51
|
Filippiadis DK, Velonakis G, Kostantos C, Kouloulias V, Brountzos E, Kelekis N, Kelekis A. Computed tomography-guided radiofrequency ablation of intra-articular osteoid osteoma: a single centre’s experience. Int J Hyperthermia 2017; 33:670-674. [DOI: 10.1080/02656736.2017.1294711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- D. K. Filippiadis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - G. Velonakis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - C. Kostantos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - V. Kouloulias
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - E. Brountzos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - N. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| |
Collapse
|
52
|
Barile A, Arrigoni F, Zugaro L, Zappia M, Cazzato RL, Garnon J, Ramamurthy N, Brunese L, Gangi A, Masciocchi C. Minimally invasive treatments of painful bone lesions: state of the art. Med Oncol 2017; 34:53. [PMID: 28236103 DOI: 10.1007/s12032-017-0909-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 12/31/2022]
Abstract
The role of the interventional radiology (IR) in the musculoskeletal system, and in particular in the bone, is a field of knowledge that is growing significantly in the last years with indications for treatment of both benign and malign lesions. In this paper, we review the state of the art of this application of the IR in the bone (bone metastasis and benign bone lesions) with discussion about all the techniques today used.
Collapse
Affiliation(s)
- Antonio Barile
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Francesco Arrigoni
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marcello Zappia
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Luca Brunese
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Carlo Masciocchi
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
53
|
The Results of Ultrasonography-Guided Percutaneous Radiofrequency Ablation in Hyperparathyroid Patients in Whom Surgery Is Not Feasible. Cardiovasc Intervent Radiol 2017; 40:596-602. [DOI: 10.1007/s00270-016-1544-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/09/2016] [Indexed: 01/20/2023]
|
54
|
Yang PL, He XJ, Li HP, Zang QJ, Wang GY. Image-guided minimally invasive percutaneous treatment of spinal metastasis. Exp Ther Med 2017; 13:705-709. [PMID: 28352355 DOI: 10.3892/etm.2017.4029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/11/2016] [Indexed: 12/25/2022] Open
Abstract
In order to provide effective options for minimally invasive treatment of spinal metastases, the present study retrospectively evaluated the efficacy and safety of image-guided minimally invasive percutaneous treatment of spinal metastases. Image-guided percutaneous vertebral body enhancement, radiofrequency ablation (RFA) and tumor debulking combined with other methods to strengthen the vertebrae were applied dependent on the indications. Percutaneous vertebroplasty (PVP) was used when vertebral body destruction was simple. In addition, RFA was used in cases where pure spinal epidural soft tissue mass or accessories (spinous process, vertebral plate and vertebral pedicle) were destroyed, but vertebral integrity and stability existed. Tumor debulking (also known as limited RFA) combined with vertebral augmentation were used in cases presenting destruction of the epidural soft tissue mass and accessories, and pathological vertebral fractures. A comprehensive assessment was performed through a standardized questionnaire and indicators including biomechanical stability of the spine, quality of life, neurological status and tumor progression status were assessed during the 6 weeks-6 months follow-up following surgery. After the most suitable treatment was used, the biomechanical stability of the spine was increased, the pain caused by spinal metastases within 6 weeks was significantly reduced, while the daily activities and quality of life were improved. The mean progression-free survival of tumors was 330±54 days, and no associated complications occurred. Therefore, the use of a combination of image-guided PVP, RFA and other methods is safe and effective for the treatment of spinal metastases.
