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Albano D, Messina C, Gitto S, Fusco S, Sconfienza LM, Bellelli A. US/CT fusion imaging and virtual navigation to guide lumbar intradiscal oxygen-ozone therapy: a pilot study. J Ultrasound 2024; 27:291-296. [PMID: 38102520 PMCID: PMC11178682 DOI: 10.1007/s40477-023-00835-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/02/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE To test the feasibility of US/CT fusion imaging to guide lumbar intradiscal O2/O3 therapy to treat discogenic degenerative low back pain due to lumbar disc herniation (LDH). METHODS We retrospectively included consecutive patients affected by low back pain and/or sciatica due to LDH resistant to conservative therapies, who underwent to lumbar intradiscal O2/O3 injection under CT/US fusion imaging guidance (Fusion Group) and standard CT guidance (Control Group). For each procedure, we collected procedure operative time, room utilization time, number of CT passes, complications, and O2/O3 intradiscal diffusion adequacy. Technical success was defined as the ability to complete the procedure as initially planned to reach the disc. Technical efficacy was based on O2/O3 intradiscal diffusion adequacy, as demonstrated by the last CT scan. RESULTS Six patients (4 males; mean age: 68 ± 15 years) were included in the Fusion group, six (4 males; mean age: 66 ± 12 years) in Control group. No complications were observed in both groups. In Fusion group we found significantly lower room utilization time (30 ± 6 min vs. 46 ± 10 min, p = 0.008), procedure operative time (14 ± 3 min vs. 24 ± 6 min, p = 0.008), and number of CT passes (2 [2,2] vs. 3 [3,3], p = 0.006) than in Control Group, respectively. Technical success and efficacy were 100% in both Groups. CONCLUSION CT/US fusion imaging seems to be a feasible and safe guidance for intradiscal O2/O3 injections, allowing decrease of procedure time and number of CT passes.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, Milan, Italy.
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Fusco
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | - Alberto Bellelli
- Unità Operativa Complessa di Radiologia Diagnostica ed Interventistica, Ospedale Fatebenefratelli San Pietro, Rome, Italy
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Wong MJ, Rajarathinam M. Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review. Can J Pain 2023; 7:2193617. [PMID: 37214187 PMCID: PMC10193888 DOI: 10.1080/24740527.2023.2193617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 05/24/2023]
Abstract
Background Axial facet joint interventions (e.g., medial branch block and radiofrequency ablation, facet joint intra-articular injection) are commonly performed for managing chronic spinal pain. Although traditionally performed with fluoroscopy or computed tomography (CT) guidance, ultrasound-guided techniques have also been developed for these interventions. Aims The aim of this study is to present contemporary ultrasound-guided techniques for facet joint interventions and synthesize data addressing their accuracy, safety, and efficacy. Methods The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies of ultrasound-guided facet joint interventions with human subjects from November 1, 1992, to November 1, 2022. Additional sources were drawn from reference lists and citations of relevant studies. Results We found 48 studies assessing ultrasound-guided facet joint interventions. Ultrasound guidance for injection of the cervical facet joints and their innervating nerves had favorable accuracy (78%-100%), with lower procedural time compared to fluoroscopy or CT guidance and comparable pain relief. Accuracy with ultrasound-guided lumbar facet joint intra-articular injection (86%-100%) was more reliable than medial branch block (72%-97%); analgesia was comparable to fluoroscopy and CT guidance. In general, these procedures were more challenging for patients with obesity, and deeper structures were more difficult to accurately target (e.g., lower cervical levels, L5 dorsal ramus). Conclusions Ultrasound-guided facet joint interventions continue to evolve. Some technically challenging interventions may be impractical for widespread usage or require further technical refinement. The utility of ultrasound guidance with obesity and abnormal anatomy may be reduced.
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Affiliation(s)
- Michael J. Wong
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Mauri G, Gitto S, Pescatori LC, Albano D, Messina C, Sconfienza LM. Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:387-392. [PMID: 32785900 DOI: 10.1055/a-1194-4225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions. MATERIALS AND METHODS This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded. RESULTS Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ± 5 vs. 26 ± 3 minutes, p = 0.002 and 7; 5.25-8.75 vs. 3; 3-3.25, p = 0.001). In controls, the mean procedure duration was 47 ± 4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5-8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal. CONCLUSION Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes.
