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Kulkarni CB, Pullara SK, C S R, Moorthy S. Complications of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Acad Radiol 2024; 31:2987-3003. [PMID: 38092590 DOI: 10.1016/j.acra.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 07/21/2024]
Abstract
Radiofrequency ablation (RFA) is a potentially curative treatment option for early Hepatocellular carcinoma. The RFA is considered safe with a relatively low incidence of complications ranging from 2%-7.9%. Though most of the complications are self-limiting, sometimes they can be life-threatening. The occurrence of the particular complication depends on various factors like tumour location and morphology, underlying disease and ablation technique. A detailed understanding of potential complications along with the associated risk factors will help to employ strategies to prevent them, identify them early and manage them when they occur. This article demonstrates various radiofrequency ablation-related complications and discusses the risk factors and technical strategies to minimise them and achieve complete ablation of the tumour.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
| | - Sreekumar Karumathil Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Rajsekar C S
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
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2
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Kobayashi M, Kato S, Demura S, Yokogawa N, Yokka A, Nakade Y, Annen R, Gabata T, Tsuchiya H. Evaluation of Conditions for the Development of Cryogenic Spinal Cord Injury Using a Canine Model: An Experimental Study on the Safety of Cryoablation for Metastatic Spinal Tumors. AJNR Am J Neuroradiol 2024; 45:424-431. [PMID: 38453412 PMCID: PMC11288574 DOI: 10.3174/ajnr.a8151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/18/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE Although the application of cryoablation to metastatic spinal tumors has been attempted, spinal cryoablation has the unique complication of cryogenic spinal cord injury. This study aimed to elucidate the conditions for the development of cryogenic spinal cord injury. MATERIALS AND METHODS Fifteen canines were used in this study. A metal probe was inserted into the 13th thoracic vertebral body. Cryoablation was performed for 10 minutes by freezing the probe in liquid nitrogen. The control canine underwent probe insertion only. Spinal cord monitoring, epidural temperature measurement, motor function assessment, and pathologic examination of the spinal cord were performed. RESULTS During the 10 minutes of cryoablation, the epidural temperature decreased and reached the lowest epidural temperature (LET) at the end of cryoablation. The LETs (degrees celsius [°C]) of each canine were -37, -30, -27, -8, -3, -2, 0, 1, 4, 8, 16, 18, 20, and 25, respectively. As the epidural temperature decreased, waveform amplitudes also decreased. At the end of cryoablation (10 minutes after the start of cryoablation), abnormal waves were observed in 92.9% (13/14) of canines. With epidural rewarming, the amplitude of the waveforms tended to recover. After epidural rewarming (2 hours after the start of cryoablation), abnormal waves were observed in 28.6% (4/14) of canines. The LETs (°C) of the canines with abnormal waves after epidural rewarming were -37, -30, -27, and -8. None of the canines with normal waves after epidural rewarming had any motor impairment. In contrast, all canines with remaining abnormal waves after epidural rewarming had motor impairment. In the pathologic assessment, cryogenic changes were found in canines with LETs (°C) of -37 -30, -27, -8, 0, and 1. CONCLUSIONS This study showed that 10-minute spinal cryoablation with LETs (°C) of -37, -30, -27, -8, 0, and 1 caused cryogenic spinal cord injury. There was no evidence of cryogenic spinal cord injury in canines with LET of ≥4°C. The epidural temperature threshold for cryogenic spinal cord injury is between 1 and 4°C, suggesting that the epidural temperature should be maintained above at least 4°C to prevent cryogenic spinal cord injury.
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Affiliation(s)
- Motoya Kobayashi
- From the Department of Orthopedic Surgery (M.K., S.K., S.D., N.Y., R.A., H.T.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Satoshi Kato
- From the Department of Orthopedic Surgery (M.K., S.K., S.D., N.Y., R.A., H.T.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Satoru Demura
- From the Department of Orthopedic Surgery (M.K., S.K., S.D., N.Y., R.A., H.T.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Noriaki Yokogawa
- From the Department of Orthopedic Surgery (M.K., S.K., S.D., N.Y., R.A., H.T.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akira Yokka
- Department of Radiology (A.Y., T.G.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yusuke Nakade
- Department of Clinical Laboratory (Y.N.), Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Ryohei Annen
- From the Department of Orthopedic Surgery (M.K., S.K., S.D., N.Y., R.A., H.T.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Toshifumi Gabata
- Department of Radiology (A.Y., T.G.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- From the Department of Orthopedic Surgery (M.K., S.K., S.D., N.Y., R.A., H.T.), Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Wu L, Hu M, Li P, Man Q, Yuan Q, Zhang X, Qiu Y, Chen L, Fan J, Zhang K. Microwave ablation combined with percutaneous vertebroplasty for treating painful non-small cell lung cancer with spinal metastases under real-time temperature monitoring. J Cancer Res Ther 2024; 20:540-546. [PMID: 38687923 DOI: 10.4103/jcrt.jcrt_1074_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024]
Abstract
PURPOSE To retrospectively study the therapeutic effect and safety performance of the combination strategies of the computed tomography (CT)-guided microwave ablation (MWA) and percutaneous vertebroplasty (PVP) as a treatment for painful non-small cell lung cancer (NSCLC) with spinal metastases. MATERIALS AND METHODS A retrospective review included 71 patients with 109 vertebral metastases who underwent microwave ablation combined with percutaneous vertebroplasty by the image-guided and real-time temperature monitoring. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry Disability Index (ODI) scores before treatment and during the follow-up period. RESULTS Technical success was achieved in all patients. The mean pre-procedure VAS score and morphine doses were 6.6 ± 1.8 (4-10) and 137.2 ± 38.7 (40-200) mg, respectively. The mean VAS scores and daily morphine doses at 24 h and 1, 4, 12, and 24 weeks postoperatively were 3.3 ± 1.9 and 73.5 ± 39.4 mg; 2.2 ± 1.5 and 40.2 ± 29.8 mg; 1.7 ± 1.2 and 31.3 ± 23.6 mg; 1.4 ± 1.1 and 27.3 ± 21.4 mg; and 1.3 ± 1.1 and 24.8 ± 21.0 mg, respectively (all P < 0.001). ODI scores significantly decreased (P < 0.05). Minor cement leakage occurred in 51 cases (46.8%), with one patient having a grade 3 neural injury. No local tumor progression was observed by follow-up imaging. CONCLUSIONS MWA combined with PVP can significantly relieve pain and improve patients' quality of life, which implied this is an effective treatment option for painful NSCLC with spinal metastases. Additionally, its efficacy should be further verified through the mid- and long-term studies.
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Affiliation(s)
- Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital Affiliated Xuzhou Medical University, Tengzhou City, Shandong Province, China
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Tomasian A, Jennings JW. Essentials of Spinal Tumor Ablation. Radiol Clin North Am 2024; 62:303-309. [PMID: 38272622 DOI: 10.1016/j.rcl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Recent advances in percutaneous minimally invasive thermal ablation and vertebral augmentation provide radiologists with important arsenal for treatment of selected patients with spinal metastases. These interventions have proven to be safe, effective, and durable in treatment of selected patients with vertebral metastases. Attention to procedure techniques, including choice of ablation modality, vertebral augmentation technique, and thermal protection, is essential for improved patient outcomes. A detailed knowledge of such interventions and implementation of procedural safety measures will further heighten radiologists' role in the management of patients with spinal metastases.
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Affiliation(s)
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 S Kingshighway Boulevard, Saint Louis, MO, USA.
