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- CTA Evaluation of Renal Tumors for Laparoscopic Nephrectomy, Partial Nephrectomy or Ablation Therapy
- CTA mapping of the renal arterial anatomy can be used to select patients for the most appropriate management pathway
- In patients with planned Laparoscopic Nephrectomy CTA can be used to show vascular maps and help prevent surgical complications
- In planning partial nephrectomy CTA can help determine what patients are good candidates for partial nephrectomy based in great part on the vascular map
- In patients with planned ablation therapy the extent of ablation can be defined and the apporoach planned
- After ablation when do we get followup studies?
- Scans should be done at 1, 3, 6 and 12 months
- After the first year follow-up is done every 6 to 12 months
- Follow-up should be done for at least 5 years
- “ Imaging surveillance of patients referred for renal RFA may be important not only to assess treatment success but also to detect new RCCs.”
Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up
Beland MD et al.
AJR 2011; 197:671-675 - “ Detection of a second RCC occurred up to 7.4 years after the initial RFA and up to 38 years after prior nephrectomy in our series. These findings indicate that long term imaging surveillance of patients referred for renal RFA may be important not only to assess treatment success but to detect new RCCs.”
Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up
Beland MD et al.
AJR 2011; 197:671-675 - “ Twenty eight patients (17%) had multiple biopsy proven RCCs. The mean interval between nephrectomy and RFA referral was 122 months (range, 12-456 months).”
Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up
Beland MD et al.
AJR 2011; 197:671-675
- “ Imaging surveillance of patients referred for renal RFA may be important not only to assess treatment success but also to detect new RCCs.”
Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up
Beland MD et al.
AJR 2011; 197:671-675 - “ Detection of a second RCC occurred up to 7.4 years after the initial RFA and up to 38 years after prior nephrectomy in our series. These findings indicate that long term imaging surveillance of patients referred for renal RFA may be important not only to assess treatment success but to detect new RCCs.”
Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up
Beland MD et al.
AJR 2011; 197:671-675 - “ Twenty eight patients (17%) had multiple biopsy proven RCCs. The mean interval between nephrectomy and RFA referral was 122 months (range, 12-456 months).”
Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up
Beland MD et al.
AJR 2011; 197:671-675 - Renal Artery Pseudoaneurysm: Presentation
- incidental finding (uncommon)
- pain at surgical site
- hematuria
- Hypotension (if it ruptures) - Renal Artery Pseudoaneurysm: Etiologies
- Iatrogenic (surgery)
- Trauma
- Atherosclerosis
- Fibromuscular dysplasia
- Vasculitis
- Infection
- Tumor "The reported incidence of renal artery pseudoaneurysms after open partial nephrectomy is 0.43%, and after laparoscopic partial nephrectomy is 1.7%."
Renal Artery Pseudoaneurysm after partial nephrectomy: three case reports and literature review
Albani JM, Novick AC
Urology 2003;62:227-231- Post Operative Mass s/p Ablation or Partial Nephrectomy: Differential Dx
- Simple cyst
- Complex cyst
- Solid mass
- Tumor recurrence
- Pseudoaneurysm Renal Halo Sign-Definition
"This post ablation appearance has been described previously as a "band or halo", a "fibrotic halo of fat" and a "bull’s eye" surrounding treated renal tumors."
Kidney Neoplasms: Renal Halo Sign After Percutaneous Radiofrequency Ablation-Incidence and Clinical Importance in 101 Consecutive Cases
Schirmang TC et al.
Radiology 2009; 253:263-269"The renal halo sign is seen in 75% of patients after percutaneous RFA of renal neoplasms. It may decrease in size over time; however, it rarely disappears."
Kidney Neoplasms: Renal Halo Sign After Percutaneous Radiofrequency Ablation-Incidence and Clinical Importance in 101 Consecutive Cases
Schirmang TC et al.
Radiology 2009; 253:263-269" The renal halo sign is seen in 75% of patients after percutaneous RFA of renal neoplasms. It may decrease in size over time; however, it rarely disappears. It is important to recognize this sign, as it can be mistaken for recurrent tumor or angiomyolioma by radiologists who are not familiar with RFA."
Kidney Neoplasms: Renal Halo Sign After Percutaneous Radiofrequency Ablation-Incidence and Clinical Importance in 101 Consecutive Cases
Schirmang TC et al.
Radiology 2009; 253:263-269"The technical success rate of ablation therapy is high, and the metastasis free survival rate for patients with localized, sporadic tumors is 97% at 2 years."
Percutaneous Image Guided Ablation of Renal Tumors
Miller JC et al.
J Am Coll Radiol 2009;6:527-530Kidney: Percutaneous Image Guided Ablation of Renal Cell Carcinoma: Indications
1. Patients who are poor medical candidates for surgery
2. Single kidney
3. Poor renal function
4. RCC in peripheral location without spread
5. Familial syndromes predisposing to multiple RCC’s
6. Life expectancy > 1 yr and < 10 years- Kidney: Percutaneous Image Guided Ablation of Renal Cell Carcinoma: Limitations
1. Tumors must be accessible percutaneously
2. Risk of damage to ureter if near tumor
3. Tumors near large blood vessels are less likely to be successfully ablated
4. Contraindicated in patients with sepsis or uncorrectable coagulopathy