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Winkler WL, Geroge IA, Gandra S, Baker JC, Tomasian A, Northrup B, Velde TLV, Hillen TJ, Luo C, Imaoka R, Dettorre GM, Jennings JW. Diagnostic Efficacy and Clinical Impact of Image-guided Core Needle Biopsy of Suspected Vertebral Osteomyelitis. Int J Infect Dis 2024:107027. [PMID: 38670483 DOI: 10.1016/j.ijid.2024.107027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The diagnostic yield and clinical impact of image-guided core needle biopsy(ICNB) of suspected vertebral osteomyelitis in adults is heterogenous in published studies due to small sample size, indicating the need for large cohort studies. METHODS A retrospective analysis of ICNBs was performed from 2010-2021 for patients with imaging findings consistent with vertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. Additionally, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. Multivariate statistical analysis was performed to evaluate the factors associated with yield. RESULTS A total of 570 biopsies performed on 527 patients were included. A histopathologic diagnosis of osteomyelitis was made in 68.4%(359/525) of biopsies, and microbiological cultures were positive in 29.6%(169/570). Elevated ESR was positively associated with a histopathologic diagnosis of osteomyelitis(OR=1.96, p=0.007), and positive cultures from bone cores(OR=1.02,p=<0.001) and aspirate(OR=1.02,p=<0.001). Increased total core length was positively associated with a histopathologic diagnosis of osteomyelitis(OR=1.81,p=0.013), and positive cultures from bone cores (OR=1.65,p=0.049). Clinical management was affected by ICNB in 37.5%(214/570) of cases. CONCLUSION In this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-third of patients.
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Affiliation(s)
- Winston L Winkler
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110.
| | - Ige A Geroge
- From the John T. Milliken Department of Internal Medicine, Division of Infectious Disease, 4523 Clayton Ave, St. Louis, MO, 63110
| | - Sumanth Gandra
- From the John T. Milliken Department of Internal Medicine, Division of Infectious Disease, 4523 Clayton Ave, St. Louis, MO, 63110
| | - Jonathan C Baker
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110
| | - Anderanik Tomasian
- From the Department of Radiology, Section of Musculoskeletal Radiology, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA, 90089
| | - Benjamin Northrup
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110
| | - Theodore L Vander Velde
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110
| | - Travis J Hillen
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110
| | - Chongliang Luo
- From the Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S Euclid Ave, St. Louis, MO, 63110
| | - Resten Imaoka
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110
| | - Gino M Dettorre
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110
| | - Jack W Jennings
- From the Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110
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Jennings JW. Combined Complementary Local Therapies for Pain Palliation and Local Control of a Pelvic Osteosarcoma. Int J Radiat Oncol Biol Phys 2024; 118:1161-1162. [PMID: 38492963 DOI: 10.1016/j.ijrobp.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 03/18/2024]
Affiliation(s)
- Jack W Jennings
- Department of Radiology, Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Tomasian A, Jennings JW. Essentials of Spinal Tumor Ablation. Radiol Clin North Am 2024; 62:303-309. [PMID: 38272622 DOI: 10.1016/j.rcl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Recent advances in percutaneous minimally invasive thermal ablation and vertebral augmentation provide radiologists with important arsenal for treatment of selected patients with spinal metastases. These interventions have proven to be safe, effective, and durable in treatment of selected patients with vertebral metastases. Attention to procedure techniques, including choice of ablation modality, vertebral augmentation technique, and thermal protection, is essential for improved patient outcomes. A detailed knowledge of such interventions and implementation of procedural safety measures will further heighten radiologists' role in the management of patients with spinal metastases.
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Affiliation(s)
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 S Kingshighway Boulevard, Saint Louis, MO, USA.