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Zheng B, Zhang P, Lv Q, Wu T, Liu Y, Tang J, Ma Y, Cheng L, Xu L, Wang Y, Xue Y, Liu J, Ren J. Development and preclinical evaluation of multifunctional hydrogel for precise thermal protection during thermal ablation. Bioact Mater 2024; 31:119-135. [PMID: 37637083 PMCID: PMC10448243 DOI: 10.1016/j.bioactmat.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Image-guided thermal ablation (TA), which is less invasive, has been widely applied for treating various kinds of tumors. However, TA still poses the potential risk of thermal damage to sensitive tissue nearby. Therefore, an adjunctive thermoprotective hydrodissection technique with constant injection of 5% glucose (5% Glu) has currently been adopted for clinical application, but this may be hazardous to humans. In this study, a multifunctional hyaluronic acid-based hydrogel (HA-Dc) was developed for hydrodissection. Compared with 5% Glu (the most clinically used solution) and the previously reported F127 hydrogel, the HA-Dc hydrogel was studied in vitro in a porcine liver model and in vivo in a rabbit model and showed good injectability and better tissue retention, stability, and thermoprotective properties throughout the TA procedure. Furthermore, in the preclinical evaluation in a Macaca fascicularis (M. fascicularis) model, HA-Dc showed excellent performance in terms of stricter neuroprotection compared with 5% Glu. In addition, the HA-Dc hydrogel with good biocompatibility and controllable degradation behavior in vivo could be a promising platform for thermal protection during clinical TA procedures.
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Affiliation(s)
- Bowen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Peng Zhang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Qijun Lv
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Yadong Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Junjie Tang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Yanping Ma
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Lili Cheng
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Langtao Xu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Yizhen Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Yifan Xue
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Jie Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
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De Vita E, Lo Presti D, Massaroni C, Iadicicco A, Schena E, Campopiano S. A review on radiofrequency, laser, and microwave ablations and their thermal monitoring through fiber Bragg gratings. iScience 2023; 26:108260. [PMID: 38026224 PMCID: PMC10660479 DOI: 10.1016/j.isci.2023.108260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Thermal ablation of tumors aims to apply extreme temperatures inside the target tissue to achieve substantial tumor destruction in a minimally invasive manner. Several techniques are comprised, classified according to the type of energy source. However, the lack of treatment selectivity still needs to be addressed, potentially causing two risks: i) incomplete tumor destruction and recurrence, or conversely, ii) damage of the surrounding healthy tissue. Therefore, the research herein reviewed seeks to develop sensing systems based on fiber Bragg gratings (FBGs) for thermal monitoring inside the lesion during radiofrequency, laser, and microwave ablation. This review shows that, mainly thanks to multiplexing and minimal invasiveness, FBGs provide an optimal sensing solution. Their temperature measurements are the feedback to control the ablation process and allow to investigate different treatments, compare their outcomes, and quantify the impact of factors such as proximity to thermal probe and blood vessels, perfusion, and tissue type.
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Affiliation(s)
- Elena De Vita
- Department of Engineering, University of Naples “Parthenope”, 80143 Naples, Italy
| | - Daniela Lo Presti
- Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Carlo Massaroni
- Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Agostino Iadicicco
- Department of Engineering, University of Naples “Parthenope”, 80143 Naples, Italy
| | - Emiliano Schena
- Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Stefania Campopiano
- Department of Engineering, University of Naples “Parthenope”, 80143 Naples, Italy
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Parvinian A, Morris JM, Johnson-Tesch BA, Kurup AN. Thermoprotection of Neural Structures During Musculoskeletal Ablation. Cardiovasc Intervent Radiol 2023; 46:1495-1503. [PMID: 36944852 DOI: 10.1007/s00270-023-03407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
Percutaneous thermal ablation is widely used for local control and palliation of a variety of lesions throughout the musculoskeletal system. In this setting, safe ablation is predicated on the avoidance of unintentional injury to vulnerable neural structures that are often in proximity to ablation targets. This article highlights key periprocedural considerations in musculoskeletal ablation and reviews the array of active and passive thermoprotective measures that are critical to safe and successful treatment.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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8
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Tomasian A, Jennings JW. Spine metastases: thermal ablation and augmentation. Skeletal Radiol 2023; 52:1921-1928. [PMID: 37171611 DOI: 10.1007/s00256-023-04348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 05/13/2023]
Abstract
Substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions including thermal ablation and vertebral augmentation offer a robust armamentarium for interventional radiologists for management of patients with spinal metastases. Such interventions have proved safe and effective in management of selected patients with vertebral metastases. Special attention to procedure techniques including choice of ablation modality, vertebral augmentation technique, and thermal protection is essential for improved patient outcomes. Familiarity with the described interventions and implementation of procedural safety measures will further enhance the role of radiologists in the management of patients with spinal metastases. This article provides a review of the most recent advances in thermal ablation and vertebral augmentation as well as the role of radiologists for treatment of spinal metastases.
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Affiliation(s)
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO, USA.
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Shashi KK, Shahin MM, Johnston P, Shaikh R. Cryoablation for Bone and Soft Tissue Lesions in Pediatric Patients: Complications and Preventive Measures. Cardiovasc Intervent Radiol 2023; 46:1249-1256. [PMID: 37580423 DOI: 10.1007/s00270-023-03523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To evaluate complications associated with cryoablation in a pediatric population and review preventive measures to mitigate these complications. MATERIAL AND METHODS Retrospective study including all the image guided cryoablations performed on pediatric population. Immediate and delayed complications were analyzed, and we identified the different protective measures used and the clinical outcomes from follow-up. Point estimates for the percentage of complications were calculated by maximum likelihood, and 95% confidence intervals for the true percentages were calculated using the Clopper-Pearson exact method. RESULTS Eighty-seven ablations were performed on 68 patients (age range of 2-18 years, mean 12.4 years) for non-neoplastic (70%) and neoplastic (30%) lesions. The percentage of ablations resulting in complications was 18% (95% confidence interval (CI) 11% to 28%). Of these, 5% (95% CI 1% to 11%) were grade 3 complications, and 14% (95% CI 7% to 23%) were grade 2 complications. Thermal protection was performed in 27.6% of ablations (n = 24). The mean clinical follow-up duration was 348 days. CONCLUSION Cryoablation in pediatric patients is relatively safe, with a major complication rate per ablation of 5%. Thermal protective measures can be considered to mitigate these complications.
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Affiliation(s)
- Kumar Kempegowda Shashi
- Department of Radiology, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Mohamed M Shahin
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Patrick Johnston
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Raja Shaikh
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Zhao Y, Liu F, Wang W. Treatment progress of spinal metastatic cancer: a powerful tool for improving the quality of life of the patients. J Orthop Surg Res 2023; 18:563. [PMID: 37537684 PMCID: PMC10399009 DOI: 10.1186/s13018-023-03975-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Spinal metastasis is a common secondary malignant tumor of the bone, often resulting in spinal cord and nerve root compression, leading to obvious pain and related compression symptoms. This condition has a high incidence and mortality rate. The treatment approach for most patients with spinal metastasis is primarily palliative. Consultation with a multidisciplinary team is widely accepted as a comprehensive treatment approach for patients with spinal metastases. With advancements in research and technology, the evaluation and treatment of spinal metastatic cancer are continuously evolving. This study provides an overview of surgical treatment, minimally invasive treatment, and radiotherapy for spinal metastatic cancer and also analyzes the clinical effects, advantages, and current limitations associated with various treatment approaches.
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Affiliation(s)
- Yuliang Zhao
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Liaoning, 110000, Shenyang, China
| | - Fei Liu
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Liaoning, 110000, Shenyang, China
| | - Wei Wang
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Liaoning, 110000, Shenyang, China.
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Tomasian A, Khan MA, Jennings JW. Percutaneous Treatment of Spinal Metastases. Neuroimaging Clin N Am 2023; 33:499-506. [PMID: 37356865 DOI: 10.1016/j.nic.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Percutaneous image-guided minimally invasive thermal ablation and vertebral augmentation are robust techniques, part of the available armamentarium used by radiologists for the management of patients with spinal metastases. Such interventions have been established to be safe and effective in treatment of selected patients with vertebral metastases. Special attention to procedure techniques including choice of ablation modality, vertebral augmentation technique, and thermal protection is essential for improved patient outcomes.
