Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
Department of Urology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
Abdom Radiol (NY). 2018 Oct;43(10):2750-2755. doi: 10.1007/s00261-018-1541-0.
The purpose of the study was to evaluate the post-contrast appearance of local tumor progression (LTP) following renal ablation to better understand patterns of tumor recurrence and to optimize follow-up imaging protocols.
From 2002 to 2015, 913 patients underwent 988 renal ablation procedures for treatment of 1064 tumors. LTP was identified in 24 (2.6%) patients during median imaging follow-up of 30 months (range 0-139). One patient with LTP was followed with non-contrast MRI only and was excluded from evaluation. Three body radiologists reviewed the contrast-enhanced CT and/or MRI follow-up imaging in the remaining 23 patients to determine the timing and imaging appearance of the recurrent tumor.
Local tumor progression was identified on contrast-enhanced CT or MRI at median 11 months (range 1 and 68) after renal ablation. Corticomedullary phase imaging was performed in 16/23 (70%) patients. LTP was identified on the corticomedullary phase in all cases, and was most conspicuous on the corticomedullary phase compared to any other phase of imaging in 15/16 (94%) patients. No cases of LTP were best visualized on non-contrast or excretory phase images.
Delayed recurrence following renal ablation is possible; therefore, extended follow-up is indicated in ablation patients. Almost all cases of LTP were best visualized on the corticomedullary phase of imaging, which should be included in any post-ablation imaging protocol. Excretory phase images were not required to diagnose LTP in any case and could be excluded from routine post-ablation follow-up.
本研究旨在评估肾消融后局部肿瘤进展（LTP）的增强后表现，以便更好地了解肿瘤复发模式，并优化随访成像方案。
2002 年至 2015 年，913 例患者接受了 988 例肾消融治疗 1064 个肿瘤。在中位 30 个月（范围 0-139 个月）的影像随访中，24 例（2.6%）患者发现 LTP。1 例 LTP 患者仅接受非增强 MRI 随访，未纳入评估。3 名体部放射科医生回顾了其余 23 例患者的增强 CT 和/或 MRI 随访影像，以确定复发性肿瘤的时间和成像表现。
肾消融后中位 11 个月（范围 1 至 68 个月）在增强 CT 或 MRI 上发现局部肿瘤进展。16/23 例（70%）患者进行了皮质髓质期成像。在所有病例中，LTP 在皮质髓质期均被识别，在 15/16 例（94%）患者中，LTP 在皮质髓质期的显示最为明显，明显优于任何其他成像期。没有 LTP 病例在非增强或排泄期图像上显示最佳。
肾消融后可能会出现延迟复发；因此，消融患者需要进行延长随访。几乎所有 LTP 病例在皮质髓质期成像上显示最佳，皮质髓质期成像应包含在任何消融后成像方案中。在任何情况下，排泄期图像都不是诊断 LTP 的必需条件，可以从常规消融后随访中排除。
