DOI: 10.1148/rg.25si055501
Microwave Ablation: Principles and Applications1
Caroline J. Simon, MD,
Damian E. Dupuy, MD and
William W. Mayo-Smith, MD
1 From the Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received January 28, 2005; revision requested March 3 and received March 31; accepted April 15. Supported in part by a grant from Vivant Medical, Mountain View, Calif. D.E.D. is a medical consultant to and receives grant support from Boston Scientific, Endocare, Valleylab, and Vivant Medical and has stock options in Viviant Medical; W.W.M.S. receives grant support from GE Medical Systems; C.J.S. has no financial relationships to disclose.
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Figure 1. Schematic illustrates the interaction between water molecules and microwaves.
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Figure 2a. (a) Photographs show current microwave applicators available for percutaneous tumor ablation (Vivant Medical). (b) Photograph of the setup for a percutaneous microwave ablation procedure shows three single microwave applicators connected to three microwave generators.
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Figure 2b. (a) Photographs show current microwave applicators available for percutaneous tumor ablation (Vivant Medical). (b) Photograph of the setup for a percutaneous microwave ablation procedure shows three single microwave applicators connected to three microwave generators.
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Figure 3a. (a) Intraoperative photograph demonstrates the US probe (arrow) used to guide microwave ablation and three single microwave applicators in a triangular configuration with 2.5-cm spacing. Note exposed liver surface (arrowhead). (b) Transverse US scan shows the three microwave antennae in cross section (arrows) within the hypoechoic liver metastasis.
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Figure 3b. (a) Intraoperative photograph demonstrates the US probe (arrow) used to guide microwave ablation and three single microwave applicators in a triangular configuration with 2.5-cm spacing. Note exposed liver surface (arrowhead). (b) Transverse US scan shows the three microwave antennae in cross section (arrows) within the hypoechoic liver metastasis.
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Figure 4a. (a) Photograph of the gross resected liver specimen shows three discrete areas of thermocoagulation (arrows). (b) Photograph of the sectioned NADH-stained gross specimen shows an area of marked thermocoagulation (arrowheads) surrounding a 4-mm hepatic vein. (c) Photomicrograph (original magnification, x40; H-E stain) of the hepatic section shows an area of thermocoagulation (arrowheads) surrounding a 3-mm artery (arrows).
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Figure 4b. (a) Photograph of the gross resected liver specimen shows three discrete areas of thermocoagulation (arrows). (b) Photograph of the sectioned NADH-stained gross specimen shows an area of marked thermocoagulation (arrowheads) surrounding a 4-mm hepatic vein. (c) Photomicrograph (original magnification, x40; H-E stain) of the hepatic section shows an area of thermocoagulation (arrowheads) surrounding a 3-mm artery (arrows).
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Figure 4c. (a) Photograph of the gross resected liver specimen shows three discrete areas of thermocoagulation (arrows). (b) Photograph of the sectioned NADH-stained gross specimen shows an area of marked thermocoagulation (arrowheads) surrounding a 4-mm hepatic vein. (c) Photomicrograph (original magnification, x40; H-E stain) of the hepatic section shows an area of thermocoagulation (arrowheads) surrounding a 3-mm artery (arrows).
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Figure 5a. (a, b) Photomicrographs (original magnification, x200) of the same sections of liver adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas except a small group of cells at the top left-hand corner (arrow in b). This effect is seen more clearly on the NADH-stained section. (c, d) Photomicrographs (original magnification, x100) of sections from normal liver parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d), show complete thermocoagulation on the left half of the slide but viable tissue on the right. The dark-blue area (viable cells) on the right is more evident on the NADH-stained slide (d).
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Figure 5b. (a, b) Photomicrographs (original magnification, x200) of the same sections of liver adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas except a small group of cells at the top left-hand corner (arrow in b). This effect is seen more clearly on the NADH-stained section. (c, d) Photomicrographs (original magnification, x100) of sections from normal liver parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d), show complete thermocoagulation on the left half of the slide but viable tissue on the right. The dark-blue area (viable cells) on the right is more evident on the NADH-stained slide (d).
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Figure 5c. (a, b) Photomicrographs (original magnification, x200) of the same sections of liver adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas except a small group of cells at the top left-hand corner (arrow in b). This effect is seen more clearly on the NADH-stained section. (c, d) Photomicrographs (original magnification, x100) of sections from normal liver parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d), show complete thermocoagulation on the left half of the slide but viable tissue on the right. The dark-blue area (viable cells) on the right is more evident on the NADH-stained slide (d).
