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Ciaffi J, Papalexis N, Vanni E, Miceli M, Faldini C, Scotti L, Zambon A, Salvarani C, Caporali R, Facchini G, Ursini F. Minimally invasive interventional procedures for osteoarthritis and inflammatory arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2024; 68:152525. [PMID: 39137511 DOI: 10.1016/j.semarthrit.2024.152525] [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] [Received: 03/03/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE to summarize the evidence on the efficacy of minimally invasive interventional procedures such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) in patients with osteoarthritis or inflammatory arthritis. METHODS a literature search was conducted in PubMed and Web of Science databases. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) were included. The results were organized according to the treated anatomical site: knee, hip, foot and ankle, shoulder, hand and wrist, sacroiliac joints. Data about treatment efficacy were extracted. The main outcome was change in pain intensity using the 0-10 visual analog scale (VAS) from baseline to 1 month. Additional timepoints at 3, 6 and 12 months were assessed. Change in functional status was evaluated. Pooled estimates were calculated as the mean difference (MD) and 95 % confidence interval relative to baseline. The meta-analyses of RCTs and NRSI were conducted separately. RESULTS of the 4599 retrieved articles, 164 were included in the review and, considering all the established timepoints, 111 (38 RCTs and 73 NRSI) were selected for the meta-analysis. Only one article described patients with inflammatory arthritis. In the meta-analysis of RCTs, one month after the procedure, MD in VAS was -3.98 (-4.41 to -3.55; k = 21) for knee RFA, and -3.18 (-3.96 to -2.39; k = 8) for sacroiliac joints RFA. In the meta-analysis of NRSI, MD in VAS was -4.12 (-4.63 to -3.61; k = 23) for knee RFA, -3.84 (-4.77 to -2.92; k = 7) for knee TAE, -4.34 (-4.96 to -3.71; k = 2) for hip RFA, -3.83 (-4.52 to -3.15; k = 3) for shoulder RFA and -4.93 (-5.58 to -4.28; k = 14) for sacroiliac joints RFA. Significant decrease in pain intensity was found also at 3, 6 and 12 months. Additionally, functional status improved at all the assessed timepoints. CONCLUSION minimally invasive interventional procedures can improve pain and functional status of patients affected by OA or chronic sacroiliac pain of degenerative origin. Further research is warranted in the field of inflammatory rheumatic diseases.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Vanni
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia and Università di Modena e Reggio Emilia, Modena, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carlo Salvarani
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia and Università di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan and ASST G. Pini-CTO, Milan, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Deviandri R, Yuliana V, Irawan D, Rahman A. Genicular nerve radiofrequency ablation for pain control following anterior cruciate ligament reconstruction - A case report. Trauma Case Rep 2022; 40:100661. [PMID: 35665197 PMCID: PMC9157187 DOI: 10.1016/j.tcr.2022.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 12/01/2022] Open
Abstract
Adequate postoperative pain control is an essential factor for the success of rehabilitation programs after anterior cruciate ligament reconstruction (ACLR). The genicular nerve radiofrequency ablation (GNRF) is a recently developed method. This study aimed to evaluate the use of GNRF in patients who underwent ACLR. We performed GNRF guided by ultrasonography for patients who underwent ACLR with aggravated pain. GNRF was performed following ACLR a day after surgery. The pain was evaluated using the Visual Analogue Scale (VAS), and the Euroqol-5 Dimension (EQ-5D) measured the quality of life on the day of one, three, and seven after surgery. Results In this study, two patients participated. In the postoperative days first, third, and seventh, the mean VAS was decreased after providing the intervention (from 8 to 5, 2, and 1, respectively). The mean EQ5D improved from 0.48 to 0.52, 0.56, 0.66, respectively. We concluded that GNRF is an adequate and safe procedure for managing postoperative pain after ACLR. It may enhance the postoperative rehabilitation program.