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Affiliation(s)
- Giovanni Mauri
- Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy
- European Institute of Oncology IRCCS, Division of Interventional Radiology, Milan, Italy
| | - Salvatore Gitto
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
| | | | - Domenico Albano
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
- Università degli Studi di Palermo, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Palermo, Italy
| | - Carmelo Messina
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
| | - Luca Maria Sconfienza
- Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Unit of Diagnostic and Interventional Radiology, Milan, Italy
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Orlandi D, Viglino U, Dedone G, Leale G, Caruso P, Mauri G, Turtulici G. US-CT fusion-guided percutaneous radiofrequency ablation of large substernal benign thyroid nodules. Int J Hyperthermia 2022; 39:847-854. [PMID: 35757935 DOI: 10.1080/02656736.2022.2091167] [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] Open
Abstract
The aim of the present study was to assess feasibility, safety and outcome of ultrasound (US) guided percutaneous radiofrequency (RF) ablation of large substernal benign thyroid nodules assisted by US-computed tomography (CT) fusion imaging and real-time virtual needle tracking (VT) system. Thirty patients (18 females, mean age 56 y, range 32-76 y) with 35 benign nonfunctioning thyroid nodules (mean volume ± SD 26.8 ± 7.6 mL; range 20-38mL) were selected for CT-US fusion guided RF ablation. Nodules' volume was evaluated before treatment and during 12-months follow-up. Complications' rate was also evaluated. US-CT fusion imaging with VT system was feasible in all cases (feasibility 100%) and it was always possible to complete the procedure as planned (technical success 100%). Minor complications occurred in 2/30 cases (6.6%). No major complications occurred. 50% volume reduction (technique efficacy) was achieved in 93% cases, with a significant mean volume reduction at 12 months follow-up (68.7 ± 10.8%), (p < .001). The VT system could be useful in thyroid nodules ablation procedures assistance being able to track the RF electrode tip even when this is obscured by the bubbles produced by the ablative process. The combination of fusion imaging with VT assisted RF ablation represents a safe, non-surgical treatment option for patients with large substernal benign thyroid nodules.
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Affiliation(s)
- Davide Orlandi
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Umberto Viglino
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Genova, Italy
| | - Giorgia Dedone
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Giacomo Leale
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Pietro Caruso
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Giovanni Mauri
- Dipartimento di Oncologia ed Emato-oncologia, Università degli studi di Milano, Milano, Italy.,Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Giovanni Turtulici
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
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Dejaco C, Machado PM, Carubbi F, Bosch P, Terslev L, Tamborrini G, Sconfienza LM, Scirè CA, Ruetten S, van Rompay J, Proft F, Pitzalis C, Obradov M, Moe RH, Mascarenhas VV, Malattia C, Klauser AS, Kent A, Jans L, Hartung W, Hammer HB, Duftner C, Balint PV, Alunno A, Baraliakos X. EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2022; 81:760-767. [PMID: 34893469 DOI: 10.1136/annrheumdis-2021-221261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). METHODS European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periarticular musculoskeletal structures, nerves and the spine. While US is the favoured imaging technique for peripheral joints and nerves, the choice of the imaging method for the spine and sacroiliac joints has to be individualised according to the target, procedure, expertise, availability and radiation exposure. All imaging guided interventions should be performed by a trained specialist using appropriate operational procedures, settings and assistance by technical personnel. CONCLUSION These are the first EULAR PtC to provide guidance on the role of imaging to guide interventional procedures in patients with RMDs.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria
- Department of Rheumatology (ASAA-SABES), Brunico Hospital, Brunico, Italy
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Philipp Bosch
- Department of Rheumatology, Medical University of Graz, Graz, Austria
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Universita degli Studi di Milano, Milano, Italy
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology, St. Anna Hospital, Herne, Germany
| | - Jef van Rompay
- Patient Research Partners, Patient Research, Antwerpen, Belgium
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Marina Obradov
- Radiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rikke Helene Moe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Vasco V Mascarenhas
- UIME (Unidade de Imagem Musculo-esquelética), Hospital da Luz Imaging Center, Lisbon, Portugal
- Rheumatic Diseases Lab, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Andrea Sabine Klauser
- Radiology II, Medical University Innsbruck Department of Radiology, Innsbruck, Austria
| | - Alison Kent
- Salisbury Hospital NHS Foundation Trust, Salisbury, UK
