Predictors of the Frequency of Ethanol Injections for Renal Cyst Ablation: A Preliminary Study

Yong Hun Kim; Bum Sang Cho

doi:10.3348/jksr.2018.78.3.193

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Kim and Cho: Predictors of the Frequency of Ethanol Injections for Renal Cyst Ablation: A Preliminary Study

Original Article

J Korean Soc Radiol 2018;78(3):193-199.

Published online: 20 January 2018

DOI: https://doi.org/10.3348/jksr.2018.78.3.193

Predictors of the Frequency of Ethanol Injections for Renal Cyst Ablation: A Preliminary Study

Yong Hun Kim, MD¹, Bum Sang Cho, MD^1,^2,^∗

¹Department of Radiology, Chungbuk National University Hostpital, Cheongju, Korea

²Department of Radiology, College of Medicine, Chungbuk National University, Cheongju, Korea

^∗Corresponding author: Bum Sang Cho, MD Department of Radiology, Chungbuk National University Hostpital, 776 1sunhwan-ro, Seowon-gu, Cheongju 28644, Korea. Tel. 82-43-262-6487 Fax. 82-43-269-6479 E-mail: sircircle@hanmail.net

Received 5 September 2017 Revised 10 October 2017 Accepted 22 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the factors facilitating the prediction of the frequency of ethanol injections in successful renal cyst ablation.

Materials and Methods

We retrospectively reviewed the computed tomography and ultrasonography scans of 37 renal cysts. Two radiologists evaluated the characteristics of the presenting renal cysts, including size, calcification, septation, and lobulated configuration. Patients were divided into an “above-four” group and “below-three” group, according to the number of ethanol injections.

Results

Among the 37 renal cysts, six belonged to the “above-four” group and 31 to the “below-three” group. The mean volume of “above-four” group was 409.48 cc and that of the other group was 301.64 cc. Seven renal cysts included three belonging to the “above-four” group, which showed calcification. Twelve renal cysts presented a multilocular appearance with thin septa, and included a cyst classified under the “above-four” group. Three renal cysts had lobulated configuration, with one of them belonging to the “above-four” group.

Conclusion

No significant correlation was found among the different factors in the prediction of the frequency of renal cyst ablation. However, calcification was the most useful parameter for prediction of the number of renal cyst ablations needed.

Keywords: Index terms Kidney Diseases Cysts Ablation Techniques Sclerotherapy Ethanol

References

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Fig. 1.

A 55-year-old woman with a Bosniak classification II lesion in the right kidney and she was performed four times ethanol injections. A, B. The renal cyst in the right kidney shows calcification (white arrows) and septa (black arrows) in non-contrast-enhanced (A) and contrast-enhanced (B) axial computed tomography scans. In addition, it has a lobulated margin (white arrowheads) with at least one lobule. C. Like the axial axis view, the coronal axis view shows a lobulated margin (arrowheads) with at least one lobule; since the lobulated margin is visible in two planes, this cyst was classified as a lobulated renal cyst with calcification and thin septa.

Fig. 2.

A 57-year-old man with a Bosniak classification I lesion in the left kidney and he was performed two times ethanol injections. A. The contrast-enhanced computed tomography axial scan shows a lobulated margin (arrowheads). B, C. The coronal scan also shows a renal cyst with a lobulated margin (arrowheads) renal cyst; however, this is not accompanied by internal septa or calcification. Hence, this case was classified as a lobulated renal cyst in the left kidney without internal septa or calcification. D. Similarly, a sonogram performed during sclerotherapy also demonstrated a lobulated contour (arrowheads).

Fig. 3.

A 71-year-old man with a Bosniak classification II lesion in the right kidney and he was performed two times ethanol injections. A, B. The axial and coronal contrast-enhanced CT scans show a renal cyst with internal linear density (white arrows). This was classified as a smooth margined renal cyst with thin septa and no calcification.

Table 1.

Image Features of Renal Cysts and the Comparison between the Two Groups

Group	Mean Volume (cc)	Calcification		Septa		Lobulated
Group	Mean Volume (cc)	Positive	Negative	Positive	Negative	Positive	Negative
Above-four	409.48	3	3	1	5	1	5
Below-three	301.64	4	27	11	20	2	29
Total	319.12	7	30	12	25	3	34
p-value	0.408	0.068		0.350		0.421

Numbers are mean volume and number of patients. p-values are for the difference between results for the “above-four” group and the “below-three” group. The subjects were divided according to the number of rounds of renal cyst ablation, with the “above-four” group including those who underwent at least four ethanol injections, and the “below-three” group including those who underwent three or fewer ethanol injections.

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