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Affiliation(s)
- R. Deviandri
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Physiology, Faculty of Medicine, Universitas Riau, Division of Orthopaedic, Arifin Achmad Hospital, Pekanbaru, Indonesia
- Corresponding author at: Faculty of Medicine, Universitas Riau, Diponegoro street no 1, Pekanbaru 28133, Indonesia.
| | - V. Yuliana
- Department of Sport and Rehabilitation, Fit Centrum, Pekanbaru, Indonesia
| | - D. Irawan
- Department of Anesthesia, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - A.N. Rahman
- Department of Orthopedic and Pain Intervention, Sentra Medika Hospital, Cisalak, Indonesia
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Intra-Articular Application of Sluijter-Teixera Poisson Pulsed Radiofrequency in Symptomatic Patients with Knee Osteoarthritis: Focus upon Clinical Efficacy and Safety. Pain Res Manag 2021; 2021:5554631. [PMID: 34518775 PMCID: PMC8433589 DOI: 10.1155/2021/5554631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
Purpose To retrospectively evaluate the effectiveness of intra-articular application of Sluijter-Teixera Poisson pulsed radiofrequency (STP PRF) in knee osteoarthritis symptomatic patients with chronic pain refractory to conservative therapies. Materials and Methods Institutional database research of two centers identified 39 cases of knee osteoarthritis patients treated with intra-articular STP PRF. Pain prior and one-week and one-, three-, six-, and twelve-month post-STP PRF was compared by means of a numeric visual scale (NVS) questionnaire. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system was used for complications reporting. Mean patient age was 71.59 ± 11.99 years, mean body mass index was 30.23 ± 4.69, and male/female ratio was 9/30. Results Mean baseline pain score was 8.31 ± 1.70 NVS units. This was reduced to a mean value of 0.90 ± 1.50 NVS units one-week post-RF, 1.08 ± 1.53 at one month, 1.54 ± 1.88 at three months, 2.33 ± 2.17 at six months, and 3.23 ± 2.23 at 12 months of follow-up (p < 0.01). Pain decrease of more than 4 NVS units was noticed in 35/39 knees (89.7%) at first week, 36/39 knees (92.3%) at first month, 35/39 knees (89.7%) at three months, 32/39 knees (82.1%) at six months, and 25/39 knees (64.1%) at one year. There was no recurrence during the follow-up. No complication was observed. Conclusions Percutaneous, intra-articular application of STP PRF is an effective and safe technique for chronic pain reduction in patients with knee osteoarthritis. Results seem to be reproducible and long lasting with significant patient satisfaction at 12-month follow-up.
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Zhao J, Wang Z, Xue H, Yang Z. Clinical efficacy of repeated intra-articular pulsed radiofrequency for the treatment of knee joint pain and its effects on inflammatory cytokines in synovial fluid of patients. Exp Ther Med 2021; 22:1073. [PMID: 34447466 PMCID: PMC8355715 DOI: 10.3892/etm.2021.10507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 06/18/2021] [Indexed: 12/29/2022] Open
Abstract
The application value of repeated intra-articular pulsed radiofrequency for the treatment of knee joint pain has remained to be determined. To investigate this, a total of 64 patients with chronic knee joint pain admitted to Caoxian People's Hospital (Caoxian, Chine) between October 2016 and May 2018 were enrolled in the present study and analyzed prospectively. The patients were randomly divided into a control group, receiving treatment with a single intra-articular pulsed radiofrequency through the knee joint (n=32), and an experimental group, receiving multiple intra-articular pulsed radiofrequency treatments through the knee joint (n=32). The visual analog scale score (VAS), clinical efficacy and adverse reactions prior to and after treatment were compared between the two treatments. Synovial fluid cytokines were measured using ELISA prior to and after treatment. After the treatment, the control group and the experimental group both had a lower VAS (P<0.001) and the control group had a higher VAS and lower pain relief than the experimental group (P<0.001). The control group had a total effectiveness rate of 78.13%, with 13 patients experiencing complete relief (40.63%), 12 patients exhibiting a marked improvement (37.5%) and 7 patients reporting no effects (21.87%). The experimental group had a total effectiveness rate of 90.63%, with 18 patients (56.25%) being cured, 11 patients having a marked effect (34.37%) and 3 patients reporting no effects (9.38%). The experimental group had a higher incidence of adverse reactions than the control group (P<0.05). After treatment, the two groups had decreased IL-6, IL-10 and TNF-α levels in the knee joint synovial fluid (P<0.05), with the experimental group having lower cytokine levels than the control group (P<0.05). These results indicated that repeated intra-articular pulsed radiofrequency is an effective method for the treatment of knee joint pain and may be used in clinical practice.