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Affiliation(s)
- Anderanik Tomasian
- University of California Irvine, 101 The City Drive South, Orange, CA, USA.
| | - Majid A Khan
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, USA
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, USA
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Pusceddu C, Marsico S, Derudas D, Ballicu N, Melis L, de Felice C, Calabrese A, Santucci D, Faiella E. Percutaneous CT-Guided Microwave Ablation Combined with Pedicle Screw Fixation Followed by Vertebroplasty (MASFVA): Initial Experience of a Minimally Invasive Treatment of Vertebral Metastases with Extension to the Vertebral Pedicle. Curr Oncol 2023; 30:1663-1672. [PMID: 36826088 PMCID: PMC9955473 DOI: 10.3390/curroncol30020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: The aim of this study was to retrospectively evaluate the safety and efficacy of a combined CT-guided percutaneous microwave ablation (MWA) and pedicle screw fixation followed by vertebroplasty (MASFVA) for the treatment and stabilization of painful vertebral metastases with vertebral pedicle involvement. (2) Methods: from January 2013 to January 2017 11 patients with 16 vertebral metastatic lesions (7 men and 5 women; mean age, 65 ± 11 years) with vertebral metastases underwent CT-guided microwave ablation and screw fixation followed by vertebroplasty (MASFVA). Technical success, complication rate, pain evaluation using a visual analogue scale (VAS), Oswestry Disability Index (ODI) and local tumor control were examined. (3) Results: Technical success rate was 100%. No procedure-related major complications occurred. VAS score decreased from 6.8 ± 0.7 to 0.6 ± 0.6. ODI score decreased from 3.1 ± 0.7 to 1.2 ± 0.4. All patients could walk independently without neurological complication after one week from the procedure. No new bone fractures or local disease recurrence occurred during a median follow-up of 12 months. (4) Conclusions: Our results suggest that MWA and percutaneous pedicle screw fixation followed by vertebroplasty for the treatment of painful vertebral metastases is a safe and effective procedure for painful vertebral metastases with vertebral pedicle involvement, allowing pain relief and local tumor control.
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Salvatore Marsico
- Department of Radiology, Hospital del Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Daniele Derudas
- Department of Hematology, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Nicola Ballicu
- Department of Oncological and Interventional Radiology, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Luca Melis
- Nuclear Medicine Department, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Carlo de Felice
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Alessandro Calabrese
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Domiziana Santucci
- Department of Radiology, Sant’Anna Hospital, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Campus Bio-medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Eliodoro Faiella
- Department of Radiology, Sant’Anna Hospital, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
- Correspondence: ; Tel.: +39-3314557202
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Wang B, Zhang K, Zhang X, Yang S, Hu M, Li P, Yang W, Fan J, Xing C, Yuan Q. Microwave ablation combined with cementoplasty under real-time temperature monitoring in the treatment of 82 patients with recurrent spinal metastases after radiotherapy. BMC Musculoskelet Disord 2022; 23:1025. [PMID: 36443787 PMCID: PMC9706973 DOI: 10.1186/s12891-022-05999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The spine is the most frequently affected part of the skeletal system to metastatic tumors. External radiotherapy is considered the first-line standard of care for these patients with spine metastases. Recurrent spinal metastases after radiotherapy cannot be treated with further radiotherapy within a short period of time, making treatment difficult. We aimed to evaluate the effectiveness and safety of MWA combined with cementoplasty in the treatment of spinal metastases after radiotherapy under real-time temperature monitoring. METHODS In this retrospective study, 82 patients with 115 spinal metastatic lesions were treated with MWA and cementoplasty under real-time temperature monitoring. Changes in visual analog scale (VAS) scores, daily morphine consumption, and Oswestry Disability Index (ODI) scores were noted. A paired Student's t-test was used to assess these parameters. Complications during the procedure were graded using the CTCAE version 5.0. RESULTS Technical success was attained in all patients. The mean VAS score was 6.3 ± 2.0 (range, 4-10) before operation, and remarkable decline was noted in one month (1.7 ± 1.0 [P < .001]), three months (1.4 ± 0.8 [P < .001]), and six months (1.3 ± 0.8 [P < .001]) after the operation. Significant reductions in daily morphine consumption and ODI scores were also observed (P < .05). Cement leakage was found in 27.8% (32/115) of lesions, with no obvious associated symptoms. CONCLUSION MWA combined with cementoplasty under real-time temperature monitoring is an effective and safe method for recurrent spinal metastases after radiotherapy.
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Affiliation(s)
- Baohu Wang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Kaixian Zhang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Xusheng Zhang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Sen Yang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Miaomiao Hu
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Peishun Li
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Wanying Yang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Jing Fan
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Chao Xing
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Qianqian Yuan
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
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Elboraey M, Garner H, Ritchie C, Spencer-Gardner L, Sherman C, Stanborough R. Hip Joint Distraction Technique during Cryoablation of Acetabular Bone Tumor to Prevent Femoral Head Osteonecrosis. J Vasc Interv Radiol 2022; 33:1447-1449. [PMID: 35940362 DOI: 10.1016/j.jvir.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mohamed Elboraey
- Division of Musculoskeletal Imaging, Mayo Clinic Florida, 4500 San Pablo Street, Jacksonville, FL 32224
| | - Hillary Garner
- Division of Musculoskeletal Imaging, Mayo Clinic Florida, 4500 San Pablo Street, Jacksonville, FL 32224
| | - Charles Ritchie
- Division of Musculoskeletal Imaging, Mayo Clinic Florida, 4500 San Pablo Street, Jacksonville, FL 32224
| | - Luke Spencer-Gardner
- Division of Musculoskeletal Imaging, Mayo Clinic Florida, 4500 San Pablo Street, Jacksonville, FL 32224
| | - Courtney Sherman
- Division of Musculoskeletal Imaging, Mayo Clinic Florida, 4500 San Pablo Street, Jacksonville, FL 32224
| | - Rupert Stanborough
- Division of Musculoskeletal Imaging, Mayo Clinic Florida, 4500 San Pablo Street, Jacksonville, FL 32224.
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15
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Tomasian A, Jennings JW. Interventional Palliation of Painful Extraspinal Musculoskeletal Metastases. Semin Intervent Radiol 2022; 39:176-183. [PMID: 35781996 DOI: 10.1055/s-0042-1745787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The musculoskeletal system is commonly involved by metastases, and skeletal-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a result of nerve compression often adversely affect patient's quality of life. There have been substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions for the management of patients with musculoskeletal metastases including thermal ablations, cementation with or without osseous reinforcement via implants, osteosynthesis, neurolysis, and palliative injections which are progressively incorporated in clinical practice. These interventions are performed, in conjunction with or supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesics, to achieve durable pain palliation, local tumor control, or cure. This article reviews minimally invasive percutaneous image-guided musculoskeletal oncologic interventions for the management of patients with extraspinal musculoskeletal metastases.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of California Irvine, Orange, California
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, Missouri
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16
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Thermal Protection Strategies and Neuromonitoring during Ablation. Semin Intervent Radiol 2022; 39:157-161. [PMID: 35781991 DOI: 10.1055/s-0042-1745795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Advanced interventional pain management approaches seek to lesion neural targets to achieve desirable analgesia; however, equally important is preservation of motor and sensory function for regional bystander nerves. The topic of neuroprotection is also relevant for thermal ablation of metastatic bone tumors in the vicinity of neural structures. This report aims to provide an IR-directed framework of thermoprotective techniques available during thermal ablation.
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17
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Kallas ON, Nezami N, Singer AD, Wong P, Kokabi N, Bercu ZL, Umpierrez M, Tran A, Reimer NB, Oskouei SV, Gonzalez FM. Cooled Radiofrequency Ablation for Chronic Joint Pain Secondary to Hip and Shoulder Osteoarthritis. Radiographics 2022; 42:594-608. [PMID: 35148246 DOI: 10.1148/rg.210074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) of the shoulder and hip is a leading cause of physical disability and mental distress. Traditional nonsurgical management alone is often unable to completely address the associated chronic joint pain. Moreover, a large number of patients are not eligible for joint replacement surgery owing to comorbidities or cost. Radiofrequency ablation (RFA) of articular sensory nerve fibers can disrupt the transmission of nociceptive signals by neurolysis, thereby providing long-term pain relief. A subtype of RFA, cooled RFA (CRFA), utilizes internally cooled electrodes to generate larger ablative zones compared with standard RFA techniques. Given the complex variable innervation of large joints such as the glenohumeral and hip joints, a larger ablative treatment zone, such as that provided by CRFA, is desired to capture a greater number of afferent nociceptive fibers. The suprascapular, axillary, and lateral pectoral nerve articular sensory branches are targeted during CRFA of the glenohumeral joint. The obturator and femoral nerve articular sensory branches are targeted during CRFA of the hip. CRFA is a promising tool in the interventionalist's arsenal for management of OA-related pain and symptoms, particularly in patients who cannot undergo, have long wait times until, or have persistent pain following joint replacement surgery. An invited commentary by Tomasian is available online. ©RSNA, 2022.