Collapse
Affiliation(s)
- Ping-Lin Yang
- Second Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Xi-Jing He
- Second Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Hao-Peng Li
- Second Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Quan-Jin Zang
- Second Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Guo-Yu Wang
- Second Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| |
Collapse
|
55
|
Bornemann R, Pflugmacher R, Frey SP, Roessler PP, Rommelspacher Y, Wilhelm KE, Sander K, Wirtz DC, Grötz SF. Temperature distribution during radiofrequency ablation of spinal metastases in a human cadaver model: Comparison of three electrodes. Technol Health Care 2016; 24:647-53. [DOI: 10.3233/thc-161160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Rahel Bornemann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Robert Pflugmacher
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Sönke P. Frey
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Philip P. Roessler
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Yorck Rommelspacher
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Kai E. Wilhelm
- Fachabteilung Radiologie, Evangelische Kliniken Bonn, Bonn, Germany
| | - Kirsten Sander
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Dieter C. Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Simon F. Grötz
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Germany
| |
Collapse
|
56
|
Prospective 1-year follow-up pilot study of CT-guided microwave ablation in the treatment of bone and soft-tissue malignant tumours. Eur Radiol 2016; 27:1477-1485. [DOI: 10.1007/s00330-016-4528-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/08/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022]
|
57
|
Li S, Chen F, Shen L, Zeng Q, Wu P. Percutaneous irreversible electroporation for breast tissue and breast cancer: safety, feasibility, skin effects and radiologic-pathologic correlation in an animal study. J Transl Med 2016; 14:238. [PMID: 27495906 PMCID: PMC4975887 DOI: 10.1186/s12967-016-0993-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 07/28/2016] [Indexed: 01/04/2023] Open
Abstract
Background To study the safety, feasibility and skin effects of irreversible electroporation (IRE) for breast tissue and breast cancer in animal models. Methods Eight pigs were used in this study. IRE was performed on the left breasts of the pigs with different skin–electrode distances, and the right breasts were used as controls. The electrodes were placed 1–8 mm away from the skin, with an electrode spacing of 1.5–2 cm. Imaging and pathological examinations were performed at specific time points for follow-up evaluation. Vital signs, skin damage, breast tissue changes and ablation efficacy were also closely observed. Eight rabbit models with or without VX2 breast tumor implantations were used to further assess the damage caused by and the repair of thin skin after IRE treatment for breast cancer. Contrast-enhanced ultrasound and elastosonography were used to investigate ablation efficacy and safety. Results During IRE, the color of the pig breast skin reversibly changed. When the skin–electrode distance was 3 mm, the breast skin clearly changed, becoming white in the center and purple in the surrounding region during IRE. One small purulent skin lesion was detected several days after IRE. When the skin–electrode distance was 5–8 mm, the breast skin became red during IRE. However, the skin architecture was normal when evaluated using gross pathology and hematoxylin-eosin staining. When the skin–electrode distance was 1 mm, skin atrophy and yellow glabrescence occurred in the rabbit breasts after IRE. When the skin–electrode distance was ≥5 mm, there was no skin damage in the rabbit model regardless of breast cancer implantation. After IRE, complete ablation of the targeted breast tissue or cancer was confirmed, and apoptosis was detected in the target tissue and outermost epidermal layer. In the ablated breasts of the surviving animals, complete mammary regeneration with normal skin and hair was observed. Furthermore, no massive fibrosis or mass formation were detected on ultrasound or through hematoxylin–eosin staining. Conclusions After IRE, the skin architecture was well preserved when the skin–electrode distance was ≥5 mm. Moreover, breast regeneration occurred without mass formation or obvious fibrosis. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0993-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sheng Li
- Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Fei Chen
- Department of Ultrasonography, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lujun Shen
- Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Qi Zeng
- Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Peihong Wu
- Department of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| |
Collapse
|
58
|
Doctor JR, Solanki SL, Patil VP, Divatia JV. Novel use of epidural catheter: Air injection for neuroprotection during radiofrequency ablation of spinal osteoid osteoma. Saudi J Anaesth 2016; 10:347-9. [PMID: 27375396 PMCID: PMC4916825 DOI: 10.4103/1658-354x.174900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Osteoid osteoma (OO) is a benign bone tumor, with a male-female ratio of approximately 2:1 and mainly affecting long bones. Ten percent of the lesions occur in the spine, mostly within the posterior elements. Treatment options for OO include surgical excision and percutaneous imaging-guided radiofrequency ablation (RFA). Lesions within the spine have an inherent risk of thermal damage to the vital structure because of proximity to the neural elements. We report a novel use of the epidural catheter for air injection for the neuroprotection of nerves close to the OO of the spine. A 12-year-old and 30 kg male child with an OO of the L3 vertebra was taken up for RFA. His preoperative examinations were within normal limits. The OO was very close to the L3 nerve root. Under general anesthesia, lumbar epidural catheter was placed in the L3-L4 space under imaging guidance. Ten ml of aliquots of air was injected under imaging guidance to avoid injury to the neural structures due to RFA. The air created a gap between neural elements and the tumor and served as an insulating material thereby protecting the neural elements from damage due to the RFA. Postoperatively, the patient did not develop any neurological deficit.