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Figure 5d. (a, b) Photomicrographs (original magnification, x200) of the same sections of liver adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas except a small group of cells at the top left-hand corner (arrow in b). This effect is seen more clearly on the NADH-stained section. (c, d) Photomicrographs (original magnification, x100) of sections from normal liver parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d), show complete thermocoagulation on the left half of the slide but viable tissue on the right. The dark-blue area (viable cells) on the right is more evident on the NADH-stained slide (d).
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Figure 6a. (a, b) Photomicrographs (original magnification, x200) of the same sections of lung adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas. (c, d) Photomicrographs (original magnification, x100) of sections from normal lung parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d) stains, show complete thermocoagulation on the left two-thirds but viable tissue on the right third of the slides. The dark-blue area (viable cells) on the right third is more clearly seen on the NADH-stained slide (d).
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Figure 6b. (a, b) Photomicrographs (original magnification, x200) of the same sections of lung adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas. (c, d) Photomicrographs (original magnification, x100) of sections from normal lung parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d) stains, show complete thermocoagulation on the left two-thirds but viable tissue on the right third of the slides. The dark-blue area (viable cells) on the right third is more clearly seen on the NADH-stained slide (d).
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Figure 6c. (a, b) Photomicrographs (original magnification, x200) of the same sections of lung adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas. (c, d) Photomicrographs (original magnification, x100) of sections from normal lung parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d) stains, show complete thermocoagulation on the left two-thirds but viable tissue on the right third of the slides. The dark-blue area (viable cells) on the right third is more clearly seen on the NADH-stained slide (d).
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Figure 6d. (a, b) Photomicrographs (original magnification, x200) of the same sections of lung adenocarcinoma stained with H-E (a) and NADH vital histochemical (b) stains show complete microwave thermocoagulation of all areas. (c, d) Photomicrographs (original magnification, x100) of sections from normal lung parenchyma, obtained for comparison after microwave ablation and stained with H-E (c) and NADH (d) stains, show complete thermocoagulation on the left two-thirds but viable tissue on the right third of the slides. The dark-blue area (viable cells) on the right third is more clearly seen on the NADH-stained slide (d).
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Figure 7a. Palliative tumor ablation in a 62-year-old man with a painful 7-cm hepatocellular carcinoma in his liver. (a) Axial CT scan obtained before ablation shows internal calcifications (arrows). (b) Axial CT scan shows three single microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. Two 10-minute, 45-W ablations were performed. (c, d) Postprocedure axial CT scans obtained with contrast material enhancement in the arterial (c) and portal venous (d) phases show a large area of thermocoagulation (arrows) with no internal enhancement. The patient was observed after the procedure and later discharged to home with no immediate complications. His pain resolved within 2 days after the procedure.
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Figure 7b. Palliative tumor ablation in a 62-year-old man with a painful 7-cm hepatocellular carcinoma in his liver. (a) Axial CT scan obtained before ablation shows internal calcifications (arrows). (b) Axial CT scan shows three single microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. Two 10-minute, 45-W ablations were performed. (c, d) Postprocedure axial CT scans obtained with contrast material enhancement in the arterial (c) and portal venous (d) phases show a large area of thermocoagulation (arrows) with no internal enhancement. The patient was observed after the procedure and later discharged to home with no immediate complications. His pain resolved within 2 days after the procedure.
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Figure 7c. Palliative tumor ablation in a 62-year-old man with a painful 7-cm hepatocellular carcinoma in his liver. (a) Axial CT scan obtained before ablation shows internal calcifications (arrows). (b) Axial CT scan shows three single microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. Two 10-minute, 45-W ablations were performed. (c, d) Postprocedure axial CT scans obtained with contrast material enhancement in the arterial (c) and portal venous (d) phases show a large area of thermocoagulation (arrows) with no internal enhancement. The patient was observed after the procedure and later discharged to home with no immediate complications. His pain resolved within 2 days after the procedure.
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Figure 7d. Palliative tumor ablation in a 62-year-old man with a painful 7-cm hepatocellular carcinoma in his liver. (a) Axial CT scan obtained before ablation shows internal calcifications (arrows). (b) Axial CT scan shows three single microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. Two 10-minute, 45-W ablations were performed. (c, d) Postprocedure axial CT scans obtained with contrast material enhancement in the arterial (c) and portal venous (d) phases show a large area of thermocoagulation (arrows) with no internal enhancement. The patient was observed after the procedure and later discharged to home with no immediate complications. His pain resolved within 2 days after the procedure.
