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Arnold L, Hendricks-Wenger A, Coutermarsh-Ott S, Gannon J, Hay AN, Dervisis N, Klahn S, Allen IC, Tuohy J, Vlaisavljevich E. Histotripsy Ablation of Bone Tumors: Feasibility Study in Excised Canine Osteosarcoma Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3435-3446. [PMID: 34462159 PMCID: PMC8578360 DOI: 10.1016/j.ultrasmedbio.2021.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 05/29/2023]
Abstract
Osteosarcoma (OS) is a primary bone tumor affecting both dogs and humans. Histotripsy is a non-thermal, non-invasive focused ultrasound method using controlled acoustic cavitation to mechanically disintegrate tissue. In this study, we investigated the feasibility of treating primary OS tumors with histotripsy using a 500-kHz transducer on excised canine OS samples harvested after surgery at the Veterinary Teaching Hospital at Virginia Tech. Samples were embedded in gelatin tissue phantoms and treated with the 500-kHz histotripsy system using one- or two-cycle pulses at a pulse repetition frequency of 250 Hz and a dosage of 4000 pulses/point. Separate experiments also assessed histotripsy effects on normal canine bone and nerve using the same pulsing parameters. After treatment, histopathological evaluation of the samples was completed. To determine the feasibility of treating OS through intact skin/soft tissue, additional histotripsy experiments assessed OS with overlying tissues. Generation of bubble clouds was achieved at the focus in all tumor samples at peak negative pressures of 26.2 ± 4.5 MPa. Histopathology revealed effective cell ablation in treated areas for OS tumors, with no evidence of cell death or tissue damage in normal tissues. Treatment through tissue/skin resulted in generation of well-confined bubble clouds and ablation zones inside OS tumors. Results illustrate the feasibility of treating OS tumors with histotripsy.
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Affiliation(s)
- Lauren Arnold
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Alissa Hendricks-Wenger
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Jessica Gannon
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Department of Mechanical Engineering, Virginia Tech, Blacksburg, Virginia, USA
| | - Alayna N Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Nikolaos Dervisis
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA; Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Shawna Klahn
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Irving C Allen
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA
| | - Joanne Tuohy
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA.
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Bansal A, Goyal A, Gamanagatti S, Srivastava DN, Manhas V. Current updates in image-guided musculoskeletal interventions. J Clin Orthop Trauma 2021; 22:101601. [PMID: 34631410 PMCID: PMC8479789 DOI: 10.1016/j.jcot.2021.101601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
Image-guided musculoskeletal interventions are frequently done in clinical practice. Even then, the literature regarding their effectiveness is relatively scarce. Image guidance adds value over the conventional landmark-based approach and should be preferred. We hereby try to list the commonly performed procedures along with the current practice guidelines regarding their clinical indications and periprocedural care.
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Affiliation(s)
- Abhinav Bansal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Effectiveness and reliability of traditional open surgery in atypical localizations of osteoid osteoma. Jt Dis Relat Surg 2021; 31:541-547. [PMID: 32962587 PMCID: PMC7607951 DOI: 10.5606/ehc.2020.74333] [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] [Indexed: 11/25/2022] Open
Abstract
Objectives
This study aims to evaluate traditional open surgery results of osteoid osteomas (OOs) in atypical localizations and explore whether open surgery can be a safe alternative in localizations where radiofrequency ablation (RFA) may not be suitable. Patients and methods
A total of 26 patients (20 males, 6 females; mean age 23.3±14.2 years; range, 4 to 65 years) having OO in atypical localizations between January 2008 and January 2017 were retrospectively evaluated. All patients underwent traditional open surgery under anesthesia. All patients were followed-up, and their clinical success and complications were evaluated. The pain intensity was assessed using the visual analog scale (VAS). Results
The postoperative first year VAS score was 0.2±0.5 (range, 0-2) (p<0.005). None of the patients showed any complications. No recurrences were reported at the end of the first year. All patients were relieved from pain due to OO in atypical localizations. Conclusion Although RFA has been accepted as the preferred treatment for OO, traditional open surgery may still be used for OO in atypical localizations yielding perfect clinical results with fewer complications. It is a safe alternative for localizations such as carpal bones, distal ulna, hand and foot where RFA complications can be seen more frequently. In these localizations, traditional open surgery can be recommended as the first treatment choice.
