Skip to main content
SpringerLink
Log in

Ice Ball Cracks on CT During Cryoablation for Renal Tumors: A Retrospective Analysis

  • Clinical Investigation
  • NON-VASCULAR INTERVENTIONS
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the frequency of ice ball cracks on CT during cryoablation of renal tumors and assess the severity of hemorrhagic complications associated with this finding.

Materials and Methods

Between March 2014 and March 2019, 130 patients underwent CT-guided cryoablation using cryoprobes with a diameter of 1.5 mm for 138 renal tumors (mean diameter, 23.6 mm; standard deviation [SD], 7.5; range, 8.3–43). Two blinded board-certified radiologists retrospectively reviewed the presence of cracks on CT obtained during the procedure. The incidence of major hemorrhage and changes in hemoglobin levels after cryoablation were examined. Factors influencing the appearance of ice ball cracks were assessed with multivariate analyses.

Results

Cracks were observed in 25 of the138 procedures (18%). Inter-reader reliabilities with kappa statistics were 0.90 and 0.84 for first and second freeze sessions, respectively. There were no major hemorrhagic events requiring blood transfusion or arterial embolization. Mean (± SD) decreases in hemoglobin levels between pre- and postoperative day 1 were 1.15 ± 0.86 g/dl in the cracks group and 1.01 ± 0.80 g/dl in the no cracks group with no significant difference (p = 0.14). Multivariate analyses identified a higher number of cryoprobes (odds ratio, 4.1; 95% confidence interval [CI] 1.7–11; p = 0.001) and no hydrodissection (odds ratio 6.7; 95% CI 2.1–28; p < 0.001) as factors associated with ice ball cracks.

Conclusion

Ice ball cracks were frequently observed on CT during cryoablation for renal tumors and were seemingly self-limiting events requiring no intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Breen DJ, King AJ, Patel N, Lockyer R, Hayes M. Image-guided cryoablation for sporadic renal cell carcinoma: three- and 5-year outcomes in 220 patients with biopsy-proven renal cell carcinoma. Radiology. 2018;289:554–61.

    Article  Google Scholar 

  2. Schmit GD, Atwell TD, Callstrom MR, et al. Ice ball fractures during percutaneous renal cryoablation: risk factors and potential implications. J Vasc Interv Radiol. 2010;21:1309–12.

    Article  Google Scholar 

  3. Cestari A, Guazzoni G, dell’Acqua V, et al. Laparoscopic cryoablation of solid renal masses: intermediate term followup. J Urol. 2004;172:1267–70.

    Article  Google Scholar 

  4. Rukstalis DB, Khorsandi M, Garcia FU, Hoenig DM, Cohen JK. Clinical experience with open renal cryoablation. Urology. 2001;57:34–9.

    Article  CAS  Google Scholar 

  5. Hruby G, Edelstein A, Karpf J, et al. Risk factors associated with renal parenchymal fracture during laparoscopic cryoablation. BJU Int. 2008;102:723–6.

    Article  Google Scholar 

  6. Ortiz-Vanderdys CG, Etafy MH, Saleh FH. Ex vivo model for renal fracture in cryoablation. Urology. 2012;80(953):e15–19.

    Google Scholar 

  7. Yu Q, Raissi D. The, “Lightning bolt” sign on computed tomography during percutaneous renal mass cryoablation. J Clin Imaging Sci. 2018;8:35.

    Article  Google Scholar 

  8. Ichijo Y, Miura H, Hirota T, et al. Ice ball cracks during CT-guided renal cryoablation using 1.5-mm-diameter cryoprobes. Cardiovasc Intervent Radiol. 2019;42:475–7.

    Article  Google Scholar 

  9. Miyazaki M, Iguchi T, Takaki H, et al. Ablation protocols and ancillary procedures in tumor ablation therapy: consensus from Japanese experts. Jpn J Radiol. 2016;34:647–56.

    Article  CAS  Google Scholar 

  10. Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Radiology. 2014;273:241–60.

