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Tiegs-Heiden CA. MR-guided Focused Ultrasound for Musculoskeletal Applications. Magn Reson Imaging Clin N Am 2024; 32:641-650. [PMID: 39322353 DOI: 10.1016/j.mric.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
MR-guided focused ultrasound (MRgFUS) has a wide range of musculoskeletal applications. Some indications are well validated, specifically the treatment of painful osseous metastases and osteoid osteoma. Others are only beginning to be studied, such as the treatment of painful facet, sacroiliac, and knee joints. MRgFUS of soft tissue lesions also shows promise, particularly in patients whom alternative modalities are not feasible or may result in significant morbidity. Ongoing and future research will illuminate the full potential for MRgFUS in the treatment of musculoskeletal conditions.
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Affiliation(s)
- Christin A Tiegs-Heiden
- Division of Musculoskeletal Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Bailey CR, Herrera DG, Neumeister N, Weiss CR. Magnetic resonance - guided treatment of low-flow vascular malformations and the technologies to potentiate adoption. Front Med (Lausanne) 2024; 11:1319046. [PMID: 38420359 PMCID: PMC10899448 DOI: 10.3389/fmed.2024.1319046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Vascular malformations are congenital, non-neoplastic lesions that arise secondary to defects in angiogenesis. Vascular malformations are divided into high-flow (arteriovenous malformation) and low-flow (venous malformations and lymphatic malformations). Magnetic resonance imaging (MRI) is the standard for pre-and post-intervention assessments, while ultrasound (US), X-ray fluoroscopy and computed tomography (CT) are used for intra-procedural guidance. Sclerotherapy, an image-guided therapy that involves the injection of a sclerosant directly into the malformation, is typically the first-line therapy for treating low-flow vascular malformations. Sclerotherapy induces endothelial damage and necrosis/fibrosis with eventual involution of the malformation. Image-guided thermal therapies involve freezing or heating target tissue to induce cell death and necrosis. MRI is an alternative for intra-procedural guidance and monitoring during the treatment of vascular malformations. MR can provide dynamic, multiplanar imaging that delineates surrounding critical structures such as nerves and vasculature. Multiple studies have demonstrated that MR-guided treatment of vascular malformations is safe and effective. This review will detail (1) the use of MR for the classification and diagnosis of vascular malformations, (2) the current literature surrounding MR-guided treatment of vascular malformations, (3) a series of cases of MR-guided sclerotherapy and thermal ablation for the treatment of vascular malformations, and (4) a discussion of technologies that may potentiate interventional MRI adoption including high intensity focused ultrasound and guided laser ablation.
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Affiliation(s)
- Christopher Ravi Bailey
- Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Daniel Giraldo Herrera
- Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | | | - Clifford Rabbe Weiss
- Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
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3
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Cryoablation of Soft Tissues Low-Flow Vascular Malformations: Clinical Outcomes and Safety. Cardiovasc Intervent Radiol 2022; 45:1784-1792. [DOI: 10.1007/s00270-022-03247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/29/2022] [Indexed: 11/02/2022]
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Janwadkar R, Leblang S, Ghanouni P, Brenner J, Ragheb J, Hennekens CH, Kim A, Sharma K. Focused Ultrasound for Pediatric Diseases. Pediatrics 2022; 149:184761. [PMID: 35229123 DOI: 10.1542/peds.2021-052714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
Focused ultrasound (FUS) is a noninvasive therapeutic technology with multiple pediatric clinical applications. The ability of focused ultrasound to target tissues deep in the body without exposing children to the morbidities associated with conventional surgery, interventional procedures, or radiation offers significant advantages. In 2021, there are 10 clinical pediatric focused ultrasound studies evaluating various musculoskeletal, oncologic, neurologic, and vascular diseases of which 8 are actively recruiting and 2 are completed. Pediatric musculoskeletal applications of FUS include treatment of osteoid osteoma and bone metastases using thermal ablation and high-intensity FUS. Pediatric oncologic applications of FUS include treatment of soft tissue tumors including desmoid tumors, malignant sarcomas, and neuroblastoma with high-intensity FUS ablation alone, or in combination with targeted chemotherapy delivery. Pediatric neurologic applications include treatment of benign tumors such as hypothalamic hamartomas with thermal ablation and malignant diffuse intrinsic pontine glioma with low-intensity FUS for blood brain barrier opening and targeted drug delivery. Additionally, low-intensity FUS can be used to treat seizures. Pediatric vascular applications of FUS include treatment of arteriovenous malformations and twin-twin transfusion syndrome using ablation and vascular occlusion. FUS treatment appears safe and efficacious in pediatric populations across many subspecialties. Although there are 7 Food and Drug Administration-approved indications for adult applications of FUS, the first Food and Drug Administration approval for pediatric patients with osteoid osteoma was obtained in 2020. This review summarizes the preclinical and clinical research on focused ultrasound of potential benefit to pediatric populations.
