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Unresectable Pulmonary Malignancies: CT-guided Percutaneous Radiofrequency Ablation—Preliminary Results¹

¹ From the Department of Radiological Sciences, UCLA Medical Center, 10833 Le Conte Ave, B2–168, Center for the Health Sciences (CHS), Los Angeles, CA 90095-1721. Received December 18, 2002; revision requested February 27, 2003; revision received May 23; accepted July 1. Address correspondence to R.D.S. (e-mail: rsuh@mednet.ucla.edu).

View larger version (117K): [in a new window]   Figure 1a. Spiral CT-guided percutaneous RF ablation of left lower lobe nodule with patient in prone position. Transverse thin-section CT was used to guide placement of (a) a 22-gauge localizer needle and (b) a multiarray probe. (c) After probe deployment, perinodular ground-glass opacification and associated trace pneumothorax are seen.

View larger version (117K): [in a new window]   Figure 1b. Spiral CT-guided percutaneous RF ablation of left lower lobe nodule with patient in prone position. Transverse thin-section CT was used to guide placement of (a) a 22-gauge localizer needle and (b) a multiarray probe. (c) After probe deployment, perinodular ground-glass opacification and associated trace pneumothorax are seen.

View larger version (119K): [in a new window]   Figure 1c. Spiral CT-guided percutaneous RF ablation of left lower lobe nodule with patient in prone position. Transverse thin-section CT was used to guide placement of (a) a 22-gauge localizer needle and (b) a multiarray probe. (c) After probe deployment, perinodular ground-glass opacification and associated trace pneumothorax are seen.

View larger version (72K): [in a new window]   Figure 2a. Transverse contrast-enhanced thin-section CT scans obtained with the patient in prone position show lingula segment nodule before and at follow-up after RF ablation. (a) Baseline CT scan obtained before RF ablation shows 2.2 x 2.8-cm nodule with enhancement of 35.9 HU. (b) Follow-up 1-month CT scan depicts marked interval increase in nodule size, with early formation of thick-walled cavity and adjacent anterolateral complicated hydropneumothorax. Lesion enhancement increase from baseline was 0.0 HU. (c) Follow-up 3-month CT scan depicts interval regression of cavitary lesion, with enhancement increase from baseline of 4.0 HU and resolution of adjacent hydropneumothorax. (d) Follow-up 6-month CT scan shows further interval regression of cavitary lesion with enhancement increase from baseline of 26.0 HU. (e) Follow-up 12-month CT scan shows interval regression of lesion with scarring and enhancement increase from baseline of 15.0 HU.

View larger version (75K): [in a new window]   Figure 2b. Transverse contrast-enhanced thin-section CT scans obtained with the patient in prone position show lingula segment nodule before and at follow-up after RF ablation. (a) Baseline CT scan obtained before RF ablation shows 2.2 x 2.8-cm nodule with enhancement of 35.9 HU. (b) Follow-up 1-month CT scan depicts marked interval increase in nodule size, with early formation of thick-walled cavity and adjacent anterolateral complicated hydropneumothorax. Lesion enhancement increase from baseline was 0.0 HU. (c) Follow-up 3-month CT scan depicts interval regression of cavitary lesion, with enhancement increase from baseline of 4.0 HU and resolution of adjacent hydropneumothorax. (d) Follow-up 6-month CT scan shows further interval regression of cavitary lesion with enhancement increase from baseline of 26.0 HU. (e) Follow-up 12-month CT scan shows interval regression of lesion with scarring and enhancement increase from baseline of 15.0 HU.

View larger version (73K): [in a new window]   Figure 2c. Transverse contrast-enhanced thin-section CT scans obtained with the patient in prone position show lingula segment nodule before and at follow-up after RF ablation. (a) Baseline CT scan obtained before RF ablation shows 2.2 x 2.8-cm nodule with enhancement of 35.9 HU. (b) Follow-up 1-month CT scan depicts marked interval increase in nodule size, with early formation of thick-walled cavity and adjacent anterolateral complicated hydropneumothorax. Lesion enhancement increase from baseline was 0.0 HU. (c) Follow-up 3-month CT scan depicts interval regression of cavitary lesion, with enhancement increase from baseline of 4.0 HU and resolution of adjacent hydropneumothorax. (d) Follow-up 6-month CT scan shows further interval regression of cavitary lesion with enhancement increase from baseline of 26.0 HU. (e) Follow-up 12-month CT scan shows interval regression of lesion with scarring and enhancement increase from baseline of 15.0 HU.