Collapse
Affiliation(s)
- JR Doctor
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Mumbai, Maharashtra, India
- Address for correspondence: Dr. Jeson Rajan Doctor, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, 2nd Floor, Operation Theatre Complex, Main Building, Parel, Mumbai, Maharashtra, India. E-mail:
| | - SL Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - VP Patil
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - JV Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Mumbai, Maharashtra, India
| |
Collapse
|
59
|
Pneumodissection for skin protection in image-guided cryoablation of superficial musculoskeletal tumours. Eur Radiol 2016; 27:1202-1210. [PMID: 27287479 DOI: 10.1007/s00330-016-4456-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/22/2016] [Accepted: 05/30/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Pneumodissection is described as a simple method for preventing skin injury during cryoablation of superficial musculoskeletal tumours. METHODS Superficial tumour cryoablations performed from 2009 to 2015 were retrospectively reviewed. Pneumodissection was performed in 13 patients when the shortest tumour-skin distance was less than 25 mm. Indications were pain palliation (n = 9) and local tumour control (n = 4). Patients, target tumours, technical characteristics and complications up to 60 days post ablation were reviewed. The ice ball-skin distances with and without pneumodissection were compared by a paired t-test and further assessed for association with covariates using ANCOVA. RESULTS Technical success for ablation was 12 of 13. The mean shortest tumour-skin distance was 15.0 mm (3.2-24.5 mm). The mean thickness of pneumodissection was 9.6 mm (5.2-16.6 mm) resulting in mean elevation of skin of 3.4 mm (1.2-5.3 mm). Mean shortest ice ball-skin distance after pneumodissection was 10.5 mm (4.2-19.7 mm). No infection or systemic air embolism was noted. No intraprocedural frostbite was observed. CONCLUSION Pneumodissection is feasible, effective and safe in protecting the skin during image-guided cryoablation of superficial tumours. KEY POINTS • Frostbite during image-guided cryoablation of superficial tumours is commonly under-reported. • Frostbites are painful and may introduce infection into the superficial ablation zone. • Warm compress, saline and CO 2 have shortcomings in protecting the skin. • Pneumodissection is free, readily available, easy to use and safe and effective.
Collapse
|
60
|
Percutaneous Biopsy and Radiofrequency Ablation of Osteoid Osteoma with Excess Reactive New Bone Formation and Cortical Thickening Using a Battery-Powered Drill for Access: A Technical Note. Cardiovasc Intervent Radiol 2016; 39:1499-505. [PMID: 27230513 DOI: 10.1007/s00270-016-1366-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To report our experience with the use of a battery-powered drill in biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation. The battery-powered drill enables obtaining the sample while drilling. MATERIALS AND METHODS During the last 18 months, 14 patients suffering from painful osteoid osteoma with excess reactive new bone formation underwent CT-guided biopsy and radiofrequency ablation. In order to assess and sample the nidus of the osteoid osteoma, a battery-powered drill was used. Biopsy was performed in all cases. Then, coaxially, a radiofrequency electrode was inserted and ablation was performed with osteoid osteoma protocol. Procedure time (i.e., drilling including local anesthesia), amount of scans, technical and clinical success, and the results of biopsy are reported. RESULTS Access to the nidus through the excess reactive new bone formation was feasible in all cases. Median procedure time was 50.5 min. Histologic verification of osteoid osteoma was performed in all cases. Radiofrequency electrode was coaxially inserted within the nidus and ablation was successfully performed in all lesions. Median amount CT scans, performed to control correct positioning of the drill and precise electrode placement within the nidus was 11. There were no complications or material failure reported in our study. CONCLUSIONS The use of battery-powered drill facilitates access to the osteoid osteoma nidus in cases where excess reactive new bone formation is present. Biopsy needle can be used for channel creation during the access offering at the same time the possibility to extract bone samples.
