CardioVascular and Interventional Radiology

, Volume 31, Issue 4, pp 762–767 | Cite as

Imaging-Guided Percutaneous Radiofrequency Ablation of Adrenal Metastases: Preliminary Results at a Single Institution with a Single Device

  • G. Carrafiello
  • D. Laganà
  • C. Recaldini
  • A. Giorgianni
  • A. Ianniello
  • D. Lumia
  • A. D’Ambrosio
  • M. Petullà
  • G. Dionigi
  • C. Fugazzola
Clinical Investigation


The aim of this study was to show the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of adrenal metastases (AM). Seven imaging-guided percutaneous RFA treatments were performed in six patients (two men and four women; mean age, 67.2 years; range, 55–74 years) with six AM who were referred to our institution from 2003 to 2006. One patient was treated twice for recurrence after first treatment. The average diameter of the treated AM was 29 mm (range, 15–40 mm). In all patients, the diagnosis was obtained with CT current protocols in use at our institution and confirmed by pathology with an image-guided biopsy. No major complications occurred. In one patient shortly after initiation of the procedure, severe hypertension was noted; another patient developed post-RFA syndrome. In five of six lesions, there was no residual enhancement of the treated tumor. In one patient CT examination showed areas of residual enhancement of the tumor after treatment. Our preliminary results suggest that imaging-guided percutaneous RFA is effective for local control of AM, without major complications and with a low morbidity rate related to the procedure. Long-term follow-up will need to be performed and appropriate patient selection criteria will need to be determined in future randomized trials.


