Cryotherapy of Renal Lesions: Enhancement on Contrast‐Enhanced Sonography on Postoperative Day 1 Does Not Imply Viable Tissue Persistence

Bertolotto, Michele; Siracusano, Salvatore; Cicero, Calogero Edoardo; Iannelli, Mariano; Silvestri, Tommaso; Celia, Antonio; Guarise, Alessandro; Stacul, Fulvio

doi:10.7863/ultra.16.02061

Cited by 7 publications

(14 citation statements)

References 34 publications

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“…Medullary perfusion follows cortical perfusion, with the outer medulla enhancing first, followed by gradual fill‐in of the pyramids . Then, according to the EFSUMB guidelines, in our departments, contrast‐enhanced sonography is increasingly used as an adjunct to CT/MRI in a variety of clinical situations related to the kidneys: among them, patients with suspected pseudotumors not solved with conventional Doppler modes, cases with renal perfusion abnormalities, complex cysts or renal masses with undetermined enhancement, patients undergoing tumor ablation before treatment and during the follow‐up, and when a contrast study is needed in a patient with severe renal impairment . Visualization of normal‐appearing branching vessels from the hilum to the renal cortex is a very useful sign that no mass is present .…”

Section: Discussionmentioning

confidence: 99%

Solid Renal Tumors Isoenhancing to Kidneys on Contrast‐Enhanced Sonography: Differentiation From Pseudomasses

Bertolotto

Cicero

Catalano

et al. 2017

J of Ultrasound Medicine

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Objectives-To estimate the prevalence of solid renal tumors isoenhancing to kidneys in all vascular phases on contrast-enhanced sonography and to investigate whether they can be differentiated from pseudomasses.Methods-A computer search of the databases of 3 institutions identified 31 patients with pseudomasses and 380 patients with solid tumors investigated with contrast-enhanced sonography. Nineteen of 380 (5%) patients had tumors isoenhancing in all phases. Images and clips of these 19 tumors and the 31 pseudomasses were blindly assessed by 2 radiologists. They were asked to differentiate tumors from pseudomasses based on echogenicity, vascular architecture, and the presence of the medulla.Results-Isoenhancing tumors were clear cell carcinomas (n 5 7), angiomyolipomas (n 5 3), papillary tumors (n 5 3), metastasis (n 5 1), and oncocytoma (n 5 1). In the 4 nonoperated tumors, the diagnosis was confirmed by progression during the follow-up. There were 3 markedly hyperechoic, 11 mildly hypo/hyperechoic, and 5 isoechoic masses. Most pseudomasses were isoechoic to kidneys (23 of 31), with the medulla identified in 22 of 31 and 15 of 31 by radiologists 1 and 2, respectively. One and 2 pseudomasses were considered tumors by radiologists 1 and 2, respectively. One isoechoic isoenhancing tumor was not identified on contrast-enhanced sonography. Isoenhancing tumors in all phases were differentiated from pseudomasses by combining grayscale and contrast-enhanced sonography (areas under the receiver operating characteristic curve, 0.997 for reader 1; 0.969 for reader 2), with very good inter-reader agreement (weighted j 5 0.81).Conclusions-In our retrospective study, 5% of solid renal lesions were isoenhancing to kidneys in all phases. Differentiation from pseudomasses was possible by looking at baseline sonographic features and vascular characteristics.

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Section: Discussionmentioning

confidence: 99%

Solid Renal Tumors Isoenhancing to Kidneys on Contrast‐Enhanced Sonography: Differentiation From Pseudomasses

Bertolotto

Cicero

Catalano

et al. 2017

J of Ultrasound Medicine

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“…Another use of CEUS is to distinguish kidney tumors and/or other conditions in which the convective B mode and US Doppler have not helpful the radiologist to a definitive diagnosis: for example, the pseudotumors have the same degree of enhancement as the remaining healthy renal parenchyma [7,8] .…”

Section: Ceusmentioning

confidence: 99%

“…However, it is also the most expensive imaging technique [6] and cannot be used in patients with a pacemaker, uncooperative patients, and patients with severe renal failure. There are occasionally issues related to patient tolerance and safety, in particular the risk of nephrogenic systemic fibrosis in patients with estimated glomerular filtration rates under 30 mL/min, when exposed to MRI contrast agents [7][8][9] . Moreover, the MRI characterization of SMRs may be difficult, as image subtraction cannot be effectively performed.…”

