CT Contrast Enhancement Following Renal Cryoablation - Does it Represent Treatment Failure?

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OBJECTIVE: For minimal invasive treatment of small renal masses, cryoablation has gained popularity. Treatment success is defined as absence of contrast enhancement on postoperative imaging of the cryoablated lesion, but contrast enhancement does not necessary equal treatment failure. This present study investigates the proportion of spontaneous resolutions after initial contrast enhancement in relation to cryoablation.

PATIENTS AND METHODS: Data were collected from a prospectively maintained clinical database containing all patients treated with primary laparoscopic and percutaneous cryoablation between August 2005 and December 2013. All images were evaluated with regard to PADUA-score, cryolesion size, contrast enhancement pattern and tissue density.

RESULTS: A total of 107 patients with a biopsy verified malignant tumor were included in the study. On postoperative imaging 33 (31%) patients presented with contrast enhancement. Spontaneous resolution was observed in 15 (45%) patients after a mean follow-up time of 14 months. Patients with cryolesions that resolved spontaneously were found to have less anatomical complex tumor compared to patients with treatment failure (PADUA 7.8 vs. 9.5, p<0.01). A total of 7 patients with a PADUA-score ≥ 10 and contrast enhancing cryolesions were diagnosed as treatment failure. No association was found between BMI, histology, treatment modality, enhancement pattern, number of applied cryoprobes and resolution.

CONCLUSION: Postoperative contrast enhancement is commonly observed after cryoablation and a large portion of these lesions often resolve spontaneously, thus not representing treatment failure. In patients with a high preoperative PADUA score and postoperative contrast enhancement of the cryolesion, treatment failure or recurrent disease should be suspected.

TidsskriftJournal of Endourology
Sider (fra-til)1353-1360
Antal sider8
StatusUdgivet - 8 jul. 2015

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