SIR 2024
Imaging
Tarik Babar, BS, MS
Medical Student
Alabama College of Osteopathic Medicine
Disclosure information not submitted.
Junaid Raja, MD, MSPH, M.S.
Assistant Professor
University of Alabama Birmingham
Financial relationships: Full list of relationships is listed on the CME information page.
Husameddin El Khudari, MD (he/him/his)
Associate Professor
UAB
Financial relationships: Full list of relationships is listed on the CME information page.
Junjian Huang, MD
Assistant Professor
UAB Heersink School of Medicine
Disclosure information not submitted.
Andrew Gunn, MD
Program Director IR/DR
University of Alabama At Birmingham
Financial relationships: Full list of relationships is listed on the CME information page.
Aliaksei Salei, MD (he/him/his)
Assistant Professor, Division of Interventional Radiology
UAB Hospital
Disclosure information not submitted.
This exhibit aims to review follow-up imaging schedules following percutaneous renal ablation for RCC. Additionally, the strengths and weaknesses of CT, MRI, and contrast-enhanced ultrasound (CEUS) when used after percutaneous renal ablation, including recognizing tumor recurrence, will be discussed via a case-based demonstration. Moreover, the most common complications of percutaneous renal ablation, including their imaging findings and clinical management will be discussed.
Background:
With greater than 400,000 new worldwide cases per year, RCC represents a major global cancer burden {1}. Surgical nephrectomy, alongside chemotherapy and radiation were previously considered the mainstays of management options. Percutaneous ablation represents an increasingly important adjunctive therapy used in the management of RCC, especially with localized disease. Appropriate follow-up imaging can identify early signs of recurrence or the presence of procedural complications. With various imaging modalities available for follow-up imaging including CT, MRI, and CEUS, it is important to recognize the indications, indications, and advantages of each.Â
Clinical Findings/Procedure Details:
Since there is a paucity of data comparing the effectiveness of the modalities against each other, the decision between post-procedural CT or MRI is driven by patient characteristics including the ability to tolerate iodinated contrast material. The sensitivity of detecting recurrent disease on CT or MRI 6 months post-procedurally is 77.8% sensitivity and 95.1% specificity with a 97.7% negative predictive value {2}. CEUS is another valuable tool that has been associated with high sensitivity, specificity, accuracy, positive and negative predictive values when used for long-term follow up after MWA {3}. Post-ablative imaging findings on CT, MRI, and CEUS will be further discussed in this exhibit, including complete and partial responses and tumor recurrence. In regard to procedural complications, small perinephric hematoma formation is commonly seen which is often asymptomatic. Major complications are seen in less than 4% of cases and include hemorrhage, abscess, and damage to collecting systems. {4,5}.
Conclusion and/or Teaching Points:
With percutaneous renal ablation seeing an increasingly important role in the management of RCC, further awareness of post-procedural imaging findings will help solidify the interventionalist’s role in overall patient management.