Published online before print November 26, 2003, 10.1148/radiol.2301020934
Percutaneous Radiofrequency Ablation for Inoperable Non–Small Cell Lung Cancer and Metastases: Preliminary Report1
Jeong Min Lee, MD,
Gong Yong Jin, MD,
S. Nahum Goldberg, MD,
Yong Cheol Lee, MD,
Gyung Ho Chung, MD,
Young Min Han, MD,
Sang Yong Lee, MD and
Chong Soo Kim, MD
1 From the Departments of Radiology (G.Y.J., G.H.C., Y.M.H., S.Y.L., C.S.K.) and Medicine (Y.C.L.), Chonbuk National University Hospital, South Korea; Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, Korea (J.M.L.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (S.N.G.). From the 2001 RSNA scientific assembly. Received July 26, 2002; revision requested September 24; final revision received April 25, 2003; accepted June 2. Address correspondence to J.M.L. (e-mail: leejm@radcom.snu.ac.kr).
View larger version (92K):
[in a new window]
|
Figure 1a. Transverse CT scans show complete necrosis of a small bronchogenic adenocarcinoma treated with one session of RF therapy in a 73-year-old man. (a) Contrast-enhanced scan obtained prior to RF therapy shows a 4.0-cm well-defined round tumor (arrow) in the right lower lobe. The tumor had an attenuation value of 58 HU and a net enhancement value of 25 HU compared with values on a precontrast scan (mean attenuation value, 33 HU; not shown). (b) On prone scan obtained during RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip is placed within the tumor. (c) Nonenhanced scan obtained immediately after RF ablation and removal of the electrode shows that a round hazy opacity (arrows) envelops the tumor nodule, which had an attenuation value of 21 HU. (d) Contrast-enhanced scan obtained 1 day after RF therapy shows absence of contrast enhancement within the tumor (mean attenuation value, 25 HU; net enhancement value, 4 HU; arrow), which indicates necrosis. (e) Contrast-enhanced scan obtained 3 months after RF therapy shows a decrease in tumor size and central cavitation (arrow) without any contrast enhancement within the tumor. (f) Contrast-enhanced scan obtained 1 year after RF therapy shows a marked decrease in tumor ablation zone size (arrow).
|
|
View larger version (136K):
[in a new window]
|
Figure 1b. Transverse CT scans show complete necrosis of a small bronchogenic adenocarcinoma treated with one session of RF therapy in a 73-year-old man. (a) Contrast-enhanced scan obtained prior to RF therapy shows a 4.0-cm well-defined round tumor (arrow) in the right lower lobe. The tumor had an attenuation value of 58 HU and a net enhancement value of 25 HU compared with values on a precontrast scan (mean attenuation value, 33 HU; not shown). (b) On prone scan obtained during RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip is placed within the tumor. (c) Nonenhanced scan obtained immediately after RF ablation and removal of the electrode shows that a round hazy opacity (arrows) envelops the tumor nodule, which had an attenuation value of 21 HU. (d) Contrast-enhanced scan obtained 1 day after RF therapy shows absence of contrast enhancement within the tumor (mean attenuation value, 25 HU; net enhancement value, 4 HU; arrow), which indicates necrosis. (e) Contrast-enhanced scan obtained 3 months after RF therapy shows a decrease in tumor size and central cavitation (arrow) without any contrast enhancement within the tumor. (f) Contrast-enhanced scan obtained 1 year after RF therapy shows a marked decrease in tumor ablation zone size (arrow).
|
|
View larger version (147K):
[in a new window]
|
Figure 1c. Transverse CT scans show complete necrosis of a small bronchogenic adenocarcinoma treated with one session of RF therapy in a 73-year-old man. (a) Contrast-enhanced scan obtained prior to RF therapy shows a 4.0-cm well-defined round tumor (arrow) in the right lower lobe. The tumor had an attenuation value of 58 HU and a net enhancement value of 25 HU compared with values on a precontrast scan (mean attenuation value, 33 HU; not shown). (b) On prone scan obtained during RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip is placed within the tumor. (c) Nonenhanced scan obtained immediately after RF ablation and removal of the electrode shows that a round hazy opacity (arrows) envelops the tumor nodule, which had an attenuation value of 21 HU. (d) Contrast-enhanced scan obtained 1 day after RF therapy shows absence of contrast enhancement within the tumor (mean attenuation value, 25 HU; net enhancement value, 4 HU; arrow), which indicates necrosis. (e) Contrast-enhanced scan obtained 3 months after RF therapy shows a decrease in tumor size and central cavitation (arrow) without any contrast enhancement within the tumor. (f) Contrast-enhanced scan obtained 1 year after RF therapy shows a marked decrease in tumor ablation zone size (arrow).
