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The outcomes of technically successful image-guided percutaneous thermal ablation of melanoma adrenal metastases involving 11 tumors in 9 consecutive patients over 12 years (2009–2020) were evaluated. All patients had multiple treated metastatic sites, and 44.4% (4/9) had greater than 5 metastatic sites. The mean maximal tumor diameter was 3.6 ± 1.6 cm. The local recurrence-free survival at 1 year was 85.7%. With a median survival of 19.4 months, 66.6% (6/9) of patients died from tumor progression. The 1- and 3-year overall survival rate was 60.0% and 30.0%, respectively. All patients were pretreated with alpha-adrenergic blockade, and 36% (4/11) developed a hypertensive crisis. The median hospital length of stay was 1 day (range, 1–2 days), without any major complications. Thermal ablation of adrenal metastasis from a melanoma provides acceptable local control and a good safety profile.

The treatment outcomes of ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma in the caudate lobe with and without fusion imaging (FI) assistance were evaluated and compared. Twenty-six patients with 28 tumors in the FI group and 8 patients with 8 tumors in the non-FI group were included. Although a higher number of tumors measured >20 mm in the FI group, the technique efficacy and local tumor progression were similar between the 2 groups (P > .99 and P = .45, respectively). FI aided in the detection, guidance, and treatment monitoring of thermal ablation for caudate lobe hepatocellular carcinomas, especially for tumors measuring >20 mm.

Purpose To assess the effectiveness, safety, and overall survival (OS) of thermal ablation as upfront treatment of intrahepatic colangiocarcinoma (ICC) in patients with cirrhosis. Materials and Methods This was a retrospective analysis of all biopsy-confirmed ICC in cirrhotic patients treated in the authors’ unit from 2001 to 2017. Baseline characteristics, ablation procedures, and complications were recorded, and time to recurrence (TTR) and OS were calculated. Twenty-seven patients were identified. Seventy percent had Child-Pugh A disease, and most had clinically significant portal hypertension. Median tumor size was 21 mm. Twenty-one cases were uninodular, and 10 were single ≤ 2 cm. Results Complete radiologic necrosis was achieved in 25 cases (92.6%). Median OS was 30.6 months (95% confidence interval [CI], 22.6–46.5), and recurrence was detected in 21 cases (77.8%) with a TTR of 10.1 months (95% CI, 7.7–20.9). In those patients with single ≤ 2-cm ICC, the OS was 94.5 months (95% CI, 11.7–not reached). Differences in OS were statistically significant between patients with single ICC ≤ 2 cm and patients with single ICC > 2 cm (P = .04) and between patients with single ICC > 2 cm and patients with multinodular ICC (P = .02). Only 1 patient had a treatment-related complication. Conclusions Thermal ablation is a safe and effective treatment for ICC in patients with cirrhosis who are not candidates for surgery. The OS is similar to that reported in surgical series, but the initial treatment success is hampered by a high rate of tumor recurrence. Encouraging long-term survival after thermal ablation is achieved in patients with single ≤ 2-cm ICC.

Purpose Hydroinfusion is a commonly used ancillary procedure during percutaneous thermal ablation of the liver that is used to separate and protect sensitive structures from the ablation zone. However, risks of hydroinfusion have not been systematically studied. The purpose of the present study was to systematically examine the frequency and severity of local and systemic complications related to hydroinfusion. Materials and Methods From January 2009 to April 2012, 410 consecutive patients underwent percutaneous thermal hepatic tumor ablation. One hundred fifty patients in the study group underwent hydroinfusion and 260 in the control group did not. Patient charts and imaging studies of both groups were reviewed to compare incidences of complications that could potentially be caused by hydroinfusion, including pleural effusion, bowel injury, infection, electrolyte imbalance, and hyperglycemia. Results Pleural effusions were found to occur more commonly in the hydroinfusion group (45.3%) than in the control group (16.5%). Pleural effusions were significantly larger ( P P = .006) in the hydroinfusion group than in the control group (one of 260 patients). Multiple patient and tumor characteristics were analyzed for association with development of major hydroinfusion-type complications (requiring therapy or extended/repeat hospitalization). Subcapsular location of tumor was the only variable to reach statistical significance ( P = .009), with all major hydroinfusion-type complications (n = 10) occurring in patients with subcapsular tumors. Conclusions Hydroinfusion is a safe procedure overall. However, pleural effusions occur commonly after hydroinfusion, tend to be moderate or large in size, and are occasionally symptomatic.

