Fintelmann Florian J, Tuncali Kemal, Puchner Stefan, Gervais Debra A, Thabet Ashraf, Shyn Paul B, Arellano Ronald S, Tatli Servet, Mueller Peter R, Silverman Stuart G, Uppot Raul N
Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111.
Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
J Vasc Interv Radiol. 2016 Mar;27(3):395-402. doi: 10.1016/j.jvir.2015.11.034. Epub 2015 Dec 24.
To identify retrospectively predictors of catecholamine surge during image-guided ablation of metastases to the adrenal gland.
Between 2001 and 2014, 57 patients (39 men, 18 women; mean age, 65 y ± 10; age range, 41-81 y) at two academic medical centers underwent ablation of 64 metastatic adrenal tumors from renal cell carcinoma (n = 27), lung cancer (n = 23), melanoma (n = 4), colorectal cancer (n = 3), and other tumors (n = 7). Tumors measured 0.7-11.3 cm (mean, 4 cm ± 2.5). Modalities included cryoablation (n = 38), radiofrequency (RF) ablation (n = 20), RF ablation with injection of dehydrated ethanol (n = 10), and microwave ablation (n = 4). Fisher exact test, univariate, and multivariate logistical regression analysis was used to evaluate factors predicting hypertensive crisis (HC).
HC occurred in 31 sessions (43%). Ventricular tachycardia (n = 1), atrial fibrillation (n = 2), and troponin leak (n = 4) developed during HC episodes. HC was significantly associated with maximum tumor diameter ≤ 4.5 cm (odds ratio [OR], 26.36; 95% confidence interval [CI], 5.26-131.99; P < .0001) and visualization of normal adrenal tissue on CT or MR imaging before the procedure (OR, 8.38; 95% CI, 2.67-25.33; P < .0001). No HC occurred during ablation of metastases in previously irradiated or ablated adrenal glands.
Patients at high risk of catecholamine surge during ablation of non-hormonally active adrenal metastases can be identified by the presence of normal adrenal tissue and tumor diameter ≤ 4.5 cm on pre-procedure CT or MR imaging.
回顾性确定影像引导下肾上腺转移瘤消融过程中儿茶酚胺激增的预测因素。
2001年至2014年期间，两个学术医学中心的57例患者（39例男性，18例女性；平均年龄65岁±10岁；年龄范围41 - 81岁）接受了64个来自肾细胞癌（n = 27）、肺癌（n = 23）、黑色素瘤（n = 4）、结直肠癌（n = 3）和其他肿瘤（n = 7）的肾上腺转移瘤的消融治疗。肿瘤大小为0.7 - 11.3 cm（平均4 cm±2.5）。消融方式包括冷冻消融（n = 38）、射频（RF）消融（n = 20）、注射无水乙醇的RF消融（n = 10）和微波消融（n = 4）。采用Fisher精确检验、单因素和多因素逻辑回归分析来评估预测高血压危象（HC）的因素。
31次消融治疗（43%）发生了HC。HC发作期间出现室性心动过速（n = 1）、心房颤动（n = 2）和肌钙蛋白泄漏（n = 4）。HC与最大肿瘤直径≤4.5 cm（比值比[OR]，26.36；95%置信区间[CI]，5.26 - 131.99；P <.0001）以及术前CT或MR成像显示正常肾上腺组织显著相关（OR，8.38；95% CI，2.67 - 25.33；P <.0001）。在先前接受过照射或消融的肾上腺中消融转移瘤期间未发生HC。
术前CT或MR成像显示存在正常肾上腺组织且肿瘤直径≤4.5 cm可识别出在消融非激素活性肾上腺转移瘤期间发生儿茶酚胺激增的高危患者。
