Image-guided Percutaneous Radiofrequency Ablation and Incidence of Post-Radiofrequency Ablation Syndrome: Prospective Survey

doi:10.1148/radiol.2373042008

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Vascular and Interventional Radiology

Image-guided Percutaneous Radiofrequency Ablation and Incidence of Post–Radiofrequency Ablation Syndrome: Prospective Survey¹

Tze M. Wah, MD², Ronald S. Arellano, MD, Debra A. Gervais, MD, Catherine A. Saltalamacchia, RN, BSN, Joanne Martino, RN, Elken F. Halpern, PhD, Michael Maher, MD and Peter R. Mueller, MD

¹ From the Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St, White Bldg 270, Boston, MA 02114-2696 (T.M.W., R.S.A., D.A.G., C.A.S., J.M., M.M., P.R.M.); and Department of Statistics, Institute for Technology Assessment, Boston, Mass (E.F.H.). Received November 25, 2004; revision requested January 25, 2005; revision received March 27; accepted April 13. Address correspondence to P.R.M. (e-mail: pmueller{at}partners.org).

PURPOSE: To evaluate prospectively the incidence of post–radiofrequency(RF) ablation syndrome and determine its impact on the quality oflife in the 10 days after percutaneous RF ablation.

MATERIALS AND METHODS: This study was approved by the institutionalreview board and was HIPAA compliant. Informed consent was obtainedfor this survey in all patients by the interventional nurse coordinators.Thirty-six patients (20 men, 16 women; mean age, 69.3 years; range,40–88 years) underwent RF ablation for 26 liver tumors and17 renal tumors. Twenty control patients (11 men, nine women; meanage, 60.8 years; range, 35–76 years) underwent biopsy of focalliver lesions or renal lesions. With a standardized questionnaire,a telephone survey was conducted on days 1, 3, 5, and 10 after RFablation or biopsy. The symptoms and interference with lifestylewere documented prospectively with a numeric intensity scale by usinggrades 0–10. Statistical analysis with Fisher exact test andanalysis of variance was performed.

RESULTS: After RF ablation, 15 (42%) patients developed low-gradefever (P < .001), 29 (81%) had flulike symptoms (P < .001),and four were asymptomatic. Symptoms peaked on day 3 and mainly resolvedby day 10. Twelve (33%) patients had complete post–RF ablationsyndrome: fever and flulike symptoms (P = .005). Flulike symptomswere more prolonged when they were accompanied with fever, peakedon day 5, and resolved more quickly for patients with renal lesionsthan they did for patients with liver lesions. Four patients hadpersistent fever caused by pneumonia (n = 2), pleural effusion andatelectasis (n = 1), or liver abscess (n = 1). No control patientsdeveloped both fever and flulike symptoms. Post–RF ablationpatients with symptoms experienced significantly greater pain andinterference with general and work activities, which peaked on day1, than did control patients (P = .01 [pain], P < .001 [generaland work activities]).

CONCLUSION: Complete post–RF ablation syndrome occurs in approximatelyone-third of patients but is self-limiting within 10 days after theprocedure. Persistent or late-onset fever may indicate concurrentinfection elsewhere or possible abscess formation.