Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
Department of Radiology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan.
Cardiovasc Intervent Radiol. 2020 Jun;43(6):882-888. doi: 10.1007/s00270-020-02454-0. Epub 2020 Mar 19.
To evaluate the frequency of ice ball cracks on CT during cryoablation of renal tumors and assess the severity of hemorrhagic complications associated with this finding.
Between March 2014 and March 2019, 130 patients underwent CT-guided cryoablation using cryoprobes with a diameter of 1.5 mm for 138 renal tumors (mean diameter, 23.6 mm; standard deviation [SD], 7.5; range, 8.3-43). Two blinded board-certified radiologists retrospectively reviewed the presence of cracks on CT obtained during the procedure. The incidence of major hemorrhage and changes in hemoglobin levels after cryoablation were examined. Factors influencing the appearance of ice ball cracks were assessed with multivariate analyses.
Cracks were observed in 25 of the138 procedures (18%). Inter-reader reliabilities with kappa statistics were 0.90 and 0.84 for first and second freeze sessions, respectively. There were no major hemorrhagic events requiring blood transfusion or arterial embolization. Mean (± SD) decreases in hemoglobin levels between pre- and postoperative day 1 were 1.15 ± 0.86 g/dl in the cracks group and 1.01 ± 0.80 g/dl in the no cracks group with no significant difference (p = 0.14). Multivariate analyses identified a higher number of cryoprobes (odds ratio, 4.1; 95% confidence interval [CI] 1.7-11; p = 0.001) and no hydrodissection (odds ratio 6.7; 95% CI 2.1-28; p < 0.001) as factors associated with ice ball cracks.
Ice ball cracks were frequently observed on CT during cryoablation for renal tumors and were seemingly self-limiting events requiring no intervention.
评估 CT 引导下冷冻消融治疗肾肿瘤时冰球出现裂纹的频率，并评估与该发现相关的严重出血并发症的严重程度。
2014 年 3 月至 2019 年 3 月，130 例患者接受了 138 个肾肿瘤的 CT 引导下冷冻消融治疗，使用直径为 1.5mm 的冷冻探针（平均直径，23.6mm；标准差[SD]，7.5；范围，8.3-43）。两位经过认证的放射科医生对术中获得的 CT 进行了盲法回顾，以评估冰球是否存在裂纹。检查了主要出血的发生率和冷冻消融后血红蛋白水平的变化。使用多元分析评估影响冰球裂纹出现的因素。
138 例手术中有 25 例（18%）出现了裂纹。两名读者的 Kappa 统计值分别为 0.90 和 0.84，用于评估第一次和第二次冷冻治疗的结果。没有需要输血或动脉栓塞的严重出血事件。有裂纹组和无裂纹组在术前和术后第 1 天的血红蛋白水平分别下降了 1.15±0.86g/dl 和 1.01±0.80g/dl，差异无统计学意义（p=0.14）。多因素分析发现，更多的冷冻探针（优势比，4.1；95%置信区间[CI] 1.7-11；p=0.001）和没有水分离（优势比，6.7；95% CI 2.1-28；p<0.001）是与冰球裂纹相关的因素。
在 CT 引导下冷冻消融治疗肾肿瘤时，冰球上经常观察到裂纹，这些裂纹似乎是自限性的，无需干预。
