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Aveta A, Iossa V, Spena G, Conforti P, Pagano G, Dinacci F, Verze P, Manfredi C, Ferro M, Lasorsa F, Spirito L, Napolitano L, Tufano A, Fiorenza A, Russo P, Crocerossa F, Lucarelli G, Perdonà S, Sanseverino R, Siracusano S, Cilio S, Pandolfo SD. Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review. Life (Basel) 2024; 14:450. [PMID: 38672721 PMCID: PMC11050889 DOI: 10.3390/life14040450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
This review focuses on ablative techniques for small renal masses (SRMs), including radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), and irreversible electroporation (IRE), and discusses recurrence management. Through an extensive literature review, we outline the procedures, outcomes, and follow-up strategies associated with each ablative method. The review provides a detailed examination of these techniques-RFA, CA, MWA, and IRE-elucidating their respective outcomes. Recurrence rates vary among them, with RFA and CA showing comparable rates, MWA demonstrating favorable short-term results, and IRE exhibiting promise in experimental stages. For managing recurrences, various strategies are considered, including active surveillance, re-ablation, or salvage surgery. Surveillance is preferred post-RFA and post-CA, due to slow SRM growth, while re-ablation, particularly with RFA and CA, is deemed feasible without additional complications. Salvage surgery emerges as a viable option for larger or resistant tumors. While ablative techniques offer short-term results comparable to surgery, further research is essential to understand their long-term effects fully. Decisions concerning recurrence management should consider individual and tumor-specific factors. Imaging, notably contrast-enhanced ultrasounds, plays a pivotal role in assessing treatment success, emphasizing the necessity of a multidisciplinary approach for optimal outcomes. The lack of randomized trials highlights the need for further research.
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Affiliation(s)
- Achille Aveta
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | - Vincenzo Iossa
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Gianluca Spena
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Paolo Conforti
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Giovanni Pagano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Fabrizio Dinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, 71013 Milan, Italy;
| | - Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Antonio Tufano
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Alessandra Fiorenza
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy;
| | - Fabio Crocerossa
- Division of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Roberto Sanseverino
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | | | - Simone Cilio
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
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Park BK. Assessment of Local Tumor Progression After Image-Guided Thermal Ablation for Renal Cell Carcinoma. Korean J Radiol 2024; 25:33-42. [PMID: 38184767 PMCID: PMC10788605 DOI: 10.3348/kjr.2023.0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 01/08/2024] Open
Abstract
Focal enhancement typically suggests local tumor progression (LTP) after renal cell carcinoma is percutaneously ablated. However, evaluating findings that are false positive or negative of LTP is less familiar to radiologists who have little experience with renal ablation. Various imaging features are encountered during and after thermal ablation. Ablation procedures and previous follow-up imaging should be reviewed before determining if there is LTP. Previous studies have focused on detecting the presence or absence of focal enhancement within the ablation zone. Therefore, various diagnostic pitfalls can be experienced using computed tomography or magnetic resonance imaging examinations. This review aimed to assess how to read images during or after ablation procedures, recognize imaging features of LTP and determine factors that influence LTP.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Gay Depassier J, Crombé A, Jambon E, Bernhard JC, Le Bras Y, Grenier N, Marcelin C. What is the benefit of gadolinium-chelate injection for the diagnosis of local recurrence of clear cell renal cell carcinoma after percutaneous thermal ablation with MRI? Diagn Interv Imaging 2023; 104:584-593. [PMID: 37442753 DOI: 10.1016/j.diii.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The purpose of this study was to compare the diagnostic capabilities of contrast-enhanced (CE)-MRI to those of non-CE-MRI to diagnose local recurrence of clear cell renal cell carcinoma (ccRCC) after percutaneous thermal ablation (TA). MATERIALS AND METHODS This institutional, review board-approved, case-control, single-center retrospective study included all consecutive adult patients with at least two post-TA MRIs showing local recurrence of ccRCC after TA validated by multidisciplinary board. 'Control' patients without recurrence were randomly-selected with a case:control ratio of 2/3. Four senior radiologists reviewed in a double-blinded fashion non-CE sequences of last two consecutive MRI examinations (non-CE-MRIs), assessed the presence of recurrence of ccRCC, then reviewed the CE sequences (CE-MRI) and determined again the presence of a recurrence. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity and accuracy were compared for each reader for non-CE-MRI and CE-MRI. RESULTS Fifty-one patients (41 men; mean age, 77.5 years) who underwent percutaneous TA for ccRCC were included. There were a total of 21 recurrences and 35 scars. Whoever the reader, AUROC was not significantly different (mean, 0.86 with-CE-MRI vs. 0.81 with non-CE-MRI; P values ranging between 0.08 and 0.98), neither sensitivity (mean, 76.2% with CE-MRI vs. 71.4% with non-CE-MRI; P values ranging between 0.06 and >0.99), nor accuracy (85.8% with CE-MRI vs. 80.8% with non-CE-MRI; P values ranging between 0.07 and >0.99). Change in specificity depended on the reader with a significant increase for one reader (+20%; P = 0.02) and a significant decrease for another reader (-17.2%; P = 0.03). CONCLUSION Non-CE MRI has good diagnostic performance for the follow-up of patients with ccRCC treated using percutaneous TA, questioning the systematic use of GBCA injection.
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Affiliation(s)
- Julien Gay Depassier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Amandine Crombé
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Jean-Christophe Bernhard
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Deparment of Urology, Hôpital Pellegrin, 33400 Bordeaux, France
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Nicolas Grenier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Bordeaux Institute of Oncology, BRIC U1312, INSERM, Université de Bordeaux, 33000 Bordeaux, France.
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Chaurasia A, Singh S, Homayounieh F, Gopal N, Jones EC, Linehan WM, Shyn PB, Ball MW, Malayeri AA. Complications after Nephron-sparing Interventions for Renal Tumors: Imaging Findings and Management. Radiographics 2023; 43:e220196. [PMID: 37384546 PMCID: PMC10323228 DOI: 10.1148/rg.220196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 07/01/2023]
Abstract
The two primary nephron-sparing interventions for treating renal masses such as renal cell carcinoma are surgical partial nephrectomy (PN) and image-guided percutaneous thermal ablation. Nephron-sparing surgery, such as PN, has been the standard of care for treating many localized renal masses. Although uncommon, complications resulting from PN can range from asymptomatic and mild to symptomatic and life-threatening. These complications include vascular injuries such as hematoma, pseudoaneurysm, arteriovenous fistula, and/or renal ischemia; injury to the collecting system causing urinary leak; infection; and tumor recurrence. The incidence of complications after any nephron-sparing surgery depends on many factors, such as the proximity of the tumor to blood vessels or the collecting system, the skill or experience of the surgeon, and patient-specific factors. More recently, image-guided percutaneous renal ablation has emerged as a safe and effective treatment option for small renal tumors, with comparable oncologic outcomes to those of PN and a low incidence of major complications. Radiologists must be familiar with the imaging findings encountered after these surgical and image-guided procedures, especially those indicative of complications. The authors review cross-sectional imaging characteristics of complications after PN and image-guided thermal ablation of kidney tumors and highlight the respective management strategies, ranging from clinical observation to interventions such as angioembolization or repeat surgery. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available in the Online Learning Center. See the invited commentary by Chung and Raman in this issue.
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Affiliation(s)
- Aditi Chaurasia
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Shiva Singh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Fatemeh Homayounieh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Nikhil Gopal
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Elizabeth C. Jones
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - W. Marston Linehan
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Paul B. Shyn
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Mark W. Ball
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Ashkan A. Malayeri
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
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Obellianne J, De Marini P, Cazzato RL, Dalili D, Garnon J, Koch G, Weiss J, Autrusseau PA, Lang H, Gangi A. Role of MRI at 1- and 3-Month Follow-up in Predicting the Likelihood of Tumor Recurrence Following Percutaneous Cryoablation of Renal Tumors. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03452-8. [PMID: 37191935 DOI: 10.1007/s00270-023-03452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/22/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To evaluate whether ablation volume difference relatively to tumoral volume, minimal distance between ablation area and necrotic tumor, or apparent diffusion coefficient (ADC) within the ablation area, measured on 1- and 3-month follow-up MRI following cryoablation of renal tumors, are associated with tumor recurrence. MATERIALS AND METHODS 136 renal tumors were retrospectively identified. Patients, tumor characteristics and follow-up MRI (1-, 3-, 6-month, and thereafter annually) were collected. Uni- and multivariate analyses were performed to assess the association between the investigated parameters and tumor recurrence. RESULTS Over the follow-up period (27.7 ± 21.9 months), 13 recurrences were identified at 20.5 ± 19.4 months. At 1- and 3-month, the mean volume difference between the ablation zone and the tumor volume were + 577.5 ± 511.3% vs + 251.4 ± 209.8% (p = 0.003), and + 268.8 ± 291.1% vs + 103.8 ± 94.6% (p = 0.023) in patients without and with tumor recurrence, respectively. At 1- and 3-month, the minimum distance between the necrotic tumor and the edge of the ablation area was 3.4 ± 2.5 vs 1.8 ± 1.9 mm (p = 0.019), and 2.4 ± 2.3 vs 1.4 ± 1.8 mm (p = 0.13) in patients without and with tumor recurrence, respectively. Analysis of ADC values was not associated with tumor recurrence. After performing the multivariate analysis, only volume difference of the ablation area compared to tumor volume was associated with absence of tumor recurrence at 1- (OR = 14.1; p = 0.001) and 3-month (OR = 8.2; p = 0.01). CONCLUSIONS Evaluation of volume difference between the ablation area and tumor volume on early (≤ 3 months) MRI follow-up identifies patients at risk of tumor recurrence.