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Affiliation(s)
- Omar N Kallas
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nariman Nezami
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Adam D Singer
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Philip Wong
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nima Kokabi
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Zachary L Bercu
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Monica Umpierrez
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Andrew Tran
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nickolas B Reimer
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Shervin V Oskouei
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Felix M Gonzalez
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
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Yevich S, Chen S, Metwalli Z, Kuban J, Lee S, Habibollahi P, McCarthy CJ, Irwin D, Huang S, Sheth RA. Radiofrequency Ablation of Spine Metastases: A Clinical and Technical Approach. Semin Musculoskelet Radiol 2021; 25:795-804. [PMID: 34937119 DOI: 10.1055/s-0041-1740351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Percutaneous radiofrequency ablation (RFA) is an integral component of the multidisciplinary treatment algorithm for both local tumor control and palliation of painful spine metastases. This minimally invasive therapy complements additional treatment strategies, such as pain medications, systemic chemotherapy, surgical resection, and radiotherapy. The location and size of the metastatic lesion dictate preprocedure planning and the technical approach. For example, ablation of lesions along the spinal canal, within the posterior vertebral elements, or with paraspinal soft tissue extension are associated with a higher risk of injury to adjacent spinal nerves. Additional interventions may be indicated in conjunction with RFA. For example, ablation of vertebral body lesions can precipitate new, or exacerbate existing, pathologic vertebral compression fractures that can be prevented with vertebral augmentation. This article reviews the indications, clinical work-up, and technical approach for RFA of spine metastases.
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Affiliation(s)
- Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Chen
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeyad Metwalli
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joshua Kuban
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Lee
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peiman Habibollahi
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colin J McCarthy
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Irwin
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Huang
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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19
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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20
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Kastler A, Barbé DA, Alemann G, Hadjidekov G, Cornelis FH, Kastler B. Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient's Experience and Pain Outcome. MEDICINA-LITHUANIA 2021; 57:medicina57090966. [PMID: 34577889 PMCID: PMC8466129 DOI: 10.3390/medicina57090966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
Background and objectives: To assess the pain relief of bipolar RFA combined or not with vertebroplasty in patients with painful vertebral metastases and to evaluate the feasibility and tolerance of the RFA procedure performed under local anesthesia. Materials and Methods: 25 patients (18 men, 7 women, mean age: 60.X y.o) with refractory painful vertebral metastasis were consecutively included between 2012 and 2019. A total of 29 radiofrequency ablation (RFA) procedures were performed under CT guidance, local anesthesia and nitrous oxide inhalation, including 16 procedures combined with vertebroplasty for bone consolidation purposes. Pain efficacy was clinically evaluated using the visual analogue scale (VAS) at day 1, 1 month, 3 months, 6 months and 12 months, and the tolerance of the procedure was evaluated. Results: Procedure tolerance was graded as either not painful or tolerable in 97% of cases. Follow-up postprocedure mean VAS score decrease was 74% at day 1: 6.6 (p < 0.001), 79% at 1 month: 6.6 (p < 0.001), 79% at 3 months: 6.5 (p < 0.001), 77% at 6 months, and 79% at 12 months: 6.6 (p < 0.001). Conclusions: Bipolar RFA, with or without combined vertebroplasty, appears to be an effective and reliable technique for the treatment of refractory vertebral metastases in patients in the palliative care setting. It is a feasible procedure under local anesthesia which is well tolerated by patients therefore allowing to broaden the indications of such procedures. Field of study: interventional radiology.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, CHUGA Grenoble Hospital, Université Grenoble Alpes, 38400 Saint Martin d’Heres, France
- Correspondence:
| | | | | | - Georges Hadjidekov
- Department of Radiology, University Hospital Lozenets, 1407 Sofia, Bulgaria;
| | - Francois H. Cornelis
- Adult Radiology Department, Necker Hospital, Paris V University, 75015 Paris, France;
| | - Bruno Kastler
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
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21
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Tomasian A, Jennings JW. Bone Metastases: State of the Art in Minimally Invasive Interventional Oncology. Radiographics 2021; 41:1475-1492. [PMID: 34469219 DOI: 10.1148/rg.2021210007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bone is the third most common site involved by cancer metastases, and skeleton-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a consequence of nerve or spinal cord compression often affect patients' functional independence and quality of life unfavorably. The annual medical-economic burden related to bone metastases is a substantial component of the total direct medical cost estimated by the National Institutes of Health. There have been substantial recent advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions for the management of patients with osseous metastatic disease. These advances include thermal ablation, cementation with or without osseous reinforcement with implants, osteosynthesis, thermal and chemical neurolyses, and palliative injections, which are progressively incorporated into the management paradigm for such patients. These interventions are performed in conjunction with or are supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesic agents to achieve durable pain palliation, local tumor control, or cure, and they provide a robust armamentarium for interventional radiologists to achieve safe and effective treatment in a multidisciplinary setting. In addition, these procedures are shifting the patient management paradigm in modern-era practice. The authors detail the state of the art in minimally invasive percutaneous image-guided musculoskeletal oncologic interventions and the role of radiologists in managing patients with skeletal metastases. ©RSNA, 2021.
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Affiliation(s)
- Anderanik Tomasian
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Jack W Jennings
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
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22
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Feasibility, safety, and efficacy of artificial carbon dioxide pneumothorax for computed tomography fluoroscopy-guided percutaneous radiofrequency ablation of hepatocellular carcinoma. Jpn J Radiol 2021; 39:1119-1126. [PMID: 34089475 DOI: 10.1007/s11604-021-01148-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To retrospectively assess the feasibility, safety, and efficacy of artificial carbon dioxide (CO2) pneumothorax for computed tomography (CT) fluoroscopy-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study included 26 sessions of 24 patients in whom the creation of artificial CO2 pneumothorax was attempted to avoid the transpulmonary route during CT fluoroscopy-guided percutaneous RF ablation of HCC between April 2011 and December 2017. In these 26 sessions, 29 HCCs (mean tumor diameter: 12 mm, range: 6-22 mm) were treated. RESULTS Adequate lung displacement after induction of artificial CO2 pneumothorax was achieved in 23 of the 26 sessions (88.5%). In the remaining three sessions, transpulmonary RF ablation, transthoracic extrapulmonary RF ablation after switching to an artificial pleural effusion procedure, or RF ablation with electrode insertion in the caudal-cranial oblique direction was performed. No major complications were found. Among the 29 treated tumors, one (3.4%) showed local progression, and the other 28 (96.6%) were completely ablated at the last follow-up (mean follow-up period: 39.3 months, range: 7-78 months). CONCLUSION Artificial CO2 pneumothorax for CT fluoroscopy-guided percutaneous RF ablation appeared to be a feasible, safe, and useful therapeutic option for HCC.
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Complications of Percutaneous Radiofrequency Ablation of Spinal Osseous Metastases: An 8-Year Single-Center Experience. AJR Am J Roentgenol 2021; 216:1607-1613. [PMID: 33787296 DOI: 10.2214/ajr.20.23494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article was to evaluate the complication rate of percutaneous radiofrequency ablation of spinal osseous metastases. MATERIALS AND METHODS. This retrospective HIPAA-compliant study reviewed complications of radiofrequency ablation combined with vertebral augmentation performed on 266 tumors in 166 consecutive patients for management of vertebral metastases between January 2012 and August 2019. Common Terminology Criteria for Adverse Events (CTCAE) was used to categorize complications as major (grade 3-4) or minor (grade 1-2). Local tumor control rate as well as pain palliation effects evaluated by the Brief Pain Inventory scores determined 1 week, 1 month, 3 months, and 6 months after treatment were documented. Wilcoxon signed rank and Mann-Whitney U tests were used for statistical analysis. RESULTS. Among 266 treated tumors, the total complication rate was 3.0% (8/266), the major complication rate was 0.4% (1/266), and the minor complication rate was 2.6% (7/266). The single major (CTCAE grade 3) periprocedural complication was characterized by lower extremity weakness, difficulty in urination, and lack of erection as a result of spinal cord venous infarct. The seven minor complications included four cases of periprocedural transient radicular pain (CTCAE grade 2) requiring transforaminal steroid injections, one case of delayed secondary vertebral body fracture (CTCAE grade 2) requiring analgesics, and two cases of asymptomatic spinal cord edema on routine follow-up imaging (CTCAE grade 1). The local tumor control rate was 78.9%. There were statistically significant pain palliation effects at all postprocedural time intervals (p < .001 for all). CONCLUSION. Radiofrequency ablation of spinal osseous metastases is safe with a 3.0% rate of complications.
