Abstract
Although only limited long-term studies evaluating thermal ablation of renal masses have been performed, it appears that thermal ablation has a comparable 5-year success rate to that of partial or total nephrectomy. This technique is often used in patients who are not good candidates for partial or total nephrectomy. Contrast-enhanced ultrasound (CEUS) has been recently approved by the Food and Drug Administration for characterization of focal liver lesions in adults and pediatric patients. CEUS can be used off label for renal applications and has been used for years in Europe and Asia. It has several advantages over contrast-enhanced computed tomography for use as the technique to guide and evaluate efficacy of thermal ablation of renal masses. These include the ability to visualize small amounts of enhancement, repeat dosing to evaluate efficacy of an ablation during a procedure, thin slice thickness, and real-time visualization. Ultrasound contrast is also non-nephrotoxic and non-hepatotoxic, allowing evaluation of patients with renal insufficiency. This article reviews the use of CEUS for the guidance and follow-up of thermal ablative procedures of renal masses.
Highlights
According to the American Cancer Society, in the United States, 63,340 new cases of renal cancer will occur in 2018, an incidence that has been increasing since the 1990s and has only recently begun to level off (1)
Much of this increase has been attributed to the improved diagnosis of small renal masses (SRM) that are localized to the kidney and often incidentally found in asymptomatic patients being imaged for other reasons (1)
These patients benefit from the fact that ultrasound contrast agents (UCAs) are not excreted into the urine and not nephrotoxic, a contradistinction to the agents used for computed tomography (CT) and magnetic resonance imaging (MRI)
Summary
According to the American Cancer Society, in the United States, 63,340 new cases of renal cancer will occur in 2018, an incidence that has been increasing since the 1990s and has only recently begun to level off (1). One possible alternative to guide the RFA procedure is to use contrast-enhanced ultrasound (CEUS), an advanced technique that utilizes ultrasound contrast agents (UCAs) to improve lesion visualization in difficult cases and to either immediately or at a later time detect residual tumor after ablation (4, 10). RFA has found an increasing role in the treatment of small renal tumors in patients who are not candidates for surgical resection, as previously outlined in the Introduction (19) It is an outpatient procedure in which a probe is inserted into the tumor and delivers thermal energy within the tissue that is created via a high-frequency alternating current released from the active electrode at the tip (1, 7, 20). On CT (as well as MRI) there is signal from the associated soft tissues, making it difficult to identify small amounts of enhancement
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