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Affiliation(s)
- Rohan Janwadkar
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Suzanne Leblang
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | | | - John Ragheb
- University of Miami Miller School of Medicine, Nicklaus Children's Hospital, Miami, Florida
| | - Charles H Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - AeRang Kim
- Children's National Hospital, George Washington School of Medicine, Washington, DC
| | - Karun Sharma
- Children's National Hospital, George Washington School of Medicine, Washington, DC
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Jones J, Bolding M, Ullman H, Kaneko N, Tateshima S. Focused Ultrasound Ablation of an Arteriovenous Malformation Model. Front Neurol 2021; 12:671380. [PMID: 34149602 PMCID: PMC8209376 DOI: 10.3389/fneur.2021.671380] [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: 02/23/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022] Open
Abstract
Brain AVMs are rare but serious vascular lesions that often pose a management dilemma between the risk of various treatment modalities and uncertain natural history during observation. We describe preliminary data on the use of focused ultrasound as a novel therapeutic strategy. In an AVM model, one session of ultrasound gradually reduced flow through the lesion without inducing rupture. Due to its non-invasive yet immediate ablative effects, focused ultrasound may allow safer treatment of AVMs. However, further studies are needed to clarify its efficacy and side effect profile.
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Affiliation(s)
- Jesse Jones
- Departments of Neurosurgery and Radiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mark Bolding
- Department of Radiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Henrik Ullman
- Department of Radiology, School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Naoki Kaneko
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Satoshi Tateshima
- Department of Radiology, School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Danahey J, Seip R, Lee B, Nassiri N, Dardik A, Guzman R, Nassiri N. Imaging of vascular malformations with a high-intensity focused ultrasound probe for treatment planning. J Vasc Surg Venous Lymphat Disord 2021; 9:1467-1472.e2. [PMID: 33838310 DOI: 10.1016/j.jvsv.2021.03.011] [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: 12/29/2020] [Accepted: 03/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to investigate whether a current commercially available high-intensity focused ultrasound (HIFU) probe can adequately image targeted vascular malformations (VMs) in anticipation of HIFU treatment planning and delivery. METHODS We enrolled 10 consecutive patients who were scheduled to undergo treatment of symptomatic peripheral VMs confirmed by routine preoperative contrast-enhanced magnetic resonance imaging and soft tissue duplex ultrasound. The lesions were situated no more than 6 cm from the skin. After induction of general anesthesia and before surgical intervention, we prepared and positioned the Sonablate HIFU probe (SonaCare Medical, LLC, Charlotte, NC) to obtain multiple B-mode images of the targeted VM in the transverse and longitudinal dimensions. We then rated the quality of the images and the feasibility of the imaging process itself using a previously devised questionnaire aimed at evaluating the adequacy of the images for potential HIFU treatment planning and delivery. The patients subsequently underwent surgical intervention and clinical follow-up for their VM per the standard protocol. RESULTS The study included 10 participants aged 21 to 67 years (mean ± standard deviation, 36.5 ± 16.5 years). Six patients (60%) identified as female. The VMs imaged consisted of eight venous (80%), one lymphatic (10%), and one combined lymphovenous (10%) malformation. The lesions were in the extremities only (50%), trunk only (20%), trunk and extremities (20%), or neck and extremities (10%). Pain related to the VM was present in all 10 patients (100%). In all 10 patients, the boundary and location of the VM could be visualized via the HIFU probe despite the diminished B-mode imaging resolution. The absence of Doppler functionality in the HIFU probe did not prevent the identification of the VMs in any patient up to a depth of 6 cm. The results from the postimaging survey showed that difficulty in preparing the study device for imaging was 1.1 ± 0.3 and difficulty in use was 1.1 ± 0.1, with a score of 1 equal to easy and 5 to difficult. The stability of the acoustic coupling to the patient was 1.3 ± 0.2, with a score of 1 representing very stable. CONCLUSIONS We were able to ultrasonically identify and outline all targeted peripheral VMs using a commercially available HIFU probe in anticipation of treatment planning and delivery. Baseline magnetic resonance imaging and soft tissue duplex ultrasound remain essential tools for guiding probe placement and HIFU imaging.