View larger version (78K): [in a new window]   Figure 2d. Transverse contrast-enhanced thin-section CT scans obtained with the patient in prone position show lingula segment nodule before and at follow-up after RF ablation. (a) Baseline CT scan obtained before RF ablation shows 2.2 x 2.8-cm nodule with enhancement of 35.9 HU. (b) Follow-up 1-month CT scan depicts marked interval increase in nodule size, with early formation of thick-walled cavity and adjacent anterolateral complicated hydropneumothorax. Lesion enhancement increase from baseline was 0.0 HU. (c) Follow-up 3-month CT scan depicts interval regression of cavitary lesion, with enhancement increase from baseline of 4.0 HU and resolution of adjacent hydropneumothorax. (d) Follow-up 6-month CT scan shows further interval regression of cavitary lesion with enhancement increase from baseline of 26.0 HU. (e) Follow-up 12-month CT scan shows interval regression of lesion with scarring and enhancement increase from baseline of 15.0 HU.

View larger version (71K): [in a new window]   Figure 2e. Transverse contrast-enhanced thin-section CT scans obtained with the patient in prone position show lingula segment nodule before and at follow-up after RF ablation. (a) Baseline CT scan obtained before RF ablation shows 2.2 x 2.8-cm nodule with enhancement of 35.9 HU. (b) Follow-up 1-month CT scan depicts marked interval increase in nodule size, with early formation of thick-walled cavity and adjacent anterolateral complicated hydropneumothorax. Lesion enhancement increase from baseline was 0.0 HU. (c) Follow-up 3-month CT scan depicts interval regression of cavitary lesion, with enhancement increase from baseline of 4.0 HU and resolution of adjacent hydropneumothorax. (d) Follow-up 6-month CT scan shows further interval regression of cavitary lesion with enhancement increase from baseline of 26.0 HU. (e) Follow-up 12-month CT scan shows interval regression of lesion with scarring and enhancement increase from baseline of 15.0 HU.

View larger version (98K): [in a new window]   Figure 3a. Transverse thin-section CT densitometry scans obtained with the patient in prone position. (a) Preablation precontrast CT scan shows lesion attenuation of 15 HU. (b) Preablation postcontrast CT scan shows maximum lesion attenuation of 88 HU (73-HU enhancement increase from baseline). (c) Precontrast 1-month follow-up CT scan shows lesion attenuation of 27 HU. (d) Postcontrast 1-month follow-up CT scan shows maximum lesion attenuation of 29 HU (2-HU enhancement from baseline).

View larger version (124K): [in a new window]   Figure 3b. Transverse thin-section CT densitometry scans obtained with the patient in prone position. (a) Preablation precontrast CT scan shows lesion attenuation of 15 HU. (b) Preablation postcontrast CT scan shows maximum lesion attenuation of 88 HU (73-HU enhancement increase from baseline). (c) Precontrast 1-month follow-up CT scan shows lesion attenuation of 27 HU. (d) Postcontrast 1-month follow-up CT scan shows maximum lesion attenuation of 29 HU (2-HU enhancement from baseline).

View larger version (93K): [in a new window]   Figure 3c. Transverse thin-section CT densitometry scans obtained with the patient in prone position. (a) Preablation precontrast CT scan shows lesion attenuation of 15 HU. (b) Preablation postcontrast CT scan shows maximum lesion attenuation of 88 HU (73-HU enhancement increase from baseline). (c) Precontrast 1-month follow-up CT scan shows lesion attenuation of 27 HU. (d) Postcontrast 1-month follow-up CT scan shows maximum lesion attenuation of 29 HU (2-HU enhancement from baseline).

View larger version (109K): [in a new window]   Figure 3d. Transverse thin-section CT densitometry scans obtained with the patient in prone position. (a) Preablation precontrast CT scan shows lesion attenuation of 15 HU. (b) Preablation postcontrast CT scan shows maximum lesion attenuation of 88 HU (73-HU enhancement increase from baseline). (c) Precontrast 1-month follow-up CT scan shows lesion attenuation of 27 HU. (d) Postcontrast 1-month follow-up CT scan shows maximum lesion attenuation of 29 HU (2-HU enhancement from baseline).

View larger version (29K): [in a new window]   Figure 4. Graph shows lesion size (product of largest diameters) (in square centimeters) and contrast enhancement (maximum postcontrast enhancement increase from baseline) for patients 5 and 7 at follow-up CT. = patient 7 enhancement, = patient 7 size, = patient 5 enhancement, = patient 5 size.

View larger version (29K): [in a new window]   Figure 5. Graph shows contrast enhancement (maximum postcontrast enhancement increase from baseline) before RF ablation (0 months) and 1, 3, 6, and 12 months after RF ablation for the six patients who underwent follow-up CT densitometry.