Michael David Rosenberg BA, Presenter: Nothing to Disclose

Charles Yoon Kim MD, Abstract Co-Author: Nothing to Disclose

Matvey Tsivian MD, Abstract Co-Author: Nothing to Disclose

Rendon C. Nelson MD, Abstract Co-Author: Consultant, General Electric Company Research support, Bracco Group Research support, Becton, Dickinson and Company Speakers Bureau, Siemens AG

To determine the incidence of collecting system and hemorrhagic complications resulting from CT-guided percutaneous cryoablation of renal tumors in which the radiographic ice ball abuts or involves the renal sinus.

This study had institutional review board approval and was HIPAA compliant; a waiver of informed consent was obtained. From November 2005 through July 2009, 129 CT-guided percutaneous cryoablations were performed at our institution on 107 patients with renal masses suspicious for renal cell carcinoma (71 males, 36 females; mean age 64, range: 45-87). Pre-procedural, intra-procedural, and post-procedural images were reviewed, and tumor size and ice ball overlap with the sinus were measured. Radiographic ice balls that abutted or overlapped the renal sinus were classified as central, with the remainder classified as non-central. Medical records and follow-up imaging studies were reviewed for significant hemorrhage requiring intervention and for evidence of collecting system injury such as urinoma, local collecting system stricture, or fistulous tract. The mean follow up was 9.3 months (range 0-45).

The mean diameter of ablated renal lesions was 2.2 cm (range 0.8-5.7). In 67 cases, the ice ball abutted or involved the renal sinus. The mean tumor diameter was significantly higher for central ice balls compared to non-central: 2.5 cm versus 1.9 cm, p<0.001. In central ice balls, a mean of 2.5 cryoprobes were used, compared to 1.8 for non-central ice balls (p<0.001). Of the central ice balls, the mean involvement of the sinus was 3 mm (range 0-19), with 41 ice balls overlapping the renal sinus by 6mm or more (mean 9.4mm). No cases of collecting system injury were identified for central or non-central ice balls. Overall, there was only one hemorrhagic complication requiring intervention, which was in a non-central ablation of a 1.4cm tumor requiring subsequent percutaneous embolization.

In our experience with CT-guided percutaneous cryoablation of renal masses where the ice ball abuts or overlaps the renal sinus, we had no cases of collecting system injuries or significant hemorrhagic complications.

Percutaneous cryoablation of renal masses with ice ball involvement of the renal sinus can be performed safely, with very low risk of collecting system and hemorrhagic complications.

Rosenberg, M, Kim, C, Tsivian, M, Nelson, R, Percutaneous Cryoablation of Renal Lesions with Radiographic Ice Ball Involvement of the Renal Sinus: Analysis of Hemorrhagic and Collecting System Complications.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011986.html