Collapse
|
61
|
Abstract
OBJECTIVE The purpose of this article is to review the current guidelines and recommendations for percutaneous image-guided treatment of musculoskeletal tumors. CONCLUSION With the ongoing technologic advances, it is essential that the musculoskeletal interventionalist is familiar with the current tools and techniques available for the treatment of soft-tissue and bone tumors. Fortunately, many of these tools are readily available in a standard interventional radiology department and can be easily applied to the musculoskeletal system.
Collapse
|
62
|
Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases. Cardiovasc Intervent Radiol 2016; 39:1332-8. [PMID: 27048488 DOI: 10.1007/s00270-016-1333-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/24/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures. MATERIALS AND METHODS Between May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57-75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment. RESULTS Four pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1-4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2-3 months; one case could not be followed due to early post-procedural oncologic mortality. CONCLUSION Percutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.
Collapse
|
63
|
Yılmaz S, Özdoğan M, Cevener M, Ozluk A, Kargi A, Kendiroglu F, Ogretmen I, Yildiz A. Use of cryoablation beyond the prostate. Insights Imaging 2016; 7:223-32. [PMID: 26762141 PMCID: PMC4805614 DOI: 10.1007/s13244-015-0460-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Cryoablation has been used for many years as a surgical ablation technique in the prostate and kidney. However, since the introduction of high-intensity focused ultrasound (HIFU) and robotic surgery for prostate tumours, its popularity in the urologic community has declined. In the early 2000s, innovations in cryoablation technology allowed the use of thinner probes, which were suitable for percutaneous application. As a result, radiologists began using cryoablation, first in the liver, and then in other organs or tissues such as the kidney, lung, breast, pancreas, bone, and soft tissue. In most of these locations, cryoablation has great potential given its inherent advantages, including the use of local anaesthesia, little or no pain during and after the procedure, real-time monitoring of the ablation area on US, CT or MRI, the potential for ablation of large tumours with multiple probes, and the ability to change the shape of the ablation in non-spherical tumours. Yet despite these advantages, the use of percutaneous cryoablation among radiologists appears to be far lower than that of heat-based ablation techniques. The aim of this article is to outline specific aspects of cryoablation and to illustrate its potential clinical applications with case presentations. KEY POINTS • Recent advances have made cryoablation suitable for percutaneous use by radiologists with image guidance. • Cryoablation has distinct advantages over heat-based ablation techniques. • Cryoablation is becoming increasingly popular for lung, breast, kidney, bone, and soft tissue tumours.
Collapse
Affiliation(s)
- Saim Yılmaz
- MIIO Group, Radiology Division, Memorial-MedStar Hospitals, Antalya, Turkey.
