Pretreatment Imaging Can Be Used to Select Imaging Guidance, Ultrasound Alone Versus CT Plus Ultrasound, for Percutaneous Renal Radiofrequency Ablation

OBJECTIVE. Although CT is most commonly used for guidance of radiofrequency ablation (RFA) of renal masses, other publications have shown that ultrasound alone may be used. Therefore, we compared the complications and technical effectiveness of renal RFA guided by ultrasound alone versus combined CT and ultrasound guidance. MATERIALS AND METHODS. We retrospectively analyzed outcomes and complications of percutaneous renal RFA in two groups of patients for whom RFA was guided by either ultrasound alone (group 1) or combined CT and ultrasound (group 2). The sole factor in determining the method of guidance was preablation imaging. All other technical factors were consistent between the two groups. RESULTS. There were 28 masses in 27 patients in group 1 and 32 masses in 29 patients in group 2. There was an overall major complication rate of 3.3% (2/60). Major complications occurred equally in group 2 (3.1% [1/32]) compared with group 1 (3.6% [1/28]). Overall ablative effectiveness was 93% (26/28) in group 1 and 84% (27/32) in group 2. There was no statistical difference between the two groups. CONCLUSION. In proper hands, sonography guidance alone is a safe and effective method for performance of renal RFA in preselected cases and can decrease CT utilization. The use of CT is reserved for situations in which pretreatment RFA imaging suggests difficulty in ultrasound mass visualization or when the mass is in close proximity to structures that may be injured by thermal ablation.