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Affiliation(s)
- Jie Zhao
- Department of Orthopaedic Surgery (Osteoarthritis), Caoxian People's Hospital, Caoxian, Shandong 274400, P.R. China
| | - Zhenyue Wang
- Department of Orthopaedic Surgery (Osteoarthritis), Caoxian People's Hospital, Caoxian, Shandong 274400, P.R. China
| | - Huaibao Xue
- Department of Orthopedics, Yutai County People's Hospital, Yutai, Shandong 272300, P.R. China
| | - Zhan Yang
- Department of Bone Surgery (Traumatized Joint Department), Caoxian People's Hospital, Caoxian, Shandong 274400, P.R. China
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Papa A, Di Dato MT, Lo Bianco G, Gazzerro G, Salzano AM, Di Costanzo E, Tammaro D, Schatman ME, Varrassi G. Intraarticular STP Radiofrequency for Painful Osteoarthritis in the Knee: A Retrospective Single Center Analysis. J Pain Res 2021; 14:2441-2447. [PMID: 34413678 PMCID: PMC8370597 DOI: 10.2147/jpr.s317569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/07/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Osteoarthritis (OA) is the most common cause of chronic knee pain, often a debilitating condition that can cause a significant reduction in functional capacity. Radiofrequency is a form of neuromodulation that modulates pain signal transmission and has become progressively more common as a treatment for knee pain. This retrospective study aims to evaluate the efficacy of intraarticular radiofrequency in patients with chronic knee OA pain. MATERIALS AND METHODS In this retrospective study, we included 129 patients undergoing intraarticular pulsed radiofrequency using the Poisson curve for energy distribution (Sluijter-Teixeira Poisson radiofrequency) (STP) from March 2018 to November 2019. Knee osteoarthritis severity was assessed prior to the procedure using the Lequesne Index, classifying patients into six groups based on level of severity. Pain intensity was assessed through a 10-cm visual analog scale (VAS), and level of patient satisfaction was assessed through a questionnaire. RESULTS In the sample, pain reduction as measured by VAS compared to baseline prior to the procedure was statistically significant immediately following the procedure, at 30 days and at 90 days (p<0.001); this difference was less significant at 180 days (p<0.005). Efficacy in patients with moderate to severe disability was considerably greater than in patients with very severe to extremely severe disability. 57.36% reported that they were very satisfied, 29.46% satisfied, 9.3% neither satisfied nor dissatisfied, 2.33% dissatisfied, and 1.55% very dissatisfied. CONCLUSION Our results suggest that STP radiofrequency may be a safe and effective procedure for knee OA, able to significantly reduce VAS scores at 1 month and 3 months compared to baseline. Based on our results, a key factor to consider when treating knee OA with STP radiofrequency is that it is more effective among patients with a lower level of disability. Due to the retrospective observational study design, prospective longitudinal investigation is required to further support the recommendation of STP radiofrequency for knee OA.
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Affiliation(s)
- Alfonso Papa
- Pain Department AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
| | | | - Giuliano Lo Bianco
- Pain Department AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
- Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Giuseppe Gazzerro
- Pain Department AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
| | - Anna Maria Salzano
- Pain Department AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
| | - Emilio Di Costanzo
- Pain Department AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
| | - Dario Tammaro
- Pain Department AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA
- School of Social Work, North Carolina State University, Raleigh, NC, USA
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Comparison of Efficacy among Three Radiofrequency Ablation Techniques for Treating Knee Osteoarthritis: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147424. [PMID: 34299875 PMCID: PMC8306337 DOI: 10.3390/ijerph18147424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 12/27/2022]
Abstract
Radiofrequency ablation (RFA) was first introduced for treating knee osteoarthritis (OA) in 2010 and has emerged as a minimally invasive treatment option. Three RFA techniques have been adopted for treating knee OA, including conventional, pulsed, and cooled RFA. However, the efficacy among different RFA techniques in the treatment of knee OA is still unclear. Three electronic databases were systematically searched for relevant articles, including PubMed, Embase, and Cochrane Library. A meta-analysis of articles that investigated the use of RFA techniques in the treatment of knee OA was conducted to pool the effect size in pain before and after treatment. A total of 20 eligible articles (including 605 patients) were included for our meta-analysis. After treatment, the patients had significant improvements in pain for all three RFA techniques when compared with the baseline level for the 1, 3-, and 6-month follow-ups (p < 0.00001). However, there were no significant differences in the efficacy among the three RFA techniques for all follow-up visits (p > 0.05). The three RFA techniques demonstrated a significant improvement in pain for up to 6 months after treatment. Comparing the efficacy of the three RFA techniques in the treatment of knee OA, our results showed that no significant differences in pain relief among the three RFA techniques were observed at the 1-, 3-, 6, and 12-month follow-up visits.