    Article  Google Scholar 

  11. Hongo F, Yamada Y, Ueda T, et al. Preoperative Lipiodol marking and its role on survival and complication rates of CT-guided cryoablation for small renal masses. BMC Urol. 2017;17:10.

    Article  Google Scholar 

  12. Michimoto K, Shimizu K, Kameoka Y, Sadaoka S, Miki J, Kishimoto K. Transcatheter arterial embolization with a mixture of absolute ethanol and iodized oil for poorly visualized endophytic renal masses prior to CT-guided percutaneous cryoablation. Cardiovasc Intervent Radiol. 2016;39:1589–94.

    Article  Google Scholar 

  13. Winokur RS, Pua BB, Madoff DC. Role of combined embolization and ablation in management of renal masses. Semin Intervent Radiol. 2014;31:82–5.

    Article  Google Scholar 

  14. Xavier B, Hervé L, Julien G. Percutaneous renal cryoablation: prospective experience treating 120 consecutive tumors. AJR. 2013;201:1353–61.

    Article  Google Scholar 

  15. Hiraki T, Gobara H, Shibamoto K, et al. Technique for creation of artificial pneumothorax for pain relief during radiofrequency ablation of peripheral lung tumors: report of seven cases. J Vasc Interv Radiol. 2011;22:503–6.

    Article  Google Scholar 

  16. Atwell TD, Vlaminck JJ, Boorjian SA, et al. Percutaneous cryoablation of stage T1b renal cell carcinoma: technique considerations, safety, and local tumor control. J Vasc Interv Radiol. 2015;26:792–9.

    Article  Google Scholar 

  17. Kutikov A, Uzzo RG. The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844–53.

    Article  Google Scholar 

  18. Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6.

    Article  CAS  Google Scholar 

  19. Anvari A, Halpern EF, Samir AE. Statistics 101 for radiologists. RadioGraphics. 2015;35:1789–801.

    Article  Google Scholar 

  20. Woodrum DA, Atwell TD, Farrell MA, Andrews JC, Charboneau JW, Callstrom MR. Role of intraarterial embolization before cryoablation of large renal tumors: a pilot study. J Vasc Interv Radiol. 2010;21:930–6.

    Article  Google Scholar 

  21. Kakarala B, Frangakis CE, Rodriguez R, Georgiades CS. Hemorrhagic complications of percutaneous cryoablation for renal tumors: results from a 7-year prospective study. Cardiovasc Intervent Radiol. 2016;39:1604–10.

    Article  Google Scholar 

  22. Schmit GD, Schenck LA, Thompson RH, et al. Predicting renal cryoablation complications: new risk score based on tumor size and location and patient history. Radiology. 2014;272:903–10.

    Article  Google Scholar 

Download references

Funding

No funding for the present study was received from any companies or organizations.

Author information

Authors and Affiliations

  1. Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Yusuke Ichijo, Hiroshi Miura, Tatsuya Hirota, Shunsuke Asai, Mitsuhiro Hisano & Kei Yamada

  2. Department of Radiology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan

    Yusuke Ichijo

  3. Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Fumiya Hongo & Osamu Ukimura

  4. Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan

    Tetsuya Katsumori

Authors
  1. Yusuke Ichijo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tatsuya Hirota
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shunsuke Asai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mitsuhiro Hisano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fumiya Hongo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Osamu Ukimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tetsuya Katsumori
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kei Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuke Ichijo.

Ethics declarations

Conflict of interest

No authors have any conflict of interest related to this manuscript.

IRB Statement

This retrospective study was approved by the institutional review board of Kyoto Prefectural University of Medicine.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ichijo, Y., Miura, H., Hirota, T. et al. Ice Ball Cracks on CT During Cryoablation for Renal Tumors: A Retrospective Analysis. Cardiovasc Intervent Radiol 43, 882–888 (2020). https://doi.org/10.1007/s00270-020-02454-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-020-02454-0

Keywords

Search

Navigation