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Renal Tumors: MR Imaging–guided Percutaneous Cryotherapy—Initial Experience in 23 Patients

Published Online:Aug 1 2005https://doi.org/10.1148/radiol.2362041107

Abstract

PURPOSE: To evaluate the initial clinical experience of magnetic resonance (MR) imaging–guided percutaneous cryotherapy of renal tumors.

MATERIALS AND METHODS: Twenty-six renal tumors (diameter range, 1.0–4.6 cm; mean, 2.6 cm) in 23 patients were treated with 27 cryoablation procedures by using a protocol approved by the human subjects committee at the authors' institution. The study complied with the Health Insurance Portability and Accountability Act. Written informed consent was obtained from each patient. There were 17 men and six women with an average age of 66 years (range, 43–86 years). Of 26 masses, 24 were renal cell carcinoma, one was a transitional cell carcinoma, and one was an angiomyolipoma. By using a 0.5-T open MR imaging system and general anesthesia in patients, one to five (mean, 2.4) needlelike cryoprobes were placed and lesions were ablated by using real-time MR imaging for intraprocedural monitoring of ice balls. Tumors were considered successfully ablated if they demonstrated no contrast enhancement at follow-up computed tomography or MR imaging (mean, 14 months; range, 4–30 months).

RESULTS: Twenty-four of 26 tumors were successfully ablated, 23 of which required only one treatment session. Two complications occurred in a total of 27 cryoablations: one hemorrhage, which required a blood transfusion, and one abscess, which was treated successfully with percutaneous catheter drainage.

CONCLUSION: MR imaging–guided percutaneous cryotherapy of renal tumors shows promise for the treatment of selected small renal tumors, and MR imaging can be used to monitor the treatment intraprocedurally. This technique may prove useful for ablation of renal tumors completely in one session, but long-term follow-up is needed.