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Winkler WL, Baker JC, Tomasian A, Vander Velde TL, Hillen TJ, Luo C, Imaoka R, Dettorre GM, Jennings JW. Diagnostic efficacy of image-guided core needle biopsy of suspected malignant osseous lesions: a retrospective cohort study from a single academic institution. Eur Radiol 2024:10.1007/s00330-024-10663-1. [PMID: 38388720 DOI: 10.1007/s00330-024-10663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To evaluate diagnostic yield and accuracy of image-guided core needle biopsy (ICNB) of suspected malignant osseous lesions in a large cohort of adults, evaluate what factors influence these measures, and offer technical recommendations to optimize yield. METHODS A retrospective analysis of 2321 ICNBs performed from 2010 to 2021 was completed. The diagnostic yield and accuracy of the biopsies as well as a series of patient, lesion-related, and technical factors were retrospectively analyzed. Multivariate statistical analysis was performed to evaluate what factors were associated with yield and accuracy. Different cutoff values of total core length and core number were then tested to determine threshold values in relation to increased diagnostic yield. RESULTS Diagnostic yield was 98.2% (2279/2321) and accuracy was 97.6% (120/123). Increased total core length (odds ratio [OR] = 2.34, 95% confidence interval [CI] (1.41-3.90), p = 0.001), core number (OR = 1.51, 95% CI (1.06-2.16), p = 0.02) and presence of primary malignancy (OR = 2.81, 95% CI (1.40-5.62), p = 0.004) were associated with improved yield. Lesion location in an extremity (OR = 0.27, 95% CI (0.11-0.68), p = 0.006) and using fluoroscopic imaging guidance (OR = 0.33, 95% CI (0.12-0.90), p = 0.03) were associated with lower yield. Cutoff thresholds in relation to increased diagnostic yield were found to be 20 mm total core length (marginal OR = 4.16, 95% CI = (2.09-9.03), p < 0.001), and three total cores obtained (marginal OR = 2.78, 95% CI (1.34-6.54), p = 0.005). None of the analyzed factors influenced diagnostic accuracy. CONCLUSIONS ICNB has a high rate of diagnostic yield and accuracy. Several factors influence diagnostic yield; 20 mm core length and three total cores optimize yield. CLINICAL RELEVANCE STATEMENT Image-guided core needle biopsy of suspected malignant osseous lesions is a safe procedure with a very high rate of diagnostic yield and accuracy. Obtaining 20 mm total core length and three total cores optimizes diagnostic yield. KEY POINTS • In a retrospective cohort study, image-guided core needle biopsy of suspected osseous malignant lesions in adults was found to have very high rates of diagnostic yield and accuracy. • Increased total core length and core number of biopsies were each associated with increased diagnostic yield, and these relationships reached thresholds at 20 mm total core length and three total cores obtained. • The presence of a known primary malignancy was also associated with increased yield while using fluoroscopic imaging guidance and lesion location in an extremity were associated with decreased yield.
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Affiliation(s)
- Winston L Winkler
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA.