Purpose To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma. Materials and Methods A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated. Results A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (−29.06 mm Hg; 95% confidence interval [CI], −33.93 to −24.19), DBP (−16.03 mm Hg; 95% CI, −18.33 to −13.73), and the number of antihypertensive medications used (−1.43; 95% CI, −1.97 to −0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration. Conclusions Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.

Purpose To examine the effect of percutaneous thermal ablation of renal masses on renal function among patients with baseline chronic kidney disease (CKD). Materials And Methods Patients with baseline CKD (initial glomerular filtration rate [GFR] 2 ) who underwent percutaneous cryoablation or radiofrequency (RF) ablation of renal masses were reviewed. Results A total of 48 patients with a GRF of 60 mL/min/1.73 m 2 or lower were treated with renal cryoablation or RF ablation and had follow-up GFR measurement 1 month afterward. Mean patient age was 73 years (range, 47–89 y). Cryoablation was performed in 22 patients and RF ablation was performed in 26. Mean tumor diameter was 3.4 cm (range, 0.9–10.2 cm). Mean overall GFRs were 39.8 mL/min/1.73 m 2 at baseline and 39.7 mL/min/1.73 m 2 at 1 month after ablation ( P = .85). A total of 38 patients had 1-year follow-up GFR measurement (cryoablation, n=18; RF ablation, n=20), and their mean GFR was 40.9 mL/min/1.73 m 2 ± 11.4 (SD), compared with a preablation GFR of 41.2 mL/min/1.73 m 2 ( P = .79). In the cryoablation group, mean GFRs at 1 month and 1 year were 41.4 mL/min/1.73 m 2 and 44.4 mL/min/1.73 m 2 , compared with respective baseline GFRs of 41.1 mL/min/1.73 m 2 and 42.1 mL/min/1.73 m 2 ( P = .75 and P = .19, respectively). In the RF ablation group, mean GFRs at 1 month and 1 year were 38.2 mL/min/1.73 m 2 and 37.8 mL/min/1.73 m 2 , compared with respective baseline GFRs of 38.7 mL/min/1.73 m 2 and 40.4 mL/min/1.73 m 2 ( P = .58 and P = .09, respectively). Conclusions Independent of ablation modality, percutaneous renal mass ablation does not appear to affect renal function among patients with CKD.

Purpose To validate a monitored, breath-hold positron emission tomography (PET)/computed tomography (CT) acquisition technique for the minimization of respiratory PET/CT image misregistration and lesion distortion during PET/CT–guided percutaneous interventional procedures. Materials and Methods Eleven patients referred for percutaneous biopsy or thermal ablation of tumors near the diaphragm were prospectively enrolled. Initial PET/CT scanning was performed by using a bellows device and monitored, same-level breath-holds for PET and CT acquisitions. Breath-hold PET consisted of nine 20-second breath-hold frames, yielding a 3-minute equivalent PET dataset. A second PET/CT scan was obtained without monitoring by using end-expiration breath-hold CT and free-breathing PET. PET/CT tumor misregistration and craniocaudal tumor diameter were measured on monitored and unmonitored PET/CT datasets. Data were analyzed by using nonparametric, two-sided, signed-rank statistical tests. Results Mean PET/CT image misregistrations in the craniocaudal, anteroposterior, and transverse planes were 2.6 mm (range, 0–7 mm), 3.3 mm (range, 1–8 mm), and 2.7 mm (range, 0–8 mm) with monitoring and 14.7 mm (range, 0–49 mm), 7.6 mm (range, 1–24 mm), and 4.0 mm (range, 0–12 mm) without monitoring, respectively. Differences were significant for craniocaudal ( P = .0087) and anteroposterior ( P = .014) planes, but not for the transverse plane ( P = .23). Mean craniocaudal target diameter was 2.5 mm (range, −2 to 9 mm) larger (ie, distorted) for unmonitored versus monitored PET ( P = .061). Conclusions Acquiring PET/CT datasets with respiratory bellows-assisted, monitored breath-holds improves PET/CT image registration versus unmonitored PET/CT and may facilitate accurate targeting during PET/CT–guided interventions in anatomic regions subject to respiratory motion.

Cryoablation refers to all methods of destroying tissue by freezing. Cryoablation causes cellular damage, death, and necrosis of tissues by direct mechanisms, which cause cold-induced injury to cells, and indirect mechanisms, which cause changes to the cellular microenvironment and impair tissue viability. Cellular injury, both indirect and direct, can be influenced by four factors: cooling rate, target temperature, time at target temperature, and thawing rate. In this review, the authors describe the mechanisms of cellular injury that occur with cryoablation, the major advantages and disadvantages of cryoablation compared with other thermal ablation techniques, and the current commercially available cryoablation ablation systems.