|
|
View larger version (111K):
[in a new window]
|
Figure 1d. Transverse CT scans show complete necrosis of a small bronchogenic adenocarcinoma treated with one session of RF therapy in a 73-year-old man. (a) Contrast-enhanced scan obtained prior to RF therapy shows a 4.0-cm well-defined round tumor (arrow) in the right lower lobe. The tumor had an attenuation value of 58 HU and a net enhancement value of 25 HU compared with values on a precontrast scan (mean attenuation value, 33 HU; not shown). (b) On prone scan obtained during RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip is placed within the tumor. (c) Nonenhanced scan obtained immediately after RF ablation and removal of the electrode shows that a round hazy opacity (arrows) envelops the tumor nodule, which had an attenuation value of 21 HU. (d) Contrast-enhanced scan obtained 1 day after RF therapy shows absence of contrast enhancement within the tumor (mean attenuation value, 25 HU; net enhancement value, 4 HU; arrow), which indicates necrosis. (e) Contrast-enhanced scan obtained 3 months after RF therapy shows a decrease in tumor size and central cavitation (arrow) without any contrast enhancement within the tumor. (f) Contrast-enhanced scan obtained 1 year after RF therapy shows a marked decrease in tumor ablation zone size (arrow).
|
|
View larger version (92K):
[in a new window]
|
Figure 1e. Transverse CT scans show complete necrosis of a small bronchogenic adenocarcinoma treated with one session of RF therapy in a 73-year-old man. (a) Contrast-enhanced scan obtained prior to RF therapy shows a 4.0-cm well-defined round tumor (arrow) in the right lower lobe. The tumor had an attenuation value of 58 HU and a net enhancement value of 25 HU compared with values on a precontrast scan (mean attenuation value, 33 HU; not shown). (b) On prone scan obtained during RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip is placed within the tumor. (c) Nonenhanced scan obtained immediately after RF ablation and removal of the electrode shows that a round hazy opacity (arrows) envelops the tumor nodule, which had an attenuation value of 21 HU. (d) Contrast-enhanced scan obtained 1 day after RF therapy shows absence of contrast enhancement within the tumor (mean attenuation value, 25 HU; net enhancement value, 4 HU; arrow), which indicates necrosis. (e) Contrast-enhanced scan obtained 3 months after RF therapy shows a decrease in tumor size and central cavitation (arrow) without any contrast enhancement within the tumor. (f) Contrast-enhanced scan obtained 1 year after RF therapy shows a marked decrease in tumor ablation zone size (arrow).
|
|
View larger version (104K):
[in a new window]
|
Figure 1f. Transverse CT scans show complete necrosis of a small bronchogenic adenocarcinoma treated with one session of RF therapy in a 73-year-old man. (a) Contrast-enhanced scan obtained prior to RF therapy shows a 4.0-cm well-defined round tumor (arrow) in the right lower lobe. The tumor had an attenuation value of 58 HU and a net enhancement value of 25 HU compared with values on a precontrast scan (mean attenuation value, 33 HU; not shown). (b) On prone scan obtained during RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip is placed within the tumor. (c) Nonenhanced scan obtained immediately after RF ablation and removal of the electrode shows that a round hazy opacity (arrows) envelops the tumor nodule, which had an attenuation value of 21 HU. (d) Contrast-enhanced scan obtained 1 day after RF therapy shows absence of contrast enhancement within the tumor (mean attenuation value, 25 HU; net enhancement value, 4 HU; arrow), which indicates necrosis. (e) Contrast-enhanced scan obtained 3 months after RF therapy shows a decrease in tumor size and central cavitation (arrow) without any contrast enhancement within the tumor. (f) Contrast-enhanced scan obtained 1 year after RF therapy shows a marked decrease in tumor ablation zone size (arrow).
|
|
View larger version (16K):
[in a new window]
|
Figure 2. Scatterplot shows the relationship between the actual ablation time and tumor diameter. An increase of the actual ablation time is observed when the tumor size increases (correlation coefficient, 0.58).
|
|
View larger version (86K):
[in a new window]
|
Figure 3a. Transverse contrast-enhanced CT scans show partial necrosis and regrowth of residual tumor in a large bronchogenic squamous cell carcinoma located in right upper lobe treated with RF ablation in a 66-year old man. (a) Before RF ablation, scan shows a 6.0-cm enhancing heterogeneous mass (mean attenuation value, 92 HU; arrow) abutting the pleura in the right upper lobe. (b) During RF ablation, a 17-gauge cluster electrode with 2.5-cm exposed tips was placed into the tumor. (c) CT scan obtained 1 day after RF therapy shows peripheral thin enhancing rim along the medial portion of the tumor (mean attenuation value, 65 HU; net enhancement value, 26 HU; arrows) and multiple air bubbles within nonenhancing area (mean attenuation value, 39 HU; net enhancement value, 1 HU) of the tumor. (d) CT scan obtained 3 months after RF ablation shows cavitation of the tumor (arrowhead) and growth of focal enhancing area (arrow) along the medial portion of the mass compared with those features on the previous follow-up CT scan (c).