© RSNA, 2005

References

  • 1 ChowWH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA1999; 281:1628–1631.
    Medline Google Scholar
  • 2 JaysonM, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology1998; 51:203–205.
    Medline Google Scholar
  • 3 VogelzangNJ, Stadler WM. Kidney cancer. Lancet1998; 352:1691–1696.
    Medline Google Scholar
  • 4 FerganyAF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol2000; 163:442–445.
    Medline Google Scholar
  • 5 FilipasD, Fichtner J, Spix C, et al. Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients. Urology2000; 56:387–392.
    Medline Google Scholar
  • 6 LernerSE, Hawkins CA, Blute ML, et al. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol2002; 167:884–889.
    Medline Google Scholar
  • 7 NovickAC, Streem S, Montie JE, et al. Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients—1989. J Urol2002; 167:878–882.
    Medline Google Scholar
  • 8 ReddanDN, Raj GV, Polascik TJ. Management of small renal tumors: an overview. Am J Med2001; 110:558–562.
    Medline Google Scholar
  • 9 SokoloffMH, deKernion JB, Figlin RA, Belldegrun A. Current management of renal cell carcinoma. CA Cancer J Clin1996; 46:284–302.
    Medline Google Scholar
  • 10 de BaereT, Kuoch V, Smayra T, et al. Radiofrequency ablation of renal cell carcinoma: preliminary clinical experience. J Urol2002; 167:1961–1964.
    Medline Google Scholar
  • 11 GervaisDA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology2003; 226:417–424.
    Google Scholar
  • 12 LewinJS, Connell CF, Duerk JL, et al. Interactive MRI-guided radiofrequency interstitial thermal ablation of abdominal tumors: clinical trial for evaluation of safety and feasibility. J Magn Reson Imaging1998; 8:40–47.
    Medline Google Scholar
  • 13 PavlovichCP, Walther MM, Choyke PL, et al. Percutaneous radiofrequency ablation of small renal tumors: initial results. J Urol2002; 167:10–15.
    Medline Google Scholar
  • 14 SuLM, Jarrett TW, Chan DY, Kavoussi LR, Solomon SB. Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results. Urology2003; 61:26–33.
    Medline Google Scholar
  • 15 DelworthMG, Pisters LL, Fornage BD, von Eschenbach AC. Cryotherapy for renal cell carcinoma and angiomyolipoma. J Urol1996; 155:252–254.
    Medline Google Scholar
  • 16 GillIS, Novick AC, Meraney AM, et al. Laparoscopic renal cryoablation in 32 patients. Urology2000; 56:748–753.
    Medline Google Scholar
  • 17 NadlerRB, Kim SC, Rubenstein JN, Yap RL, Campbell SC, User HM. Laparoscopic renal cryosurgery: the Northwestern experience. J Urol2003; 170:1121–1125.
    Medline Google Scholar
  • 18 ShingletonWB, Sewell PE Jr. Percutaneous renal tumor cryoablation with magnetic resonance imaging guidance. J Urol2001; 165:773–776.
    Medline Google Scholar
  • 19 ShingletonWB, Sewell PE Jr. Percutaneous renal cryoablation of renal tumors in patients with von Hippel-Lindau disease. J Urol2002; 167:1268–1270.
    Medline Google Scholar
  • 20 ShingletonWB, Sewell PE Jr. Cryoablation of renal tumours in patients with solitary kidneys. BJU Int2003; 92:237–239.
    Medline Google Scholar
  • 21 UchidaM, Imaide Y, Sugimoto K, Uehara H, Watanabe H. Percutaneous cryosurgery for renal tumours. Br J Urol1995; 75:132–136.
    Medline Google Scholar
  • 22 GhavamianR, Cheville JC, Lohse CM, Weaver AL, Zincke H, Blute ML. Renal cell carcinoma in the solitary kidney: an analysis of complications and outcome after nephron sparing surgery. J Urol2002; 168:454–459.
    Medline Google Scholar
  • 23 MollV, Becht E, Ziegler M. Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients. J Urol1993; 150:319–323.
    Medline Google Scholar
  • 24 ZucchiA, Mearini L, Mearini E, Costantini E, Vivacqua C, Porena M. Renal cell carcinoma: histological findings on surgical margins after nephron sparing surgery. J Urol2003; 169:905–908.
    Medline Google Scholar
  • 25 SchenckJF, Jolesz FA, Roemer PB, et al. Superconducting open-configuration MR imaging system for image-guided therapy. Radiology1995; 195:805–814.
    Google Scholar
  • 26 SilvermanSG, Collick BD, Figueira MR, et al. Interactive MR-guided biopsy in an open-configuration MR imaging system. Radiology1995; 197:175–181.
    Google Scholar
  • 27 SilvermanSG, Tuncali K, Adams DF, et al. MR imaging-guided percutaneous cryotherapy of liver tumors: initial experience. Radiology2000; 217:657–664.
    Google Scholar
  • 28 HughesCW, Bell C. Anesthesia equipment in remote hospital locations. St Louis, Mo: Mosby, 1993; 565–587.
    Google Scholar
  • 29 ShellockFG, Kanal E: Magnetic resonance: bioeffects, safety, and patient management. New York, NY: Raven, 1994; 61–69.
    Google Scholar
  • 30 HongJS, Wong S, Pease G, Rubinsky B. MR imaging assisted temperature calculations during cryosurgery. Magn Reson Imaging1994; 12:1021–1031.
    Medline Google Scholar
  • 31 MatsumotoR, Oshio K, Jolesz FA. Monitoring of laser and freezing-induced ablation in the liver with T1-weighted MR imaging. J Magn Reson Imaging1992; 2:555–562.
    Medline Google Scholar
  • 32 MatsumotoR, Selig AM, Colucci VM, Jolesz FA. MR monitoring during cryotherapy in the liver: predictability of histologic outcome. J Magn Reson Imaging1993; 3:770–776.
    Medline Google Scholar
  • 33 PeaseGR, Wong ST, Roos MS, Rubinsky B. MR image-guided control of cryosurgery. J Magn Reson Imaging1995; 5:753–760.
    Medline Google Scholar
  • 34 Mayo-SmithWW, Dupuy DE, Parikh PM, Pezzullo JA, Cronan JJ. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: techniques and outcomes of 38 treatment sessions in 32 consecutive patients. AJR Am J Roentgenol2003; 180:1503–1508.
    Medline Google Scholar
  • 35 SolbiatiL, Ierace T, Tonolini M, Cova L. Guidance and monitoring of radiofrequency liver tumor ablation with contrast-enhanced ultrasound. Eur J Radiol2004; 51(suppl):S19–S23.
    Medline Google Scholar
  • 36 FarrellMA, Charboneau JW, Callstrom MR, Reading CC, Engen DE, Blute ML. Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation. AJR Am J Roentgenol2003; 181:1315–1317.
    Medline Google Scholar
  • 37 TuncaliK, vanSonnenberg E, Shankar S, Mortele KJ, Cibas ES, Silverman SG. Evaluation of patients referred for percutaneous ablation of renal tumors: importance of a preprocedural diagnosis. AJR Am J Roentgenol2004; 183:575–582.
    Medline Google Scholar

Article History

Published in print: Aug 2005