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Affiliation(s)
- Jules Obellianne
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, , London, KT18 7EG, UK
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | | | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, Strand London, London, WC2R 2LS, UK
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Yim K, Leeman JE. Radiation Therapy in the Treatment of Localized and Advanced Renal Cancer. Urol Clin North Am 2023; 50:325-334. [PMID: 36948675 DOI: 10.1016/j.ucl.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Renal cell carcinoma (RCC) has historically been considered resistant to radiotherapy. However, advances in the field of radiation oncology have led to safe delivery of higher radiation doses through the use of stereotactic body radiotherapy (SBRT) that have shown significant activity against RCC. SBRT has now been shown to be a highly effective modality for management of localized RCC for nonsurgical candidates. Increasing evidence also points to a role for SBRT in the management of oligometastatic RCC as a means for not only providing palliation but prolonging time to progression and potentially improving survival.
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Affiliation(s)
- Kendrick Yim
- Division of Urology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02215, USA
| | - Jonathan E Leeman
- Department of Radiation Oncology, Dana Farber Cancer Institute/ Brigham and Women's Hospital, Boston, MA, USA.
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Bodard S, Boudhabhay I, Dariane C, Delavaud C, Guinebert S, Joly D, Timsit MO, Mejean A, Verkarre V, Hélénon O, Richard S, Correas JM. Percutaneous Thermal Ablation for Renal Tumors in Patients with Birt–Hogg–Dubé Syndrome. Cancers (Basel) 2022; 14:cancers14204969. [PMID: 36291753 PMCID: PMC9599652 DOI: 10.3390/cancers14204969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
BHD syndrome is characterized by an increased risk of bilateral and multifocal renal cell carcinoma (RCCs), but is rarely metastatic. Our report aims to analyze the outcome of patients with BHD syndrome who underwent percutaneous thermal ablation (TA). The present report included six BHD syndrome patients (five men) with a mean age of 66 ± 11 (SD) years who had a proven germline FLCN gene mutation and underwent TA for a renal tumor. Nineteen renal tumors (median two tumors per patient; range: 1–3), including seven chromophobe RCCs, five clear-cell RCCs, four papillary RCCs, two clear-cell papillary RCC, and one hybrid oncocytic/chromophobe tumor were treated in 14 ablation sessions. The mean size of the tumors was 21 ± 11 (SD) mm (median: 20 mm; interquartile range (IQR): 14–25 mm) for a mean volume of 7 ± 11 (SD) mL (median: 3; IQR: 1–5 mL). Technical success was achieved in all ablation sessions (primary success rate, 100%). The procedure was well tolerated under conscious sedation with no significant Clavien–Dindo complication (grade 2, 3, 4). All patients were alive with no distant metastasis during a median follow-up period of 74 months (range: 33–83 months). No local tumor progression was observed. The mean decrease in estimated glomerular filtration rate was 8 mL/min/1.73 m2. No patients required dialysis or renal transplantation. In this case series, percutaneous TA appeared as a safe and efficient nephron-sparing treatment for treating RCCs associated with BHD syndrome, even in the case of advanced chronic kidney disease.
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Affiliation(s)
- Sylvain Bodard
- AP-HP, Hôpital Necker Enfants Malades, Service d’Imagerie Adulte, F-75015 Paris, France
- Université de Paris Cité, F-75006 Paris, France
- Sorbonne Université, CNRS, INSERM Laboratoire d’Imagerie Biomédicale, F-75005 Paris, France
- Correspondence: ; Tel.: +33-618816210
| | - Idris Boudhabhay
- Université de Paris Cité, F-75006 Paris, France
- AP-HP, Hôpital Necker Enfants Malades, Service de Néphrologie–Transplantation Adulte, F-75015 Paris, France
| | - Charles Dariane
- Université de Paris Cité, F-75006 Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Urologie, F-75015 Paris, France
| | - Christophe Delavaud
- AP-HP, Hôpital Necker Enfants Malades, Service d’Imagerie Adulte, F-75015 Paris, France
| | - Sylvain Guinebert
- AP-HP, Hôpital Necker Enfants Malades, Service d’Imagerie Adulte, F-75015 Paris, France
- Université de Paris Cité, F-75006 Paris, France
| | - Dominique Joly
- Université de Paris Cité, F-75006 Paris, France
- AP-HP, Hôpital Necker Enfants Malades, Service de Néphrologie–Transplantation Adulte, F-75015 Paris, France
| | - Marc-Olivier Timsit
- Université de Paris Cité, F-75006 Paris, France
- AP-HP, Hôpital Necker Enfants Malades, Service de Néphrologie–Transplantation Adulte, F-75015 Paris, France
- Réseau National pour Cancers Rares de l’Adulte PREDIR labellisé par l’INCa/AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Arnaud Mejean
- Université de Paris Cité, F-75006 Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Urologie, F-75015 Paris, France
- Réseau National pour Cancers Rares de l’Adulte PREDIR labellisé par l’INCa/AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Virginie Verkarre
- Université de Paris Cité, F-75006 Paris, France
- Réseau National pour Cancers Rares de l’Adulte PREDIR labellisé par l’INCa/AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Anatomie et Cytologie Pathologiques, F-75015 Paris, France
| | - Olivier Hélénon
- AP-HP, Hôpital Necker Enfants Malades, Service d’Imagerie Adulte, F-75015 Paris, France
- Université de Paris Cité, F-75006 Paris, France
| | - Stéphane Richard
- Réseau National pour Cancers Rares de l’Adulte PREDIR labellisé par l’INCa/AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, F-75014, France
- UMR 9019-CNRS, Gustave Roussy Cancer Campus, F-94800 Villejuif, France
- Service d’Urologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Jean-Michel Correas
- AP-HP, Hôpital Necker Enfants Malades, Service d’Imagerie Adulte, F-75015 Paris, France
- Université de Paris Cité, F-75006 Paris, France
- Sorbonne Université, CNRS, INSERM Laboratoire d’Imagerie Biomédicale, F-75005 Paris, France
- Réseau National pour Cancers Rares de l’Adulte PREDIR labellisé par l’INCa/AP-HP, Hôpital Bicêtre, F-94270 Le Kremlin-Bicêtre, France
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Diagnostic Workup for Patients with Solid Renal Masses: A Cost-Effectiveness Analysis. Cancers (Basel) 2022; 14:cancers14092235. [PMID: 35565365 PMCID: PMC9104211 DOI: 10.3390/cancers14092235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background: For patients with solid renal masses, a precise differentiation between malignant and benign tumors is crucial for forward treatment management. Even though MRI and CT are often deemed as the gold standard in the diagnosis of solid renal masses, CEUS may also offer very high sensitivity in detection. The aim of this study therefore was to evaluate the effectiveness of CEUS from an economical point of view. Methods: A decision-making model based on a Markov model assessed expenses and utilities (in QALYs) associated with CEUS, MRI and CT. The utilized parameters were acquired from published research. Further, a Monte Carlo simulation-based deterministic sensitivity analysis of utilized variables with 30,000 repetitions was executed. The willingness-to-pay (WTP) is at USD 100,000/QALY. Results: In the baseline, CT caused overall expenses of USD 10,285.58 and an efficacy of 11.95 QALYs, whereas MRI caused overall expenses of USD 7407.70 and an efficacy of 12.25. Further, CEUS caused overall expenses of USD 5539.78, with an efficacy of 12.44. Consequently, CT and MRI were dominated by CEUS, and CEUS remained cost-effective in the sensitivity analyses. Conclusions: CEUS should be considered as a cost-effective imaging strategy for the initial diagnostic workup and assessment of solid renal masses compared to CT and MRI.
