Michele Bertolotto MD, Presenter: Nothing to Disclose

Fulvio Stacul MD, Abstract Co-Author: Nothing to Disclose

Calogero Cicero, Abstract Co-Author: Nothing to Disclose

Francesca Cacciato, Abstract Co-Author: Nothing to Disclose

Salvatore Siracusano MD, Abstract Co-Author: Nothing to Disclose

Maria Assunta Cova MD, Abstract Co-Author: Nothing to Disclose

Matilde Cazzagon, Abstract Co-Author: Nothing to Disclose

Antonio Celia, Abstract Co-Author: Nothing to Disclose

To evaluate the diagnostic accuracy of contrast enhanced ultrasound (CEUS) in the early detection of residual tumor after cryoablation.

Twenty-six patients with 31 renal tumors (20 men, 6 women; mean age, 69 years; range, 52–81 years) underwent percutaneous cryoablation between August 2011 and July 2013. All tumors were treated with CT guidance. Patients underwent CEUS before, within 1 day (early follow-up CEUS), 1 month and 3 months after the ablation. In patients with persistent lesion vascularity at early follow-up CEUS the test was repeated also 1 week after the treatment. Reference standard was MRI/CT performed every 6 months after cryoablation for the first two years, and then yearly.

The mean tumor size was 20 mm (range, 6-37 mm). One patient was lost to follow up. Twenthy-five patients with 30 renal tumors were followed-up for at least 6 months and all underwent CEUS. MRI was perfomed in 21 patients, CT in 4 patients who had contraindications to MR scanning. The mean follow-up period was 15 months (range, 6-24 months). Early CEUS follow-up displayed a completely avascular lesion in 24/30 renal lesions. Minimum to mild perilesional enhancement was present in 4 cases, which disappeared progressively during the follow-up. One type IV cystic tumor had two intralesional vegetations (10 and 20 mm, respectively), which were still vascularized early after cryoablation and during the follow-up and were categorized as residual tumor. Severe comorbidities precluded from repeated cryoablation. Two lesions were vascularized in the early CEUS follow-up while the CEUS investigation repeated 1 week and 1 month after the treatment documented progressive devascularization of the mass.

CEUS is an effective alternative to CT and MRI for the early diagnosis of residual tumour after renal percutaneous cryoablation. Care should be taken, however, in interpreting persistent vascularity in the early CEUS follow-up as residual tumor. Repeated CEUS investigations allow to differentiate between a late devascularization of a successfully ablated tumor and persistent disease.

CEUS is able to monitor the result of cryoablation of renal tumors. Early features after the treatment, however, should be interpreted with caution to avoid misdiagnosis of persistent disease.

Bertolotto, M, Stacul, F, Cicero, C, Cacciato, F, Siracusano, S, Cova, M, Cazzagon, M, Celia, A, Cryotherapy for Renal-cell Cancer: Evaluation of the Efficacy of the Treatment with Contrast-Enhanced Ultrasonography (CEUS).  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014233.html