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Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure?

Publication ,  Journal Article
Tsivian, M; Kim, CY; Caso, JR; Rosenberg, MD; Nelson, RC; Polascik, TJ
Published in: J Endourol
April 2012

BACKGROUND AND PURPOSE: Renal cryoablation has gained popularity as a treatment option for localized renal masses. Treatment success is typically defined by the absence of contrast enhancement on follow-up imaging. We investigate the evolution of lesions that demonstrate contrast enhancement on CT after renal cryoablation. PATIENTS AND METHODS: Retrospective review of records of laparoscopic and percutaneous cryoablation (LCA and PCA) was performed, identifying records with postoperative radiographic enhancement. Imaging studies were reviewed and radiographic (pre- and post-contrast Hounsfield units, pattern and location of enhancement) and clinical data including follow up were collected. RESULTS: One hundred and seventy-two cryoablation procedures were analyzed. Of these, 30 (17.4%) showed enhancement on follow-up CT. In 28 cases, contrast enhancement was demonstrated on the first postoperative study. Seven patients underwent salvage treatments. Spontaneous resolution of enhancement was noted in 17 (56.7%) cases. No association was found between enhancement pattern (diffuse/nodular/rim) and resolution. Of lesions enhancing >35 HU, only 14.3% resolved spontaneously. Delayed enhancement (after negative imaging studies) occurred in two patients; both underwent salvage treatments. CONCLUSIONS: Most of the time, contrast-enhancements after cryoablation are evident on the first follow-up imaging study. More than 50% of these resolve spontaneously, and only one of four patients need salvage treatment. Delayed appearance of enhancement after previously negative imaging and highly enhancing lesions (>35 HU) are unlikely to resolve and should be considered suspicious for local recurrence or incomplete ablation. Further investigation is warranted to reach a consensus on a radiographic definition of local recurrence after renal cryoablation.

Duke Scholars

Published In

J Endourol

DOI

EISSN

1557-900X

Publication Date

April 2012

Volume

26

Issue

4

Start / End Page

330 / 335

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Failure
  • Tomography, X-Ray Computed
  • Postoperative Care
  • Middle Aged
  • Male
  • Laparoscopy
  • Kidney Neoplasms
  • Kidney
  • Humans
 

Citation

APA
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MLA
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Tsivian, M., Kim, C. Y., Caso, J. R., Rosenberg, M. D., Nelson, R. C., & Polascik, T. J. (2012). Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure? J Endourol, 26(4), 330–335. https://doi.org/10.1089/end.2011.0337
Tsivian, Matvey, Charles Y. Kim, Jorge R. Caso, Michael D. Rosenberg, Rendon C. Nelson, and Thomas J. Polascik. “Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure?J Endourol 26, no. 4 (April 2012): 330–35. https://doi.org/10.1089/end.2011.0337.
Tsivian M, Kim CY, Caso JR, Rosenberg MD, Nelson RC, Polascik TJ. Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure? J Endourol. 2012 Apr;26(4):330–5.
Tsivian, Matvey, et al. “Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure?J Endourol, vol. 26, no. 4, Apr. 2012, pp. 330–35. Pubmed, doi:10.1089/end.2011.0337.
Tsivian M, Kim CY, Caso JR, Rosenberg MD, Nelson RC, Polascik TJ. Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure? J Endourol. 2012 Apr;26(4):330–335.
Journal cover image

Published In

J Endourol

DOI

EISSN

1557-900X

Publication Date

April 2012

Volume

26

Issue

4

Start / End Page

330 / 335

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Failure
  • Tomography, X-Ray Computed
  • Postoperative Care
  • Middle Aged
  • Male
  • Laparoscopy
  • Kidney Neoplasms
  • Kidney
  • Humans