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MRI-guided Percutaneous Cryoablation of Renal Tumors: Use of External Manual Displacement of Adjacent Bowel Loops

Tuncali K., Morrison P.R., Tatli S., Silverman S.G.


Institution:	Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA. ktuncali@partners.org
Publisher:	Eur J Radiol
Publication Date:	Aug-2006
Volume Number:	59
Issue Number:	2
Pages:	198-202
Citation:	Eur J Radiol. 2006 Aug;59(2):198-202.
PubMed ID:	16716551
Appears in Collections:	NCIGT, Prostate Group
Generated Citation:	Tuncali K., Morrison P.R., Tatli S., Silverman S.G. MRI-guided Percutaneous Cryoablation of Renal Tumors: Use of External Manual Displacement of Adjacent Bowel Loops. Eur J Radiol. 2006 Aug;59(2):198-202. PMID: 16716551.
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We sought to investigate retrospectively the safety and effectiveness of using external hand compression to displace adjacent bowel loops during MRI-guided percutaneous cryoablation of renal tumors. MATERIALS AND METHODS: Fourteen patients (six women, eight men; mean age: 72 years) with 15 renal tumors (mean diameter: 2.4 cm; range: 1.4-4.6 cm) adjacent to bowel were treated with MRI-guided percutaneous cryoablation during which bowel was displaced manually. Bowel loop of concern was ascending colon (n=5), descending colon (n=8), descending colon and small bowel (n=1), ascending colon and small bowel (n=1). To analyze effectiveness of the maneuver, mean distance between tumor margin and bowel before and after the maneuver were compared and analyzed using paired Student's t-test. Minimum distance between iceball edge and adjacent bowel with external manual displacement during freezing was also measured. Safety was assessed by analyzing post-procedural MR imaging for adjacent bowel wall thickening and focal fluid collections as well as patients' clinical and imaging follow-up. RESULTS: Mean distance between tumor margin and closest adjacent bowel increased from 0.8 cm (range: 0-2 cm) before external manual compression to 2.6 cm (range: 1.6-4.1 cm) with manual displacement (p<0.01). Mean minimum distance between iceball edge and closest adjacent bowel during the procedures was 1.6 cm (range: 0.5-3.5 cm). No evidence of bowel injury was encountered. Twelve of 15 tumors had follow-up (mean: 10 months) that showed no tumor recurrence. CONCLUSION: MRI-guided percutaneous cryoablation of renal tumors adjacent to bowel can be done safely and effectively using external hand compression to displace bowel loops.

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