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Cho HK, Park GY, Sung WJ, Kawk SG, Jung WB. Effects of intra-articular pulsed radiofrequency current administration on a rabbit model of rheumatoid arthritis. Exp Ther Med 2020; 20:29. [PMID: 32952620 PMCID: PMC7480132 DOI: 10.3892/etm.2020.9157] [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: 02/10/2020] [Accepted: 06/17/2020] [Indexed: 11/05/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial proliferation and inflammation. Intra-articular corticosteroid injections are commonly used for the treatment of arthritis affecting one or two joints. Although corticosteroid injections are fast-acting, repeated usage can result in severe adverse events. Recently, intra-articular pulsed radiofrequency (PRF) stimulation has been proposed to treat arthritis. The aim of the present study was to compare the effectiveness of intra-articular PRF with corticosteroid injection based on histopathological and motion analysis of an ovalbumin (OVA)-induced RA rabbit model. RA was induced in the right knee joint of 18 rabbits via OVA injection. The rabbits were randomly allocated into a PRF, an intra-articular corticosteroid injection or a sham PRF stimulation group. Movement was assessed in the rabbits before treatment, then at 2, 4 and 8 weeks after treatment using walking distance, fast walking time and mean walking speed. Histopathological evaluation of the distal femur and synovium was conducted 2, 4 and 8 weeks after treatment. Motion analysis demonstrated that changes in all movement variables showed significant group and time interaction as well as group effect among the three groups. The semiquantitative score based on the histopathological findings for the distal femoral condyle decreased 2 and 4 weeks after both the PRF and steroid groups, compared with the sham PRF group. Moreover, in the synovium, the semiquantitative histological score in the PRF and steroid groups tended to be lower compared with the sham PRF group, although this result was not statistically significant. Thus, intra-articular PRF stimulation may delay cartilage destruction and improve functional motion in RA.
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Affiliation(s)
- Hee Kyung Cho
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Gi-Young Park
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Woo Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Sang Gyu Kawk
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Won Bin Jung
- Department of Physical Medicine and Rehabilitation, Seongju Moo Gang Hospital, Seongju 40026, Republic of Korea
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Leoni MLG, Schatman ME, Demartini L, Lo Bianco G, Terranova G. Genicular Nerve Pulsed Dose Radiofrequency (PDRF) Compared to Intra-Articular and Genicular Nerve PDRF in Knee Osteoarthritis Pain: A Propensity Score-Matched Analysis. J Pain Res 2020; 13:1315-1321. [PMID: 32581573 PMCID: PMC7280065 DOI: 10.2147/jpr.s240138] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Chronic knee osteoarthritic (OA) pain is a common and debilitating complaint in elderly patients. Despite numerous pharmaceutical options, the majority of patients still experience long-term pain. Genicular nerve (GN) radiofrequency has become increasingly popular as a treatment for knee pain. This retrospective study aimed to evaluate the effects of pulse dose radiofrequency (PDRF) in patients with chronic knee OA pain. Patients and Methods Propensity score matching analysis was performed in a retrospective cohort of 78 patients with moderate-severe knee OA pain unresponsive to conservative treatment who underwent PDRF GN or intra-articular (IA) and PDRF GN. Pain relief was measured using the numeric rating scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient Global Impression of Change (PGIC) at 3 and 6 months post-intervention. Results A significant reduction in NRS scores was reported at 3 (p<0.001) and 6 months (p<0.001) after PDRF in both groups. NRS was lower in PDRF IA + GN than PDRF GN (p<0.0001). WOMAC pain was significantly reduced at 3 months in PDRF IA + GN group (baseline: 10.12±3.14, 3 months: 6.25±2.44, p=0.0001). WOMAC stiffness and function were improved only at 3 months in PDRF IA + GN compared to baseline (p=0.007 and p=0.006, respectively). A longer period of pain relief was reported after PDRF IA + GN (6.75±2.42 months) compared to PDRF GN (4.31±2.85 months, p<0.001) in association with higher PGIC scores. Conclusion This is the first study that compared two different PDRF techniques. PDRF GN and PDRF IA + GN were both effective in reducing pain at 3 and 6 months follow-up. However, only PDRF IA + GN was able to improve WOMAC scores at 3 months after the treatment with a longer period of efficacy compared to PDRF GN alone.
