J Korean Soc Radiol.  2012 Nov;67(5):387-395. 10.3348/jksr.2012.67.5.387.

Follow-Up of Cryoablated Renal Cell Carcinoma with Residual Contrast Enhancement on CT and MRI

• Park EK
• Sung DJ
• Park BJ
• Kim MJ
• Han NY
• Cho SB
• Kang SH

• KMID: 1819754
• DOI: http://doi.org/10.3348/jksr.2012.67.5.387

Abstract

PURPOSE
To describe the characteristics of residual contrast enhancement (CE) in cryoablated renal cell carcinoma (RCC) with regard to eventual resolution and the presence of residual tumor on follow-up CT and MRI.
MATERIALS AND METHODS
22 patients with 24 RCCs underwent laparoscopic renal cryoablation and follow-up CT (n = 19) and MRI (n = 3) for a mean of 28 months. Two radiologists retrospectively assessed the CT and MRI images for the tumor size and characteristics of residual CE in the cryolesions: peripheral rim (< 10% of the maximum cryolesion diameter), focal eccentric (10-25%), and thick internal enhancement (> 25%).
RESULTS
Residual CE was seen in 13 cryolesions (54%) at 3-month follow-up. Peripheral rim and focal eccentric enhancement was seen in six (25%) and four (16.7%) cryolesions, persisted for a mean follow-up of 4.5 and 6 months, and disappeared completely at a mean follow-up of 10.5 and 12 months, respectively. Three (12.5%) cryolesions showed persistent thick internal enhancement at 6-month follow-up, and were treated with radiofrequency ablation or chemotherapy. The cryolesions had decreased in size by an average of 20.2% and 39.7% at 6 and 12 months after cryoablation, respectively.
CONCLUSION
Follow-up for > or = 12 months is needed to assess treatment outcomes in patients with peripheral rim or focal eccentric enhancement of cryoablated RCCs, which may persist until 12 months postoperatively without remnant viable tumor.

MeSH Terms

Carcinoma, Renal Cell
Cryosurgery
Follow-Up Studies
Humans
Neoplasm, Residual
Retrospective Studies

Figure

• 

  Fig. 1 The chart shows 24 renal cell carcinomas in 22 patients who underwent contrast-enhanced CT and MRI after laparoscopic renal cryoablation. At 3 month follow-up, 13 cryolesions showed residual contrast enhancement. CT images show characteristic examples of residual contrast enhancement (arrows). Note.-CE = contrast enhancement, RCC = renal cell carcinoma

• 

  Fig. 2 Peripheral rim enhancement after cryoablation in a 73-year-old man with renal cell carcinoma. A. Contrast-enhanced CT before cryoablation shows 3.2 cm enhancing renal cell carcinoma (arrow) in the right kidney. B. Contrast-enhanced CT obtained 3 months after cryoablation shows peripheral rim enhancement (arrows) in the cryolesion. C. Contrast-enhanced CT obtained 12 months after cryoablation shows complete resolution of the peripheral rim enhancement and a reduction in the size of the cryolesion (arrow).

• 

  Fig. 3 Focal eccentric enhancement after cryoablation in a 52-year-old man with renal cell carcinoma. A. Contrast-enhanced CT before cryoablation shows 4.5 cm enhancing renal cell carcinoma (arrow) in the right kidney. B. Contrast-enhanced CT obtained 3 months after cryoablation shows residual focal eccentric enhancement (arrows) in the cryolesion. C. Contrast-enhanced CT obtained 18 months after cryoablation shows complete resolution of focus enhancement and a size reduction of the cryolesion (arrow).

• 

  Fig. 4 Persistent thick internal enhancement after cryoablation in a 59-year-old man with renal cell carcinoma. A. Contrast-enhanced MRI before cryoablation shows 2 cm enhancing renal cell carcinoma (arrow) in the right kidney. B. Contrast-enhanced MRI obtained 3 months after cryoablation shows thick internal enhancement (arrow) in the cryolesion. C. Contrast-enhanced MRI obtained 12 months after cryoablation shows interval enlargement of the enhancing focus (arrow), representing residual viable tumor in the cryolesion.

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