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Transosseous Temperature Monitoring of the Anterior Epidural Space during Thermal Ablation in the Thoracic Spine. Cardiovasc Intervent Radiol 2021; 44:982-987. [PMID: 33629134 DOI: 10.1007/s00270-021-02771-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/12/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE To present the technique of combined temperature monitoring and hydrodissection of the anterior epidural space during thermal ablation in the thoracic spine. MATERIALS AND METHODS Data from 8 patients were retrieved retrospectively with thoracic spinal metastases located near the posterior wall of the vertebral body. Thermal ablation was performed with temperature monitoring and hydrodissection of the anterior epidural space. RESULTS Technical success, defined as a fulfilled ablation protocol without changes of the temperature of the epidural space below 10°/above 45° that could not be controlled by active hydrodissection, was 100%. The mean time to deploy the thermosensor was 19.5 ± 4.8 min (range 13-35). There was one post-operative transient intercostal neuralgia. No spinal cord or nerve root injuries arose. Two local recurrences occurred at a mean follow-up of 20 ± 9 months. CONCLUSION Transosseous temperature monitoring of the anterior epidural space in the thoracic spine is a feasible technique and seems safe.
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Zaltieri M, Massaroni C, Cauti FM, Schena E. Techniques for Temperature Monitoring of Myocardial Tissue Undergoing Radiofrequency Ablation Treatments: An Overview. SENSORS (BASEL, SWITZERLAND) 2021; 21:1453. [PMID: 33669692 PMCID: PMC7922285 DOI: 10.3390/s21041453] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
Cardiac radiofrequency ablation (RFA) has received substantial attention for the treatment of multiple arrhythmias. In this scenario, there is an ever-growing demand for monitoring the temperature trend inside the tissue as it may allow an accurate control of the treatment effects, with a consequent improvement of the clinical outcomes. There are many methods for monitoring temperature in tissues undergoing RFA, which can be divided into invasive and non-invasive. This paper aims to provide an overview of the currently available techniques for temperature detection in this clinical scenario. Firstly, we describe the heat generation during RFA, then we report the principle of work of the most popular thermometric techniques and their features. Finally, we introduce their main applications in the field of cardiac RFA to explore the applicability in clinical settings of each method.
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Affiliation(s)
- Martina Zaltieri
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
| | - Carlo Massaroni
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
| | - Filippo Maria Cauti
- Arrhythmology Unit, Cardiology Division, S. Giovanni Calibita Hospital, Isola Tiberina, 00186 Rome, Italy;
| | - Emiliano Schena
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
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Seager M, Kumar S, Lim E, Munneke G, Bandula S, Walkden M. Renal cryoablation - a practical guide for interventional radiologists. Br J Radiol 2020; 94:20200854. [PMID: 32960674 DOI: 10.1259/bjr.20200854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Renal cryoablation is a treatment option for early stage renal cell carcinomas with excellent oncological outcomes and low morbidity. This review outlines the technique of renal cryoablation and provides a guide for interventional radiologists on setting up an integrated service within a renal cancer network multidisciplinary setting. Patient selection and preparation, together with the technical aspects which ensure optimal oncological outcomes and avoid collateral damage to adjacent organs are highlighted.
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Affiliation(s)
- Matthew Seager
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Shankar Kumar
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Emma Lim
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Graham Munneke
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Steve Bandula
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Miles Walkden
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
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Maybody M, Soliman MM, Yamada Y, Tahour D, Hsu M, Moskowitz CS, Katsoulakis E, Solomon SB. Temporary Organ Displacement to Escalate Radiation Dose to Retroperitoneal Tumors and Decrease Toxicity to Organs at Risk. J Vasc Interv Radiol 2020; 31:1578-1586. [PMID: 32861570 DOI: 10.1016/j.jvir.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To demonstrate that temporary organ displacement (TOD) by drainage catheter placement and hydrodissection is feasible and reproducible for simulation (SIM) and stereotactic body radiation treatment (SBRT). MATERIALS AND METHODS Between February 2010 and December 2018, 31 consecutive patients (20 men and 11 women; median age, 59 years; range 20-80 years) received both SIM and SBRT with TOD. The minimum required displacement was 10 mm between the gross tumor volume (GTV) and the organ at risk (OAR). Complete displacement was defined as the ability to displace the OAR from the GTV a minimum of 10 mm across the entire boundary. SIM was performed with hydrodissection on the same day. On the day of SBRT, displacement was reproduced by hydrodissection. Displacement was measured on computed tomography images of TOD, SIM, and SBRT. The drain was removed after SBRT. RESULTS TOD (hydrodissection) was significantly associated with successful displacement of the OAR from a GTV greater than 10 mm (median, 20 mm vs 4.1 mm, P < .001) and maintained displacement at SIM and SBRT (SIM: 29.4 mm vs 4.1 mm, P < .001; SBRT: 32.4 mm vs 4.1 mm, P < .001). The OAR-GTV boundary showed a median reduction of 35 mm (95% confidence interval, 27.5-37.5 mm) after TOD. TOD achieved complete displacement in 22 of 31 (71%) patients, and 25 of 31 (81%) patients were able to undergo single-fraction ablative SBRT. No patients developed procedure-related complications within 30 days. SIM and SBRT were successful without OAR toxicities within a median of 33 months (range, 3-92 months). CONCLUSIONS TOD with placement of drain and hydrodissection is technically feasible and safe and maintains displacement for SIM and SBRT.
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Affiliation(s)
- Majid Maybody
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Mohamed M Soliman
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Tahour
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chaya S Moskowitz
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evangelia Katsoulakis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Percutaneous Minimally Invasive Thermal Ablation of Osseous Metastases: Evidence-Based Practice Guidelines. AJR Am J Roentgenol 2020; 215:502-510. [DOI: 10.2214/ajr.19.22521] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Daubié S, Pilleul F, Thivolet A, Kalenderian AC, Cuinet M, Ricoeur A, Schiffler C, Bouhamama A, Chvetzoff G, Mastier C. Cryoneurolysis in Patients with Dorsal Neuropathic Pain Secondary to Tumor Invasion. J Vasc Interv Radiol 2020; 31:917-924. [PMID: 32376175 DOI: 10.1016/j.jvir.2020.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 12/26/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion. MATERIALS AND METHODS Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain. RESULTS Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred. CONCLUSIONS Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.
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Affiliation(s)
- Sophie Daubié
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France.
| | - Frank Pilleul
- CREATIS, UMR CNRS (Unités Mixtes de Recherche Centre National de Recherche Scientifique) 5220 - INSERM 1206, Lyon, France
| | - Arnaud Thivolet
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | | | - Marie Cuinet
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Alexis Ricoeur
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Camille Schiffler
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Amine Bouhamama
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Gisele Chvetzoff
- DISSPO (Département des Soins de Support du Patient en Oncologie), Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Charles Mastier
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
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31
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Tomasian A, Jennings JW. Percutaneous minimally invasive thermal ablation for management of osseous metastases: recent advances. Int J Hyperthermia 2019; 36:3-12. [DOI: 10.1080/02656736.2019.1613573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Jack W. Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, MO, USA
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Local Control and Analgesic Efficacy of Percutaneous Cryoablation for Desmoid Tumors. Cardiovasc Intervent Radiol 2019; 43:110-119. [PMID: 31471720 DOI: 10.1007/s00270-019-02323-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Cryoablation is being more and more often used to treat desmoid tumors. We report our experience of cryoablation as a local and analgesic treatment for inoperable or recurring desmoid tumors. METHODS This study includes 34 patients who underwent percutaneous cryoablation of 41 desmoid tumors between July 2012 and September 2016. All patients underwent pain assessment using a visual analog scale (VAS) and preoperative imaging. All cryoablation procedures were performed using the same cryoablation system. Patients received clinical and radiological follow-up at 6 months post-procedure, with pain-rating and adverse events being recorded. A long-term follow-up was achieved until 31 December 2018. Disease-free survival at 3 years was also recorded. Radiological tumor response was determined by tumor measurements using RECIST 1.1. RESULTS Twelve patients benefitted from curative treatment on 100% of the tumor volume, but 22 patients received debulking treatment because of the risk of neighboring structures. Two patients had a postoperative hematoma grade 2 of the CIRSE classification system for complications, and two patients had grade 4 complications involving palsy of the common fibular nerve. Disease-free survival at 3 years was 42.2%. The mean VAS pain scores were 5.7 and 2.4 at pretreatment and 6 months, respectively, showing a mean reduction of 3.3 (p < 0.001). At 6 months, all measured tumor dimensions were significantly lower than pretreatment. CONCLUSION Cryoablation is an effective therapeutic option for the local treatment and for the analgesic management of desmoid tumors.