- MIIO: Mediterranean Integrative and Innovative Oncology, Antalya, Turkey.
| | - Mustafa Özdoğan
- MIIO Group, Medical Oncology Division, Memorial-MedStar Hospitals, Antalya, Turkey
| | - Metin Cevener
- MIIO Group, Radiology Division, Memorial-MedStar Hospitals, Antalya, Turkey
| | - Ali Ozluk
- MIIO Group, General Surgery Division, Memorial-MedStar Hospitals, Antalya, Turkey
| | - Aysegul Kargi
- MIIO Group, Medical Oncology Division, Memorial-MedStar Hospitals, Antalya, Turkey
| | - Feride Kendiroglu
- MIIO Group, Radiology Division, Memorial-MedStar Hospitals, Antalya, Turkey
| | - Irfan Ogretmen
- MIIO Group, Medical Oncology Division, Memorial-MedStar Hospitals, Antalya, Turkey
| | - Akin Yildiz
- MIIO Group, Nuclear Medicine Division, Memorial-MedStar Hospitals, Antalya, Turkey
| |
Collapse
|
64
|
Abstract
The field of cryosurgery began nearly 40 years ago with the open application of liquid nitrogen to ablate tumors. Recent developments in imaging and cryoprobe technology allow for percutaneous ablation of tumors. Computed tomography (CT)-guided cryoablation has particular use in treating musculoskeletal neoplasms because of the ability to image the lethal ice zone around both bone and soft tissue structures. This manuscript will review the development, indications, and results of cryoablation as applied to musculoskeletal neoplasms. This technique holds promise for the treatment of benign conditions as well as the palliation and durable treatment of musculoskeletal metastases; it is not commonly indicated in the curative treatment of primary malignant bone or soft tissue sarcomas.
Collapse
|
65
|
Common procedures and strategies for anaesthesia in interventional radiology. Curr Opin Anaesthesiol 2015; 28:458-63. [DOI: 10.1097/aco.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
66
|
Abstract
Skeletal metastasis is a common cause of severe morbidity, reduction in quality of life (QOL) and often early mortality. Its prevalence is rising due to a higher rate of diagnosis, better systemic treatment, longer lives with the disease and higher disease burden rate. As people with cancer live longer and with rising sensitivity of body imaging and surveillance, the incidence of pathological fracture, metastatic epidural cord compression is rising and constitutes a challenge for the orthopedic surgeon to maintain their QOL. Metastatic disease is no longer a death sentence condemning patients to "terminal care." In the era of multidisciplinary care and effective systemic targeted and nontargeted therapy, patient expectations of QOL, even during palliative end of care period is high. We lay emphasis on proving the diagnosis of metastasis by biopsy and histopathology and discuss imaging modalities to help estimate fracture risk and map disease extent. This article discusses at length the evidence and decision-making process of various modalities to treat skeletal metastasis. The modalities range from radiation including image-guided, stereotactic and whole body radiation, systemic targeted or hormonal therapy, spinal decompression with or without stabilization, extended curettage with stabilization, resection in select cases with megaprosthetic or biological reconstruction, percutaneous procedures using radio frequency ablation, cementoplasties and discusses the role of emerging modalities like high frequency ultrasound-guided ablation, cryotherapy and whole body radionuclide therapy. The focus lies on the role of multidisciplinary care, which considers complex decisions on patient centric prognosis, comorbidities, cost, feasibility and expectations in order to maximize outcomes on QOL issues.
Collapse
Affiliation(s)
- Manish G Agarwal
- P.D. Hinduja National Hospital, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
| | - Prakash Nayak
- P.D. Hinduja National Hospital, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
| |
Collapse
|
67
|
Retrograde Transpubic Approach for Percutaneous Radiofrequency Ablation and Cementoplasty of Acetabular Metastasis. Case Rep Radiol 2015; 2015:146963. [PMID: 26491595 PMCID: PMC4602320 DOI: 10.1155/2015/146963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 11/25/2022] Open
Abstract
We report a case of painful and disabling anterior acetabular bone metastasis treated with bipolar radiofrequency ablation and cementoplasty. Due to the high risk of complications related to the proximity of the femoral neurovascular structures with a direct approach, we successfully performed a retrograde transpubic approach under combined CT and fluoroscopic guidance. In the present report, we describe this approach detailing its indications, advantages, and the technical tips to achieve a safe and satisfactory procedure.
Collapse
|