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Figure 8a. Microwave ablation of a hepatic metastasis in an 82-year-old woman with a cardiac pacemaker and metastatic colon cancer to both lung and liver. She had responded well to chemotherapy and had only one hepatic lesion, measuring approximately 4.3 cm in greatest diameter, in liver segment 7. (a) CT scan shows three single microwave antennae, which were positioned with fluoroscopic guidance in the center of the lesion. Two 10-minute, 45-W ablations were performed. (b, c) Contrast-enhanced CT scans obtained immediately after the procedure in the arterial (b) and portal venous (c) phases show successful microwave ablation of the lesion, with an area of thermocoagulation (arrows) measuring 5.3 cm in greatest diameter. Surrounding peripheral hyperemia represents postablation changes at the site of the lesion. No immediate complications were observed.
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Figure 8b. Microwave ablation of a hepatic metastasis in an 82-year-old woman with a cardiac pacemaker and metastatic colon cancer to both lung and liver. She had responded well to chemotherapy and had only one hepatic lesion, measuring approximately 4.3 cm in greatest diameter, in liver segment 7. (a) CT scan shows three single microwave antennae, which were positioned with fluoroscopic guidance in the center of the lesion. Two 10-minute, 45-W ablations were performed. (b, c) Contrast-enhanced CT scans obtained immediately after the procedure in the arterial (b) and portal venous (c) phases show successful microwave ablation of the lesion, with an area of thermocoagulation (arrows) measuring 5.3 cm in greatest diameter. Surrounding peripheral hyperemia represents postablation changes at the site of the lesion. No immediate complications were observed.
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Figure 8c. Microwave ablation of a hepatic metastasis in an 82-year-old woman with a cardiac pacemaker and metastatic colon cancer to both lung and liver. She had responded well to chemotherapy and had only one hepatic lesion, measuring approximately 4.3 cm in greatest diameter, in liver segment 7. (a) CT scan shows three single microwave antennae, which were positioned with fluoroscopic guidance in the center of the lesion. Two 10-minute, 45-W ablations were performed. (b, c) Contrast-enhanced CT scans obtained immediately after the procedure in the arterial (b) and portal venous (c) phases show successful microwave ablation of the lesion, with an area of thermocoagulation (arrows) measuring 5.3 cm in greatest diameter. Surrounding peripheral hyperemia represents postablation changes at the site of the lesion. No immediate complications were observed.
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Figure 9a. Microwave ablation of primary lung cancer in an 86-year-old man who presented with a suspicious right lower lobe mass in the azygoesophageal recess. (a) Preprocedure positron emission tomographic scans show localized fluorodeoxyglucose activity (arrows) with no nodal disease, findings consistent with stage 1 lung cancer. Results of onsite cytopathologic analysis of the biopsy specimen confirmed the diagnosis of non–small cell lung cancer. The mass was 4.3 cm in greatest dimension. (b) CT scan shows a 14.5-gauge microwave antenna that was advanced with fluoroscopic guidance into the mass along its superior portion. Two 10-minute, 45-W microwave ablations were performed. (c) On a postprocedure contrast-enhanced CT scan obtained through the lower thorax at the level of the mass, no marked enhancement within the lesion is seen. Note successful coagulation of the tumor up against the right inferior pulmonary vein (arrow). The patient was discharged to home in stable condition. (d) CT scan obtained at 9-month follow-up shows interval shrinkage and no enhancement of the mass (arrow).
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Figure 9b. Microwave ablation of primary lung cancer in an 86-year-old man who presented with a suspicious right lower lobe mass in the azygoesophageal recess. (a) Preprocedure positron emission tomographic scans show localized fluorodeoxyglucose activity (arrows) with no nodal disease, findings consistent with stage 1 lung cancer. Results of onsite cytopathologic analysis of the biopsy specimen confirmed the diagnosis of non–small cell lung cancer. The mass was 4.3 cm in greatest dimension. (b) CT scan shows a 14.5-gauge microwave antenna that was advanced with fluoroscopic guidance into the mass along its superior portion. Two 10-minute, 45-W microwave ablations were performed. (c) On a postprocedure contrast-enhanced CT scan obtained through the lower thorax at the level of the mass, no marked enhancement within the lesion is seen. Note successful coagulation of the tumor up against the right inferior pulmonary vein (arrow). The patient was discharged to home in stable condition. (d) CT scan obtained at 9-month follow-up shows interval shrinkage and no enhancement of the mass (arrow).