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Affiliation(s)
- James Danahey
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Ralf Seip
- SonaCare Medical, LLC, Charlotte, NC
| | - Brian Lee
- SonaCare Medical, LLC, Charlotte, NC
| | - Nima Nassiri
- Institute of Urology, University of Southern California, Los Angeles, Calif
| | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Raul Guzman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn; Vascular Malformations Program, Yale New Haven Hospital, New Haven, Conn.
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Devarakonda SB, Stringer K, Rao M, Myers M, Banerjee R. Assessment of Enhanced Thermal Effect Due to Gold Nanoparticles during MR-Guided High-Intensity Focused Ultrasound (HIFU) Procedures Using a Mouse-Tumor Model. ACS Biomater Sci Eng 2019; 5:4102-4111. [PMID: 33448811 DOI: 10.1021/acsbiomaterials.9b00368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An in vivo study was conducted using a mouse tumor model, to assess the utility of using gold nanoparticles (gNPs) during HIFU procedures to locally enhance heating at low powers. Tumors were grown using melanoma tumor cells (B16/F10) subcutaneously on the right flanks of mice (C57Bl/6J). Physiologically relevant concentrations (0 and 0.125%) of gNPs were directly injected into the tumors. Sonications at acoustic powers of 10 and 30 W were performed for a duration of 16 s inside a magnetic-resonance system. Temperature increases and lesion volumes were calculated and compared for procedures with and without gNPs. Histopathology study was conducted using a cleaved caspase 3 antibody and hematoxylin and eosin staining after removing the tumors from the mice. For an acoustic power of 30 W, end-of-sonication temperature increases of 25.4 ± 3.8 °C (0% gNP) and 42.2 ± 4.6 °C (0.125% gNP) were measured. Using cleaved caspase 3 antibody, it was observed that more than 1% of nuclei are affected in the case of 0.125% and 30 W but only 0.01% of nuclei are affected in the 0% case. For 30 W and a gNP concentration of 0.125%, a lesion volume of 0.33 ± 0.22 mm3 was obtained, while no lesion was observed without gNP's.
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Affiliation(s)
- Surendra B Devarakonda
- Department of Mechanical, Materials Engineering, College of Engineering and Applied Science, University of Cincinnati, 593 Rhodes Hall, Cincinnati, Ohio 45221, United States
| | - Keith Stringer
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, United States
| | - Marepalli Rao
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio 45221, United States
| | - Matthew Myers
- Division of Solid and Fluid Mechanics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Rupak Banerjee
- Department of Mechanical, Materials Engineering, College of Engineering and Applied Science, University of Cincinnati, 593 Rhodes Hall, Cincinnati, Ohio 45221, United States
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Choi WK, Bailey CR, Fritz J, Weiss CR. MR-Guided Sclerotherapy for the Treatment of Low-Flow Vascular Malformations. Top Magn Reson Imaging 2018; 27:153-161. [PMID: 29870467 DOI: 10.1097/rmr.0000000000000154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Low-flow vascular malformations are congenital lesions that can occur throughout the body. Treatment of these lesions is indicated to ameliorate pain, cosmetic disfigurement, and functional impairment. The first-line treatment of low-flow vascular malformations is percutaneous sclerotherapy. Traditionally, sclerotherapy is performed with a combination of ultrasound and fluoroscopy. However, malformations that are deep in the abdomen and pelvis or are obscured by overlying fascia or scar may be difficult to be visualized with ultrasound and fluoroscopy. MR-guided sclerotherapy has emerged as an alternative modality that can be used to needle guidance and sclerosant monitoring. In this review, we discuss the historical and current use of MR-guided sclerotherapy for the treatment of low-flow vascular malformations.