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Mariconda C, Megna M, Farì G, Bianchi FP, Puntillo F, Correggia C, Fiore P. Therapeutic exercise and radiofrequency in the rehabilitation project for hip osteoarthritis pain. Eur J Phys Rehabil Med 2020; 56:451-458. [PMID: 32162859 DOI: 10.23736/s1973-9087.20.06152-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Severe hip osteoarthritis is responsible for disabling pain and functional impairment of the joint. Although total hip arthroplasty (THA) is a successful treatment, some patients have multiple comorbidities that represent contraindications for THA. Conventional drug therapies are often ineffective or responsible for numerous side effects. For these patients, it is difficult to draw up an acceptable rehabilitation path, as the main limitation is intense pain. New rehabilitation strategies that relieve pain and improve articular function need to be developed. The combination of traditional treatments such as education and therapeutic exercise with innovative, minimally-invasive therapies such as continuous radiofrequency (CRF) appears to reduce hip pain by determining the neurolysis of the joint. AIM The aim of our study was to describe the reduction in pain and improvements in joint function when CRF is combined with the therapeutic exercise in rehabilitation of patients with severe hip osteoarthritis. DESIGN Case series study. SETTING Rehabilitation service outpatients. POPULATION Twenty-five patients with severe hip osteoarthritis causing disabling pain and with contraindications to THA, and for whom conventional drug therapies were ineffective or responsible for numerous side effects. METHODS The study design included: initial clinical-functional assessment using the Harris Hip Score (HHS), the Numeric Rating Scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); a pre-lesion anaesthetic block; hip neuroablation with CRF; a three-week kinesitherapy protocol (3 sessions per week); two further assessments using the same scales one month (T1) and six months (T2) after CRF. RESULTS Improvements at T1 and T2 follow-ups, after CRF (P=0.000) were recorded for articular pain and function. However, results at T2 were worse than those at T1 (P=0.000). CONCLUSIONS CRF combined with therapeutic exercise in rehabilitation of severe hip osteoarthritis is an attractive option for significant pain relief as it allows patients to carry out kinesitherapy more easily. CLINICAL REHABILITATION IMPACT CRF could represent a valid alternative in the rehabilitation of patients with severe hip osteoarthritis especially when other therapeutic approaches are unworkable.
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Affiliation(s)
- Carlo Mariconda
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, Turin, Italy
| | - Marisa Megna
- Department of Basic Medicine, Neuroscience, and Sense Organs, Aldo Moro University, Bari, Italy
| | - Giacomo Farì
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, Turin, Italy - .,Department of Basic Medicine, Neuroscience, and Sense Organs, Aldo Moro University, Bari, Italy
| | - Francesco P Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Filomena Puntillo
- Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Carla Correggia
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, Turin, Italy
| | - Pietro Fiore
- Department of Physical Medicine and Rehabilitation, Ospedali Riuniti University Hospitals, University of Foggia, Foggia, Italy
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Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies. Pain Res Manag 2020; 2020:3873098. [PMID: 32148599 PMCID: PMC7049418 DOI: 10.1155/2020/3873098] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.
