Adjunctive Techniques for Optimizing Percutaneous CT-Guided Cryoablation of Renal Tumours.

Percutaneous computed tomography (CT) -guided cryoablation is an effective curative treatment for renal cell carcinoma. Improvements in treatment efficacy reflect not only the learning curve but also the integration of multiple adjunctive techniques that can be implemented at different stages of the procedure. Tumour targeting can be enhanced by intravenous contrast administration, or by intra-arterial delivery of contrast medium or iodized oil. Fusion imaging is another option to improve tumour delineation by registering intraprocedural CT with prior cross-sectional imaging. Probe placement for difficult-to-access lesions may be facilitated by alternative access routes, while electromagnetic navigation and robotic systems are being developed as alternatives to manual advancement. To mitigate the cold-sink effect and reduce bleeding risk, transarterial techniques such as embolization or temporary arterial occlusion can be added. Finally, thermoprotective manoeuvres are increasingly used to displace adjacent organs, thereby improving the feasibility, safety, and efficacy of renal cryoablation.