|
|
View larger version (124K):
[in a new window]
|
Figure 3b. Transverse contrast-enhanced CT scans show partial necrosis and regrowth of residual tumor in a large bronchogenic squamous cell carcinoma located in right upper lobe treated with RF ablation in a 66-year old man. (a) Before RF ablation, scan shows a 6.0-cm enhancing heterogeneous mass (mean attenuation value, 92 HU; arrow) abutting the pleura in the right upper lobe. (b) During RF ablation, a 17-gauge cluster electrode with 2.5-cm exposed tips was placed into the tumor. (c) CT scan obtained 1 day after RF therapy shows peripheral thin enhancing rim along the medial portion of the tumor (mean attenuation value, 65 HU; net enhancement value, 26 HU; arrows) and multiple air bubbles within nonenhancing area (mean attenuation value, 39 HU; net enhancement value, 1 HU) of the tumor. (d) CT scan obtained 3 months after RF ablation shows cavitation of the tumor (arrowhead) and growth of focal enhancing area (arrow) along the medial portion of the mass compared with those features on the previous follow-up CT scan (c).
|
|
View larger version (91K):
[in a new window]
|
Figure 3c. Transverse contrast-enhanced CT scans show partial necrosis and regrowth of residual tumor in a large bronchogenic squamous cell carcinoma located in right upper lobe treated with RF ablation in a 66-year old man. (a) Before RF ablation, scan shows a 6.0-cm enhancing heterogeneous mass (mean attenuation value, 92 HU; arrow) abutting the pleura in the right upper lobe. (b) During RF ablation, a 17-gauge cluster electrode with 2.5-cm exposed tips was placed into the tumor. (c) CT scan obtained 1 day after RF therapy shows peripheral thin enhancing rim along the medial portion of the tumor (mean attenuation value, 65 HU; net enhancement value, 26 HU; arrows) and multiple air bubbles within nonenhancing area (mean attenuation value, 39 HU; net enhancement value, 1 HU) of the tumor. (d) CT scan obtained 3 months after RF ablation shows cavitation of the tumor (arrowhead) and growth of focal enhancing area (arrow) along the medial portion of the mass compared with those features on the previous follow-up CT scan (c).
|
|
View larger version (102K):
[in a new window]
|
Figure 3d. Transverse contrast-enhanced CT scans show partial necrosis and regrowth of residual tumor in a large bronchogenic squamous cell carcinoma located in right upper lobe treated with RF ablation in a 66-year old man. (a) Before RF ablation, scan shows a 6.0-cm enhancing heterogeneous mass (mean attenuation value, 92 HU; arrow) abutting the pleura in the right upper lobe. (b) During RF ablation, a 17-gauge cluster electrode with 2.5-cm exposed tips was placed into the tumor. (c) CT scan obtained 1 day after RF therapy shows peripheral thin enhancing rim along the medial portion of the tumor (mean attenuation value, 65 HU; net enhancement value, 26 HU; arrows) and multiple air bubbles within nonenhancing area (mean attenuation value, 39 HU; net enhancement value, 1 HU) of the tumor. (d) CT scan obtained 3 months after RF ablation shows cavitation of the tumor (arrowhead) and growth of focal enhancing area (arrow) along the medial portion of the mass compared with those features on the previous follow-up CT scan (c).
|
|
View larger version (106K):
[in a new window]
|
Figure 4a. Transverse CT scans show large pneumothorax that formed after RF ablation in a 27-year-old woman with growing metastatic choriocarcinoma not responding to multiple sessions of systemic chemotherapy. (a) During RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip was placed within the tumor, and treated areas of the tumor appeared as areas of hypoattenuation relative to residual tumor. (b) After RF ablation, a pneumothorax (arrows) occurred in the right pleural space, which was treated with thoracostomy tube insertion.
|
|
View larger version (65K):
[in a new window]
|
Figure 4b. Transverse CT scans show large pneumothorax that formed after RF ablation in a 27-year-old woman with growing metastatic choriocarcinoma not responding to multiple sessions of systemic chemotherapy. (a) During RF ablation, a 17-gauge single electrode with 3.0-cm exposed tip was placed within the tumor, and treated areas of the tumor appeared as areas of hypoattenuation relative to residual tumor. (b) After RF ablation, a pneumothorax (arrows) occurred in the right pleural space, which was treated with thoracostomy tube insertion.
|
|
Copyright © 2004 by the Radiological Society of North America.
