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Adrenal Neoplasms: CT-guided Radiofrequency Ablation—Preliminary Results¹

¹ From the Department of Radiology, Rhode Island Hospital, Brown Medical School, 593 Eddy St, Providence, RI 02903. From the 2002 RSNA scientific assembly. Received June 27, 2003; revision requested August 26; revision received September 11; accepted October 20. Address correspondence to W.W.M.S. (e-mail: wmayo-smith@lifespan.org).

View larger version (161K): [in a new window]   Figure 1a. Isolated bilateral adrenal metastases from renal cell carcinoma in 60-year-old man. (a) Transverse CT fluoroscopic image obtained with patient in left decubitus position shows cluster electrode (arrow) in left adrenal mass. (b) Transverse contrast-enhanced CT image obtained with patient in supine position 1 month after RF treatment shows no enhancement of treated left adrenal metastasis (arrow) and enhancement of right adrenal metastasis (arrowhead). (c) Transverse contrast-enhanced CT image obtained with patient in supine position 20 months after RF ablation of left adrenal metastasis and 19 months after treatment of right adrenal metastasis shows stability in size of lesions and no enhancement of either gland (arrows). Enhancement of inferior vena cava (arrowhead), which lies anterior to right adrenal gland, is observed. Biochemical assays showed no residual adrenal function, and this finding was consistent with complete destruction of adrenal tissue.

View larger version (132K): [in a new window]   Figure 1b. Isolated bilateral adrenal metastases from renal cell carcinoma in 60-year-old man. (a) Transverse CT fluoroscopic image obtained with patient in left decubitus position shows cluster electrode (arrow) in left adrenal mass. (b) Transverse contrast-enhanced CT image obtained with patient in supine position 1 month after RF treatment shows no enhancement of treated left adrenal metastasis (arrow) and enhancement of right adrenal metastasis (arrowhead). (c) Transverse contrast-enhanced CT image obtained with patient in supine position 20 months after RF ablation of left adrenal metastasis and 19 months after treatment of right adrenal metastasis shows stability in size of lesions and no enhancement of either gland (arrows). Enhancement of inferior vena cava (arrowhead), which lies anterior to right adrenal gland, is observed. Biochemical assays showed no residual adrenal function, and this finding was consistent with complete destruction of adrenal tissue.

View larger version (149K): [in a new window]   Figure 1c. Isolated bilateral adrenal metastases from renal cell carcinoma in 60-year-old man. (a) Transverse CT fluoroscopic image obtained with patient in left decubitus position shows cluster electrode (arrow) in left adrenal mass. (b) Transverse contrast-enhanced CT image obtained with patient in supine position 1 month after RF treatment shows no enhancement of treated left adrenal metastasis (arrow) and enhancement of right adrenal metastasis (arrowhead). (c) Transverse contrast-enhanced CT image obtained with patient in supine position 20 months after RF ablation of left adrenal metastasis and 19 months after treatment of right adrenal metastasis shows stability in size of lesions and no enhancement of either gland (arrows). Enhancement of inferior vena cava (arrowhead), which lies anterior to right adrenal gland, is observed. Biochemical assays showed no residual adrenal function, and this finding was consistent with complete destruction of adrenal tissue.

View larger version (153K): [in a new window]   Figure 2a. Biopsy-proved right adrenal pheochromocytoma in 66-year-old man with obesity, chronic obstructive pulmonary disease, sleep apnea, diabetes, cirrhosis, portal hypertension, esophageal varices, cardiac ejection fraction of 18%, and hypertension. (a) Transverse CT image obtained with patient in right decubitus position before ablation shows small right adrenal mass (arrow). (b) Transverse CT fluoroscopic image obtained with patient in right decubitus position shows cluster electrode (arrow) in right adrenal mass. (c) Transverse contrast-enhanced CT image obtained with patient in supine position 1 month after RF ablation shows no enhancement of mass (arrow). Poor image quality is due to patient’s large body habitus. Patient’s blood pressure was normal when all antihypertensive medications were discontinued after treatment.

View larger version (154K): [in a new window]   Figure 2b. Biopsy-proved right adrenal pheochromocytoma in 66-year-old man with obesity, chronic obstructive pulmonary disease, sleep apnea, diabetes, cirrhosis, portal hypertension, esophageal varices, cardiac ejection fraction of 18%, and hypertension. (a) Transverse CT image obtained with patient in right decubitus position before ablation shows small right adrenal mass (arrow). (b) Transverse CT fluoroscopic image obtained with patient in right decubitus position shows cluster electrode (arrow) in right adrenal mass. (c) Transverse contrast-enhanced CT image obtained with patient in supine position 1 month after RF ablation shows no enhancement of mass (arrow). Poor image quality is due to patient’s large body habitus. Patient’s blood pressure was normal when all antihypertensive medications were discontinued after treatment.

View larger version (143K): [in a new window]   Figure 2c. Biopsy-proved right adrenal pheochromocytoma in 66-year-old man with obesity, chronic obstructive pulmonary disease, sleep apnea, diabetes, cirrhosis, portal hypertension, esophageal varices, cardiac ejection fraction of 18%, and hypertension. (a) Transverse CT image obtained with patient in right decubitus position before ablation shows small right adrenal mass (arrow). (b) Transverse CT fluoroscopic image obtained with patient in right decubitus position shows cluster electrode (arrow) in right adrenal mass. (c) Transverse contrast-enhanced CT image obtained with patient in supine position 1 month after RF ablation shows no enhancement of mass (arrow). Poor image quality is due to patient’s large body habitus. Patient’s blood pressure was normal when all antihypertensive medications were discontinued after treatment.

View larger version (151K): [in a new window]   Figure 3a. Images obtained in 74-year-old man who had melanoma metastatic to the right adrenal gland and residual disease at follow-up. (a) Transverse CT fluoroscopic image obtained with patient in prone position during RF ablation shows cluster electrode (arrow) in large adrenal mass. (b) Transverse contrast-enhanced CT image obtained with patient in supine position 6 months after original RF ablation shows central necrosis with peripheral residual enhancement of tumor (arrow).

View larger version (118K): [in a new window]   Figure 3b. Images obtained in 74-year-old man who had melanoma metastatic to the right adrenal gland and residual disease at follow-up. (a) Transverse CT fluoroscopic image obtained with patient in prone position during RF ablation shows cluster electrode (arrow) in large adrenal mass. (b) Transverse contrast-enhanced CT image obtained with patient in supine position 6 months after original RF ablation shows central necrosis with peripheral residual enhancement of tumor (arrow).