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Figure 9c. Microwave ablation of primary lung cancer in an 86-year-old man who presented with a suspicious right lower lobe mass in the azygoesophageal recess. (a) Preprocedure positron emission tomographic scans show localized fluorodeoxyglucose activity (arrows) with no nodal disease, findings consistent with stage 1 lung cancer. Results of onsite cytopathologic analysis of the biopsy specimen confirmed the diagnosis of non–small cell lung cancer. The mass was 4.3 cm in greatest dimension. (b) CT scan shows a 14.5-gauge microwave antenna that was advanced with fluoroscopic guidance into the mass along its superior portion. Two 10-minute, 45-W microwave ablations were performed. (c) On a postprocedure contrast-enhanced CT scan obtained through the lower thorax at the level of the mass, no marked enhancement within the lesion is seen. Note successful coagulation of the tumor up against the right inferior pulmonary vein (arrow). The patient was discharged to home in stable condition. (d) CT scan obtained at 9-month follow-up shows interval shrinkage and no enhancement of the mass (arrow).
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Figure 9d. Microwave ablation of primary lung cancer in an 86-year-old man who presented with a suspicious right lower lobe mass in the azygoesophageal recess. (a) Preprocedure positron emission tomographic scans show localized fluorodeoxyglucose activity (arrows) with no nodal disease, findings consistent with stage 1 lung cancer. Results of onsite cytopathologic analysis of the biopsy specimen confirmed the diagnosis of non–small cell lung cancer. The mass was 4.3 cm in greatest dimension. (b) CT scan shows a 14.5-gauge microwave antenna that was advanced with fluoroscopic guidance into the mass along its superior portion. Two 10-minute, 45-W microwave ablations were performed. (c) On a postprocedure contrast-enhanced CT scan obtained through the lower thorax at the level of the mass, no marked enhancement within the lesion is seen. Note successful coagulation of the tumor up against the right inferior pulmonary vein (arrow). The patient was discharged to home in stable condition. (d) CT scan obtained at 9-month follow-up shows interval shrinkage and no enhancement of the mass (arrow).
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Figure 10a. Microwave ablation of metastatic pulmonary lesions in a 15-year-old girl with a history of recurrent rhabdomyosarcoma and lung metastases, in whom systemic chemotherapy had previously failed. (a) Preprocedure CT scan shows a right upper lobe metastatic lesion measuring 4.2 cm in greatest diameter. (b) CT scan shows three single 14.5-gauge microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. One 10-minute 45-W ablation was performed. The patient suffered a pneumothorax with an air leak that required chest tube insertion and hospitalization for 4 days. (c–f) Contrast-enhanced CT scans obtained at 1-month follow-up show cavitation and no enhancement in the lesion and persistent tracks from the microwave antennae (arrow). Microwave ablation technology enables the use of multiple antennae in the treatment of pulmonary metastatic disease.
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Figure 10b. Microwave ablation of metastatic pulmonary lesions in a 15-year-old girl with a history of recurrent rhabdomyosarcoma and lung metastases, in whom systemic chemotherapy had previously failed. (a) Preprocedure CT scan shows a right upper lobe metastatic lesion measuring 4.2 cm in greatest diameter. (b) CT scan shows three single 14.5-gauge microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. One 10-minute 45-W ablation was performed. The patient suffered a pneumothorax with an air leak that required chest tube insertion and hospitalization for 4 days. (c–f) Contrast-enhanced CT scans obtained at 1-month follow-up show cavitation and no enhancement in the lesion and persistent tracks from the microwave antennae (arrow). Microwave ablation technology enables the use of multiple antennae in the treatment of pulmonary metastatic disease.
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Figure 10c. Microwave ablation of metastatic pulmonary lesions in a 15-year-old girl with a history of recurrent rhabdomyosarcoma and lung metastases, in whom systemic chemotherapy had previously failed. (a) Preprocedure CT scan shows a right upper lobe metastatic lesion measuring 4.2 cm in greatest diameter. (b) CT scan shows three single 14.5-gauge microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. One 10-minute 45-W ablation was performed. The patient suffered a pneumothorax with an air leak that required chest tube insertion and hospitalization for 4 days. (c–f) Contrast-enhanced CT scans obtained at 1-month follow-up show cavitation and no enhancement in the lesion and persistent tracks from the microwave antennae (arrow). Microwave ablation technology enables the use of multiple antennae in the treatment of pulmonary metastatic disease.