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Affiliation(s)
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Laura Demartini
- Pain Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Giuliano Lo Bianco
- Basildon and Thurrock University Hospital, Essex, London, Orsett Hospital, Pain Management and Neuromodulation, London, Essex, UK.,IRCCS Centro Regionale Oncologico Basilicata, Rionero in Vulture, Italy.,Department of Biomedical and Biotechnological Sciences (Biometec), Università di Catania, Catania, Italy
| | - Gaetano Terranova
- Anaesthesia and Intensive Care Department, Asst Gaetano Pini, Milano, Italy
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Ajrawat P, Radomski L, Bhatia A, Peng P, Nath N, Gandhi R. Radiofrequency Procedures for the Treatment of Symptomatic Knee Osteoarthritis: A Systematic Review. PAIN MEDICINE 2020; 21:333-348. [PMID: 31578561 DOI: 10.1093/pm/pnz241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of radiofrequency (RF) ablation and neuromodulation modalities for knee osteoarthritis (OA). METHODS The Pubmed, Medline, Embase, and Cochrane Library databases were searched from inception to August 2018. All comparative and noncomparative studies that reported clinical outcome measures and adverse events related to RF modalities for knee OA were included. Pain scores, physical function measures, quality of life (QOL), patient satisfaction, and adverse events for three months and beyond of postprocedure follow-up were analyzed qualitatively. RESULTS Thirty-three studies, including 13 randomized controlled trials (RCTs), two nonrandomized comparative studies, and 18 noncomparative cohort studies, were identified, with 1,512 patients (mean age = 64.3 years, 32.5% males). All 33 studies were considered to be of moderate or high methodological quality. All 33/33 (100%) studies reported alleviation of OA-related knee pain from baseline until three to 12 months with RF modalities, with six comparative studies reporting 194/296 (65.5%) and 29/150 (19.3%) RF and control patients achieving >50% pain relief, respectively. Three of the 33 studies reported QOL, with three of three studies (100%) achieving improvements in disease-specific QOL from baseline until three to 12 months. Twenty-eight of the 33 studies reported functional outcomes, with 27/28 (96%) studies obtaining enhanced functionality from baseline up until three to 12 months. Ten of the 33 studies reported patient satisfaction, with eight of 10 studies (80%) indicating that patients were significantly satisfied after RF procedures, and from these eight studies, four were comparative studies that indicated that 86/154 (56%) and 33/104 (32%) RF and control patients were extremely satisfied or satisfied, respectively. Regarding adverse events (AEs), 29 of the 33 studies reported AEs, with 20/29 (69%) studies indicating no AEs related to the RF modalities and the remaining nine studies only indicating minor localized AEs. Twenty-nine of the 33 studies indicated no serious knee-related AEs pertaining to RF modalities. CONCLUSIONS Current evidence substantiates that RF modalities for knee OA potentially improve pain, functionality, and disease-specific QOL for up to three to 12 months with minimal localized complications. This suggests that RF modalities are perhaps an effective adjunct therapy for patients with knee OA who are unresponsive to conservative therapies. Further RCTs with larger sample sizes and long-term follow-up that directly compare the three primary RF modalities are warranted to confirm the clinical efficaciousness and superiority of these RF modalities for knee OA.
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Affiliation(s)
- Prabjit Ajrawat
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lenny Radomski
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anuj Bhatia
- Department of Anesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada
| | - Phillip Peng
- Department of Anesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nikhil Nath
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Ariel de Lima D, Gonçalves MCK, Grando STCES, Cintra TLDL, Pinto DM, Gonçalves RK. Indications of the Neurotomy of Genicular Nerves by Radiofrequency for the Treatment of Knee Osteoarthritis: A Literature Review. Rev Bras Ortop 2019; 54:233-240. [PMID: 31363275 PMCID: PMC6597460 DOI: 10.1055/s-0039-1692121] [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: 01/15/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022] Open
Abstract
Osteoarthritis (OA) is one of the most frequent and incapacitating pathologies today, especially of the knee. Among the possible approaches for knee OA, the neurotomy of the genicular nerves by radiofrequency (RF) has been gaining prominence. However, as this is a relatively new procedure, indications for its implementation are still unclear. The objective of the present review is to identify the main indications of the use of RF for the treatment of knee OA in the medical literature. A review of the literature was performed in January 2018 through a search in the PubMed, ClinicalKey and Google Scholar databases. After reviewing the main articles on the subject, it was concluded that the main indications of the use of RF for the treatment of knee OA were: OA Kellgren-Lawrence grades 3 and 4, with moderate to severe pain and failure of conservative treatment, mainly in elderly people; persistence of pain even after total knee arthroplasty (TKA); patients with an indication for TKA who refuse to undergo surgical treatment.
