patients. Further study is warranted.
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Affiliation(s)
- Matthew J Maurice
- Center for Urologic Oncology & Minimally Invasive Therapies, Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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Iannuccilli JD, Dupuy DE, Mayo-Smith WW. Solid renal masses: effectiveness and safety of image-guided percutaneous radiofrequency ablation. ACTA ACUST UNITED AC 2013; 37:647-58. [PMID: 21968698 DOI: 10.1007/s00261-011-9807-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With increasing emphasis on minimally invasive nephron-sparing techniques for treatment of renal tumors, image-guided percutaneous radiofrequency ablation (RFA) has emerged as a safe and effective method of tumor eradication that may be performed on an outpatient basis, with relatively low morbidity and mortality. This review addresses the clinical and technical considerations, risks, complications, and currently reported efficacy data pertaining to RFA of renal tumors, as well as the standardized approach to treatment and follow-up currently used in our practice.
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Affiliation(s)
- Jason D Iannuccilli
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA.
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Abstract
Thermoablation (TA) has become an increasingly popular treatment for small renal masses (SRMs). Although long-term outcomes are not currently reported, TA may have a role in being an alternative to radical or partial nephrectomy. This review gives a broad overview of TA and discusses current controversies in the field.
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Affiliation(s)
- Phillip H Abbosh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Geeslin MG, Cressman EN. Thermochemical Ablation: A Device for a Novel Interventional Concept. J Med Device 2012; 6. [PMCID: PMC3707189 DOI: 10.1115/1.4005785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 11/07/2011] [Indexed: 10/23/2023] Open
Abstract
Solid focal and oligometastatic malignancies are appropriate targets for minimally invasive ablative procedures. Thermochemical ablation is an experimental minimally invasive procedure, which exploits certain features of current thermal and chemical tumor ablation therapies. Engineering principles have been used to design a device, which has been research-proven-capable of coagulating tissue through the combination of a thermal and chemical insult. This interventional device completes this assignment by separately guiding the flow of chemical reagents, drawn from auxiliary systems, to a point at the distal tip of an assembled apparatus. At this position, the respective flow-streams converge and undergo an exothermic reaction to produce a heated, hyperosmolar solute, which serves to ablate the targeted tissue. Ex and in vivo studies have confirmed the utility of this device and the physiologic toleration of this interventional concept.
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Affiliation(s)
- Matthew G. Geeslin
- University of Minnesota Medical School,University of Minnesota,Minneapolis, MN 55455e-mail:
| | - Erik N. Cressman
- Department of Radiology,University of Minnesota,Minneapolis, MN 55455
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Energy Ablative Techniques in Renal Cell Carcinoma. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tsoumakidou G, Buy X, Garnon J, Enescu J, Gangi A. Percutaneous Thermal Ablation: How to Protect the Surrounding Organs. Tech Vasc Interv Radiol 2011; 14:170-6. [DOI: 10.1053/j.tvir.2011.02.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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