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Felipe VB, Ananya B, Ying T, Qiang L, Ji-Bin L, John RE. Renal Contrast-enhanced Ultrasound: Clinical Applications and Emerging Researc. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022; 6:129. [DOI: 10.37015/audt.2022.220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
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10
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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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Bertolotto M, Campo I, Sachs C, Ciabattoni R, Cicero C, Drudi FM, Derchi LE, Cova MA. Contrast-enhanced ultrasound after successful cryoablation of benign and malignant renal tumours: how long does tumour enhancement persist? J Med Imaging Radiat Oncol 2021; 65:272-278. [PMID: 33547767 DOI: 10.1111/1754-9485.13149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To investigate how long successfully ablated tumours take to become completely avascular at CEUS after cryoablation. METHODS Ninety-five patients had percutaneous cryoablation of 103 renal tumours investigated at CEUS on post-operative day one. If the lesion was avascular, a contrast-CT/MR was scheduled six months after the procedure, while CEUS was repeated if the lesion still displayed enhancement, until the disappearance of intralesional vascularity. Technical success was defined when the tumour was covered completely by the ablation zone. Technique efficacy was assessed at six months of follow-up. RESULTS Technical efficacy was obtained for 101/103 cryoablations, 56% of which (57/101) were avascular on post-operative day one. After one week, two weeks, one month 83%, 91% and 100% of these 101 lesions, respectively, were avascular. Two tumours were unsuccessfully treated. They displayed persistent intralesional vascularity at CEUS one month after the procedure. CONCLUSIONS After cryoablation, obtaining CEUS before one month may be misleading. When technical efficacy is obtained, disappearance of intralesional enhancement is observed within two weeks in the majority of cases (91%), but can persist until one month. Identification of tumour enhancement after one month may be concerning for residual viable tumour.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, ULSS 2 Marca Trevigiana, Conegliano (TV), Italy
| | - Camilla Sachs
- S.C. Radiologia Pordenone - Sacile, Azienda sanitaria Friuli Occidentale (ASFO), Pordenone (PN), Italy
| | - Riccardo Ciabattoni
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Calogero Cicero
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | - Francesco Maria Drudi
- Department of Radiology, University Sapienza of Rome, Policlinico Umberto I, Roma, Italy
| | - Lorenzo E Derchi
- Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, Policlinico San Martino IST, Genova, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Wu PH, Bedoya M, White J, Brace CL. Feature-based automated segmentation of ablation zones by fuzzy c-mean clustering during low-dose computed tomography. Med Phys 2021; 48:703-714. [PMID: 33237594 PMCID: PMC8594246 DOI: 10.1002/mp.14623] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Intra-procedural monitoring and post-procedural follow-up is necessary for a successful ablation treatment. An imaging technique which can assess the ablation geometry accurately is beneficial to monitor and evaluate treatment. In this study, we developed an automated ablation segmentation technique for serial low-dose, noisy ablation computed tomography (CT) or contrast-enhanced CT (CECT). METHODS Low-dose, noisy temporal CT and CECT volumes were acquired during microwave ablation on normal porcine liver (four with non-contrast CT and eight with CECT). Highly constrained backprojection (HYPR) processing was used to recover ablation zone information compromised by low-dose noise. First-order statistic features and normalized fractional Brownian features (NBF) were used to segment ablation zones by fuzzy c-mean clustering. After clustering, the segmented ablation zone was refined by cyclic morphological processing. Automatic and manual segmentations were compared to gross pathology with Dice's coefficient (morphological similarity), while cross-sectional dimensions were compared by percent difference. RESULTS Automatic and manual segmentations of the ablation zone were very similar to gross pathology (Dice Coefficients: Auto.-Path. = 0.84 ± 0.02; Manu.-Path. = 0.76 ± 0.03, P = 0.11). The differences in ablation area, major diameter and minor diameter were 17.9 ± 3.2%, 11.1 ± 3.2% and 16.2 ± 3.4%, respectively, when comparing automatic segmentation to gross pathology, which were lower than the differences of 32.9 ± 16.8%, 13.0 ± 9.8% and 21.8 ± 5.8% when comparing manual segmentation to gross pathology. Manual segmentations tended to overestimate gross pathology when ablation area was less than 15 cm2 , but the automated segmentation tended to underestimate gross pathology when ablation zone is larger than 20 cm2 . CONCLUSION Fuzzy c-means clustering may be used to aid automatic segmentation of ablation zones without prior information or user input, making serial CT/CECT has more potential to assess treatments intra-procedurally.
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Affiliation(s)
- Po-hung Wu
- Department of Electrical and Computer Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Mariajose Bedoya
- Department of Medical Physics, University of Wisconsin - Madison, 1111 Highland Ave, Rm 1005, Madison, WI 53705, USA
| | - Jim White
- Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Christopher L. Brace
- Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA
- Department of Radiology, University of Wisconsin - Madison, 1111 Highland Ave, Madison, WI 53705, USA
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Wetley KA, Abel EJ, Dreyfuss LD, Huang W, Brace CL, Wells SA. CT and MR imaging surveillance of stage 1 renal cell carcinoma after microwave ablation. Abdom Radiol (NY) 2020; 45:2810-2824. [PMID: 32715335 DOI: 10.1007/s00261-020-02662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe the CT and MR imaging findings after microwave ablation of clinical stage 1 renal cell carcinoma (RCC). METHODS This single-center retrospective study was performed under a waiver of informed consent. 49 patients (38 M/11F, mean age 66 ± 9.0) with 52 cT1a RCC and 19 patients (10M/9F, mean age 67 ± 9.7) with 19 cT1b RCC were treated with percutaneous microwave ablation between January 2012 and June 2014. The size and volume of the RCC and ablation zone were measured and the kidney, ablation zones and retroperitoneum were assessed at immediate post-procedure CT and surveillance CT and MRI. RESULTS Median imaging follow-up was 18 months (IQR 12-28). Ablation zones were heterogeneously hyperintense on T1W and hypointense on T2W MRI and hyperdense at CT. Thin peripheral, but no internal enhancement after contrast administration signified successful ablation zones. Ablation zones decreased in size, but did not resolve during surveillance. Immediate post-procedure subcapsular gas and hematoma (5/71, 7%) resolved prior to first follow-up. Focal, enhancing soft tissue within the ablation zone, invariably along the renal margin, signified local recurrence. Local recurrence rates were higher for T1b (2/19, 11%) compared to T1a (1/52, 2%). Urinomas (4/71, 6%) decreased in size and resolved during surveillance. Retroperitoneal fat necrosis (6/71, 9%), with opposed-phase loss of T1W MRI signal, was confirmed at histology after percutaneous biopsy. CONCLUSION CT and MR imaging features after microwave ablation of renal cell carcinoma are predictable and reliably demonstrate treatment success, early and delayed complications, and local recurrences that can guide patient management.
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Affiliation(s)
- Karla A Wetley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
| | - E Jason Abel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Leo D Dreyfuss
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Wei Huang
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA.