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Cunningham J, Sharma R, Kirzner A, Hwang S, Lefkowitz R, Greenspan D, Shapoval A, Panicek DM. Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability. Skeletal Radiol 2016; 45:1069-78. [PMID: 27105618 PMCID: PMC4912434 DOI: 10.1007/s00256-016-2389-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/27/2016] [Accepted: 04/06/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the etiologies of myonecrosis in oncology patients and to assess interobserver variability in interpreting its MRI features. MATERIALS AND METHODS Pathology records in our tertiary cancer hospital were searched for proven myonecrosis, and MRIs of affected regions in those patients were identified. MRI reports that suggested myonecrosis were also identified. Each MRI was reviewed independently by 2 out of 6 readers to assess anatomical site, size, and signal intensities of muscle changes, and the presence of the previously reported stipple sign (enhancing foci within a region defined by rim enhancement). The stipple sign was assessed again, weeks after a training session. Cohen kappa and percentage agreement were calculated. Medical records were reviewed for contemporaneous causes of myonecrosis. RESULTS MRI reports in 73 patients suggested the diagnosis of myonecrosis; pathological proof was available in another 2. Myonecrosis was frequently associated with radiotherapy (n = 34 patients, 45 %); less frequent causes included intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, and diabetes. Myonecrosis usually involved the lower extremity, the pelvis, and the upper extremity; mean size was 13.0 cm. The stipple sign was observed in 55-100 % of patients at first assessment (κ = 0.09-0.42; 60-80 % agreement) and 55-100 % at second (κ = 0.0-0.58; 72-90 % agreement). Enhancement surrounded myonecrosis in 55-100 % patients (κ = 0.03-0.32; 58-70 % agreement). CONCLUSION Myonecrosis in oncology patients usually occurred after radiotherapy, and less commonly after intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, or diabetes. Although interobserver variability for MRI features of myonecrosis exists (even after focused training), a combination of findings facilitates diagnosis and conservative management.
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Affiliation(s)
- Jane Cunningham
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Richa Sharma
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Anna Kirzner
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Sinchun Hwang
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065,Weill Medical College of Cornell University, New York, NY 10065
| | - Robert Lefkowitz
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065,Weill Medical College of Cornell University, New York, NY 10065
| | - Daniel Greenspan
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Anton Shapoval
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - David M. Panicek
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065,Weill Medical College of Cornell University, New York, NY 10065
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Lalam RK, Cribb GL, Cassar-Pullicino VN, Cool WP, Singh J, Tyrrell PNM, Tins BJ, Winn N. Radiofrequency thermo-ablation of PVNS in the knee: initial results. Skeletal Radiol 2015; 44:1777-84. [PMID: 26290324 DOI: 10.1007/s00256-015-2233-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/25/2015] [Accepted: 08/03/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pigmented villonodular synovitis (PVNS) is normally treated by arthroscopic or open surgical excision. We present our initial experience with radiofrequency thermo-ablation (RF ablation) of PVNS located in an inaccessible location in the knee. MATERIALS Review of all patients with histologically proven PVNS treated with RF ablation and with at least 2-year follow-up. RESULTS Three patients met inclusion criteria and were treated with RF ablation. Two of the patients were treated successfully by one ablation procedure. One of the three patients had a recurrence which was also treated successfully by repeat RF ablation. There were no complications and all patients returned to their previous occupations following RF ablation. CONCLUSION In this study we demonstrated the feasibility of performing RF ablation to treat PVNS in relatively inaccessible locations with curative intent. We have also discussed various post-ablation imaging appearances which can confound the assessment for residual/recurrent disease.
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Affiliation(s)
- Radhesh K Lalam
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK.