| | - Jonathan C Baker
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Anderanik Tomasian
- Department of Radiology, Section of Musculoskeletal Radiology, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA, 90089, USA
| | - Theodore L Vander Velde
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Travis J Hillen
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Resten Imaoka
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Gino M Dettorre
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Jack W Jennings
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
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Benabdallah N, Lu P, Abou DS, Zhang H, Ulmert D, Hobbs RF, Gay HA, Simons BW, Saeed MA, Rogers BE, Jha AK, Tai YC, Malone CD, Ippolito JE, Michalski J, Jennings JW, Baumann BC, Pachynski RK, Thorek DLJ. Beyond Average: α-Particle Distribution and Dose Heterogeneity in Bone Metastatic Prostate Cancer. J Nucl Med 2024; 65:245-251. [PMID: 38124163 PMCID: PMC10858382 DOI: 10.2967/jnumed.123.266571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Indexed: 12/23/2023] Open
Abstract
α-particle emitters are emerging as a potent modality for disseminated cancer therapy because of their high linear energy transfer and localized absorbed dose profile. Despite great interest and pharmaceutical development, there is scant information on the distribution of these agents at the scale of the α-particle pathlength. We sought to determine the distribution of clinically approved [223Ra]RaCl2 in bone metastatic castration-resistant prostate cancer at this resolution, for the first time to our knowledge, to inform activity distribution and dose at the near-cell scale. Methods: Biopsy specimens and blood were collected from 7 patients 24 h after administration. 223Ra activity in each sample was recorded, and the microstructure of biopsy specimens was analyzed by micro-CT. Quantitative autoradiography and histopathology were segmented and registered with an automated procedure. Activity distributions by tissue compartment and dosimetry calculations based on the MIRD formalism were performed. Results: We revealed the activity distribution differences across and within patient samples at the macro- and microscopic scales. Microdistribution analysis confirmed localized high-activity regions in a background of low-activity tissue. We evaluated heterogeneous α-particle emission distribution concentrated at bone-tissue interfaces and calculated spatially nonuniform absorbed-dose profiles. Conclusion: Primary patient data of radiopharmaceutical therapy distribution at the small scale revealed that 223Ra uptake is nonuniform. Dose estimates present both opportunities and challenges to enhance patient outcomes and are a first step toward personalized treatment approaches and improved understanding of α-particle radiopharmaceutical therapies.
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Affiliation(s)
- Nadia Benabdallah
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Peng Lu
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Diane S Abou
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Hanwen Zhang
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - David Ulmert
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Robert F Hobbs
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Brian W Simons
- Center for Comparative Medicine, Baylor University, Houston, Texas
| | - Muhammad A Saeed
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Buck E Rogers
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Abhinav K Jha
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Yuan-Chuan Tai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Christopher D Malone
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Radiation Oncology, Springfield Clinic, Springfield, Illinois; and
| | - Russell K Pachynski
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Daniel L J Thorek
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri;
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Oncologic Imaging Program, Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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6
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Tomasian A, Jennings JW. Benign Bone Tumors Beyond Osteoid Osteoma: Percutaneous Minimally Invasive Image-Guided Interventions. Cardiovasc Intervent Radiol 2023; 46:1483-1494. [PMID: 37532944 DOI: 10.1007/s00270-023-03515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/09/2023] [Indexed: 08/04/2023]
Abstract
Painful benign bone tumors often adversely influence quality of life primarily due to skeletal-related events such as unremittable pain, pathologic fracture, neurologic deficit, as well as skeletal growth disturbance. Substantial advances in percutaneous minimally invasive interventions for treatment of painful benign bone tumors beyond osteoid osteoma have been established as safe, efficacious, and durable treatments to achieve definitive cure. This article details the available armamentarium and most recent advances in minimally invasive percutaneous interventions and the role of radiologists for the management of patients with benign bone tumors beyond osteoid osteoma.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiological Sciences, University of California, Irvine Medical Center, 101 The City Dr. S, Orange, CA, 92868, USA.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, 510 South Kingshighway Blvd, St. Louis, MO, 63110, USA
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Tomasian A, Jennings JW. Spine metastases: thermal ablation and augmentation. Skeletal Radiol 2023; 52:1921-1928. [PMID: 37171611 DOI: 10.1007/s00256-023-04348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 05/13/2023]
Abstract
Substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions including thermal ablation and vertebral augmentation offer a robust armamentarium for interventional radiologists for management of patients with spinal metastases. Such interventions have proved safe and effective in management of selected patients with vertebral metastases. Special attention to procedure techniques including choice of ablation modality, vertebral augmentation technique, and thermal protection is essential for improved patient outcomes. Familiarity with the described interventions and implementation of procedural safety measures will further enhance the role of radiologists in the management of patients with spinal metastases. This article provides a review of the most recent advances in thermal ablation and vertebral augmentation as well as the role of radiologists for treatment of spinal metastases.
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Affiliation(s)
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO, USA.