| | - Lennart Jans
- Radiology, Ghent University Hospital Radiology Department, Gent, Belgium
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach, Germany
| | - Hilde Berner Hammer
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, University of L'Aquila Department of Clinical Medicine Life Health and Environmental Sciences, L'Aquila, Italy
| | - Xenofon Baraliakos
- Rheumatology, Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Herne, Germany
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Cao J, Xie P, Feng F, Li K, Tan L, Chen Z, Ren J, Zheng R, Rong L. Potential Application of MR-MR-US Fusion Imaging Navigation with Needle Tail Intelligent Positioning in Guiding Puncture in Percutaneous Transforaminal Endoscopic Discectomy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3458-3469. [PMID: 34593278 DOI: 10.1016/j.ultrasmedbio.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
This study sought to investigate the feasibility of using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) fusion imaging navigation (FIN) with needle tail intelligent positioning (NTIP) to guide puncture in percutaneous transforaminal endoscopic discectomy (PTED). First, in a pig experiment, we found that puncture errors in lumbar intervertebral foramen (LIF) puncture using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) FIN with NTIP for experienced and novice operators were 2.00 ± 1.00 and 2.57 ± 0.98 mm, respectively (p = 0.231), suggesting this technique was minimally dependent on experience. Then, two experienced surgeons agreed (inter-observer agreement к=0.801) that the quality of MR-MR fusion images was good or sufficient. Finally, we performed PTED in eight patients using MR-MR-US FIN with NTIP, and no significant complications were reported during LIF puncture. Overall, MR-MR-US FIN with NTIP may be a potential application for guiding puncture in PTED, but more clinical studies with a larger sample size are required to further evaluate the advantages of MR-MR-US FIN with NTIP.
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Affiliation(s)
- Junyan Cao
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Peigen Xie
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Zihao Chen
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China.
| | - Limin Rong
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.
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Role of Fusion Imaging in Image-Guided Thermal Ablations. Diagnostics (Basel) 2021; 11:diagnostics11030549. [PMID: 33808572 PMCID: PMC8003372 DOI: 10.3390/diagnostics11030549] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Abstract
Thermal ablation (TA) procedures are effective treatments for several kinds of cancers. In the recent years, several medical imaging advancements have improved the use of image-guided TA. Imaging technique plays a pivotal role in improving the ablation success, maximizing pre-procedure planning efficacy, intraprocedural targeting, post-procedure monitoring and assessing the achieved result. Fusion imaging (FI) techniques allow for information integration of different imaging modalities, improving all the ablation procedure steps. FI concedes exploitation of all imaging modalities’ strengths concurrently, eliminating or minimizing every single modality’s weaknesses. Our work aims to give an overview of FI, explain and analyze FI technical aspects and its clinical applications in ablation therapy and interventional oncology.
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Emmanuel G, Arnaud P, Jonathan G, Marie R, Iulia M, Sanjiva P, Jean-François F, Olivier V. Real-time ultrasound-computed tomography image fusion for transforaminal lumbar approach: a lumbosacral spine phantoms study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1270-1276. [PMID: 33713176 DOI: 10.1007/s00586-021-06794-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Ultrasound (US) is increasingly used for transforaminal approaches. We evaluated whether fusing computed tomography (CT) images with dynamic US could be based on bony and surface landmarks in two phantom models. METHODS Recordings were performed in a gelatin-based sonographic phantom and in a computerized imaging reference system training phantom. Three anesthesiologists performed 10 US and CT image fusions via three different techniques: (1) using locations of the fifth lumbar vertebra (L5) spinous process and the two posterior superior iliac spines in both images, (2) using the two lateral edges of the laminae rather than posterior superior iliac spines, and (3) using skin landmarks. Techniques were compared using values of precision (High quality of fusion: VP inferior to 10). Three punctures targeting the L4-L5 right foramina were made, and needle positions were checked using X-ray. RESULTS Sixty fusions were performed in the gelatin phantom and 90 in the training phantom. VPs values of the 150 fusions were inferior to 5. Technique 2 was superior to one [operator 1: VP: 1.12 ± 0.54 vs. 2.38 ± 1.49; operator 2: 0.6 ± 0.39 vs. 3.66 ± 1.22; operator 3: 0.89 ± 0.31 vs. 1.23 ± 0.63 (p < 0.001)] with the gelatin phantom. There were no differences with the second phantom. X-ray examinations confirmed L4-L5 needle positioning. CONCLUSION Bony and surface landmarks allowed for accurate fusion of CT and US images of the lumbar spine. These techniques, performed on phantoms, allowed for precise localization and puncturing of lumbar neural foramina.