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Complications of Computer Tomography Assisted Radiofrequency Ablation in the Treatment of Osteoid Osteoma. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4376851. [PMID: 31223617 PMCID: PMC6541958 DOI: 10.1155/2019/4376851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/19/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Abstract
Background Osteoid osteoma (OO) is one of the most commonly occurring benign bone tumors. It constitutes 10-12% of benign bone tumors and 2-3% of primary bone tumors. In radiofrequency ablation (RFA) treatment, the cells of the tumor are thermally inactivated by the help of electrodes shaped like needles. In our study, we aimed to show the major and minor complications in patients undergoing RFA and to show what should be done to prevent these complications. Methods The study was carried out as a prospective study on the follow-up of 87 osteoid osteoma patients treated between 2015 and 2017. The youngest of the patients was 1 year old and the oldest was 42 years old. The RFA procedure lasted 10 min on average, excluding anesthesia and preparation. All lesions were ablated at 90 degrees for 7 minutes with the heat increased gradually. All patients were followed up for 1 day in the orthopedics clinic. Results Complications were observed in 7 patients. The lesions with the most complications were observed to be in the tibia, second-degree burns were seen in 2 patients, and superficial skin infection was observed in 2 patients. In 1 patient, the probe tip was broken and remained within the bone. Intramuscular hematoma was detected in 1 lesion located in the proximal femur. A complaint of numbness in the fingers developed in a lesion located in the metacarpus. Conclusion Preventive measures should be taken before the procedure in order to prevent minor complications, and, for major complications, close follow-up should be done after the procedure and patients should be kept away from heavy physical activities for the first 3 months.
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Yamagami T, Yoshimatsu R, Kajiwara K, Yamanishi T, Minamiguchi H, Karashima T, Inoue K. Protection from injury of organs adjacent to a renal tumor during percutaneous cryoablation. Int J Urol 2019; 26:785-790. [PMID: 31094038 DOI: 10.1111/iju.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/07/2019] [Indexed: 01/20/2023]
Abstract
Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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Affiliation(s)
- Jack W. Jennings
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, Siteman Cancer Center, 510 S Kingshighway Blvd, St Louis, MO 63110
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Smirniotopoulos J, Cheng W, Krohmer S, Kee S, Pua B. Interventional Oncology: Keeping Out of Trouble in Ablation Techniques. Tech Vasc Interv Radiol 2018; 21:223-227. [PMID: 30545500 DOI: 10.1053/j.tvir.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interventional radiologists provide an essential role in the therapy and management of cancer patients. Computed-tomography (CT) guided percutaneous procedures have enabled interventionalists to treat multiple solid organ malignancies with minimal risk, however, certain lesions may present challenges to physicians due to a difficult approach, or their close proximity to other vital structures. The following presents a brief summary of tips and tricks the interventionalist may use to provide their patients with safe and effective therapy.
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Affiliation(s)
- John Smirniotopoulos
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Wayne Cheng
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Steven Krohmer
- Department of Interventional Radiology, University of Kentucky, Lexington, KY
| | - Stephen Kee
- Department of Interventional Radiology, University of California Medical Center, Los Angeles, CA
| | - Bradley Pua
- Department of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY.
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Yevich S, Odisio BC, Sheth R, Tselikas L, de Baère T, Deschamps F. Integrated CT-Fluoroscopy Equipment: Improving the Interventional Radiology Approach and Patient Experience for Treatment of Musculoskeletal Malignancies. Semin Intervent Radiol 2018; 35:229-237. [PMID: 30402005 DOI: 10.1055/s-0038-1669962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Integrated CT-fluoroscopy equipment augments the comprehensive approach to the treatment of musculoskeletal (MSK) malignancy by interventional radiology techniques. As the role of minimally invasive treatment expands to meet the highly variable presentation of MSK malignancy, creative solutions to treatment challenges are required to improve locoregional tumor control and durability of pain palliation. Challenges to effective treatment can often be attributed to a combination of aggressive tumor biology, large size, forbidding location, and adverse vascularity. In these cases, a tailored treatment approach may necessitate the application of multiple interventional radiology (IR) techniques that require different image guidance capabilities. Integrated CT-fluoroscopy equipment provides the means to leverage both imaging modalities within the same procedural setting to facilitate the simultaneous application of multiple synergistic treatments and protective measures. This article examines the potential role of hybrid units in the IR treatment of challenging MSK malignancies as a means to empower a paradigm transition for a more comprehensive and patient-tailored approach.
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Affiliation(s)
- Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno C Odisio
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul Sheth
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Thierry de Baère
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
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Garnon J, Cazzato RL, Caudrelier J, Nouri-Neuville M, Rao P, Boatta E, Ramamurthy N, Koch G, Gangi A. Adjunctive Thermoprotection During Percutaneous Thermal Ablation Procedures: Review of Current Techniques. Cardiovasc Intervent Radiol 2018; 42:344-357. [DOI: 10.1007/s00270-018-2089-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
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Hermida M, Cassinotto C, Piron L, Assenat E, Pageaux GP, Escal L, Pierredon-Foulongne MA, Verzilli D, Jaber S, Guiu B. Percutaneous thermal ablation of hepatocellular carcinomas located in the hepatic dome using artificial carbon dioxide pneumothorax: retrospective evaluation of safety and efficacy. Int J Hyperthermia 2018; 35:90-96. [PMID: 29923441 DOI: 10.1080/02656736.2018.1477206] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The targeting of hepatocellular carcinomas (HCC) in the hepatic dome can be challenging during percutaneous thermal ablation (PTA). The aims of this study were (1) to evaluate the safety and efficacy of PTA of HCC in the hepatic dome that cannot be visualized under US, using artificial CO2 pneumothorax and CT-guidance and (2) to compare the results with US-visible HCC located in the liver dome treated under US-guidance. MATERIALS Over a 32-month period, 56 HCC located in the hepatic dome were extracted from a prospectively maintained database. Twenty-eight cases (US-guidance group) were treated under US-guidance, while the others (n = 28, CT-CO2 group) were treated under CT-guidance using artificial CO2 pneumothorax after lipiodol tagging of the tumor. The primary technical success and complications rates of this technique were retrospectively assessed. Local tumor progression (LTP), intrahepatic distant recurrence (IDR), local recurrence-free survival (LRFS) and overall survival (OS) were also compared between both groups. RESULTS Primary technical success was 100% in both groups. No major complications occurred. After a median follow-up of 13.8 months (range, 1-33.4 months), LTP occurred in 10.7% (3/28) in CT-CO2 vs. 25% (7/28) in the US-guidance group (p = NS). IDR occurred in 39.3% (11/28) in CT-CO2 vs. 28.6% (8/28) in the US-guidance group (p = NS). Death occurred in 17.9% (5/28) of patients in both groups. LRFS and OS did not significantly differ using Kaplan-Meier survival estimates. CONCLUSION CT-guided PTA after artificially induced CO2 pneumothorax is a safe and efficient technique to treat HCC located in the hepatic dome.