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Cazzato RL, Garnon J, De Marini P, Auloge P, Koch G, Dalili D, Buy X, Palussiere J, Rao PP, Tricard T, Lang H, Gangi A. Is percutaneous image-guided renal tumour ablation ready for prime time? Br J Radiol 2020; 93:20200284. [PMID: 32543890 DOI: 10.1259/bjr.20200284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In the last few decades, thermal ablation (TA) techniques have been increasingly applied to treat small localised renal cell carcinomas. Despite this trend, there is still an underuse of TA compared to surgery and a substantial lack of high-quality evidence derived from large, prospective, randomised controlled trials comparing the long-term oncologic outcomes of TA and surgery. Therefore, in this narrative review, we assess published guidelines and recent literature concerning the diagnosis and management of kidney-confined renal cell carcinoma to understand whether percutaneous image-guided TA is ready to be proposed as a first-line treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre De Marini
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Department of Diagnostic and Interventional Radiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, 0 St Thomas St, London SE1 9RS, United Kingdom
| | - Xavier Buy
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Jean Palussiere
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Pramod Prabhakar Rao
- Interventional Radiology, Civil Hospital of Colmar; 39 Avenue de la Liberté, 68024 Colmar, France
| | - Thibault Tricard
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Hervé Lang
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
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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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16
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Li H, Lin Z, Chen J, Guo R. Evaluation of the MR and pathology characteristics immediately following percutaneous MR-guided microwave ablation in a rabbit kidney VX2 tumor implantation model. Int J Hyperthermia 2019; 36:1197-1206. [PMID: 31814458 DOI: 10.1080/02656736.2019.1687944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: This study aimed to evaluate the immediate efficacy of magnetic resonance (MR)-guided microwave ablation (MWA) in rabbit kidneys implanted with VX2 tumors.Materials and methods: MR-guided MWA was performed in eight VX2 tumor-bearing rabbits. MR images after ablation were obtained and analyzed. The differences between the tissue specimens and MR images obtained after ablation were compared.Results: On the three-dimensional volumetric interpolated breath-hold T1-weighted (3D-VIBE-T1WI) sequence, a low signal intensity indicated the primary tumor at the center of the ablation area, which was surrounded by a peripheral high-signal area. The signal for the primary tumor in the fast spin-turbo spin-echo T2-weighted (FS-TSE-T2WI) sequence was lower than before, and the ablation zone showed a low signal that completely covered the primary tumor. There was no significant difference in volume among the low-signal areas of the primary tumor on FS-TSE-T2WI before MWA, the central low-signal area on 3D-VIBE-T1WI after MWA, and the tumor coagulation necrosis area on the tissue specimens (p > 0.05). No significant difference was found in the volume of ablation zones among the tissue specimens, the high-signal area around the lesion on the 3D-VIBE-T1WI sequence, and the low-signal area covering the lesion on the FS-TSE-T2WI sequence (p > 0.05).Conclusion: Magnetic resonance imaging (MRI) is an effective method for immediate efficacy evaluation of rabbit renal VX2 tumors after MWA and can serve as a valuable reference for the clinical assessment of post-ablative renal tumors.
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Affiliation(s)
- Hao Li
- Department of Interventional Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhengyu Lin
- Department of Interventional Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Rui Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Bressem KK, Vahldiek JL, Erxleben C, Shnayien S, Poch F, Geyer B, Lehmann KS, Hamm B, Niehues SM. Improved Visualization of the Necrotic Zone after Microwave Ablation Using Computed Tomography Volume Perfusion in an In Vivo Porcine Model. Sci Rep 2019; 9:18506. [PMID: 31811190 PMCID: PMC6898643 DOI: 10.1038/s41598-019-55026-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/21/2019] [Indexed: 01/02/2023] Open
Abstract
After hepatic microwave ablation, the differentiation between fully necrotic and persistent vital tissue through contrast enhanced CT remains a clinical challenge. Therefore, there is a need to evaluate new imaging modalities, such as CT perfusion (CTP) to improve the visualization of coagulation necrosis. MWA and CTP were prospectively performed in five healthy pigs. After the procedure, the pigs were euthanized, and the livers explanted. Orthogonal histological slices of the ablations were stained with a vital stain, digitalized and the necrotic core was segmented. CTP maps were calculated using a dual-input deconvolution algorithm. The segmented necrotic zones were overlaid on the DICOM images to calculate the accuracy of depiction by CECT/CTP compared to the histological reference standard. A receiver operating characteristic analysis was performed to determine the agreement/true positive rate and disagreement/false discovery rate between CECT/CTP and histology. Standard CECT showed a true positive rate of 81% and a false discovery rate of 52% for display of the coagulation necrosis. Using CTP, delineation of the coagulation necrosis could be improved significantly through the display of hepatic blood volume and hepatic arterial blood flow (p < 0.001). The ratios of true positive rate/false discovery rate were 89%/25% and 90%/50% respectively. Other parameter maps showed an inferior performance compared to CECT.
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Affiliation(s)
- Keno K Bressem
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Janis L Vahldiek
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christoph Erxleben
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Franz Poch
- Department of Surgery, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Beatrice Geyer
- Department of Surgery, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kai S Lehmann
- Department of Surgery, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - B Hamm
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan M Niehues
- Department of Radiology, Charité, Hindenburgdamm 30, 12203, Berlin, Germany
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Negative Predictive Value of Contrast-Enhanced Ultrasound of Liver and Kidney Thermal Ablation Sites for Local Tumour Progression During Long-term Follow-up: A Retrospective Consecutive Study. Can Assoc Radiol J 2019; 70:434-440. [PMID: 31585824 DOI: 10.1016/j.carj.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 06/09/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To determine negative predictive value (NPV) of contrast-enhanced ultrasound (CEUS) to demonstrate local tumour progression (LTP) at thermal ablation (TA) sites. METHODS Our institutional review board approved this retrospective study; acquisition of consent was waived. Consecutive CEUS examinations performed between 2004-2014 for TA site evaluation on patients who could not undergo enhanced computed tomography (CT) or magnetic resonance imaging (MRI), or had inconclusive CT or MRI, were retrospectively reviewed. Those reported as no abnormal enhancement in or surrounding TA site were included. CEUS examination was considered true-negative based on stability or lack of enhancement/washout on follow-up imaging for at least 1 year, and false-negative (FN), if there was an arterially enhancing focus with wash-out at or surrounding TA site on subsequent follow-up imaging. RESULTS Study population included 56 tumours in 54 patients, 11 women, 43 men; mean age 71 years. Two patients had TA of two different hepatocellular carcinomas. Thirty-six examinations were for hepatic TA and twenty for renal TA. Lesion sizes ranged from 1 cm to 7 cm (mean 3.1 ± 1.2). Mean diameter of 7 recurrences was 13.8 mm. Overall FN rate was 12.5% (7/56). Corresponding numbers were 0% (0/20) for renal TA and 19.4% (7/36) for hepatic TA. Overall NPV of CEUS was 87.5% (49/56) (confidence interval [CI]: 78.8%-96.2%). NPV for renal TA was 100% (20/20) (CI: 100%-100%) and for hepatic TA 81.5% (29/36) (CI: 67.6 %-93.5%). CONCLUSION In this cohort, CEUS showed high NPV for exclusion of LTP at renal TA sites. NPV for hepatic TA sites was high but lower than renal TA.
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Guo F, Hu B, Chen L, Li J. Clinical application of contrast-enhanced ultrasound after percutaneous renal tumor ablation. Br J Radiol 2019; 92:20190183. [PMID: 31509441 DOI: 10.1259/bjr.20190183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA). METHODS 31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors. RESULTS The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%. CONCLUSION After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI. ADVANCES IN KNOWLEDGE In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.
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Affiliation(s)
- Fang Guo
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No.600 Yishan Road, Shanghai, China
| | - Bing Hu
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No.600 Yishan Road, Shanghai, China
| | - Lei Chen
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No.600 Yishan Road, Shanghai, China
| | - Jia Li
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No.600 Yishan Road, Shanghai, China
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Lum MA, Shah SB, Durack JC, Nikolovski I. Imaging of Small Renal Masses before and after Thermal Ablation. Radiographics 2019; 39:2134-2145. [PMID: 31560613 DOI: 10.1148/rg.2019190083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thermal ablation of small renal masses is increasingly accepted as an alternative to partial nephrectomy, particularly in patients with multiple comorbidities. Many professional societies support this alternate treatment with updated guidelines. Before performing thermal ablation, it is important to stratify risk and assess technical feasibility by evaluating tumor imaging features such as size, location, and centrality. Routine postablation imaging with CT or MRI is necessary for assessment of residual or recurrent tumor, evidence of complications, or new renal masses outside the ablation zone. The normal spectrum and evolution of findings at CT and MRI include a halo appearance of the ablation zone, ablation zone contraction, and ablation zone calcifications. Tumor recurrence frequently manifests at CT or MRI as new nodular enhancement at the periphery of an expanding ablation zone, although it is normal for the ablation zone to enlarge within the first few months. Recognizing early tumor recurrence is important, as small renal masses are often easily treated with repeat ablations. Potential complications of thermal ablation include vascular injury, urine leak, ureteral stricture, nerve injury, and bowel perforation. The risk of these complications may be related to tumor size and location.©RSNA, 2019.
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Affiliation(s)
- Mark A Lum
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
| | - Shreena B Shah
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
| | - Jeremy C Durack
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
| | - Ines Nikolovski
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
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Tibana TK, Grubert RM, Camilo DMR, Marchiori E, Nunes TF. Computed tomography-guided puncture using a mobile application for a motion sensor-equipped smartphone. Radiol Bras 2019; 52:245-246. [PMID: 31435086 PMCID: PMC6696760 DOI: 10.1590/0100-3984.2018.0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Abstract
OBJECTIVE Imaging plays a key role in the assessment of patients before, during, and after percutaneous cryoablation of hepatic tumors. Intra-procedural and early post-procedure imaging with CT and MRI is vital to the assessment of technical success including adequacy of ablation zone coverage. Recognition of the normal expected post-procedure findings of hepatic cryoablation such as ice ball formation, hydrodissection, and the normal appearance of the ablation zone is crucial to be able to differentiate from complications including vascular, biliary, or non-target organ injury. Delayed imaging is essential for determination of clinical effectiveness and detection of unexpected findings such as residual unablated tumor and local tumor progression. The purpose of this article is to review the spectrum of expected and unexpected imaging findings that may occur during or after percutaneous cryoablation of hepatic tumors. CONCLUSION Differentiating expected from unexpected findings during and after hepatic cryoablation helps radiologists identify residual or recurrent tumor and detect procedure-related complications.