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Affiliation(s)
- Diego Ariel de Lima
- Grupo de Joelho do Instituto de Traumatologia e Ortopedia Romeu Krause (ITORK), Recife, PE, Brasil.,Universidade Federal Rural do Semi-Árido (UFERSA), Mossoró, RN, Brasil
| | | | | | | | - Dilamar Moreira Pinto
- Grupo de Joelho do Instituto de Traumatologia e Ortopedia Romeu Krause (ITORK), Recife, PE, Brasil
| | - Romeu Krause Gonçalves
- Grupo de Joelho do Instituto de Traumatologia e Ortopedia Romeu Krause (ITORK), Recife, PE, Brasil
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Abstract
PURPOSE OF REVIEW Chronic pain of the lower extremity remains challenging to manage. Radiofrequency ablation procedure applies heat to nerve fibers with the goal of mitigating chronic pain conditions of the knee. However, the clinical efficacy has not yet been adequately established. The goal of this review paper is to report the use of radiofrequency ablations in the treatment of osteoarthritis of the knee. RECENT FINDINGS PubMed and the Cochrane Controlled Trials Register were searched (final search 28 February 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," and "pain" in the English literature. Bibliographies of the published papers were screened for relevance to lower extremity radiofrequency ablation therapies. The quality of selected publications was assessed using the Cochrane risk of bias instrument. Of the 923 papers screened, 317 were further investigated for relevance. Our final search methodology yielded 19 studies that investigated the use of radiofrequency ablation at the knee. Of these 19 studies, there were four randomized control trials, two non-randomized control trials, three prospective studies, two retrospective studies, one case-control study, one technical report, and seven case reports. In summary, the data available suggests radiofrequency ablation as a promising and efficacious with all 19 studies revealing significant short- and long-term pain reductions in patients with knee pain.
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12
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Imani F, Patel VB. Therapeutic Challenges for Knee Osteoarthritis. Anesth Pain Med 2019; 9:e95377. [PMID: 31497526 PMCID: PMC6712428 DOI: 10.5812/aapm.95377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vikram B. Patel
- Phoenix Interventional Center for Advanced Learning, Algonquin, Illinois, USA
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13
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Jamison DE, Cohen SP. Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection. J Pain Res 2018; 11:1879-1888. [PMID: 30271194 PMCID: PMC6151104 DOI: 10.2147/jpr.s144633] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The use of radiofrequency ablation (RFA) procedures to treat chronic knee pain has surged in the past decade, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness. Methods A comprehensive literature review was performed on anatomy, selection criteria, technical parameters, results of clinical studies, and complications. Databases searched included MEDLINE and Google Scholar, with all types of clinical and preclinical studies considered. Results We identified nine relevant clinical trials, which included 592 patients, evaluating knee RFA for osteoarthritis and persistent postsurgical pain. These included one randomized, placebo-controlled trial, one randomized controlled trial evaluating RFA as add-on therapy, four comparative-effectiveness studies, two randomized trials comparing different techniques and treatment paradigms, and one non-randomized, controlled trial. The results of these studies demonstrate significant benefit for both reduction and functional improvement lasting between 3 and 12 months, with questionable utility for prognostic blocks. There was considerable variation in the described neuroanatomy, neural targets, radiofrequency technique, and selection criteria. Conclusion RFA of the knee appears to be a viable and effective treatment option, providing significant benefit to well-selected patients lasting at least 3 months. More research is needed to better identify neural targets, refine selection criteria to include the use of prognostic blocks, optimize treatment parameters, and better elucidate relative effectiveness compared to other treatments.