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Figure 10d. Microwave ablation of metastatic pulmonary lesions in a 15-year-old girl with a history of recurrent rhabdomyosarcoma and lung metastases, in whom systemic chemotherapy had previously failed. (a) Preprocedure CT scan shows a right upper lobe metastatic lesion measuring 4.2 cm in greatest diameter. (b) CT scan shows three single 14.5-gauge microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. One 10-minute 45-W ablation was performed. The patient suffered a pneumothorax with an air leak that required chest tube insertion and hospitalization for 4 days. (c–f) Contrast-enhanced CT scans obtained at 1-month follow-up show cavitation and no enhancement in the lesion and persistent tracks from the microwave antennae (arrow). Microwave ablation technology enables the use of multiple antennae in the treatment of pulmonary metastatic disease.
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Figure 10e. Microwave ablation of metastatic pulmonary lesions in a 15-year-old girl with a history of recurrent rhabdomyosarcoma and lung metastases, in whom systemic chemotherapy had previously failed. (a) Preprocedure CT scan shows a right upper lobe metastatic lesion measuring 4.2 cm in greatest diameter. (b) CT scan shows three single 14.5-gauge microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. One 10-minute 45-W ablation was performed. The patient suffered a pneumothorax with an air leak that required chest tube insertion and hospitalization for 4 days. (c–f) Contrast-enhanced CT scans obtained at 1-month follow-up show cavitation and no enhancement in the lesion and persistent tracks from the microwave antennae (arrow). Microwave ablation technology enables the use of multiple antennae in the treatment of pulmonary metastatic disease.
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Figure 10f. Microwave ablation of metastatic pulmonary lesions in a 15-year-old girl with a history of recurrent rhabdomyosarcoma and lung metastases, in whom systemic chemotherapy had previously failed. (a) Preprocedure CT scan shows a right upper lobe metastatic lesion measuring 4.2 cm in greatest diameter. (b) CT scan shows three single 14.5-gauge microwave antennae, which were positioned with fluoroscopic guidance into the center of the lesion. One 10-minute 45-W ablation was performed. The patient suffered a pneumothorax with an air leak that required chest tube insertion and hospitalization for 4 days. (c–f) Contrast-enhanced CT scans obtained at 1-month follow-up show cavitation and no enhancement in the lesion and persistent tracks from the microwave antennae (arrow). Microwave ablation technology enables the use of multiple antennae in the treatment of pulmonary metastatic disease.
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Figure 11a. Microwave ablation of a renal tumor in an 85-year-old woman. A solid renal mass of the right kidney was incidentally discovered at US performed for abdominal pain. (a) US scan of the right kidney shows a discrete mass 3.7 cm in greatest dimension (cursors). (b) CT fluoroscopic scan obtained with the patient prone shows a single microwave applicator within the mass. Two 10-minute ablations were performed. (c) Contrast-enhanced CT scan obtained at 4-month follow-up shows lack of enhancement in the mass (arrows).
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Figure 11b. Microwave ablation of a renal tumor in an 85-year-old woman. A solid renal mass of the right kidney was incidentally discovered at US performed for abdominal pain. (a) US scan of the right kidney shows a discrete mass 3.7 cm in greatest dimension (cursors). (b) CT fluoroscopic scan obtained with the patient prone shows a single microwave applicator within the mass. Two 10-minute ablations were performed. (c) Contrast-enhanced CT scan obtained at 4-month follow-up shows lack of enhancement in the mass (arrows).
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Figure 11c. Microwave ablation of a renal tumor in an 85-year-old woman. A solid renal mass of the right kidney was incidentally discovered at US performed for abdominal pain. (a) US scan of the right kidney shows a discrete mass 3.7 cm in greatest dimension (cursors). (b) CT fluoroscopic scan obtained with the patient prone shows a single microwave applicator within the mass. Two 10-minute ablations were performed. (c) Contrast-enhanced CT scan obtained at 4-month follow-up shows lack of enhancement in the mass (arrows).