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Instant Outcome Evaluation of Microwave Ablation With Subtraction CT in an In Vivo Porcine Model. Invest Radiol 2019; 54:333-339. [DOI: 10.1097/rli.0000000000000545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wasnik AP, Higgins EJ, Fox GA, Caoili EM, Davenport MS. Yield of Routine Image-Guided Biopsy of Renal Mass Thermal Ablation Zones: 11-Year Experience. Acad Radiol 2019; 26:232-238. [PMID: 29934021 DOI: 10.1016/j.acra.2018.05.016] [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: 04/11/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the yield of routine image-guided core biopsy of renal cell carcinoma (RCC) thermal ablation zones. METHODS Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant quality improvement effort. Routine core biopsy of RCC ablation zones was performed 2 months postablation from July 2003 to December 2014. Routine nicotinamide adenine dinucleotide staining was performed by specialized genitourinary pathologists to assess cell viability. The original purpose of performing routine postablation biopsy was to verify, in addition to imaging, whether the mass was completely treated. Imaging was stratified as negative, indeterminate, or positive for viable malignancy. Histology was stratified as negative, indeterminate, positive, or nondiagnostic for viable malignancy. Histology results were compared to prebiopsy imaging findings. RESULTS Routine ablation zone biopsy was performed after 50% (146/292) of index ablations (24 cryoablations, 122 radiofrequency ablations), and postablation imaging was performed more often with multiphasic computed tomography than magnetic resonance imaging (100 vs 46, p < 0.0001). When imaging was negative (n = 117), biopsy added no additional information (92% [n = 108] negative, 0.9% [n = 1] indeterminate, 7% [n = 8] nondiagnostic). When imaging was indeterminate (n = 19), 11% (n = 2) of biopsies had viable RCC and 89% (n = 17) were negative. When imaging was positive, biopsy detected viable neoplasm in only 10% (1/10) of cases; 80% (8/10) were negative and 10% (1/10) were nondiagnostic. CONCLUSION Routine biopsy of renal ablation zones to validate postablation imaging results was not value-added and therefore was discontinued at the study institution.
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Russo U, Maestroni U, Papapietro RV, Trunfio V, Ziglioli F, Ferretti S, Brunese L, Carrafiello G, De Filippo M. Imaging after radiofrequency ablation of renal tumors. Future Oncol 2018; 14:2915-2922. [DOI: 10.2217/fon-2017-0661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The number of percutaneous radiofrequency ablation procedures performed for renal tumors is progressively increasing worldwide. Periodic imaging follow-up has the double role to guarantee the treatment efficacy over time and to early detect any possible complication. Tumor size reductions, as well as the appearance of the characteristic ‘halo sign’, are normal findings that represent good ablative outcomes. However the most reliable factor of ablation efficacy remains the total absence of contrast enhancing zones within the ablated area. The aim of this article is to illustrate the typical aspect of an effective radiofrequency ablation treatment, which are the imaging findings that may suggest the presence of residual tumoral tissue and which are the main early and late procedural complications.
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Affiliation(s)
- Umberto Russo
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | | | - Roberto Vito Papapietro
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | - Vincenzo Trunfio
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | | | | | - Luca Brunese
- Department of Medicine & Health Sciences, University of Molise, Campobasso, Italy
| | | | - Massimo De Filippo
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
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Eiken PW, Atwell TD, Kurup AN, Boorjian SA, Thompson RH, Schmit GD. Imaging following renal ablation: what can we learn from recurrent tumors? Abdom Radiol (NY) 2018. [PMID: 29525875 DOI: 10.1007/s00261-018-1541-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the post-contrast appearance of local tumor progression (LTP) following renal ablation to better understand patterns of tumor recurrence and to optimize follow-up imaging protocols. METHODS From 2002 to 2015, 913 patients underwent 988 renal ablation procedures for treatment of 1064 tumors. LTP was identified in 24 (2.6%) patients during median imaging follow-up of 30 months (range 0-139). One patient with LTP was followed with non-contrast MRI only and was excluded from evaluation. Three body radiologists reviewed the contrast-enhanced CT and/or MRI follow-up imaging in the remaining 23 patients to determine the timing and imaging appearance of the recurrent tumor. RESULTS Local tumor progression was identified on contrast-enhanced CT or MRI at median 11 months (range 1 and 68) after renal ablation. Corticomedullary phase imaging was performed in 16/23 (70%) patients. LTP was identified on the corticomedullary phase in all cases, and was most conspicuous on the corticomedullary phase compared to any other phase of imaging in 15/16 (94%) patients. No cases of LTP were best visualized on non-contrast or excretory phase images. CONCLUSIONS Delayed recurrence following renal ablation is possible; therefore, extended follow-up is indicated in ablation patients. Almost all cases of LTP were best visualized on the corticomedullary phase of imaging, which should be included in any post-ablation imaging protocol. Excretory phase images were not required to diagnose LTP in any case and could be excluded from routine post-ablation follow-up.
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Affiliation(s)
- Patrick W Eiken
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Stephen A Boorjian
- Department of Urology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - R Houston Thompson
- Department of Urology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Grant D Schmit
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
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Abstract
Small renal masses are increasingly detected incidentally at imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This article will summarize the current evidence of imaging features that correlate with the biology of small solid renal masses, and discuss key approaches in imaging characterization of these masses using CT and MRI.
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Affiliation(s)
- Zhen J Wang
- 1 Department of Radiology and Biomedical Imaging, University of California San Francisco , San Francisco, CA , USA
| | - Antonio C Westphalen
- 1 Department of Radiology and Biomedical Imaging, University of California San Francisco , San Francisco, CA , USA
| | - Ronald J Zagoria
- 1 Department of Radiology and Biomedical Imaging, University of California San Francisco , San Francisco, CA , USA
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Renal Cell Carcinoma Perfusion before and after Radiofrequency Ablation Measured with Dynamic Contrast Enhanced MRI: A Pilot Study. Diagnostics (Basel) 2018; 8:diagnostics8010003. [PMID: 29316711 PMCID: PMC5871986 DOI: 10.3390/diagnostics8010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 01/31/2023] Open
Abstract
Aim: To investigate if the early treatment effects of radiofrequency ablation (RFA) on renal cell carcinoma (RCC) can be detected with dynamic contrast enhanced (DCE)-MRI and to correlate RCC perfusion with RFA treatment time. Materials and methods: 20 patients undergoing RFA of their 21 RCCs were evaluated with DCE-MRI before and at one month after RFA treatment. Perfusion was estimated using the maximum slope technique at two independent sittings. Total RCC blood flow was correlated with total RFA treatment time, tumour location, size and histology. Results: DCE-MRI examinations were successfully evaluated for 21 RCCs (size from 1.3 to 4 cm). Perfusion of the RCCs decreased significantly (p < 0.0001) from a mean of 203 (±80) mL/min/100 mL before RFA to 8.1 (±3.1) mL/min/100 mL after RFA with low intra-observer variability (r ≥ 0.99, p < 0.0001). There was an excellent correlation (r = 0.95) between time to complete ablation and pre-treatment total RCC blood flow. Tumours with an exophytic location exhibit the lowest mean RFA treatment time. Conclusion: DCE-MRI can detect early treatment effects by measuring RCC perfusion before and after RFA. Perfusion significantly decreases in the zone of ablation, suggesting that it may be useful for the assessment of treatment efficacy. Pre-RFA RCC blood flow may be used to predict RFA treatment time.
