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MR Imaging Follow-up after Percutaneous Radiofrequency Ablation of Renal Cell Carcinoma: Findings in 18 Patients during First 6 Months¹

¹ From the Department of Radiology, Duke University Medical Center, Duke North-Room 1417, Erwin Rd, Durham, NC 27710 (E.M.M.); Department of Radiology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, Ohio (S.G.N.); and Department of Radiology, Johns Hopkins University, Baltimore, Md (J.S.L.). From the 2004 RSNA Annual Meeting. Received May 13, 2004; revision requested August 2; revision received September 14; accepted October 20. Address correspondence to E.M.M. (e-mail: elmar.merkle@duke.edu).

View larger version (166K): [in a new window]   Figure 1. Coronal high-field-strength breath-hold T2-weighted half-Fourier RARE MR image (800/42, one signal acquired, 205 x 256 matrix, 36 x 36-cm field of view) obtained at 2-week follow-up shows hypointense RF-induced thermal ablation zone (arrowheads) at posterior aspect of interpolar region of the right kidney.

View larger version (164K): [in a new window]   Figure 2a. Transverse two-dimensional T1-weighted GRE MR images (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view) of four different ablated RCCs (arrowheads) demonstrate the spectrum of possible signal intensity characteristics at high-field-strength (1.5-T) imaging. Thermal ablation zones may appear (a) hypointense, (b) isointense, or (c) hyperintense. The signal intensities of three of the 21 ablation zones, one of which is shown in d (arrowheads), were even higher than the signal intensity of the adjacent perirenal fat.

View larger version (148K): [in a new window]   Figure 2b. Transverse two-dimensional T1-weighted GRE MR images (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view) of four different ablated RCCs (arrowheads) demonstrate the spectrum of possible signal intensity characteristics at high-field-strength (1.5-T) imaging. Thermal ablation zones may appear (a) hypointense, (b) isointense, or (c) hyperintense. The signal intensities of three of the 21 ablation zones, one of which is shown in d (arrowheads), were even higher than the signal intensity of the adjacent perirenal fat.

View larger version (170K): [in a new window]   Figure 2c. Transverse two-dimensional T1-weighted GRE MR images (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view) of four different ablated RCCs (arrowheads) demonstrate the spectrum of possible signal intensity characteristics at high-field-strength (1.5-T) imaging. Thermal ablation zones may appear (a) hypointense, (b) isointense, or (c) hyperintense. The signal intensities of three of the 21 ablation zones, one of which is shown in d (arrowheads), were even higher than the signal intensity of the adjacent perirenal fat.

View larger version (163K): [in a new window]   Figure 2d. Transverse two-dimensional T1-weighted GRE MR images (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view) of four different ablated RCCs (arrowheads) demonstrate the spectrum of possible signal intensity characteristics at high-field-strength (1.5-T) imaging. Thermal ablation zones may appear (a) hypointense, (b) isointense, or (c) hyperintense. The signal intensities of three of the 21 ablation zones, one of which is shown in d (arrowheads), were even higher than the signal intensity of the adjacent perirenal fat.

View larger version (171K): [in a new window]   Figure 3a. Transverse high-field-strength two-dimensional fast low-angle shot GRE MR images (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view) obtained at 2-week follow-up show appearances of an RF-induced thermal ablation zone (arrowheads) at posterior aspect of interpolar region of the right kidney. (a) On unenhanced image, the ablation zone is hyperintense owing to hemorrhage. (b) On gadolinium-enhanced image, the ablation zone has enhancing margins.

View larger version (167K): [in a new window]   Figure 3b. Transverse high-field-strength two-dimensional fast low-angle shot GRE MR images (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view) obtained at 2-week follow-up show appearances of an RF-induced thermal ablation zone (arrowheads) at posterior aspect of interpolar region of the right kidney. (a) On unenhanced image, the ablation zone is hyperintense owing to hemorrhage. (b) On gadolinium-enhanced image, the ablation zone has enhancing margins.

View larger version (102K): [in a new window]   Figure 4a. Transverse high-field-strength MR images of the ablation zone (arrows) after the first of two debulking thermal ablation procedures performed to palliate patient with a large central RCC of the right kidney and global renal function impairment. (a) On breath-hold T2-weighted half-Fourier RARE image (800/42, one signal acquired, 205 x 256 matrix, 30 x 40-cm field of view), the ablation zone is hypointense. (b) On unenhanced two-dimensional T1-weighted in-phase GRE image (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40- cm field of view), the ablation zone is hyperintense. (c) On gadolinium-enhanced two-dimensional T1-weighted GRE image (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view), the ablation zone has no enhancement. The area of residual tumor (white arrowheads) can be readily identified as hyperintense tissue capping the anteromedial aspect of the ablation zone in a, as an isointense area in b, and as a markedly enhancing area in c. Note the left-sided nephrostomy tube (black arrowheads in a and c).

View larger version (105K): [in a new window]   Figure 4b. Transverse high-field-strength MR images of the ablation zone (arrows) after the first of two debulking thermal ablation procedures performed to palliate patient with a large central RCC of the right kidney and global renal function impairment. (a) On breath-hold T2-weighted half-Fourier RARE image (800/42, one signal acquired, 205 x 256 matrix, 30 x 40-cm field of view), the ablation zone is hypointense. (b) On unenhanced two-dimensional T1-weighted in-phase GRE image (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40- cm field of view), the ablation zone is hyperintense. (c) On gadolinium-enhanced two-dimensional T1-weighted GRE image (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view), the ablation zone has no enhancement. The area of residual tumor (white arrowheads) can be readily identified as hyperintense tissue capping the anteromedial aspect of the ablation zone in a, as an isointense area in b, and as a markedly enhancing area in c. Note the left-sided nephrostomy tube (black arrowheads in a and c).

View larger version (104K): [in a new window]   Figure 4c. Transverse high-field-strength MR images of the ablation zone (arrows) after the first of two debulking thermal ablation procedures performed to palliate patient with a large central RCC of the right kidney and global renal function impairment. (a) On breath-hold T2-weighted half-Fourier RARE image (800/42, one signal acquired, 205 x 256 matrix, 30 x 40-cm field of view), the ablation zone is hypointense. (b) On unenhanced two-dimensional T1-weighted in-phase GRE image (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40- cm field of view), the ablation zone is hyperintense. (c) On gadolinium-enhanced two-dimensional T1-weighted GRE image (fast low-angle shot sequence, 222/2.6, 70° flip angle, 205 x 256 matrix, 30 x 40-cm field of view), the ablation zone has no enhancement. The area of residual tumor (white arrowheads) can be readily identified as hyperintense tissue capping the anteromedial aspect of the ablation zone in a, as an isointense area in b, and as a markedly enhancing area in c. Note the left-sided nephrostomy tube (black arrowheads in a and c).