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Figure 12a. Microwave ablation of an undifferentiated adrenal cortical carcinoma in a 79-year-old man with a history of unsuccessful surgical excision because of involvement of the liver and inferior vena cava. (a) Contrast-enhanced CT scan of the abdomen shows a complex large right adrenal mass (arrows) that invades the right lobe of the liver and compresses the inferior vena cava. (b) CT scan shows three single microwave applicators, which were positioned with fluoroscopic guidance in a triangular configuration and advanced into the center of the large heterogeneous mass. Four 10-minute 45-W ablations were performed. (c) Contrast-enhanced CT scan obtained immediately after the procedure shows complete thermocoagulation of the mass (arrows). The patient tolerated the procedure well and was discharged the same day. Because of the presence of retrocrural adenopathy, he was referred for postablation external-beam radiation therapy to treat these regions. (d, e) On CT scans obtained at 7-month follow-up, the nonenhancing tumor mass (arrows) appears smaller and exerts less mass effect on the inferior vena cava.
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Figure 12b. Microwave ablation of an undifferentiated adrenal cortical carcinoma in a 79-year-old man with a history of unsuccessful surgical excision because of involvement of the liver and inferior vena cava. (a) Contrast-enhanced CT scan of the abdomen shows a complex large right adrenal mass (arrows) that invades the right lobe of the liver and compresses the inferior vena cava. (b) CT scan shows three single microwave applicators, which were positioned with fluoroscopic guidance in a triangular configuration and advanced into the center of the large heterogeneous mass. Four 10-minute 45-W ablations were performed. (c) Contrast-enhanced CT scan obtained immediately after the procedure shows complete thermocoagulation of the mass (arrows). The patient tolerated the procedure well and was discharged the same day. Because of the presence of retrocrural adenopathy, he was referred for postablation external-beam radiation therapy to treat these regions. (d, e) On CT scans obtained at 7-month follow-up, the nonenhancing tumor mass (arrows) appears smaller and exerts less mass effect on the inferior vena cava.
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Figure 12c. Microwave ablation of an undifferentiated adrenal cortical carcinoma in a 79-year-old man with a history of unsuccessful surgical excision because of involvement of the liver and inferior vena cava. (a) Contrast-enhanced CT scan of the abdomen shows a complex large right adrenal mass (arrows) that invades the right lobe of the liver and compresses the inferior vena cava. (b) CT scan shows three single microwave applicators, which were positioned with fluoroscopic guidance in a triangular configuration and advanced into the center of the large heterogeneous mass. Four 10-minute 45-W ablations were performed. (c) Contrast-enhanced CT scan obtained immediately after the procedure shows complete thermocoagulation of the mass (arrows). The patient tolerated the procedure well and was discharged the same day. Because of the presence of retrocrural adenopathy, he was referred for postablation external-beam radiation therapy to treat these regions. (d, e) On CT scans obtained at 7-month follow-up, the nonenhancing tumor mass (arrows) appears smaller and exerts less mass effect on the inferior vena cava.
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Figure 12d. Microwave ablation of an undifferentiated adrenal cortical carcinoma in a 79-year-old man with a history of unsuccessful surgical excision because of involvement of the liver and inferior vena cava. (a) Contrast-enhanced CT scan of the abdomen shows a complex large right adrenal mass (arrows) that invades the right lobe of the liver and compresses the inferior vena cava. (b) CT scan shows three single microwave applicators, which were positioned with fluoroscopic guidance in a triangular configuration and advanced into the center of the large heterogeneous mass. Four 10-minute 45-W ablations were performed. (c) Contrast-enhanced CT scan obtained immediately after the procedure shows complete thermocoagulation of the mass (arrows). The patient tolerated the procedure well and was discharged the same day. Because of the presence of retrocrural adenopathy, he was referred for postablation external-beam radiation therapy to treat these regions. (d, e) On CT scans obtained at 7-month follow-up, the nonenhancing tumor mass (arrows) appears smaller and exerts less mass effect on the inferior vena cava.
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Figure 12e. Microwave ablation of an undifferentiated adrenal cortical carcinoma in a 79-year-old man with a history of unsuccessful surgical excision because of involvement of the liver and inferior vena cava. (a) Contrast-enhanced CT scan of the abdomen shows a complex large right adrenal mass (arrows) that invades the right lobe of the liver and compresses the inferior vena cava. (b) CT scan shows three single microwave applicators, which were positioned with fluoroscopic guidance in a triangular configuration and advanced into the center of the large heterogeneous mass. Four 10-minute 45-W ablations were performed. (c) Contrast-enhanced CT scan obtained immediately after the procedure shows complete thermocoagulation of the mass (arrows). The patient tolerated the procedure well and was discharged the same day. Because of the presence of retrocrural adenopathy, he was referred for postablation external-beam radiation therapy to treat these regions. (d, e) On CT scans obtained at 7-month follow-up, the nonenhancing tumor mass (arrows) appears smaller and exerts less mass effect on the inferior vena cava.