| | - Gillian L Cribb
- Department of Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, USA
| | - Victor N Cassar-Pullicino
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Wim P Cool
- Department of Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, USA
| | - Jaspreet Singh
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Prudencia N M Tyrrell
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Bernhard J Tins
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Naomi Winn
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
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Errani C, Longhi A, Rossi G, Rimondi E, Biazzo A, Toscano A, Alì N, Ruggieri P, Alberghini M, Picci P, Bacci G, Mercuri M. Palliative therapy for osteosarcoma. Expert Rev Anticancer Ther 2014; 11:217-27. [DOI: 10.1586/era.10.172] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ultrasound-guided radiofrequency ablation of early breast cancer in a resection specimen: lessons for further research. Breast 2012; 22:543-7. [PMID: 23228482 DOI: 10.1016/j.breast.2012.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/02/2012] [Accepted: 11/18/2012] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the feasibility and effectiveness of radiofrequency ablation (RFA) in breast cancer, using different histopathologic staining methods to evaluate tissue viability. MATERIALS AND METHODS In twenty patients with unifocal small (≤1, 5 cm) invasive ductal carcinoma, ultrasound-guided RFA was performed immediately after surgery. Cell viability was assessed using cytokeratin 8 (CK 8) and nicotinamide adenine dinucleotide diaphorase (NADHD) in addition to hematoxylin-eosin (HE). RESULTS At histopathological examination, ex vivo RFA resulted in complete cell death of the target lesion in 17/20 patients. In two cases viable ductal carcinoma in situ (DCIS) was found just outside the completely ablated lesion. CONCLUSION RFA of small invasive breast cancer seems to be a feasible treatment option. Both NADHD and CK 8 demonstrate a clear and comparable demarcation between viable and non-viable tissue. A high level of accuracy is required in proper positioning of the needle electrode and a "hot retraction" is mandatory.
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Faroja M, Ahmed M, Appelbaum L, Ben-David E, Moussa M, Sosna J, Nissenbaum I, Goldberg SN. Irreversible electroporation ablation: is all the damage nonthermal? Radiology 2012; 266:462-70. [PMID: 23169795 DOI: 10.1148/radiol.12120609] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine whether high-dose irreversible electroporation (IRE) ablation induces thermal effects in normal liver tissue. MATERIALS AND METHODS Animal care and use committee approval was obtained prior to the experiments. IRE ablation (n = 78) was performed by a single four-person team in vivo in 22 porcine livers by applying electric current to two 1.3-cm-diameter circular flat-plate electrodes spaced 1 cm apart. Cardiac-gated IRE pulses (n = 40-360) were systematically applied at varying voltages (1500-2900 V). End temperatures at the ablation zone center were measured and were correlated with ablation time, energy parameters, and resultant treatment effect as determined at gross pathologic and histopathologic examination. Temperatures were then monitored at the center and periphery of four ablations created by using a four-electrode IRE array (3000 V, 90 pulses per electrode pair). Data were analyzed by using multivariate analysis of variance with multiple comparisons and/or paired t tests and regression analysis, as appropriate. RESULTS Temperature rose above the 34°C baseline after IRE in all flat-plate experiments and correlated linearly (R(2) = 0.39) with IRE "energy dose" (product of voltage and number of pulses) and more tightly in univariate analysis with both voltage and number of pulses. Thus, mean temperatures as high as 86°C ± 3 (standard deviation) were seen for 2500 V and 270 pulses. Ablations of 90 pulses or more at 2500 V produced temperatures of 50°C or greater and classic gross and histopathologic findings of thermal coagulation (pyknotic nuclei and streaming cytoplasm). For lower IRE doses (ie, 2100 V, 90 pulses), temperatures remained below 45°C, and only IRE-associated pathologic findings (ie, swollen sinusoids, dehydrated cells, and hemorrhagic infiltrate) were seen. For the four-electrode arrays, temperatures measured 54.2°C ± 6.1 at the electrode surfaces and 38.6°C ± 3.2 at the ablation zone margin. CONCLUSION In some conditions of high intensity, IRE can produce sufficient heating to induce "white zone" thermal coagulation. While this can be useful in some settings to increase tumor destruction, further characterization of the thermal profile created with clinical electrodes and energy parameters is therefore needed to better understand the best ways to avoid unintended damage when ablating near thermally sensitive critical structures.
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Affiliation(s)
- Mohammad Faroja
- Department of Surgery and Radiology, Hadassah Hebrew University Medical Center, Kiryat Hadassah, POB 12000, 91120 Jerusalem, Israel.