Neil M. Khilnani, MD, Clement J. Grassi, MD, Sanjoy Kundu, MD, FRCPC, Horacio R. D’Agostino, MD, Arshad Ahmed Khan, MD, J. Kevin McGraw, MD, Donald L. Miller, MD, Steven F. Millward, MD, Robert B. Osnis, MD, Darren Postoak, MD, Cindy Kaiser Saiter, NP, Marc S. Schwartzberg, MD, Timothy L. Swan, MD, Suresh Vedantham, MD, Bret N. Wiechmann, MD, Laura Crocetti, MD, John F. Cardella, MD, and Robert J. Min, MD, for the Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Society of Interventional Radiology Standards of Practice Committees

In recent years, research advancement in stem cell therapy has been rapid. Accordingly, general clinical, scientific, and public attention to the application of stem cell therapy has been substantial. Promises are great, most notably with regard to the application of stem cell therapy for diseases that are currently difficult to treat or incurable such as Parkinson disease or diabetes mellitus. It is in the best interest of patient care for diagnostic and interventional radiologists to be actively involved in the development of these therapies, both at the bench and at the bedside in clinical studies. Specifically, the diagnostic radiologist can become an expert in imaging, tracking, and monitoring of stem cells and in the assessment of engraftment efficiency, whereas the interventionalist is a natural expert in targeted stem cell delivery by means of different routes (percutaneous, selective intravenous, or intraarterial). In addition, there is a potential role for the interventionalist to create engraftment territory and increase engraftment bed fertility with controlled intentional tissue destruction (eg, by means of thermal ablation) that might precede stem cell administration.

To determine influence of hepatic vein size on perfusion-mediated attenuation in adjacent microwave thermal ablation.With approval of the institutional animal research committee, seven Yorkshire pigs underwent percutaneous (n = 2) or open (n = 5) microwave liver ablation under general anesthesia. In each, multiple ultrasound-guided, nonoverlapping thermal lesions were created within 1 cm of hepatic veins in a 5-10-minute ablation at 45 W. After euthanasia, the liver was harvested and sectioned at 0.5-cm intervals and the degree of perivascular coagulation attenuation was graded on histopathologic analysis. Correlation between venous size (small,or =3 mm; medium, 3-6 mm; and large,6 mm) and attenuation grade was performed with use of the Spearman rank test.In 63 of 103 sections (61%)--29 of 37 (78%) small, 27 of 48 (56%) medium, and seven of 18 (39%) large veins--the thermal injury extended to the vein wall around the entire circumference of the coagulation front without distortion of the ablation margin. In 40 of 103 sections (38.9%), varying degrees of concave distortion of perivenous ablation margins were noted, with significant correlation between vein size and heat-sink extent (P.01). However, thermal injury extended to the vascular wall in all sections without complete circumferential sparing of liver tissue. Around two thrombosed veins, thermal lesions encased the vessels, producing paradoxically convex ablation margins.Although the heat-sink effect was significantly dependent on hepatic vein size, the majority of pathologic sections exhibited no or minimal effect. Further study is required to assess clinical implications.

PURPOSE To evaluate the clinical outcomes in patients with early-stage non–small-cell lung cancer (NSCLC) after combined treatment with thermal ablation and radiation therapy (RT). MATERIALS AND METHODS Forty-one patients with inoperable stage I/II NSCLC tumors underwent thermal ablation and RT at our institution between 1998 and 2005. Thirty-seven radiofrequency (RF) ablation procedures and four microwave ablation procedures were performed. Ablations were followed by standard-fraction external-beam RT within 90 days ( n = 27) or postprocedural brachytherapy ( n = 14). Survival and local recurrence were the primary endpoints evaluated by Kaplan-Meier analysis. RESULTS The median follow-up was 19.5 months. The overall survival rates were 97.6% at 6 months, 86.8% at 1 year, 70.4% at 2 years, and 57.1% at 3 years. Patients with tumors smaller than 3 cm ( n = 17) had an average survival time of 44.4 ± 5.4 months (SE). Patients with tumors 3 cm or larger ( n = 24) had an average survival time of 34.6 ± 7.0 months ( P = .08). Local recurrence occurred in 11.8% of tumors smaller than 3 cm after an average of 45.6 ± 4.1 months and in 33.3% of the larger tumors after an average of 34.0 ± 7.8 months ( P = .03). Outcomes in the brachytherapy and RT groups did not differ significantly. Nine of 15 pneumothoraces required chest tube drainage (22.0%). CONCLUSIONS Thermal ablation followed by RT for inoperable stage I/II NSCLC has a relatively low rate of complications that are easily managed. Combined therapy may result in an improved survival compared with either modality alone.