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Affiliation(s)
- Guntz Emmanuel
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Rue Wayez, 35, 1420, Braine-l'Alleud, Belgium.
| | - Pourveur Arnaud
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Rue Wayez, 35, 1420, Braine-l'Alleud, Belgium
| | - Gouwy Jonathan
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Rue Wayez, 35, 1420, Braine-l'Alleud, Belgium
| | - Renard Marie
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Rue Wayez, 35, 1420, Braine-l'Alleud, Belgium
| | - Mocanu Iulia
- Department of Radiology, Hôpital Braine L'Alleud Waterloo, Braine-l'Alleud, Belgium
| | - Pather Sanjiva
- Department of Radiology, Hôpital Braine L'Alleud Waterloo, Braine-l'Alleud, Belgium
| | - Fils Jean-François
- Ars Statistica Private Statistic Society. Nivelles (S.P.R.L), 1400, Nivelles, Belgium
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Jiménez Díaz F, Gitto S, Sconfienza LM, Draghi F. Ultrasound of iliotibial band syndrome. J Ultrasound 2020; 23:379-385. [PMID: 32514741 DOI: 10.1007/s40477-020-00478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/29/2022] Open
Abstract
Iliotibial band syndrome or friction syndrome is an overuse disorder of the lateral knee. It is commonly reported in athletes, such as runners and cyclists, and refers to pain related to physical activity. The diagnosis is based on clinical history and physical assessment. Imaging, including ultrasound, is mainly performed in recurrent or refractory cases. The purpose of this paper is to review the etiology, diagnosis, and therapy of iliotibial band syndrome with a focus on ultrasound imaging and ultrasound-guided treatment. Ultrasound findings include soft-tissue edematous swelling or discrete fluid collection, suggestive of bursitis, between the iliotibial band and the lateral femoral epicondyle. The thickening of the iliotibial band has been inconsistently reported. Treatment varies according to the disease phase and, in the acute phase, consists of rest, physical therapy, and anti-inflammatory medications. Ultrasound-guided local steroid injections are effective in relieving symptoms.
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Affiliation(s)
- Fernando Jiménez Díaz
- Sport Sciences Faculty, Castilla La Mancha University, Toledo, Spain
- San Antonio Catholic University (UCAM), Murcia, Spain
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Ferdinando Draghi
- Istituto di Radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Xie P, Feng F, Cao J, Chen Z, He B, Kang Z, He L, Wu W, Tan L, Li K, Zheng R, Rong L. Real-time ultrasonography-magnetic resonance image fusion navigation for percutaneous transforaminal endoscopic discectomy. J Neurosurg Spine 2020; 33:192-198. [PMID: 32217792 DOI: 10.3171/2020.1.spine191223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Percutaneous transforaminal endoscopic discectomy (PTED) is usually performed under fluoroscopic guidance and is associated with a large radiation dose. Ultrasonography (US)-MR image fusion navigation combines the advantages of US and MRI and requires significantly less radiation than fluoroscopy. The purpose of this study was to evaluate the safety and effectiveness of US-MR image fusion navigation for PTED. METHODS From January to September 2018, patients with L4-5 lumbar disc herniation requiring PTED were randomized to have the procedure conducted with US-MR image fusion navigation or fluoroscopy. The number of fluoroscopies, radiation dose, duration of imaging guidance, intraoperative visual analog scale (VAS) pain score, intraoperative complications, and clinical outcomes were compared between the groups. RESULTS There were 10 patients in the US-MR navigation group and 10 in the fluoroscopy group, and there were no significant differences in age, sex ratio, or BMI between the 2 groups (all p > 0.05). Intraoperatively, the total radiation dose, number of fluoroscopies performed, duration of image guidance, and VAS low-back and leg pain scores were all significantly lower in the US-MRI navigation group than in the fluoroscopy group (all p < 0.05). There were no intraoperative complications in either group. Postoperative improvements in Japanese Orthopaedic Association, Oswestry Disability Index, and VAS pain scale scores were similar between the 2 groups. CONCLUSIONS US-MR image fusion navigation is a promising technology for performing PTED and requires significantly less radiation than fluoroscopy.Clinical trial registration no.: NCT03403244 (ClinicalTrials.gov).