Radiofrequency ablation Metastatic adrenal neoplasm Interventional radiology 


  1. 1.
    Abrams HL, Spiro R, Goldstein N (1950) Metastasis in carcinoma: analysis of 1000 autopsied cases. Cancer 3:74–85PubMedCrossRefGoogle Scholar
  2. 2.
    Bullock WK, Hirst AE Jr (1953) Metastatic carcinoma of the adrenal. Am J Med Sci 226:521–524PubMedGoogle Scholar
  3. 3.
    Cedermark BJ, Blumenson LE, Pickren JW et al (1977) The significance of metastases to the adrenal glands in adenocarcinoma of the colon and rectum. Surg Gynecol Obstet 144:537–546PubMedGoogle Scholar
  4. 4.
    Momoi H, Shimahara Y, Terajima H et al (2002) Management of adrenal metastasis from hepatocellular carcinoma. Surg Today 32:1035–1041PubMedCrossRefGoogle Scholar
  5. 5.
    Sakamoto Y, Kubota K, Mori M et al (1999) Surgical management for adrenal gland metastasis of hepatocellular carcinoma. Hepato-Gastroenterology 46:1036–1041PubMedGoogle Scholar
  6. 6.
    Taniai N, Egami K, Wada M et al (1999) Adrenal metastasis from hepatocellular carcinoma: report of 3 cases. Hepato-Gastroenterology 46:2523–2528PubMedGoogle Scholar
  7. 7.
    Hokotate H, Inoue H, Baba Y et al (2003) Aldosteronomas: experience with superselective adrenal arterial embolization in 33 cases. Radiology 227:401–406PubMedCrossRefGoogle Scholar
  8. 8.
    Inoue H, Nakajo M, Miyazono N et al (1997) Transcatheter arterial ablation of aldosteronomas with high-concentration ethanol: preliminary and long-term results. AJR 168:1241–1245PubMedGoogle Scholar
  9. 9.
    Miyazono N, Ueno K, Nakajo M et al (1996) Transcatheter arterial and adrenal embolization with iohexol-ethanol solutions: animal experimental study and clinical application. Invest Radiol 31:755–760PubMedCrossRefGoogle Scholar
  10. 10.
    Shibata T, Maetani Y, Ametani F et al (2000) Percutaneous ethanol injection for treatment of adrenal metastasis from hepatocellular carcinoma. AJR 174:333–335PubMedGoogle Scholar
  11. 11.
    Maki DD, Haskal ZJ, Matthies A et al (2000) Percutaneous ethanol ablation of an adrenal tumor. AJR 174:1031–1032PubMedGoogle Scholar
  12. 12.
    Liang HL, Pan HB, Lee YH et al (1999) Small functional adrenal cortical adenoma: treatment with CT-guided percutaneous acetic acid injection—report of three cases. Radiology 213:612–615PubMedGoogle Scholar
  13. 13.
    Takada K, Nakamura K, Usuki N et al (1989) Adrenal arterial embolization and radiotherapy of a case with metastatic adrenal tumor and its tumor thrombus in inferior vena cava from hepatocellular carcinoma. Rinsho Hoshasen 34(12):1529–1532PubMedGoogle Scholar
  14. 14.
    Paul CA, Virgo KS, Wade TP et al (2000) Adrenalectomy for isolated adrenal metastases from non-adrenal cancer. Int J Oncol 17:181–187PubMedGoogle Scholar
  15. 15.
    Lo CY, Van Heerden JA, Soreide JA et al (1996) Adrenalectomy for metastatic disease to the adrenal glands. Br J Surg 83:528–531PubMedCrossRefGoogle Scholar
  16. 16.
    Kim SH, Brennan MF, Russo P et al (1998) The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer 82:389–394PubMedCrossRefGoogle Scholar
  17. 17.
    Mitchell IC, Nwariaku FE (2007) Adrenal masses in the cancer patient: surveillance or excision. Oncologist 12:168–174PubMedCrossRefGoogle Scholar
  18. 18.
    Sarela AI, Murphy I, Coit DG et al (2003) Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol 10:1191–1196PubMedCrossRefGoogle Scholar
  19. 19.
    Antonelli A, Cozzoli A, Simeone C et al (2006) Surgical treatment of adrenal metastasis from renal cell carcinoma: a single-centre experience of 45 patients. BJU Int 97:505–508PubMedCrossRefGoogle Scholar
  20. 20.
    Wood BJ, Abraham J, Hvizda JL et al (2003) Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases. Cancer 97:554–560PubMedCrossRefGoogle Scholar
  21. 21.
    Mayo-Smith WW, Dupuy DE (2004) Adrenal neoplasms: CT-guided radiofrequency ablation—preliminary results. Radiology 231:225–230PubMedCrossRefGoogle Scholar
  22. 22.
    Lo HW, Tsai YJ, Chen PH et al (2003) Radiofrequency ablation for treatment of hepatocellular carcinoma with cirrhosis. Hepatogastroenterology 50:645–650PubMedGoogle Scholar
  23. 23.
    Curley SA (2003) Radiofrequency ablation of malignant liver tumors. Ann Surg Oncol 10:338–347PubMedCrossRefGoogle Scholar
  24. 24.
    Lencioni R, Cioni D, Bartolozzi C (2001) Percutaneous radiofrequency thermal ablation of liver malignancies: techniques, indications, imaging findings, and clinical results. Abdom Imaging 26:345–360PubMedCrossRefGoogle Scholar
  25. 25.
    Gervais DA, McGovern F, Arellano RS et al (2003) Renal cell carcinoma: clinical experience and technical success with radiofrequency ablation of 42 tumors. Radiology 226:417–424PubMedCrossRefGoogle Scholar
  26. 26.
    Farrell MA, Charboneau WJ, DiMarco DS et al (2003) Imaging-guided radiofrequency ablation of solid renal tumors. AJR 180:1509–1513PubMedGoogle Scholar
  27. 27.
    Breen DJ, Rutherford EE, Stedman B et al (2007) Managment of renal tumors by image-guided radiofrequency ablation: experience in 105 tumors. CardioVasc Interv Radiol 30(5):936–942CrossRefGoogle Scholar
  28. 28.
    Sabharwal R, Vladica P (2006) Renal tumors: technical success and early clinical experience with radiofrequency ablation of 18 tumors. CardioVasc Interv Radiol 29(2):202–209CrossRefGoogle Scholar
  29. 29.
    Boland GW, Lee MJ, Gazelle GS et al (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR 171(1):201–204 PubMedGoogle Scholar
  30. 30.
    Fugazzola C, Carrafiello G, Laganà D et al (2003) Neoplasie del surrene. Diagnostica per Immagini. Radiologia. In: Olivetti L, Chiesa A (eds) Neoplasie del rene, surrene e retroperitoneo: dalla diagnosi alla terapia. Ed Poletto, Milano, pp 113–130Google Scholar
  31. 31.
    Rossi R, Savastano S, Tommaselli AP et al (1995) Percutaneous computed tomography-guided ethanol injection in aldosterone-producing adrenocortical adenoma. Eur J Endocrinol 132:302–305PubMedCrossRefGoogle Scholar
  32. 32.
    Liang HL, Pan HB, Lee YH et al (1999) Small functional adrenal cortical adenoma: treatment with CT-guided percutaneous acetic acid injection—report of three cases. Radiology 213:612–615PubMedGoogle Scholar
  33. 33.
    Lo WK, van Sonnenberg E, Shankar S et al (2006) Percutaneous CT-guided radiofrequency ablation of symptomatic bilateral adrenal metastases in a single session. J Vasc Interv Radiol 17:175–179PubMedCrossRefGoogle Scholar
  34. 34.
    Rhim H, Dodd GD III, Chintapalli KN et al (2004) Radiofrequency thermal ablation of abdominal tumors: lessons learned from complications. Radiographics 24:41–52PubMedCrossRefGoogle Scholar
  35. 35.
    Chini EN, Brown MJ, Farrell MA et al (2004) Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anestesia. Anesth Analg 99:1867–1869 PubMedCrossRefGoogle Scholar
  36. 36.
    Onik G, Onik C, Medary I et al (2003) Life-threatening hypertensive crises in two patients undergoing hepatic radiofrequency ablation. AJR 181:495–497PubMedGoogle Scholar
  37. 37.
    Gulla N, Patriti A, Fabbri B et al (2003) Surgical technique and haemodynamic changes in adrenalectomy for secreting neoplasia: personal experience and review of the literature. Minerva Chir 58:87–92PubMedGoogle Scholar
  38. 38.
    Atwell TD, Wass CT, Charboneau JW et al (2006) Malignant hypertension during cryoablation of an adrenal gland tumor. J Vasc Interv Radiol 17:573–575PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • G. Carrafiello
    • 1
    • 2
  • D. Laganà
    • 2
  • C. Recaldini
    • 2
  • A. Giorgianni
    • 2
  • A. Ianniello
    • 2
  • D. Lumia
    • 2
  • A. D’Ambrosio
    • 2
  • M. Petullà
    • 2
  • G. Dionigi
    • 3
  • C. Fugazzola
    • 2
  1. 1.Radiologia Ospedale di Circolo-Fondazione MacchiVareseItaly
  2. 2.Department of RadiologyUniversity of InsubriaVareseItaly
  3. 3.Department of General SurgeryUniversity of InsubriaVareseItaly

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