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Affiliation(s)
| | | | - Jan Fritz
- Johns Hopkins Russell H. Morgan Department of Radiology and Radiological Science, Division of Musculoskeletal Radiology
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, MD
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Ghanouni P, Kishore S, Lungren MP, Bitton R, Chan L, Avedian R, Bazzocchi A, Butts Pauly K, Napoli A, Hovsepian DM. Treatment of Low-Flow Vascular Malformations of the Extremities Using MR-Guided High Intensity Focused Ultrasound: Preliminary Experience. J Vasc Interv Radiol 2018; 28:1739-1744. [PMID: 29157478 DOI: 10.1016/j.jvir.2017.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/29/2017] [Accepted: 06/02/2017] [Indexed: 10/18/2022] Open
Abstract
Five patients with painful vascular malformations of the extremities that were refractory to standard treatment and were confirmed as low-flow malformations on dynamic contrast-enhanced magnetic resonance (MR) imaging were treated with MR imaging-guided high intensity focused ultrasound. Daily maximum numeric rating scale scores for pain improved from 8.4 ± 1.5 to 1.6 ± 2.2 (P = .004) at a median follow-up of 9 months (range, 4-36 mo). The size of the vascular malformations decreased on follow-up MR imaging (median enhancing volume, 8.2 mL [0.7-10.1 mL] before treatment; 0 mL [0-2.3 mL] after treatment; P = .018) at a median follow-up of 5 months (range, 3-36 mo). No complications occurred.
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Affiliation(s)
- Pejman Ghanouni
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488.
| | - Sirish Kishore
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Matthew P Lungren
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Rachelle Bitton
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Lauren Chan
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Raffi Avedian
- Department of Orthopedic Surgery, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Alberto Bazzocchi
- Department of Diagnostic and Interventional Radiology, Rizzoli Institute, Bologna, Italy
| | - Kim Butts Pauly
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | | | - David M Hovsepian
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
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10
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High-intensity focused ultrasound (HIFU) treatment for uterine fibroids: a meta-analysis. Arch Gynecol Obstet 2017; 296:1181-1188. [DOI: 10.1007/s00404-017-4548-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022]
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Cornelis FH, Marin F, Labrèze C, Pinsolle V, Le Bras Y, Midy D, Grenier N. Percutaneous cryoablation of symptomatic venous malformations as a second-line therapeutic option: a five-year single institution experience. Eur Radiol 2017; 27:5015-5023. [PMID: 28677056 DOI: 10.1007/s00330-017-4892-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/17/2017] [Accepted: 05/11/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To report the mid-term outcomes of percutaneous cryoablation (PCA) performed as second-line therapeutic option of venous malformations (VM). MATERIAL AND METHODS From 2011 to 2015, PCA was offered in 24 patients (mean age: 31 years, range: 12-64) as second-line treatment for recurrence of symptoms after sclerotherapy and when resection was not possible (due to lesion location or previous failure) or refused by the patient. Adverse effects were recorded, disease-free survival (DFS) and local tissue control (LTC) rates were calculated based on symptoms and volume evolution. RESULTS Mean follow-up was 18.7 months (6-48). Nine (37.5%, 9/24) adverse effects occurred and three (12.5%, 3/24) were severe. Mean pain assessed by visual analog scale (VAS) was 41.7 mm (0-80) before treatment and 20.3 mm (0-80) (p=0.01) after. Mean volume decreased significantly after treatment from 22.4 cm3 (0.9-146) to 8.35 cm3 (0-81.3) (p<0.001). Pain recurred in nine patients and size of one lesion increased. The DFS and LTC rates were 54% [95%CI: 22.94-77.27] and 93.33% [61.26-99.03] at 24 months, respectively. Only VM volume >10 cm3 was associated with a higher risk of local recurrence (p=0.05). CONCLUSION PCA as second-line treatment appears to be safe and effective for local control of VM according to mid-term results. KEY POINTS • Percutaneous cryoablation of venous malformations appeared well tolerated. • Size of venous malformations decreased significantly after percutaneous cryoablation (p<0.001). • Pain decreased significantly after percutaneous cryoablation of venous malformations (p=0.01).