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Li R, Xu S, Pritchard WF, Karanian JW, Krishnasamy VP, Wood BJ, Tse ZTH. AngleNav: MEMS Tracker to Facilitate CT-Guided Puncture. Ann Biomed Eng 2018; 46:452-463. [PMID: 29305735 DOI: 10.1007/s10439-017-1968-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022]
Abstract
As a low-cost needle navigation system, AngleNav may be used to improve the accuracy, speed, and ease of CT-guided needle punctures. The AngleNav hardware includes a wireless device with a microelectromechanical (MEMS) tracker that can be attached to any standard needle. The physician defines the target, desired needle path and skin entry point on a CT slice image. The accuracy of AngleNav was first tested in a 3D-printed calibration platform in a benchtop setting. An abdominal phantom study was then performed in a CT scanner to validate the accuracy of the device's angular measurement. Finally, an in vivo swine study was performed to guide the needle towards liver targets (n = 8). CT scans of the targets were used to quantify the angular errors and needle tip-to-targeting distance errors between the planned needle path and the final needle position. The MEMS tracker showed a mean angular error of 0.01° with a standard deviation (SD) of 0.62° in the benchtop setting. The abdominal phantom test showed a mean angular error of 0.87° with an SD of 1.19° and a mean tip-to-target distance error of 4.89 mm with an SD of 1.57 mm. The animal experiment resulted in a mean angular error of 6.6° with an SD of 1.9° and a mean tip-to-target distance error of 8.7 mm with an SD of 3.1 mm. These results demonstrated the feasibility of AngleNav for CT-guided interventional workflow. The angular and distance errors were reduced by 64.4 and 54.8% respectively if using AngleNav instead of freehand insertion, with a limited number of operators. AngleNav assisted the physicians to deliver accurate needle insertion during CT-guided intervention. The device could potentially reduce the learning curve for physicians to perform CT-guided needle targeting.
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Affiliation(s)
- Rui Li
- School of Electrical and Computer Engineering, The University of Georgia, Athens, GA, 30602, USA
| | - Sheng Xu
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - William F Pritchard
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - John W Karanian
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - Zion Tsz Ho Tse
- School of Electrical and Computer Engineering, The University of Georgia, Athens, GA, 30602, USA. .,3T Technologies, LLC, Marietta, GA, 30067, USA.
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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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Wah TM. Image-guided ablation of renal cell carcinoma. Clin Radiol 2017; 72:636-644. [PMID: 28527529 DOI: 10.1016/j.crad.2017.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/07/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023]
Abstract
This review article aims to provide an overview of image-guided ablation of renal cell carcinoma (RCC) since it was first introduced in 1998. This will cover the background and rationale behind its development; an overview of the evidence for current thermal technology, such as heat-based, e.g., radiofrequency ablation (RFA), microwave ablation (MWA), and cold-based energies, e.g., cryoablation used; and summarise the published evidence regarding its treatment efficacy and oncological outcome. In addition, it aims to provide an insight into the potential role of the new non-thermal ablative technology, e.g., irreversible electroporation (IRE)/Nanoknife in image-guided ablation of RCC, as well as areas of challenge that will require further research and clinical evaluation to ensure delivery of a quality patient-centred interventional oncology (IO) service in image-guided ablation of RCC.
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Affiliation(s)
- T M Wah
- Institute of Oncology, St. James's University Hospital, Diagnostic and Interventional Radiology, Leeds, UK.
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Hirata M, Watanabe R, Koyano Y, Sugata S, Takeda Y, Nakamura S, Akamune A, Tsuda T, Mochizuki T. Using a Motion Sensor-Equipped Smartphone to Facilitate CT-Guided Puncture. Cardiovasc Intervent Radiol 2017; 40:609-615. [DOI: 10.1007/s00270-017-1605-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/03/2017] [Indexed: 11/29/2022]
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Bertolotto M, Siracusano S, Cicero C, Iannelli M, Silvestri T, Celia A, Guarise A, Stacul F. Cryotherapy of Renal Lesions: Enhancement on Contrast-Enhanced Sonography on Postoperative Day 1 Does Not Imply Viable Tissue Persistence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:301-310. [PMID: 27914172 DOI: 10.7863/ultra.16.02061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate whether persistent enhancement detected on contrast-enhanced sonography at postoperative day 1 (early contrast-enhanced sonography) after cryoablation of renal tumors implies the presence of residual viable tumor tissue, defined as residual enhancing tissue on reference imaging (computed tomography or magnetic resonance imaging) performed 6 months after the procedure. METHODS Seventy-four patients with percutaneous cryoablation of renal tumors had early contrast-enhanced sonography from November 2011 to August 2015. Two independent readers evaluated early contrast-enhanced sonographic findings and contrast-enhanced sonographic investigations performed 1 month after cryoablation of lesions that displayed enhancement on early contrast-enhanced sonography. They scored intralesional enhancement in 4 groups: no enhancement, few intralesional vessels, focal enhancing areas, and diffuse enhancement. Inter-reader agreement in evaluating lesion vascularity on early contrast-enhanced sonography was assessed with weighted κ statistics. Computed tomography or magnetic resonance imaging performed 6 months after the treatment was the reference procedure for assessing the absence or presence of residual disease. RESULTS Inter-reader agreement in assessing intratumoral vascularization on early contrast-enhanced sonography was very good (κ = 0.90). Enhancement was absent for both readers in 33 of 74 cases; only a few intralesional vessels were visible in 21; whereas diffuse or focal enhancement was present in 13. In the remaining 7 patients, there were differences. Four lesions with focal enhancement on early contrast-enhanced sonography and 1 that was considered avascular had residual tumors on reference imaging. Ablation was successful in the remaining 69 of 74 patients (93%). CONCLUSIONS After cryoablation, intratumoral enhancement on early contrast-enhanced sonography does not imply tumor cell viability.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Salvatore Siracusano
- Department of Urology, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Calogero Cicero
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Mariano Iannelli
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Tommaso Silvestri
- Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Antonio Celia
- Department of Urology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Alessandro Guarise
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Fulvio Stacul
- S. C. Radiologia Ospedale Maggiore, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
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Assessment of Early Treatment Response With DWI After CT-Guided Radiofrequency Ablation of Functioning Adrenal Adenomas. AJR Am J Roentgenol 2016; 207:804-810. [DOI: 10.2214/ajr.16.16207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Wu PH, Brace CL. Analysis of iodinated contrast delivered during thermal ablation: is material trapped in the ablation zone? Phys Med Biol 2016; 61:6041-54. [PMID: 27452478 DOI: 10.1088/0031-9155/61/16/6041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intra-procedural contrast-enhanced CT (CECT) has been proposed to evaluate treatment efficacy of thermal ablation. We hypothesized that contrast material delivered concurrently with thermal ablation may become trapped in the ablation zone, and set out to determine whether such an effect would impact ablation visualization. CECT images were acquired during microwave ablation in normal porcine liver with: (A) normal blood perfusion and no iodinated contrast, (B) normal perfusion and iodinated contrast infusion or (C) no blood perfusion and residual iodinated contrast. Changes in CT attenuation were analyzed from before, during and after ablation to evaluate whether contrast was trapped inside of the ablation zone. Visualization was compared between groups using post-ablation contrast-to-noise ratio (CNR). Attenuation gradients were calculated at the ablation boundary and background to quantitate ablation conspicuity. In Group A, attenuation decreased during ablation due to thermal expansion of tissue water and water vaporization. The ablation zone was difficult to visualize (CNR = 1.57 ± 0.73, boundary gradient = 0.7 ± 0.4 HU mm(-1)), leading to ablation diameter underestimation compared to gross pathology. Group B ablations saw attenuation increase, suggesting that iodine was trapped inside the ablation zone. However, because the normally perfused liver increased even more, Group B ablations were more visible than Group A (CNR = 2.04 ± 0.84, boundary gradient = 6.3 ± 1.1 HU mm(-1)) and allowed accurate estimation of the ablation zone dimensions compared to gross pathology. Substantial water vaporization led to substantial attenuation changes in Group C, though the ablation zone boundary was not highly visible (boundary gradient = 3.9 ± 1.1 HU mm(-1)). Our results demonstrate that despite iodinated contrast being trapped in the ablation zone, ablation visibility was highest when contrast is delivered intra-procedurally. Therefore, CECT may be feasible for real-time thermal ablation monitoring.
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Affiliation(s)
- Po-Hung Wu
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, 1415 Engineering Dr, Madison, WI 53706, USA
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Masciocchi C, Arrigoni F, La Marra A, Mariani S, Zugaro L, Barile A. Treatment of focal benign lesions of the bone: MRgFUS and RFA. Br J Radiol 2016; 89:20150356. [PMID: 27197743 DOI: 10.1259/bjr.20150356] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The objective of this study was to evaluate the role of MR-guided focused ultrasound surgery and radiofrequency ablation in the management of bone and soft-tissue lesions. Musculoskeletal interventional radiology represents an interesting option for the treatment of benign bone and soft-tissue lesions to avoid the invasiveness of surgery and related risks. The imaging techniques now available, besides representing an optimal guide, allow control of the temperature reached in the region of interest, avoiding or minimizing damage to the sensitive structures surrounding the lesion.
