Efficacy, safety and effectiveness of image-guided percutaneous microwave ablation in cystic renal lesions Bosniak III or IV after 24 months follow up

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Efficacy, safety and effectiveness of image-guided percutaneous microwave ablation in cystic renal lesions Bosniak III or IV after 24 months follow up Gianpaolo Carrafiello, Gianlorenzo Dionigi, Anna Maria Ierardi, Mario Petrillo, Federico Fontana, Chiara Floridi, Luigi Boni, Francesca Rovera, Stefano Rausei, Alberto Mangano, Sebastiano Spampatti, Alberto Marconi, Giulio Carcano, Renzo Dionigi International Journal of Surgery Volume 11, Pages S30-S35 (December 2013) DOI: 10.1016/S1743-9191(13)60010-2 Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd Terms and Conditions

Fig. 1 (A) An exophytic rounded cystic lesion characterized by (B) an avid contrast enhancement along septa at CEUS examination. (C,D) The same lesion showed no enhancement at CECT (arrowhead); (D) a ring of fat-stranding due to persisting edema persists at CECT performed 1 month after treatment (arrowhead). International Journal of Surgery 2013 11, S30-S35DOI: (10.1016/S1743-9191(13)60010-2) Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd Terms and Conditions

Fig. 2 Two different lesions observed and treated in the same patient (top and bottom panels). Top panel: (A) antenna entrance site; (B) lesion (asterisk); (C) this lesion appeared as completely necrotized without contrast enhancement at CECT performed 1 month after MWA treatment. Bottom panel: (D,E) the larger lesion appeared necrotized with a “halo” of fat-stranding 1 month after MWA treatment (arrowhead, E); (F) the “halo” progressively disappeared at CECT 24 months after treatment: a volume reduction of the ablated lesion was identified (arrowhead). International Journal of Surgery 2013 11, S30-S35DOI: (10.1016/S1743-9191(13)60010-2) Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd Terms and Conditions

Fig. 3 (A,B) A small rounded exophytic lesion on axial (arrowhead, A) and coronal (arrowhead, B) reformatted CECT images before MWA treatment. (C) The same lesion during the MWA session: the dotted line shows the planned antenna track, the green circle the antenna entrance site and the violet oval the planned ablation area (diameter 3.7 cm). (D) The asterisk shows the ablated area on CECT performed immediately after MWA treatment; in particular some air bubbles of vaporization near the ablated site may be observed. (E,F) CECT performed 1 month (arrow, E) and 24 months (arrow, F) after MWA treatment showing absence of residue/recurrence. International Journal of Surgery 2013 11, S30-S35DOI: (10.1016/S1743-9191(13)60010-2) Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd Terms and Conditions