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Renal Cell Carcinoma: Clinical Experience and Technical Success with Radio-frequency Ablation of 42 Tumors¹

¹ From the Departments of Radiology (D.A.G., R.S.A., P.R.M.) and Urology (F.J.M., W.S.M.), White 270, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. Received December 18, 2001; revision requested February 26, 2002; final revision received June 10; accepted June 20. Address correspondence to D.A.G. (e-mail: dgervais@partners.org).

View larger version (125K): [in a new window]   Figure 1a. (a) Transverse CT image obtained after intravenous administration of contrast material in a 67-year-old woman with multiple medical problems and a small exophytic RCC tumor (arrow). Transverse CT images obtained 6 months after RF ablation (b) without and (c) with contrast material enhancement show a nonenhancing residual mass (arrow) with fat at both renal interfaces. Soft-tissue stranding in the perirenal fat is also present; the dominant strands run roughly parallel to the tumor margin.

View larger version (132K): [in a new window]   Figure 1b. (a) Transverse CT image obtained after intravenous administration of contrast material in a 67-year-old woman with multiple medical problems and a small exophytic RCC tumor (arrow). Transverse CT images obtained 6 months after RF ablation (b) without and (c) with contrast material enhancement show a nonenhancing residual mass (arrow) with fat at both renal interfaces. Soft-tissue stranding in the perirenal fat is also present; the dominant strands run roughly parallel to the tumor margin.

View larger version (127K): [in a new window]   Figure 1c. (a) Transverse CT image obtained after intravenous administration of contrast material in a 67-year-old woman with multiple medical problems and a small exophytic RCC tumor (arrow). Transverse CT images obtained 6 months after RF ablation (b) without and (c) with contrast material enhancement show a nonenhancing residual mass (arrow) with fat at both renal interfaces. Soft-tissue stranding in the perirenal fat is also present; the dominant strands run roughly parallel to the tumor margin.

View larger version (146K): [in a new window]   Figure 2a. (a) Transverse CT image obtained after intravenous administration of contrast material in a 32-year-old man with VHL shows two enhancing RCC tumors (straight solid arrows). A fat plane separates the anterior tumor from the duodenum (curved arrow). The anterior tumor has a component in the perirenal fat but also juts into the renal sinus adjacent to the renal vein (open arrow). (b) Transverse CT image obtained during RF ablation performed with this patient in a prone position shows a cluster electrode (arrow) in the anterior tumor. The needle electrode was advanced slightly to abut the medial edge of the anterior tumor during RF ablation. The posterior tumor contains a biopsy needle that was removed before RF ablation was performed. (c) Transverse CT image obtained during RF ablation. The cluster electrode (arrow) was repositioned into the more posterior aspect of the anterior tumor. Again, the electrode was advanced until it abutted the medial edge of the tumor. (d) Transverse follow-up CT image obtained after intravenous administration of contrast material 1 month after RF ablation shows a small crescent of residual enhancement (arrow) in the anterior tumor at the interface with the renal vein. This region was ablated at a second visit. (e) Transverse follow-up CT image obtained after intravenous administration of contrast material 6 months after complete ablation shows that the anterior tumor (arrow) does not enhance and is 1.2 cm smaller than it was on images obtained in the previous studies.

View larger version (149K): [in a new window]   Figure 2b. (a) Transverse CT image obtained after intravenous administration of contrast material in a 32-year-old man with VHL shows two enhancing RCC tumors (straight solid arrows). A fat plane separates the anterior tumor from the duodenum (curved arrow). The anterior tumor has a component in the perirenal fat but also juts into the renal sinus adjacent to the renal vein (open arrow). (b) Transverse CT image obtained during RF ablation performed with this patient in a prone position shows a cluster electrode (arrow) in the anterior tumor. The needle electrode was advanced slightly to abut the medial edge of the anterior tumor during RF ablation. The posterior tumor contains a biopsy needle that was removed before RF ablation was performed. (c) Transverse CT image obtained during RF ablation. The cluster electrode (arrow) was repositioned into the more posterior aspect of the anterior tumor. Again, the electrode was advanced until it abutted the medial edge of the tumor. (d) Transverse follow-up CT image obtained after intravenous administration of contrast material 1 month after RF ablation shows a small crescent of residual enhancement (arrow) in the anterior tumor at the interface with the renal vein. This region was ablated at a second visit. (e) Transverse follow-up CT image obtained after intravenous administration of contrast material 6 months after complete ablation shows that the anterior tumor (arrow) does not enhance and is 1.2 cm smaller than it was on images obtained in the previous studies.