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Affiliation(s)
- Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Province of L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Province of L'Aquila, Italy
| | - Alice La Marra
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Province of L'Aquila, Italy
| | - Silvia Mariani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Province of L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Province of L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Province of L'Aquila, Italy
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Wallace AN, Tomasian A, Vaswani D, Vyhmeister R, Chang RO, Jennings JW. Radiographic Local Control of Spinal Metastases with Percutaneous Radiofrequency Ablation and Vertebral Augmentation. AJNR Am J Neuroradiol 2016; 37:759-65. [PMID: 26635286 DOI: 10.3174/ajnr.a4595] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/18/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Combination radiofrequency ablation and vertebral augmentation is an emerging minimally invasive therapy for patients with metastatic spine disease who have not responded to or have contraindications to radiation therapy. The purpose of this study was to evaluate the rate of radiographic local control of spinal metastases treated with combination radiofrequency ablation and vertebral augmentation. MATERIALS AND METHODS We retrospectively reviewed our tumor ablation database for all patients who underwent radiofrequency ablation and vertebral augmentation of spinal metastases between April 2012 and July 2014. Tumors treated in conjunction with radiation therapy were excluded. Tumor characteristics, procedural details, and complications were recorded. Posttreatment imaging was reviewed for radiographic evidence of tumor progression. RESULTS Fifty-five tumors met study inclusion criteria. Radiographic local tumor control rates were 89% (41/46) at 3 months, 74% (26/35) at 6 months, and 70% (21/30) at 1 year after treatment. Clinical follow-up was available in 93% (51/55) of cases. The median duration of clinical follow-up was 34 weeks (interquartile range, 15-89 weeks), during which no complications were reported and no patients had clinical evidence of metastatic spinal cord compression at the treated levels. CONCLUSIONS Combination radiofrequency ablation and vertebral augmentation appears to be an effective treatment for achieving local control of spinal metastases. A prospective clinical trial is now needed to replicate these results.
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Affiliation(s)
- A N Wallace
- From the Mallinckrodt Institute of Radiology (A.N.W., A.T., D.V., J.W.J.), Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - A Tomasian
- From the Mallinckrodt Institute of Radiology (A.N.W., A.T., D.V., J.W.J.), Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - D Vaswani
- From the Mallinckrodt Institute of Radiology (A.N.W., A.T., D.V., J.W.J.), Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - R Vyhmeister
- Washington University School of Medicine (R.V., R.O.C.), St. Louis, Missouri
| | - R O Chang
- Washington University School of Medicine (R.V., R.O.C.), St. Louis, Missouri
| | - J W Jennings
- From the Mallinckrodt Institute of Radiology (A.N.W., A.T., D.V., J.W.J.), Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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False-Positive Tumor Enhancement After Cryoablation of Renal Cell Carcinoma: A Prospective Study. AJR Am J Roentgenol 2016; 206:332-9. [DOI: 10.2214/ajr.15.14821] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Genson PY, Mourey E, Moulin M, Favelier S, Di Marco L, Chevallier O, Cercueil JP, Krausé D, Cormier L, Loffroy R. Image-guided percutaneous microwave ablation of small renal tumours: short- and mid-term outcomes. Quant Imaging Med Surg 2015; 5:649-55. [PMID: 26682134 DOI: 10.3978/j.issn.2223-4292.2015.10.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The purpose is to assess the short- and mid-term outcomes of microwave ablation (MWA) of small renal tumours in selected patients. METHODS From August 2012 to February 2015, 29 renal tumours in 23 patients (17 male, 6 female, mean age 75 years) were treated by percutaneous MWA under imaging guidance. The tumours were 1-4.7 cm in diameter (mean size, 2.7 cm). Therapeutic effects were assessed at follow-up with magnetic resonance imaging (MRI). All patients were followed up for 2-25 months (mean, 12.2 months) to observe the therapeutic effects and complications. Changes in renal function at day 1 after treatment were statistically analyzed using the Student paired t-test or the paired Wilcoxon test. RESULTS Technical success was achieved in all cases. One severe bleeding complication post-procedure occurred leading to death. No other unexpected side effects were observed after the MWA procedures. Clinical effectiveness was 100%. None of the patients showed recurrence on MRI imaging follow-up. No significant changes in renal function were noted after treatment (P=0.57). CONCLUSIONS Our preliminary study demonstrates that the use of MWA for the treatment of small renal tumours can be applied as safely and efficiently as other ablative techniques in selected patients not eligible for surgery.
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Affiliation(s)
- Pierre-Yves Genson
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Eric Mourey
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Morgan Moulin
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Sylvain Favelier
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Lucy Di Marco
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Olivier Chevallier
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Jean-Pierre Cercueil
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Denis Krausé
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Luc Cormier
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Romaric Loffroy
- 1 Department of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France ; 3 Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 323 Charleston, USA ; 4 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
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Abstract
Birt-Hogg-Dubé (BHD) syndrome is an inherited renal cancer syndrome in which affected individuals are at risk of developing benign cutaneous fibrofolliculomas, bilateral pulmonary cysts and spontaneous pneumothoraces, and kidney tumours. Bilateral multifocal renal tumours that develop in BHD syndrome are most frequently hybrid oncocytic tumours and chromophobe renal carcinoma, but can present with other histologies. Germline mutations in the FLCN gene on chromosome 17 are responsible for BHD syndrome--BHD-associated renal tumours display inactivation of the wild-type FLCN allele by somatic mutation or chromosomal loss, confirming that FLCN is a tumour suppressor gene that fits the classic two-hit model. FLCN interacts with two novel proteins, FNIP1 and FNIP2, and with AMPK, a negative regulator of mTOR. Studies with FLCN-deficient cell and animal models support a role for FLCN in modulating the AKT-mTOR pathway. Emerging evidence links FLCN with a number of other molecular pathways and cellular processes important for cell homeostasis that are frequently deregulated in cancer, including regulation of TFE3 and/or TFEB transcriptional activity, amino-acid-dependent mTOR activation through Rag GTPases, TGFβ signalling, PGC1α-driven mitochondrial biogenesis, and autophagy. Currently, surgical intervention is the only therapy available for BHD-associated renal tumours, but improved understanding of the FLCN pathway will hopefully lead to the development of effective forms of targeted systemic therapy for this disease.
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Affiliation(s)
- Laura S. Schmidt
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bldg 10, CRC, Room 1-5940, Bethesda, MD 20892-1107 USA
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD 21702 USA
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bldg 10, CRC, Room 1-5940, Bethesda, MD 20892-1107 USA
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Minimally Invasive Percutaneous Treatment of Small Renal Tumors with Irreversible Electroporation: A Single-Center Experience. J Vasc Interv Radiol 2015; 26:1465-71. [PMID: 26250855 DOI: 10.1016/j.jvir.2015.06.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate whether irreversible electroporation (IRE) can be used as an ablation technique for small renal tumors (T1a cancers or small benign tumors) and to describe features after ablation on computed tomography (CT) or magnetic resonance (MR) imaging. MATERIALS AND METHODS In this retrospective study, 20 patients (mean age, 65 y ± 12.8 y) underwent CT-guided IRE of T1a renal carcinoma (n = 13) or small benign or indeterminate renal masses < 4 cm in size (n = 7). Mean tumor size was 2.2 cm ± 0.7. The ablation area was verified with contrast-enhanced imaging performed immediately after the procedure to determine technical success. Imaging was performed 6 weeks (20 of 20 patients), 6 months (15 of 20), and 12 months (6 of 20) after ablation. Medical records and CT/MR imaging features of all patients were reviewed for recurrence, symptoms, and complications after treatment. RESULTS Technical success was achieved in all patients (100%); there were no major procedure-related complications. Minor complications occurred in 7 patients, including self-limiting perinephric hematomas, pain difficult to control, and urinary retention. Mean procedure time was 2.0 hours ± 0.7. At 6 weeks, 2 patients required salvage therapy because of incomplete ablation. At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 6) was noted to have experienced recurrence. CT/MR imaging after IRE ablation demonstrated an area of nonenhancement in the treatment zone that involuted over ~6 months. CONCLUSIONS Renal IRE appears to be a safe treatment for small renal tumors. Tumors treated with IRE demonstrated nonenhancement in the treatment zone with involution on follow-up CT/MR imaging.
