On the contrary 1 patient had local residual tumor evidenced by renal mass persistence and pathological contrast enhancement with nodular feature in the cryoablated area (TA 14,3 sec; TTP 38,3 sec; WIR 11,56/sec; PCE 301,23 HU) compared to normal ipsilateral

cortex (TA 13,8 sec; TTP 44,4 sec; WIR 9,41; PCE 374,18 HU). The GSK2118436 clinical trial mean BV value at the same residual tumour area was 140,68 ± 24,48 mL/100 g (vs. BV of 116,14 ± 14,27 in normal parenchyma), BF and PS mean values respectively were 562,72 ± 97,96 mL/100 g/min (vs. 393,8 ± 59,01 mL/100 g/min in normal parenchyma) and 73,52 ± 28,1 mL/100 g/min (vs. 41,88 ± 19,89 mL/100 g/min in normal parenchyma). MTT was 15 ± 0,1 sec (vs. 17,69 ± 0,4 sec in normal parenchyma). At a six months postoperative follow-up, 11 patients (73%) underwent CT guided percutaneous core needle biopsy. Two/Three needle cores were obtained per patient with a spring loaded, 18 gauge Nirogacestat cell line core biopsy device. According to pCT results with one case of persistent disease, of 25 needle cores obtained, two specimen of RCC were identified in 1 patients. This patient was scheduled for salvage laparoscopic

cryoablation and is currently under image monitoring without actual evidence of local residual or metastatic disease at the 12 months follow-up. In the remaining 23 needle cores available, a varying evidence of irreversible cell death was depicted including: hemosiderin deposits in 10 (43%), coagulative necrosis in 8 (35%), and fibrosis in 5 (22%) cores. Discussion Perfusion imaging is a non-invasive functional technique firstly introduced by Miles [16, 17] and implemented for the evaluation of neoplastic disease on account of its diagnostic and prognostic value as observed for treatment response of lymphoma [18] and head-and-neck

Etofibrate cancer [19], for predictive malignancy value in pulmonary solitary nodule [20], for monitoring of hemodynamic changes after anti-angiogenic therapy [21]. The growing availability of new multislice Vactosertib manufacturer computed tomographies (MSCTs) and software programs for post-processing perfusion measurements have allowed additional functional informations regarding flow quantification of cross section areas. As far as we know, there are no published reports about the use of pCT in monitoring of cryoablated RCC. Cryoablation technique is a thermal minimally invasive treatment, developed as an alternative to conventional surgical resection in patients with selected case of RCC, especially for whom the risk of surgery is too great [9, 22–28]. The area of necrosis resulting from cryoablation is directed by cytotoxic effect from intracellular ice crystallization during the active freezing cycles and micro-occlusive tissue ischemia by the active or passive thaw cycle [29]. With time fibrosis occurs and the ablated area decreases in size. Although cryoablation of select renal masses is an effective technique in local tumor control [28, 30], the ablated renal tumor area is not excised.