Section: Mrimentioning

confidence: 99%

“…This signal is the first post operative day not allow to diagnose a failure of the procedure. For this reason, it is important to perform a CEUS at 30 days to evaluate a successful or uncessful ablation [ Figure 10] [8] . This is particularly true in cryoablated lesions (15%-20% of cases) that can exhibit post-ablation contrast enhancement on initial postoperative imaging and also for the first few months, which resolves in 45% of patients in a period from 1 up to 14 months.…”

Section: Imaging Modalities -Follow-upmentioning

confidence: 99%

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Imaging

Cicero¹,

Casarin²,

Curr��³

et al. 2019

MIS

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The incidence of renal cell carcinoma is rising and its represents the 2%, 3% of all cancers. The increased use of ultrasonography, contrast enhanced ultrasonography, computed tomography and magnetic resonance imaging have resulted in incidentally detected small renal masses (SRMs). SRMs represent a heterogeneous group of tumors that included metastatic lesions, benign, malignant, and cystic lesions. With the increase number of renal incidentalomas, we have seen an increase in therapeutic choices (surgery, ablation therapies and active surveillance). The role of imaging has progressively grown over the decades and became currently a cornerstone that is needed to perform diagnosis, treatment and follow-up of SRMs after ablation treatment. Hence, in this review, we critically assess recent literature on the role of imaging in the context of ablation management of SRMs with a focus on the diagnosis and follow-up protocol.

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“…If no relevant complications are seen, nor intralesional vascularity, follow-up is performed at increasing intervals, typically 3-6 months and 12 months after cryoablation, and yearly thereafter, to identify any residual tumour tissue early on, and then local recurrences [6][7][8][9][10] . It is our practice to initially document absence of residual tumour tissue six months after the procedure 11 .…”

Section: Introductionmentioning

confidence: 99%

Contrast‐enhanced ultrasound after successful cryoablation of benign and malignant renal tumours: how long does tumour enhancement persist?

Bertolotto

Campo²,

Sachs³

et al. 2021

J Med Imag Rad Onc

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Introduction: To investigate how long successfully ablated tumours take to become completely avascular at CEUS after cryoablation. Methods: Ninety-five patients had percutaneous cryoablation of 103 renal tumours investigated at CEUS on post-operative day one. If the lesion was avascular, a contrast-CT/MR was scheduled six months after the procedure, while CEUS was repeated if the lesion still displayed enhancement, until the disappearance of intralesional vascularity. Technical success was defined when the tumour was covered completely by the ablation zone. Technique efficacy was assessed at six months of follow-up. Results: Technical efficacy was obtained for 101/103 cryoablations, 56% of which (57/101) were avascular on post-operative day one. After one week, two weeks, one month 83%, 91% and 100% of these 101 lesions, respectively, were avascular. Two tumours were unsuccessfully treated. They displayed persistent intralesional vascularity at CEUS one month after the procedure. Conclusions: After cryoablation, obtaining CEUS before one month may be misleading. When technical efficacy is obtained, disappearance of intralesional enhancement is observed within two weeks in the majority of cases (91%), but can persist until one month. Identification of tumour enhancement after one month may be concerning for residual viable tumour.

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Cryotherapy of Renal Lesions: Enhancement on Contrast‐Enhanced Sonography on Postoperative Day 1 Does Not Imply Viable Tissue Persistence

Abstract: After cryoablation, intratumoral enhancement on early contrast-enhanced sonography does not imply tumor cell viability.

Cited by 7 publications

References 34 publications

Solid Renal Tumors Isoenhancing to Kidneys on Contrast‐Enhanced Sonography: Differentiation From Pseudomasses

Solid Renal Tumors Isoenhancing to Kidneys on Contrast‐Enhanced Sonography: Differentiation From Pseudomasses

Imaging

Contrast‐enhanced ultrasound after successful cryoablation of benign and malignant renal tumours: how long does tumour enhancement persist?

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