CT-Guided RFA of Pheochromocytomas in Von Hippel-Lindau Disease: Treatment Safety and Imaging Features

Purpose : To retrospectively assess the percutaneous radiofrequency ablation (RFA) safety and imaging features of pheochromocytomas in von Hippel Lindau disease (VHLD). Materials and Methods : Between September 2012 and February 2025, eight pheochromocytomas in six patients with VHLD were treated in eight CT-guided RFA sessions. Treatment outcomes, hypertensive crisis, kidney attenuation, and radiation dose were assessed. The Wilcoxon matched-pairs signed-rank test and Friedman test with post-hoc tests were used for statistical analysis. Results : Of the eight pheochromocytomas, seven were completely ablated in one session, and no local tumor progression, tumor recurrence, or major complications were observed. Only one patient had a residual tumor when a low tube current (30 mA) was used. Of the eight RFA sessions, five resulted in markedly elevated blood pressure during the RFA cycles (p=0.0078). The hypertensive crises were managed with intravenous antihypertensive administration. During hypertensive crises, the kidneys became hyperattenuating (p<0.05)but renal function was not reduced. The median dose length product was 1185.8 mGycm (350.1–1690.9 mGycm). Conclusion : CT-guided RFA has potential to safely treat pheochromocytomas in patients with VHLD. Hypertensive crisis is frequent but well-controlled. It makes kidneyshyperattenuating, probably due to vasospasm resulting from the hyperexcretion of catecholamines.