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Figure 13a. Microwave ablation of a left adrenal metastasis in a 75-year-old woman with a history of previously resected periampullary cancer. (a) Preprocedure T2-weighted magnetic resonance (MR) image shows a cystic metastasis (arrow) at the left adrenal gland. (b) Preprocedure CT scan of the left adrenal gland shows an enlarged metastasis (arrows), now measuring 4 cm in greatest diameter (compared with the MR imaging appearance). (c, d) CT scans show a 15-cm microwave ablation applicator (Trio; Vivant Medical) that was advanced under fluoroscopic guidance into the center of the lesion. The three coiled tines were deployed within the lesion with satisfactory placement. A single 5-minute 60-W treatment was performed. The patient experienced one episode of hypertension during the procedure, which was immediately controlled by beta-blockade. (e, f) Contrast-enhanced CT scans of the adrenal glands obtained immediately after ablation demonstrate a large nonenhancing mass (arrows). The patient was observed after the procedure and discharged home later that same day in stable condition and with no immediate complications.
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Figure 13b. Microwave ablation of a left adrenal metastasis in a 75-year-old woman with a history of previously resected periampullary cancer. (a) Preprocedure T2-weighted magnetic resonance (MR) image shows a cystic metastasis (arrow) at the left adrenal gland. (b) Preprocedure CT scan of the left adrenal gland shows an enlarged metastasis (arrows), now measuring 4 cm in greatest diameter (compared with the MR imaging appearance). (c, d) CT scans show a 15-cm microwave ablation applicator (Trio; Vivant Medical) that was advanced under fluoroscopic guidance into the center of the lesion. The three coiled tines were deployed within the lesion with satisfactory placement. A single 5-minute 60-W treatment was performed. The patient experienced one episode of hypertension during the procedure, which was immediately controlled by beta-blockade. (e, f) Contrast-enhanced CT scans of the adrenal glands obtained immediately after ablation demonstrate a large nonenhancing mass (arrows). The patient was observed after the procedure and discharged home later that same day in stable condition and with no immediate complications.
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Figure 13c. Microwave ablation of a left adrenal metastasis in a 75-year-old woman with a history of previously resected periampullary cancer. (a) Preprocedure T2-weighted magnetic resonance (MR) image shows a cystic metastasis (arrow) at the left adrenal gland. (b) Preprocedure CT scan of the left adrenal gland shows an enlarged metastasis (arrows), now measuring 4 cm in greatest diameter (compared with the MR imaging appearance). (c, d) CT scans show a 15-cm microwave ablation applicator (Trio; Vivant Medical) that was advanced under fluoroscopic guidance into the center of the lesion. The three coiled tines were deployed within the lesion with satisfactory placement. A single 5-minute 60-W treatment was performed. The patient experienced one episode of hypertension during the procedure, which was immediately controlled by beta-blockade. (e, f) Contrast-enhanced CT scans of the adrenal glands obtained immediately after ablation demonstrate a large nonenhancing mass (arrows). The patient was observed after the procedure and discharged home later that same day in stable condition and with no immediate complications.
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Figure 13d. Microwave ablation of a left adrenal metastasis in a 75-year-old woman with a history of previously resected periampullary cancer. (a) Preprocedure T2-weighted magnetic resonance (MR) image shows a cystic metastasis (arrow) at the left adrenal gland. (b) Preprocedure CT scan of the left adrenal gland shows an enlarged metastasis (arrows), now measuring 4 cm in greatest diameter (compared with the MR imaging appearance). (c, d) CT scans show a 15-cm microwave ablation applicator (Trio; Vivant Medical) that was advanced under fluoroscopic guidance into the center of the lesion. The three coiled tines were deployed within the lesion with satisfactory placement. A single 5-minute 60-W treatment was performed. The patient experienced one episode of hypertension during the procedure, which was immediately controlled by beta-blockade. (e, f) Contrast-enhanced CT scans of the adrenal glands obtained immediately after ablation demonstrate a large nonenhancing mass (arrows). The patient was observed after the procedure and discharged home later that same day in stable condition and with no immediate complications.
