700 FOLLOW-UP OF LAPAROSCOPIC RENAL CRYOABLATION (LRC) BY CONTRAST ENHANCED ULTRASOUND

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2012700 FOLLOW-UP OF LAPAROSCOPIC RENAL CRYOABLATION (LRC) BY CONTRAST ENHANCED ULTRASOUND Kurdo Barwari, Hessel Wijkstra, Jean de la Rosette, and Pilar Laguna Kurdo BarwariKurdo Barwari Amsterdam, Netherlands More articles by this author , Hessel WijkstraHessel Wijkstra Amsterdam, Netherlands More articles by this author , Jean de la RosetteJean de la Rosette Amsterdam, Netherlands More articles by this author , and Pilar LagunaPilar Laguna Amsterdam, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stringent radiological follow-up (FU) after ablation is essential and commonly performed by means of CT-scans with contrast. Major drawbacks of CT are the associated exposure to ionizing radiation and nephrotoxic contrast-agent. CEUS (Contrast Enhanced Ultrasound ) has shown potential to demonstrate microvasculature without using ionizing radiation nor a toxic contrast-agent. In this pilot study we assessed whether CEUS can be used as the imaging modality for follow-up after LRC. METHODS From Jan. 2006-Mar. 2009 a CEUS (the index test) was performed before and after renal cryoablation (at 3 and 12 months) in addition to the regular cross sectional imaging with contrast (the reference test). Using a perfusion/enhancement-score (PS) (0=no perfusion/enhancement, 1=rim perfusion/enhancement, 2=diffuse perfusion/enhancement, 3=localized perfusion/enhancement, 4=no perfusion/enhancement defect) the perfusion resp. enhancement in the lesion was assessed on both modalities (CEUS and CT /MRI) at all moments in time. Analysis was aimed at concordance of PS and presence of false negative/positive results. RESULTS In total 45 cases (45 tumors) were included of which 29 biopsy proven RCC. Mean tumor size was 2.66 (SD 0.77) cm. There were no post-procedural persistent tumors at 3 months, nor did any recurrences develop during the 12 month study period. Pre-LRC: In 26 tumors both modalities were present. In 20/26 there was concordance of PS (77%). There were no cases with no perfusion on one modality (PS 0) and at least PS=1 on the other modality. 3m FU: In 31 tumors both modalities were present. In 25/31 there was concordance of PS (81%). 4/31 cases showed enhancement on the CT-scan (all PS 1) without perfusion on CEUS (13%). In all cases enhancement on CT disappeared on subsequent scans. 2/31 cases showed perfusion on CEUS without enhancement on CT (7%). 12m FU: In 21 tumors both modalities were present. In 19/21 there was concordance of PS (91%). There were no cases with enhancement on CT without perfusion on CEUS and 2/21 cases with perfusion on CEUS without enhancement on CT (10%). CONCLUSIONS CEUS is a safe imaging technique enabling visualization of microvasculature. There is a high concordance of PS between CEUS and CT in all points of time. There were few false-positive CEUS-images. This pilot study suggests that CEUS might be useful as the FU-modality after LRC without exposure to ionizing radiation and nephrotoxic contrast-agent. Expansion of the cohort including recurrences is needed before routine implementation of CEUS in the FU-algorithm. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e286-e287 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kurdo Barwari Amsterdam, Netherlands More articles by this author Hessel Wijkstra Amsterdam, Netherlands More articles by this author Jean de la Rosette Amsterdam, Netherlands More articles by this author Pilar Laguna Amsterdam, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...