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Mavrogenis AF, Rossi G, Altimari G, Calabrò T, Angelini A, Palmerini E, Rimondi E, Ruggieri P. Palliative embolisation for advanced bone sarcomas. Radiol Med 2012; 118:1344-59. [DOI: 10.1007/s11547-012-0868-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/04/2011] [Indexed: 01/26/2023]
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Mertyna P, Goldberg W, Yang W, Goldberg SN. Thermal ablation a comparison of thermal dose required for radiofrequency-, microwave-, and laser-induced coagulation in an ex vivo bovine liver model. Acad Radiol 2009; 16:1539-48. [PMID: 19836267 DOI: 10.1016/j.acra.2009.06.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 05/22/2009] [Accepted: 06/23/2009] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES To compare thermal dosimetry metrics for specified diameters of coagulation achieved using three different ablation energy sources. MATERIALS AND METHODS 204 ablations measuring 20, 30, or 40 +/- 2 mm were created in an ex-vivo bovine liver model using 1) 2.5 cm cluster RF electrodes (n = 114), 2) 3 cm microwave antennas (n = 45), and 3) 3 cm laser diffusing fibers (n = 45). Continuous temperature monitoring was performed 5-20 mm from the applicators to calculate: a) the area under the curve (AUC), b) cumulative equivalent minutes at 43 degrees C (CEM43), and c) Arrhenius damage integral (Omega) for the critical ablation margin (DOC), with results compared by multivariate analysis of variance and regression analysis. RESULTS The end temperatures at the margin of coagulation varied, and was lowest for the RF cluster electrode (33-58 degrees C), higher for laser (52-72 degrees C), and covered the widest range for microwave (42-95 degrees C). These end temperatures correlated with applied energy, as linear functions (r(2) = 0.74-0.96). The total heat needed to achieve ablation (AUC) varied with applied energy and coagulation diameter as negative exponential (RF and laser) or negative power (microwave) functions (r(2) = 0.82-0.98). Similarly, CEM43 values varied exponentially with energy and distance (r(2) = 0.52-0.76) over a wide range of values (10(12)). Likewise, Omega varied not only based upon energy source and DOC, but also as a positive linear correlation to applied energy and with sigmoid correlation to duration of ablation (r(2) = 0.85-0.97). CONCLUSION Our study demonstrates that the thermal dosimetry of ablation is not based solely on a fixed end temperature at the margin of the coagulation zone. Thermal dosimetry is not constant, but dependent on the type and amount of energy applied and distance suggesting the need to take into account the rate of heat transfer for ablation dosimetry.
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Martel Villagrán J, Bueno Horcajadas A, Ortiz Cruz E. Tratamiento mediante radiofrecuencia percutánea de los tumores óseos benignos: osteoma osteoide, osteoblastoma y condroblastoma. RADIOLOGIA 2009; 51:549-58. [DOI: 10.1016/j.rx.2009.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/04/2009] [Accepted: 08/17/2009] [Indexed: 01/14/2023]
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Future directions in percutaneous vertebroplasty. Radiol Med 2009; 114:976-83. [PMID: 19554420 DOI: 10.1007/s11547-009-0418-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Accepted: 01/27/2009] [Indexed: 10/20/2022]
Abstract
The first percutaneous vertebroplasty, used to treat a painful cervical haemangioma, was performed by a French team in 1984 and reported in the literature in 1987. This technique has rapidly become the standard of care for treatment of medically refractory painful vertebral compression fractures. Vertebral fractures usually become evident because of pain of varying intensity that reduces the patient's quality of life, producing functional limitations, depression, disability, height loss, spinal instability and kyphotic deformity associated with impaired lung capacity. Many diseases may underlie vertebral compression fractures, such as osteoporosis, trauma, neoplasms and haemangioma. Vertebroplasty, as derived from our experience and a review of the literature data, has more than 70%-90% effectiveness for short-term pain reduction and return to activity. The aim of this paper was to describe the state of the art of this spinal interventional radiology procedure and to examine the future directions of percutaneous vertebroplasty.
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