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Affiliation(s)
- Peigen Xie
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Feng Feng
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Junyan Cao
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Zihao Chen
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Bingjun He
- 3Radiology, The Third Affiliated Hospital of Sun Yat-sen University
| | - Zhuang Kang
- 3Radiology, The Third Affiliated Hospital of Sun Yat-sen University
| | - Lei He
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Wenbin Wu
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Lei Tan
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Kai Li
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Rongqin Zheng
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Limin Rong
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
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Ultrasound- versus fluoroscopy-guided injections in the lower back for the management of pain: a systematic review. Eur Radiol 2019; 29:3401-3409. [PMID: 30887198 DOI: 10.1007/s00330-019-06065-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Ultrasound-guided spinal injections are less common than fluoroscopy-guided injections. Although unable to penetrate bones, ultrasound guidance has a number of advantages including convenience and reduced exposure to ionizing radiation. However, it is not known how ultrasound-guided injections compare to fluoroscopy-guided injections in the management of lower back pain. Our objective is to systematically review the literature comparing ultrasound-guided injections to fluoroscopy-guided injections for the management of lower back pain. METHODS Medline, Cochrane CENTRAL Register of Controlled Trials, Embase, and NHSEED were searched from 2007 to September 26, 2017. Inclusion criteria included (1) randomized controlled trial design, (2) compared ultrasound-guided and fluoroscopy-guided injections for lower back pain, (3) dose and volume of medications injected were identical between trial arms, and (4) reported original data. RESULTS One hundred one unique records were identified, and 21 studies were considered for full-text inclusion. Nine studies formed the final data set. Studies comparing ultrasound- and fluoroscopy-guided injections for lower back pain management reported no difference in pain relief, procedure time, number of needle passes, changes in disability indices, complications or adverse events, post-procedure opioid consumption, or patient satisfaction. CONCLUSION Fluoroscopic guidance of injections for the management of lower back pain is similar in efficacy to ultrasound guidance. The exact role of ultrasound guidance needs to be further studied, especially for nerve root injections, where safety is the major concern. KEY POINTS • There were no differences in pain relief, procedure time, number of needle passes, changes in disability indices, complications or adverse events, post-procedure opioid consumption, or patient satisfaction between ultrasound- and fluoroscopy-guided injections for the management of lower back pain. • Given the lack of evidence to demonstrate superior efficacy and the added harms with fluoroscopic guidance, ultrasound guidance may be the preferred method of guidance for injections to manage lower back pain in appropriate patients. Further study is required to understand the exact role of ultrasound in image-guided injections.
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12
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Interventional therapeutic procedures to treat degenerative and inflammatory musculoskeletal conditions: state of the art. Radiol Med 2019; 124:1112-1120. [PMID: 30828775 DOI: 10.1007/s11547-019-01018-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
Imaging-guided interventional procedures have become increasingly popular in the treatment of several pathologic conditions in the musculoskeletal system. Besides oncological treatments, musculoskeletal procedures can be performed to treat different degenerative or inflammatory conditions. This paper is aimed to review clinical indications and technical aspects of these kinds of procedures. In particular, we revise the general aspects common to most procedures and the different imaging-guided interventions which can be performed around joints, soft tissues, and spine.