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Affiliation(s)
- David E Jamison
- Department of Anesthesiology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA, .,Department of Anesthesiology, Uniformed Services University of Health Sciences (USUHS), Bethesda, MD, USA,
| | - Steven P Cohen
- Department of Anesthesiology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA, .,Department of Anesthesiology, Uniformed Services University of Health Sciences (USUHS), Bethesda, MD, USA, .,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department of Physical Medicine and Rehabilitation, USUHS, Bethesda, MD, USA,
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14
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Pulse-dose radiofrequency treatment in pain management-initial experience. Skeletal Radiol 2018; 47:609-618. [PMID: 29275456 DOI: 10.1007/s00256-017-2854-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/31/2017] [Accepted: 12/08/2017] [Indexed: 02/02/2023]
Abstract
Radiofrequency procedures have been used for treating various chronic pain conditions for decades. These minimally invasive percutaneous treatments employ an alternating electrical current with oscillating radiofrequency wavelengths to eliminate or alter pain signals from the targeted site. The aim of the continuous radiofrequency procedure is to increase the temperature sufficiently to create an irreversible thermal lesion on nerve fibres and thus permanently interrupt pain signals. The pulsed radiofrequency procedure utilises short pulses of radiofrequency current with intervals of longer pauses to avert a temperature increase to the level of permanent tissue damage. The goal of these pulses is to alter the processing of pain signals, but to avoid relevant structural damage to nerve fibres, as seen in the continuous radiofrequency procedure. The pulse-dose radiofrequency procedure is a technical improvement of the pulsed radiofrequency technique in which the delivery mode of the current is adapted. During the pulse-dose radiofrequency procedure thermal damage is avoided. In addition, the amplitude and width of the consecutive pulses are kept the same. The method ensures that each delivered pulse keeps the same characteristics and therefore the dose is similar between patients. The current review outlines the pulse-dose radiofrequency procedure and presents our institution's chronic pain management studies.
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15
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Filippiadis D, Velonakis G, Mazioti A, Konstantos C, Brountzos E, Kelekis N, Kelekis A. Intra-articular application of pulsed radiofrequency combined with viscosupplementation for improvement of knee osteoarthritis symptoms: a single centre prospective study. Int J Hyperthermia 2018; 34:1265-1269. [DOI: 10.1080/02656736.2017.1409910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- D. Filippiadis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - G. Velonakis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Mazioti
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - C. Konstantos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - E. Brountzos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - N. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
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16
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Sarı S, Aydın ON, Turan Y, Özlülerden P, Efe U, Kurt Ömürlü İ. Which one is more effective for the clinical treatment of chronic pain in knee osteoarthritis: radiofrequency neurotomy of the genicular nerves or intra-articular injection? Int J Rheum Dis 2016; 21:1772-1778. [DOI: 10.1111/1756-185x.12925] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sinem Sarı
- Department of Anesthesiology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Osman N. Aydın
- Department of Algology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Yasemin Turan
- Department of Physical Medicine and Rehabilitation; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Pınar Özlülerden
- Department of Algology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - Ufuk Efe
- Department of Anesthesiology; Medical Faculty; Adnan Menderes University; Aydin Turkey
| | - İmran Kurt Ömürlü
- Department of Biostatistics; Medical Faculty; Adnan Menderes University; Aydin Turkey
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17
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18
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Lalam RK, Winn N, Cassar-Pullicino VN. Interventional articular and para-articular knee procedures. Br J Radiol 2015; 89:20150413. [PMID: 26682669 DOI: 10.1259/bjr.20150413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The knee is a common area of the body to undergo interventional procedures. This article discusses image-guided interventional issues specific to the knee area. The soft tissues in and around the knee are frequently affected by sport-related injuries and often need image-guided intervention. This article details the specific technical issues related to intervention in these soft tissues, including the iliotibial tract, fat pads, patellar tendon and other tendons, bursae and the meniscus. Most often, simple procedures such as injection and aspiration are performed without image guidance. Rarely image-guided diagnostic arthrography and therapeutic joint injections are necessary. The technique, indications and diagnostic considerations for arthrography are discussed in this article. Primary bone and soft-tissue tumours may involve the knee and adjacent soft tissues. Image-guided biopsies are frequently necessary for these lesions; this article details the technical issues related to image-guided biopsy around the knee. A number of newer ablation treatments are now available, including cryoablation, high-frequency ultrasound and microwave ablation. Radiofrequency ablation, however, still remains the most commonly employed ablation technique. The indications, technical and therapeutic considerations related to the application of this technique around the knee are discussed here. Finally, we briefly discuss some newer, but as of yet, unproven image-guided interventions for osteochondral lesions and Brodie's abscess.