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Allard CB, Coret A, Dason S, Tajzler C, Shayegan B, Matsumoto ED, Kapoor A. Contrast-enhanced Ultrasonography for Surveillance of Radiofrequency-ablated Renal Tumors: A Prospective, Radiologist-blinded Pilot Study. Urology 2015; 86:1174-8. [PMID: 26123518 DOI: 10.1016/j.urology.2015.04.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/03/2015] [Accepted: 04/25/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To prospectively evaluate the performance of contrast-enhanced ultrasonography (CEUS) for surveillance after radiofrequency ablation (RFA) of small renal masses by comparing CEUS to the contrast-enhanced computed tomography (CECT), the current gold standard. PATIENTS AND METHODS Patients underwent surveillance after RFA of small renal masses (≤4 cm) consisting of CECT scans at 3 and 6 months and every 6 months thereafter. Participants additionally underwent ≥1 CEUS within 90 days before CECT. Percutaneous biopsy was performed for lesions suspicious for recurrence on CECT. Independent, blinded radiologists interpreted CEUS and CECT scans. Intermodality agreement was evaluated with the kappa coefficient. RESULTS In total, 37 pairs of CEUS and CECT scans were performed. Median tumor size was 2.5 cm (range, 1.4-4.0 cm). Median follow-up from RFA to CEUS was 25 months. Renal tumor recurrences were diagnosed by CECT in 3 patients and confirmed histopathologically by percutaneous biopsy; 34 CECT scans were negative for recurrence. The diagnostic rate of CEUS was 94.6%; 2 CEUS scans were nondiagnostic because of patient body habitus. Among diagnostic CEUS scans, tumor enhancement was present in 3 and absent in 32. We observed perfect concordance between CEUS and CECT (=1.0; P <.0001). CONCLUSION This is the first prospective study incorporating radiologist blinding to evaluate CEUS for RFA surveillance. Our findings suggest CEUS may ultimately be incorporated into RFA surveillance protocols. The operator dependency of CEUS is a possible barrier to its widespread adoption. These findings justify larger studies with longer follow-up.
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Affiliation(s)
- Christopher B Allard
- Division of Urology, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA
| | - Alexander Coret
- Department of Radiology, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Shawn Dason
- Department of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Camilla Tajzler
- Department of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Bobby Shayegan
- Department of Urology, McMaster University, Hamilton, Ontario, Canada
| | | | - Anil Kapoor
- Department of Urology, McMaster University, Hamilton, Ontario, Canada.
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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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Avances en imágenes para la estadificación y seguimiento de pacientes con carcinoma de células renales. Rev Urol 2014. [DOI: 10.1016/s0120-789x(14)50057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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De Filippo M, Bozzetti F, Martora R, Zagaria R, Ferretti S, Macarini L, Brunese L, Rotondo A, Rossi C. Radiofrequency thermal ablation of renal tumors. Radiol Med 2014; 119:499-511. [PMID: 25024061 DOI: 10.1007/s11547-014-0412-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/30/2014] [Indexed: 01/08/2023]
Abstract
Percutaneous radiofrequency ablation (PRFA) of renal malignancies is currently a therapeutic option for patients who are not able to undergo surgery. Some authors consider PRFA as the therapeutic standard in the treatment of renal neoplasms in non-operable patients due to comorbid conditions and in patients with mild-moderate renal failure, to preserve residual renal functionality. The use of PRFA has become more and more widespread due to a rise in the incidental detection of renal cell carcinomas with the ever-increasing use of Imaging for the study of abdominal diseases. Clinical studies indicate that RF ablation is an effective therapy with a low level of risk of complications, which provides good results in selected patients over short and medium term periods of time, however up to now few long-term studies have been carried out which can confirm the effectiveness of PRFA.
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Affiliation(s)
- Massimo De Filippo
- Section of Diagnostic Imaging, Department of Surgical Sciences, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy,
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Abstract
OBJECTIVE Solid renal masses are most often incidentally detected at imaging as small (≤ 4 cm) localized lesions. These lesions comprise a wide spectrum of benign and malignant histologic subtypes, but are largely treated with surgical resection given the limited ability of imaging to differentiate among them with consistency and high accuracy. Numerous studies have thus examined the ability of CT and MRI techniques to separate benign lesions from malignancies and to predict renal cancer histologic grade and subtype. This article synthesizes the evidence regarding renal mass characterization at CT and MRI, provides diagnostic algorithms for evidence-based practice, and highlights areas of further research needed to drive imaging-based management of renal masses. CONCLUSION Despite extensive study of morphologic and quantitative criteria at conventional imaging, no CT or MRI techniques can reliably distinguish solid benign tumors, such as oncocytoma and lipid-poor angiomyolipoma, from malignant renal tumors. Larger studies are required to validate recently developed techniques, such as diffusion-weighted imaging. Evidence-based practice includes MRI to assess renal lesions in situations where CT is limited and to help guide management in patients who are considered borderline surgical candidates.
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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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Comparison of Contrast-Enhanced Ultrasound Scan (CEUS) and MRI in the follow-up of cryoablation for small renal tumors. Experience on 25 cases. Urologia 2014; 81 Suppl 23:S1-8. [DOI: 10.5301/ru.2014.11986] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 12/13/2022]
Abstract
Introduction Percutaneous ablation in the kidney is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection. Its increasing use has been largely prompted by the rising incidental detection of renal cell carcinomas with cross-sectional imaging and the need to preserve renal function in patients with comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. To date, clinical studies indicate that cryoablation is an effective therapy with acceptable short- to intermediate-term outcomes and with a low risk in the appropriate setting. This article focuses on the efficiency of contrast enhanced ultrasound scan (CEUS) as compared to contrast enhanced magnetic resonance imaging (MRI) during the follow-up after cryoablation of small renal tumors. Material and Methods In our Department, percutaneous or laparoscopic assisted cryoablation is offered in the treatment of small renal masses. Between January 2009 and January 2013, 25 patients (pts) were treated with laparoscopic assisted cryoablation or percutaneous cryoablation for renal tumors <3.5 cm in pts unfit for surgery. All pts had severe comorbidities (ASA score 3). Transperitoneal laparoscopic approach was performed in 11 pts, extraperitoneal approach in 3 pts, percutaneous technique was performed in 11 patients. “Tru-cut biopsy” of the renal mass was always performed before cryoablation. The SeedNet system (Galil Medical, Arden Hills, MN) was used in 12/25 pts; the Precise system (Galil Medical, Arden Hills, MN) was used in 13/25 pts. In all cases, IceRod needles were used. Real-time ultrasound guidance was used to localize the tumour and to monitor the progression of “iceball”. A double “freeze-thaw cycle” was used. All pts had MRI and CEUS before cryoablation and the follow-up consisted in CEUS/MRI every 3 months during the first year and every 6 months thereafter. Results The mean age of the 25 pts was 67.7 years (range 56–79); 5 pts were females and 20 were males. The mean tumor size was 2.8 cm (range 1.5–3.5). No patient required conversion to open procedure. 19 tumors were located at the lower pole, 4 were interpolar and 2 tumors were located at the upper pole. There were no intraoperative complications. The mean hospital stay was 4 days (range 1–7). Two pts required a blood transfusion; there was no statistically significant difference between preoperative and postoperative serum creatinine levels. The biopsy showed RCC in all cases. In 24/25 patients both CEUS and MRI showed no enhancement. In 1/25 pts, during the follow-up, CEUS and MRI showed a well visible recurrence at the perfusion study. It was histologically confirmed. The final results of CEUS and MRI were concordant in all pts. Conclusions CEUS is effective during the follow-up of renal tumor cryoablation. It could be an alternative technique to standard CT and MRI, with some advantages: low cost, short time consuming procedure, no radiation exposure, reduced amount of contrast agent (1–2 mL) and rare adverse reactions.
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Abstract
In addition to the associated cutaneous and pulmonary manifestations, individuals with the Birt-Hogg-Dubé (BHD) syndrome have an increased risk of developing kidney cancer, which is often bilateral and multifocal. The risk of developing a renal tumor in this population does not decrease with age and therefore warrants a lifelong screening approach. We recommend abdominal imaging every 36 months in individuals without renal lesions at initial screening. Once renal tumors are identified, they should be followed with interval imaging studies until the largest tumor reaches 3 cm in maximal diameter, at which point nephron-sparing surgery should be ideally pursued. While the histology of renal tumors can vary in the BHD syndrome, most tumors possess a relatively indolent natural history and do not require adjuvant therapy if resected when localized to the kidney. With this approach, the vast majority of patients will achieve a curative oncologic outcome and avoid the medical sequelae of chronic renal insufficiency that could otherwise result from total nephrectomy.
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50
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Kielar AZ, Hibbert RM, Maturen KE. Imaging after local tumor therapies: kidney and liver. Semin Roentgenol 2014; 48:273-84. [PMID: 23796378 DOI: 10.1053/j.ro.2013.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Ania Z Kielar
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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