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Dietrich TJ, Peterson CK, Zeimpekis KG, Bensler S, Sutter R, Pfirrmann CWA. Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes. Radiology 2019; 290:752-759. [DOI: 10.1148/radiol.2018181224] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Tobias J. Dietrich
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Cynthia K. Peterson
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Konstantinos G. Zeimpekis
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Susanne Bensler
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Reto Sutter
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Christian W. A. Pfirrmann
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
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Yingying LMM, Peng HMD, Shoupeng LMM, Mingbo ZMD. Real-time Ultrasound Volume Navigation Guided Transforaminal Percutaneous Endoscopic Lumbar Discectomy in Anatomic Variation: A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2019. [DOI: 10.37015/audt.2019.191232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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De Silva T, Uneri A, Zhang X, Ketcha M, Han R, Sheth N, Martin A, Vogt S, Kleinszig G, Belzberg A, Sciubba DM, Siewerdsen JH. Real-time, image-based slice-to-volume registration for ultrasound-guided spinal intervention. Phys Med Biol 2018; 63:215016. [PMID: 30372418 DOI: 10.1088/1361-6560/aae761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Real-time fusion of magnetic resonance (MR) and ultrasound (US) images could facilitate safe and accurate needle placement in spinal interventions. We develop an entirely image-based registration method (independent of or complementary to surgical trackers) that includes an efficient US probe pose initialization algorithm. The registration enables the simultaneous display of 2D ultrasound image slices relative to 3D pre-procedure MR images for navigation. A dictionary-based 3D-2D pose initialization algorithm was developed in which likely probe positions are predefined in a dictionary with feature encoding by Haar wavelet filters. Feature vectors representing the 2D US image are computed by scaling and translating multiple Haar basis filters to capture scale, location, and relative intensity patterns of distinct anatomical features. Following pose initialization, fast 3D-2D registration was performed by optimizing normalized cross-correlation between intra- and pre-procedure images using Powell's method. Experiments were performed using a lumbar puncture phantom and a fresh cadaver specimen presenting realistic image quality in spinal US imaging. Accuracy was quantified by comparing registration transforms to ground truth motion imparted by a computer-controlled motion system and calculating target registration error (TRE) in anatomical landmarks. Initialization using a 315-length feature vector yielded median translation accuracy of 2.7 mm (3.4 mm interquartile range, IQR) in the phantom and 2.1 mm (2.5 mm IQR) in the cadaver. By comparison, storing the entire image set in the dictionary and optimizing correlation yielded a comparable median accuracy of 2.1 mm (2.8 mm IQR) in the phantom and 2.9 mm (3.5 mm IQR) in the cadaver. However, the dictionary-based method reduced memory requirements by 47× compared to storing the entire image set. The overall 3D error after registration measured using 3D landmarks was 3.2 mm (1.8 mm IQR) mm in the phantom and 3.0 mm (2.3 mm IQR) mm in the cadaver. The system was implemented in a 3D Slicer interface to facilitate translation to clinical studies. Haar feature based initialization provided accuracy and robustness at a level that was sufficient for real-time registration using an entirely image-based method for ultrasound navigation. Such an approach could improve the accuracy and safety of spinal interventions in broad utilization, since it is entirely software-based and can operate free from the cost and workflow requirements of surgical trackers.
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Affiliation(s)
- T De Silva
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States of America
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Real-time fusion-imaging in low back pain: a new navigation system for facet joint injections. Radiol Med 2018; 123:851-859. [PMID: 29968070 DOI: 10.1007/s11547-018-0916-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023]
Abstract
AIMS AND OBJECTIVES The aim of the current study is to present our experience in lumbar spine interventional procedures performed with a newly developed multimodal echo-navigator (EcoNav) and to evaluate short-term clinical outcomes of a series of patients affected by facet joint disease (FJD) treated with steroid and anaesthetic injection under fusion-imaging guidance, compared to a cohort of patients that received the same treatment under computed tomography (CT) guidance. METHODS Sixty-five consecutive patients (34 females; mean age 68.3 ± 12.8 years) with a clinical diagnosis of non-radicular low back pain lasting for more than 6-weeks and magnetic resonance (MR) or CT confirmed FJD were enrolled for image-guided FJI. Twenty-eight patients underwent FJI with fusion-guided technique, while CT-guided procedures were performed in the other cases. Clinical and procedural data were recorded and compared at a mean follow-up of 6.1 ± 2.0 months. RESULTS A significant improvement in clinical parameters was observed for both fusion-guided and CT-guided group. Comparing both groups, no statistically significant difference could be detected neither at baseline conditions nor during the follow-up period. No significant periprocedural complication occurred in both groups. A satisfaction rate of 92.3 and 81.1% was reported for fusion-guided and CT-guided group, respectively. CONCLUSION EcoNav fusion-imaging system represents a safe, feasible, effective and reproducible guidance option in FJD infiltration procedures, also avoiding use of ionising radiations.