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Affiliation(s)
- Margaux Hermida
- a Department of Radiology , St-Eloi University Hospital , Montpellier , France
| | | | - Lauranne Piron
- a Department of Radiology , St-Eloi University Hospital , Montpellier , France
| | - Eric Assenat
- c Department of Hepatology , St-Eloi University Hospital , Montpellier , France
| | - Georges-Philippe Pageaux
- d Department of Anesthesiology and Critical Care , St-Eloi University Hospital , Montpellier , France
| | - Laure Escal
- a Department of Radiology , St-Eloi University Hospital , Montpellier , France
| | | | - Daniel Verzilli
- e INSERM U1194, Montpellier Cancer Research Institute , Montpellier , France
| | - Samir Jaber
- e INSERM U1194, Montpellier Cancer Research Institute , Montpellier , France
| | - Boris Guiu
- a Department of Radiology , St-Eloi University Hospital , Montpellier , France.,b Department of Digestive Oncology , St-Eloi University Hospital , Montpellier , France
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Oñate Miranda M, Moser TP. A practical guide for planning pelvic bone percutaneous interventions (biopsy, tumour ablation and cementoplasty). Insights Imaging 2018; 9:275-285. [PMID: 29564836 PMCID: PMC5991000 DOI: 10.1007/s13244-018-0600-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
Percutaneous approaches for pelvic bone procedures (bone biopsies, tumour ablation and cementoplasty) are multiple and less well systematised than for the spine or extremities. Among the different imaging techniques that can be used for guidance, computed tomography (CT) scan is the modality of choice because of the complex pelvic anatomy. In specific cases, such as cementoplasty where real-time evaluation is a determinant, a combination of CT and fluoroscopy is highly recommended. The objective of this article is to propose a systematic approach for image-guided pelvic bone procedures, as well as to provide some technical tips. We illustrate the article with multiple examples, and diagrams of the approaches and important structures to avoid to perform these procedures safely. TEACHING POINTS • Pelvic bone procedures are safe to perform if anatomical landmarks are recognised. • The safest approach varies depending on the pelvic level. • CT is the modality of choice for guiding pelvic percutaneous procedures. • Fluoroscopy is recommended when real-time monitoring is mandatory. • MRI can also be used for guiding pelvic percutaneous procedures.
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Affiliation(s)
- Marta Oñate Miranda
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada
| | - Thomas P Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada.
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Percutaneous Thermal Ablation of Spinal Metastases: Recent Advances and Review. AJR Am J Roentgenol 2018; 210:142-152. [DOI: 10.2214/ajr.17.18205] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Yuan F, Zhao G, Panhwar F. Enhanced killing of HepG2 during cryosurgery with Fe 3O 4-nanoparticle improved intracellular ice formation and cell dehydration. Oncotarget 2017; 8:92561-92577. [PMID: 29190938 PMCID: PMC5696204 DOI: 10.18632/oncotarget.21499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/08/2017] [Indexed: 12/17/2022] Open
Abstract
Cryosurgery is a minimally invasive treatment that utilize extreme low temperatures to destroy abnormal tissues. The clinical monitoring methods for cryosurgery are almost based on the visualization of the iceball. However, for a normal cryosurgery process, the effective killing region is always smaller than the iceball. As a result, the end of the cryosurgery process can only be judged by the surgeons according to their experience. The subjective judgement is one of the main reasons for poor estimation of tumor ablation, and it sparks high probability of recurrence and metastasis associate with cryosurgery. Being different from the previous optimization studies, we develop a novel approach with the aid of nanoparticles to enlarge the effective killing region of entire iceball, and thus it greatly decrease the difficulty of precise judgement of the cryosurgery only by applying the common clinical imaging methods. To verify this approach, both the experiments on a tissue-scale phantom with embedded living HepG2 cells in agarose and on a cell-scale cryo-microscopic freeze-thaw stage are performed. The results indicate that the introduction of the self-synthesized Fe3O4 nanoparticles significantly improved cell killing in the cryosurgery and the range of killing is extended to the entire iceball. The potential mechanism is further revealed by the cryo-microscopic experiments, which verifies the presence of Fe3O4 nanoparticles can significantly enhance the probability of intracellular ice formation and the cell dehydration during freezing hence it promote precise killing of the cells. These findings may further promote the widespread clinical application of modern cryosurgery.
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Affiliation(s)
- Fuquan Yuan
- Center for Biomedical Engineering, Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, Anhui, China
| | - Gang Zhao
- Center for Biomedical Engineering, Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, Anhui, China
- Anhui Provincial Engineering Research Center for Biopreservation and Artificial Organs, Hefei 230027, Anhui, China
| | - Fazil Panhwar
- Center for Biomedical Engineering, Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, Anhui, China
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Abstract
Understanding and management of vascular anomalies has always been intriguing. These disorders exhibit an expected pattern of clinical presentation and progression, and characteristic imaging findings. Significant progress in understanding and treating patients with vascular anomalies has been made in the past quarter century. Newer multidisciplinary domains for treating these disorders with medical drugs and less invasive image-guided or surgical procedures are constantly evolving. Vascular anomalies can exhibit aggressive tumor-like behavior resulting in recurrence or persistent symptoms after treatment. Thermal ablation has been widely used in tumor treatment. This has generated interest on using thermal ablation for treating vascular anomalies. Percutaneous image-guided cryoablation is increasingly used for this purpose as compared with other ablation technologies. Availability of small caliber cryoprobes and the ability to monitor the freeze zone in real time have made this an attractive option to interventional radiologists. These experiences are relatively new and limited. It is helpful to understand the emerging role of this technology in the treatment of vascular anomalies.
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Affiliation(s)
- Raja Shaikh
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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44
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Protection of the Proximal Articular Cartilage During Percutaneous Thermal Ablation of Acetabular Metastasis Using Temperature Monitoring. Cardiovasc Intervent Radiol 2017; 41:163-169. [DOI: 10.1007/s00270-017-1755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
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45
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Air-blocking ablation of osteoid osteoma; a technical note. Skeletal Radiol 2017; 46:957-960. [PMID: 28466103 DOI: 10.1007/s00256-017-2659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
Osteoid osteoma accounts for approximately 10-12% of all benign bone tumors. Surgery was the treatment of choice for osteoid osteomas until percutaneous radiofrequency ablation (RFA) was introduced in 1992. Although RFA is generally considered curative in the treatment of osteoid osteoma, disease recurrence after ablation has been reported. We report a case in which RFA was delayed by the presence air surrounding the ablation probe. In this case, ablation could only be performed after the probe was removed and saline was injected through the introducer needle to displace the air. Air is reported to decrease radiofrequency energy transmission; a simple measure like injecting saline through an introducer could prevent such a complication. We also suggest that partial air in the ablation bed surrounding the ablation probe could decrease the energy transmission and may be one of the causes of early recurrences. Saline injection could be helpful in providing a more reliable environment for ablation.
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46
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Wallace AN, Hillen TJ, Friedman MV, Zohny ZS, Stephens BH, Greco SC, Talcott MR, Jennings JW. Percutaneous Spinal Ablation in a Sheep Model: Protective Capacity of an Intact Cortex, Correlation of Ablation Parameters with Ablation Zone Size, and Correlation of Postablation MRI and Pathologic Findings. AJNR Am J Neuroradiol 2017; 38:1653-1659. [PMID: 28572150 DOI: 10.3174/ajnr.a5228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Despite the growing use of percutaneous ablation therapy for the treatment of metastatic spine disease, several issues have yet to be fully addressed. Our aims were to determine whether the vertebral body cortex protects against ablation-induced spinal cord injury; correlate radiofrequency, cryo-, and microwave ablation parameters with resulting spinal ablation zone dimensions and describe normal spinal marrow postablation changes on MR imaging. MATERIALS AND METHODS Ten thoracolumbar vertebrae in 3 sheep were treated with radiofrequency ablation, cryoablation, or microwave ablation under fluoroscopic guidance. Technique parameters were chosen to produce ablation zones that exceeded the volume of the vertebral bodies in sheep 1 and were confined to the vertebrae in sheep 2 and 3. Expected ablation zone dimensions were based on data provided by the device manufacturers. Postablation MR imaging was performed at 48 hours (sheep 1) or 7 days (sheep 2 and 3). RESULTS In sheep 1, cryoablation and microwave ablations extended into the spinal canal and caused histologically confirmed neurologic injury, but radiofrequency ablation did not. The mean difference between the lengths of the radiofrequency ablation zone dimensions measured on gross pathology compared with those expected was 9.6 ± 4.1 mm. The gross pathologic cryo- and microwave ablation zone dimensions were within 1 mm of those expected. All modalities produced a nonenhancing ablation zone with a rim of enhancement, corresponding histologically to marrow necrosis and hemorrhagic congestion. CONCLUSIONS An intact cortex appears to protect against radiofrequency ablation-induced spinal cord injury, but not against non-impedance-based modalities. Ablation dimensions produced by microwave and cryoablation are similar to those expected, while radiofrequency ablation dimensions are smaller. Ablation of normal marrow produces a rim of enhancement at the margin of the ablation zone on MR imaging.