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Affiliation(s)
- F H Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France. .,Department of Radiology, Tenon Hospital, APHP, 4 rue de la Chine, 75020, Paris, France.
| | - F Marin
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - C Labrèze
- Department of Pediatric Dermatology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - V Pinsolle
- Department of Aesthetic Surgery, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Y Le Bras
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - D Midy
- Department of Vascular Surgery, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - N Grenier
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
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Percutaneous Image-Guided Cryoablation as Second-Line Therapy of Soft-Tissue Venous Vascular Malformations of Extremities: A Prospective Study of Safety and 6-Month Efficacy. Cardiovasc Intervent Radiol 2017; 40:1358-1366. [PMID: 28361195 DOI: 10.1007/s00270-017-1636-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the safety and short-term efficacy of percutaneous image-guided cryoablation performed as second-line therapy of venous vascular malformations (VVM) of extremities. MATERIALS AND METHODS In this non-blinded, no-randomized trial, cryoablation was proposed in 14 patients presenting with symptomatic VVM for recurrences after treatment. Eligibility criteria were: cryoablation feasible, localization at least 5 mm from skin and nerves, absence of contra-indication for anesthesia. Safety was evaluated by the common terminology criteria for adverse events (AE). Clinical response was assessed by evaluating pain at day 7, month 2 and 6 using visual analog scale; quality of life before cryoablation and at 2 and 6 months after using questionnaire. Evolution of volume was evaluated by MRI at 6 months. Comparison was performed using the Wilcoxon test. RESULTS A technical success was observed in all cases. While 11 patients (78.6%) presented AE (13 grade 1-2 and 3 grade 3), only two severe AE (grade 3) related to cryoablation occurred in two patients (14.3%) during the 6-month follow-up: one immediate sciatic paralysis and one delayed paresthesia. A clinical response was observed in 12 patients (85.7%) at 6 months. Pain decreased significantly from 42.5 ± 14.2 mm before the intervention to 11.8 ± 17.9 mm at 6 months (P = 0.002). A significant decrease in the mean volume from 12.8 ± 14.3 to 3 ± 2.7 cm3 was observed at 6 months (P = 0.002). CONCLUSION Percutaneous cryoablation is a promising alternative treatment for sclerotherapy-resistant venous malformations. However, to improve safety, careful patient selection and treatment planning will be mandatory.
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13
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Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther 2016; 6:557-569. [PMID: 28123976 DOI: 10.21037/cdt.2016.11.10] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Venous malformation (VM) is the most common type of congenital vascular malformation (CVM). They are present at birth and are often symptomatic, causing morbidity and pain. VMs can be challenging to diagnose and are often confused with hemangioma in terminology as well as with imaging. An accurate clinical history and cross-sectional imaging are critical for diagnosis and for devising management. This manuscript will review imaging approaches to diagnosing VMs and current treatment strategies.
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Affiliation(s)
- Sasan Behravesh
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Wayne Yakes
- Vascular Malformation Center, Englewood, CO 80113, USA
| | - Nikhil Gupta
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Brian W Chong
- Department of Radiology and Neurological Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA;; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
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