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Technical and clinical feasibility of contrast-enhanced ultrasound evaluation of long bone non-infected nonunion healing. Radiol Med 2018; 123:703-709. [PMID: 29730840 DOI: 10.1007/s11547-018-0902-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/20/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To assess the technical feasibility of contrast-enhanced ultrasound (CEUS) in the monitoring of non-infected long bone nonunion healing. METHODS Twenty-five patients (16 males; mean age: 40.4 ± 11.7) with long bone nonunion were treated using surgery and mesenchymal stem cells and platelet-rich plasma. They performed CEUS up to 15 days before, 7 days, 4 and 8 weeks after treatment. To categorize the angiogenesis around the fracture site, the microvascular blood flow from CEUS was classified into four categories, depending on the portion of the investigated area that was involved in the neovascularization process: grade 0 = 0%; grade 1 = 0-30%; grade 2 = 30-70%; grade 3 = 70-100%. Nonparametric Friedman and Wilcoxon statistics were used. RESULTS Before treatment, neovascularization was graded as 0 in 15/25 patients, as 1 in 10/25. Vascularity significantly increased over time (P < 0.001), namely: 1 (25th-75th percentile = 1-2) at 7 days; 2 (1-2) at 4 weeks; 3 (0-2) at 8 weeks. All patients but one showed early progressive increase in neovascularization well identified with CEUS at the fracture site. CONCLUSION CEUS is a feasible method to monitor healing in patients with long bone nonunion.
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D'Aprile P, Nasuto M, Tarantino A, Cornacchia S, Guglielmi G, Jinkins JR. Magnetic Resonance Imaging in degenerative disease of the lumbar spine: Fat Saturation technique and contrast medium. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:208-219. [PMID: 29350649 PMCID: PMC6179082 DOI: 10.23750/abm.v89i1-s.7024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/12/2022]
Abstract
Purpose: To examine both anterior and posterior elements of the lumbar spine in patients with low back pain using MRI T2-weighted sequences with Fat Saturation (FS) and contrast enhanced T1-weighted sequences with FS.Materials and methods: Two thousand eight hundred and twenty (2820) patients (1628 male, 1192 female, mean age 54) presenting low back pain underwent MRI standard examination (Sagittal T1w TSE and T2w TSE, axial T1 SE) with the addition of sagittal and axial T2w Fat Sat (FS) sequences. Among all the patients, 987 (35%) have been studied adding Contrast Enhanced (CE) T1w FS sequences after administration of contrast medium. Results: Among 987 patients studied with contrast medium, we found: active-inflammatory intervertebral osteochondrosis in 646 (65%) patients; degenerative-inflammatory changes in facet joints (facet joint effusion, synovitis, synovial cysts) in 462 (47%); spondylolysis in 69 (7%); degenerative-inflammatory changes of the flava, interspinous and supraspinous ligaments in 245 (25%); inflammatory changes of posterior perispinal muscles in 84 (8%) patients. Conclusions: In patients with suspected no-disc-related low back pain, the implementation of T2w FS and CE T1w FS sequences to the standard MR protocol could allow a better identification of degenerative-inflammatory changes more likely associated to the pain. (www.actabiomedica.it)
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Liguori A, Galli F, Gurgitano M, Borelli A, Pandolfi M, Caranci F, Magenta Biasina AM, Pompili GGM, Piccolo CL, Miele V, Masciocchi C, Carrafiello G. Clinical and instrumental assessment of herniated discs after nucleoplasty: a preliminary study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:220-229. [PMID: 29350650 PMCID: PMC6179072 DOI: 10.23750/abm.v89i1-s.7025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The therapy for low back pain boasts different approaches; one of these is nucleoplasty. We wanted to assess the effectiveness of nucleoplasty both by clinical response both by MR imaging evaluation, including even extrusions larger than one third of the spinal canal. METHODS Fifty-seven patients were treated with nucleoplasty in our hospital, 11 of these patients accepted both clinical and MRI evaluation after six months from treatment. The clinical evaluation was performed with Visual Analogue Scale (VAS) of pain, scored before and after the procedure. MRI evaluation consisted of analysing some imaging parameters of disc protrusions before and after the