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Affiliation(s)
- Radhesh K Lalam
- Department of Diagnostic imaging, Robert Jones and Agnes Hunt Orthopaedic hospital, Oswestry, UK
| | - Naomi Winn
- Department of Diagnostic imaging, Robert Jones and Agnes Hunt Orthopaedic hospital, Oswestry, UK
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Masala S, Fiori R, Raguso M, Calabria E, Cuzzolino A, Fusco A, Simonetti G. Pulse-dose radiofrequency can reduce chronic pain in trapezio-metacarpal osteoarthritis: A mini-invasive therapeutic approach. Int J Rheum Dis 2015; 20:309-316. [PMID: 25990465 DOI: 10.1111/1756-185x.12635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To assess the efficiency of pulse-dose radiofrequency (PDRF) in the management of chronic pain in patients with trapezio-metacarpal osteoarthritis (OA). METHODS Seventy-five patients with trapezio-metacarpal OA were treated with the PDRF between October 2011 and September 2013. A 22-gauge cannula with a 5-cm length was introduced with percutaneous access in the lateral region of the affected trapezio-metacarpal joint. The PDRF procedure was performed with 1200 pulses at 45 V and 20 msec duration, followed by a 480 msec silent phase. The follow-up visits were performed at 1 month, 3 and 6 months after the PDRF procedure. All patients underwent a second treatment between 7 and 9 months after the first PDRF procedure with a new follow-up scheme at 1, 3, 6 and 9 months. RESULTS Mean visual analogue scale (VAS) scores before the procedures was 8.5 ± 1.1. A great reduction in pain intensity was reported at 3 months after the PDRF procedure (mean VAS scores 3.1 ± 0.9, P < 0.05). Pain intensity began to increase back to pre-procedural values after 4 months (mean VAS scores at 6 months was 7.9 ± 1.3, P < 0.05). After the second PDRF treatment the mean VAS scores decreased to 3.3 ± 0.8 at 3 months, but increased to 8.1 ± 1.6 at 9 months. (P < 0.05). No complications after the procedures were observed. CONCLUSIONS The PDRF may be a safe, repeatable and effective short-term pain management technique in patients with trapezio-metacarpal OA. Larger, randomized controlled studies are indicated to better clarify the efficacy and utility of the PDRF.
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Affiliation(s)
- Salvatore Masala
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy
| | - Roberto Fiori
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Raguso
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy
| | - Eros Calabria
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandro Cuzzolino
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy
| | - Armando Fusco
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy
| | - Giovanni Simonetti
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy
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Masala S, Fiori R, Calabria E, Raguso M, de Vivo D, Cuzzolino A, Simonetti G. Management of pain on hallux valgus with percutaneous intra-articular Pulse-Dose Radiofrequency. Int J Rheum Dis 2014; 20:46-52. [DOI: 10.1111/1756-185x.12414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Salvatore Masala
- Department of Diagnostic and Molecular Imaging; Interventional Radiology and Radiation Therapy; University of Rome “Tor Vergata”; Rome Italy
| | - Roberto Fiori
- Department of Diagnostic and Molecular Imaging; Interventional Radiology and Radiation Therapy; University of Rome “Tor Vergata”; Rome Italy
| | - Eros Calabria
- Department of Diagnostic and Molecular Imaging; Interventional Radiology and Radiation Therapy; University of Rome “Tor Vergata”; Rome Italy
| | - Mario Raguso
- Department of Diagnostic and Molecular Imaging; Interventional Radiology and Radiation Therapy; University of Rome “Tor Vergata”; Rome Italy
| | - Dominique de Vivo
- Department of Diagnostic and Molecular Imaging; Interventional Radiology and Radiation Therapy; University of Rome “Tor Vergata”; Rome Italy
| | - Alessandro Cuzzolino
- Department of Diagnostic and Molecular Imaging; Interventional Radiology and Radiation Therapy; University of Rome “Tor Vergata”; Rome Italy
| | - Giovanni Simonetti
- Department of Diagnostic and Molecular Imaging; Interventional Radiology and Radiation Therapy; University of Rome “Tor Vergata”; Rome Italy
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