View larger version (141K): [in a new window]   Figure 2c. (a) Transverse CT image obtained after intravenous administration of contrast material in a 32-year-old man with VHL shows two enhancing RCC tumors (straight solid arrows). A fat plane separates the anterior tumor from the duodenum (curved arrow). The anterior tumor has a component in the perirenal fat but also juts into the renal sinus adjacent to the renal vein (open arrow). (b) Transverse CT image obtained during RF ablation performed with this patient in a prone position shows a cluster electrode (arrow) in the anterior tumor. The needle electrode was advanced slightly to abut the medial edge of the anterior tumor during RF ablation. The posterior tumor contains a biopsy needle that was removed before RF ablation was performed. (c) Transverse CT image obtained during RF ablation. The cluster electrode (arrow) was repositioned into the more posterior aspect of the anterior tumor. Again, the electrode was advanced until it abutted the medial edge of the tumor. (d) Transverse follow-up CT image obtained after intravenous administration of contrast material 1 month after RF ablation shows a small crescent of residual enhancement (arrow) in the anterior tumor at the interface with the renal vein. This region was ablated at a second visit. (e) Transverse follow-up CT image obtained after intravenous administration of contrast material 6 months after complete ablation shows that the anterior tumor (arrow) does not enhance and is 1.2 cm smaller than it was on images obtained in the previous studies.

View larger version (147K): [in a new window]   Figure 2d. (a) Transverse CT image obtained after intravenous administration of contrast material in a 32-year-old man with VHL shows two enhancing RCC tumors (straight solid arrows). A fat plane separates the anterior tumor from the duodenum (curved arrow). The anterior tumor has a component in the perirenal fat but also juts into the renal sinus adjacent to the renal vein (open arrow). (b) Transverse CT image obtained during RF ablation performed with this patient in a prone position shows a cluster electrode (arrow) in the anterior tumor. The needle electrode was advanced slightly to abut the medial edge of the anterior tumor during RF ablation. The posterior tumor contains a biopsy needle that was removed before RF ablation was performed. (c) Transverse CT image obtained during RF ablation. The cluster electrode (arrow) was repositioned into the more posterior aspect of the anterior tumor. Again, the electrode was advanced until it abutted the medial edge of the tumor. (d) Transverse follow-up CT image obtained after intravenous administration of contrast material 1 month after RF ablation shows a small crescent of residual enhancement (arrow) in the anterior tumor at the interface with the renal vein. This region was ablated at a second visit. (e) Transverse follow-up CT image obtained after intravenous administration of contrast material 6 months after complete ablation shows that the anterior tumor (arrow) does not enhance and is 1.2 cm smaller than it was on images obtained in the previous studies.

View larger version (152K): [in a new window]   Figure 2e. (a) Transverse CT image obtained after intravenous administration of contrast material in a 32-year-old man with VHL shows two enhancing RCC tumors (straight solid arrows). A fat plane separates the anterior tumor from the duodenum (curved arrow). The anterior tumor has a component in the perirenal fat but also juts into the renal sinus adjacent to the renal vein (open arrow). (b) Transverse CT image obtained during RF ablation performed with this patient in a prone position shows a cluster electrode (arrow) in the anterior tumor. The needle electrode was advanced slightly to abut the medial edge of the anterior tumor during RF ablation. The posterior tumor contains a biopsy needle that was removed before RF ablation was performed. (c) Transverse CT image obtained during RF ablation. The cluster electrode (arrow) was repositioned into the more posterior aspect of the anterior tumor. Again, the electrode was advanced until it abutted the medial edge of the tumor. (d) Transverse follow-up CT image obtained after intravenous administration of contrast material 1 month after RF ablation shows a small crescent of residual enhancement (arrow) in the anterior tumor at the interface with the renal vein. This region was ablated at a second visit. (e) Transverse follow-up CT image obtained after intravenous administration of contrast material 6 months after complete ablation shows that the anterior tumor (arrow) does not enhance and is 1.2 cm smaller than it was on images obtained in the previous studies.