treatment. RESULTS In 10 out of 11 (91%) patients, VAS was reduced and only 1 out of 11 (9%) had the same pain after procedure. The mean of decrease of VAS score was 64%. In our population 8/11 (72%) patients had a herniation larger than 1/3 of the sagittal diameter of spinal canal and 100% of them had an improvement with a mean VAS reduction value of 75%. With MRI evaluation, the mean percentage of expulsion before and after treatment was respectively 40% and 34%. The expulsion decreased in 7/13 discs, remained equal in 4/13, and increased in 2/13 discs. Among the 9 larger protrusions, 3 didn't change, 6 reduced with a decrease mean value of 13%. Other MRI parameters didn't change significantly. CONCLUSIONS Our preliminary experience supports the success of coblation on pain relief, aiming to show progressively that this treatment is suitable even in case of great extrusions, which are generally treated only with surgical approach. It's not clear the usefulness of MRI control yet, even if in most of cases we could have found a certain reduction of expulsion degree.
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Chianca V, Albano D, Messina C, Midiri F, Mauri G, Aliprandi A, Catapano M, Pescatori LC, Monaco CG, Gitto S, Pisani Mainini A, Corazza A, Rapisarda S, Pozzi G, Barile A, Masciocchi C, Sconfienza LM. Rotator cuff calcific tendinopathy: from diagnosis to treatment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:186-196. [PMID: 29350647 PMCID: PMC6179075 DOI: 10.23750/abm.v89i1-s.7022] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches. (www.actabiomedica.it)
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Silvestri E, Barile A, Albano D, Messina C, Orlandi D, Corazza A, Zugaro L, Masciocchi C, Sconfienza LM. Interventional therapeutic procedures in the musculoskeletal system: an Italian Survey by the Italian College of Musculoskeletal Radiology. Radiol Med 2017; 123:314-321. [PMID: 29249079 DOI: 10.1007/s11547-017-0842-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE To perform an online survey among all members of the Italian College of Musculoskeletal Radiology to understand how therapeutic musculoskeletal procedures are performed in daily practice in Italy. METHODS We administered an online survey to all 2405 members about the use of therapeutic musculoskeletal procedures in their institutions asking 16 different questions. Subgroup analysis was performed between general and orthopaedic hospitals with Mann-Whitney U and χ 2 statistics. RESULTS A total of 129/2405 answers (5.4% of members) were included in our analysis. A median of 142.5 (25th-75th percentiles: 50-535.5; range 10-5000) therapeutic musculoskeletal procedures per single institution was performed in 2016. Arthropathic pain was the main indication. The most common procedures were joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy. Ultrasound-guided procedures were mainly performed in ultrasonography rooms (77.4%) rather than in dedicated interventional rooms (22.6%). Conversely, fluoroscopic procedures were performed almost with the same frequency in interventional radiology suites (52.4%) and in general radiology rooms (47.6%). In most institutions (72%), autologous blood or components were not used. The median number of therapeutic musculoskeletal procedures performed in orthopaedic hospitals was significantly higher than in general hospitals (P = 0.002), as well as for the use of autologous preparations (P = 0.004). CONCLUSION Joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy were the most common therapeutic musculoskeletal procedures, being arthropathic pain the main indication. The percentage of procedures and the use of autologous preparations were significantly higher in orthopaedic hospitals than in general hospitals.
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Affiliation(s)
- Enzo Silvestri
- Unit of Radiology, Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy.,S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale di Genova, Salita Superiore San Rocchio 31/A, 16122, Genoa, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Davide Orlandi
- Unit of Radiology, Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy.,S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale di Genova, Salita Superiore San Rocchio 31/A, 16122, Genoa, Italy
| | - Angelo Corazza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Luigi Zugaro
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
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