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Figure 13e. Microwave ablation of a left adrenal metastasis in a 75-year-old woman with a history of previously resected periampullary cancer. (a) Preprocedure T2-weighted magnetic resonance (MR) image shows a cystic metastasis (arrow) at the left adrenal gland. (b) Preprocedure CT scan of the left adrenal gland shows an enlarged metastasis (arrows), now measuring 4 cm in greatest diameter (compared with the MR imaging appearance). (c, d) CT scans show a 15-cm microwave ablation applicator (Trio; Vivant Medical) that was advanced under fluoroscopic guidance into the center of the lesion. The three coiled tines were deployed within the lesion with satisfactory placement. A single 5-minute 60-W treatment was performed. The patient experienced one episode of hypertension during the procedure, which was immediately controlled by beta-blockade. (e, f) Contrast-enhanced CT scans of the adrenal glands obtained immediately after ablation demonstrate a large nonenhancing mass (arrows). The patient was observed after the procedure and discharged home later that same day in stable condition and with no immediate complications.
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Figure 13f. Microwave ablation of a left adrenal metastasis in a 75-year-old woman with a history of previously resected periampullary cancer. (a) Preprocedure T2-weighted magnetic resonance (MR) image shows a cystic metastasis (arrow) at the left adrenal gland. (b) Preprocedure CT scan of the left adrenal gland shows an enlarged metastasis (arrows), now measuring 4 cm in greatest diameter (compared with the MR imaging appearance). (c, d) CT scans show a 15-cm microwave ablation applicator (Trio; Vivant Medical) that was advanced under fluoroscopic guidance into the center of the lesion. The three coiled tines were deployed within the lesion with satisfactory placement. A single 5-minute 60-W treatment was performed. The patient experienced one episode of hypertension during the procedure, which was immediately controlled by beta-blockade. (e, f) Contrast-enhanced CT scans of the adrenal glands obtained immediately after ablation demonstrate a large nonenhancing mass (arrows). The patient was observed after the procedure and discharged home later that same day in stable condition and with no immediate complications.
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Figure 14a. Microwave ablation of metastatic bladder cancer in the acetabulum of a 70-year-old man with severe debilitating pain after radiation therapy. (a) CT scan shows a 14.5-gauge microwave antenna that was placed into the center of the metastasis with fluoroscopic guidance. A single 10-minute 45-W microwave ablation was performed. Remote thermocouple measurements adjacent to the microwave antenna along the tumor margin demonstrated intratumoral cytotoxic temperatures of 63°C–67°C at the end of the procedure. (b) Contrast-enhanced CT scan obtained after microwave ablation shows complete thermocoagulation encompassing the entire metastasis. (c) Contrast-enhanced CT scan obtained at 6-month follow-up shows an interval decrease in the size of the bone metastasis, with no pronounced enhancement (arrow). The patient was completely pain-free.
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Figure 14b. Microwave ablation of metastatic bladder cancer in the acetabulum of a 70-year-old man with severe debilitating pain after radiation therapy. (a) CT scan shows a 14.5-gauge microwave antenna that was placed into the center of the metastasis with fluoroscopic guidance. A single 10-minute 45-W microwave ablation was performed. Remote thermocouple measurements adjacent to the microwave antenna along the tumor margin demonstrated intratumoral cytotoxic temperatures of 63°C–67°C at the end of the procedure. (b) Contrast-enhanced CT scan obtained after microwave ablation shows complete thermocoagulation encompassing the entire metastasis. (c) Contrast-enhanced CT scan obtained at 6-month follow-up shows an interval decrease in the size of the bone metastasis, with no pronounced enhancement (arrow). The patient was completely pain-free.
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Figure 14c. Microwave ablation of metastatic bladder cancer in the acetabulum of a 70-year-old man with severe debilitating pain after radiation therapy. (a) CT scan shows a 14.5-gauge microwave antenna that was placed into the center of the metastasis with fluoroscopic guidance. A single 10-minute 45-W microwave ablation was performed. Remote thermocouple measurements adjacent to the microwave antenna along the tumor margin demonstrated intratumoral cytotoxic temperatures of 63°C–67°C at the end of the procedure. (b) Contrast-enhanced CT scan obtained after microwave ablation shows complete thermocoagulation encompassing the entire metastasis. (c) Contrast-enhanced CT scan obtained at 6-month follow-up shows an interval decrease in the size of the bone metastasis, with no pronounced enhancement (arrow). The patient was completely pain-free.
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Copyright © 2005 by the Radiological Society of North America.