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Affiliation(s)
- A N Wallace
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
| | - T J Hillen
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
| | - M V Friedman
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
| | - Z S Zohny
- Department of Neurosurgery (Z.S.Z., B.H.S.)
| | | | - S C Greco
- Division of Comparative Medicine (S.C.G., M.R.T.), Washington University, St Louis, Missouri
| | - M R Talcott
- Division of Comparative Medicine (S.C.G., M.R.T.), Washington University, St Louis, Missouri
| | - J W Jennings
- From the Mallinckrodt Institute of Radiology (A.N.W., T.J.H., M.V.F., J.W.J.)
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Mauri G, Nicosia L, Varano GM, Bonomo G, Della Vigna P, Monfardini L, Orsi F. Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation. Insights Imaging 2017; 8:357-363. [PMID: 28500486 PMCID: PMC5438321 DOI: 10.1007/s13244-017-0555-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/08/2017] [Accepted: 04/13/2017] [Indexed: 12/17/2022] Open
Abstract
Abstract Image-guide thermal ablations are nowadays increasingly used to provide a minimally invasive treatment to patients with renal tumours, with reported good clinical results and low complications rate. Different ablative techniques can be applied, each with some advantages and disadvantages according to the clinical situation. Moreover, percutaneous ablation of renal tumours might be complex in cases where there is limited access for image guidance or a close proximity to critical structures, which can be unintentionally injured during treatment. In the present paper we offer an overview of the most commonly used ablative techniques and of the most important manoeuvres that can be applied to enhance the safety and effectiveness of percutaneous image-guided renal ablation. Emphasis is given to the different technical aspects of cryoablation, radiofrequency ablation, and microwave ablation, on the ideal operating room setting, optimal image guidance, application of fusion imaging and virtual navigation, and contrast enhanced ultrasound in the guidance and monitoring of the procedure. Moreover, a series of protective manoeuvre that can be used to avoid damage to surrounding sensitive structures is presented. A selection of cases of image-guided thermal ablation of renal tumours in which the discussed technique were used is presented and illustrated. Teaching points • Cryoablation, radiofrequency and microwave ablation have different advantages and disadvantages. • US, CT, fusion imaging, and CEUS increase an effective image-guidance. • Different patient positioning and external compression may increase procedure feasibility. • Hydrodissection and gas insufflation are useful to displace surrounding critical structures. • Cold pyeloperfusion can reduce the thermal damage to the collecting system.
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Affiliation(s)
- Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy. .,Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, Italy.
| | - L Nicosia
- Scuola di specializzazione in Radiodiagnostica, Università degli studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - G M Varano
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
| | - G Bonomo
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
| | - P Della Vigna
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
| | - L Monfardini
- Dipartimento di radiologia e diagnostica per immagini, Poliambulazna di Brescia, Via Leonida Bissolati 57, Brescia, Italy
| | - F Orsi
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy
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Tomasian A, Wallace AN, Jennings JW. Benign Spine Lesions: Advances in Techniques for Minimally Invasive Percutaneous Treatment. AJNR Am J Neuroradiol 2017; 38:852-861. [PMID: 28183835 DOI: 10.3174/ajnr.a5084] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Minimally invasive percutaneous imaging-guided techniques have been shown to be safe and effective for the treatment of benign tumors of the spine. Techniques available include a variety of tumor ablation technologies, including radiofrequency ablation, cryoablation, microwave ablation, alcohol ablation, and laser photocoagulation. Vertebral augmentation may be performed after ablation as part of the same procedure for fracture stabilization or prevention. Typically, the treatment goal in benign spine lesions is definitive cure. Painful benign spine lesions commonly encountered in daily practice include osteoid osteoma, osteoblastoma, vertebral hemangioma, aneurysmal bone cyst, Paget disease, and subacute/chronic Schmorl node. This review discusses the most recent advancement and use of minimally invasive percutaneous therapeutic options for the management of benign spine lesions.
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Affiliation(s)
- A Tomasian
- From the Department of Radiology (A.T.), University of Southern California, Los Angeles, California
| | - A N Wallace
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
| | - J W Jennings
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
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Mauri G, Nicosia L, Varano GM, Shyn P, Sartori S, Tombesi P, Di Vece F, Orsi F, Solbiati L. Unusual tumour ablations: report of difficult and interesting cases. Ecancermedicalscience 2017; 11:733. [PMID: 28487751 PMCID: PMC5406223 DOI: 10.3332/ecancer.2017.733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 01/02/2023] Open
Abstract
Image-guided ablations are nowadays applied in the treatment of a wide group of diseases and in different organs and regions, and every day interventional radiologists have to face more difficult and unusual cases of tumour ablation. In the present case review, we report four difficult and unusual cases, reporting some tips and tricks for a successful image-guided treatment.
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Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luca Nicosia
- Postgraduate School of Radiology, University of Milan, Italy
| | | | - Paul Shyn
- Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sergio Sartori
- Section of Interventional Ultrasound, Department of Internal Medicine, St Anna Hospital Ferrara, Italy
| | - Paola Tombesi
- Section of Interventional Ultrasound, Department of Internal Medicine, St Anna Hospital Ferrara, Italy
| | - Francesca Di Vece
- Section of Interventional Ultrasound, Department of Internal Medicine, St Anna Hospital Ferrara, Italy
| | - Franco Orsi
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luigi Solbiati
- Department of Radiology, Humanitas University and Research Hospital, Rozzano (Milan), Italy
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50
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Percutaneous Image-Guided Cryoablation as Second-Line Therapy of Soft-Tissue Venous Vascular Malformations of Extremities: A Prospective Study of Safety and 6-Month Efficacy. Cardiovasc Intervent Radiol 2017; 40:1358-1366. [PMID: 28361195 DOI: 10.1007/s00270-017-1636-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the safety and short-term efficacy of percutaneous image-guided cryoablation performed as second-line therapy of venous vascular malformations (VVM) of extremities. MATERIALS AND METHODS In this non-blinded, no-randomized trial, cryoablation was proposed in 14 patients presenting with symptomatic VVM for recurrences after treatment. Eligibility criteria were: cryoablation feasible, localization at least 5 mm from skin and nerves, absence of contra-indication for anesthesia. Safety was evaluated by the common terminology criteria for adverse events (AE). Clinical response was assessed by evaluating pain at day 7, month 2 and 6 using visual analog scale; quality of life before cryoablation and at 2 and 6 months after using questionnaire. Evolution of volume was evaluated by MRI at 6 months. Comparison was performed using the Wilcoxon test. RESULTS A technical success was observed in all cases. While 11 patients (78.6%) presented AE (13 grade 1-2 and 3 grade 3), only two severe AE (grade 3) related to cryoablation occurred in two patients (14.3%) during the 6-month follow-up: one immediate sciatic paralysis and one delayed paresthesia. A clinical response was observed in 12 patients (85.7%) at 6 months. Pain decreased significantly from 42.5 ± 14.2 mm before the intervention to 11.8 ± 17.9 mm at 6 months (P = 0.002). A significant decrease in the mean volume from 12.8 ± 14.3 to 3 ± 2.7 cm3 was observed at 6 months (P = 0.002). CONCLUSION Percutaneous cryoablation is a promising alternative treatment for sclerotherapy-resistant venous malformations. However, to improve safety, careful patient selection and treatment planning will be mandatory.
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