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Crawford DA, Bauer B, Jennings JW. Portable Cautery Device as an Aid to Eject a Lodged Sclerotic Bone Biopsy Specimen. J Vasc Interv Radiol 2023; 34:1631-1633. [PMID: 37217160 DOI: 10.1016/j.jvir.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- Daniel A Crawford
- Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO 63110.
| | - Benjamin Bauer
- Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO
| | - Jack W Jennings
- Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO
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Tomasian A, Khan MA, Jennings JW. Percutaneous Treatment of Spinal Metastases. Neuroimaging Clin N Am 2023; 33:499-506. [PMID: 37356865 DOI: 10.1016/j.nic.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Percutaneous image-guided minimally invasive thermal ablation and vertebral augmentation are robust techniques, part of the available armamentarium used by radiologists for the management of patients with spinal metastases. Such interventions have been established to be safe and effective in treatment of selected patients with vertebral metastases. Special attention to procedure techniques including choice of ablation modality, vertebral augmentation technique, and thermal protection is essential for improved patient outcomes.
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Affiliation(s)
- Anderanik Tomasian
- University of California Irvine, 101 The City Drive South, Orange, CA, USA.
| | - Majid A Khan
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, USA
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, USA
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Khan MA, Jennings JW, Baker JC, Smolock AR, Shah LM, Pinchot JW, Wessell DE, Kim CY, Lenchik L, Parsons MS, Huhnke G, Shek-Man Lo S, Lu Y, Potter C, Reitman C, Sahgal A, Sharma A, Yalla NM, Beaman FD, Kapoor BS, Burns J. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update. J Am Coll Radiol 2023; 20:S102-S124. [PMID: 37236738 DOI: 10.1016/j.jacr.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Jack W Jennings
- Research Author, Washington University, Saint Louis, Missouri
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, St. Louis, Missouri
| | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | | | - Charles Y Kim
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Gina Huhnke
- Deaconess Hospital, Evansville, Indiana American College of Emergency Physicians
| | - Simon Shek-Man Lo
- University of Washington School of Medicine, Seattle, Washington Commission on Radiation Oncology
| | - Yi Lu
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Christopher Potter
- Brigham & Women's Hospital, Boston, Massachusetts Committee on Emergency Radiology-GSER
| | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina North American Spine Society
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Commission on Radiation Oncology
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida Commission on Nuclear Medicine and Molecular Imaging
| | - Naga M Yalla
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri, Primary care physician
| | | | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Gangahar CN, Dehner CA, Wang DP, Amini B, Hillen T, O'Conor C, Jennings SN, Byrnes K, Montgomery EA, Czerniak BA, Bridge JA, Schroeder MC, Jennings JW, Wang WL, Chrisinger JSA. Intraosseous hibernoma: clinicopathologic and imaging analysis of 18 cases. Histopathology 2023. [PMID: 37099409 DOI: 10.1111/his.14928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/27/2023]
Abstract
AIMS Intraosseous hibernomas are rarely reported tumours with brown adipocytic differentiation of unknown aetiology, with only 38 cases documented in the literature. We sought to further characterise the clinicopathologic, imaging and molecular features of these tumours. METHODS AND RESULT Eighteen cases were identified occurring in eight females and 10 males (median age = 65 years, range = 7-75). Imaging indication was cancer surveillance/staging in 11 patients and clinical concern for a metastasis was raised in 13 patients. The innominate bone (7), sacrum (5), mobile spine (4), humerus (1) and femur (1) were involved. Median tumour size was 1.5 cm (range = 0.8-3.8). Tumours were sclerotic (11), mixed sclerotic and lytic (4) or occult (1). Microscopically, tumours were composed of large polygonal cells with distinct cell membranes, finely vacuolated cytoplasm, central or paracentral small bland nuclei with prominent scalloping. Growth around trabecular bone was observed. Tumour cells were immunoreactive for S100 protein (15/15) and adipophilin (5/5), while negative for keratin AE1/AE3(/PCK26) (0/14) and brachyury (0/2). Chromosomal microarray analysis, performed on four cases, did not show clinically significant copy number variation across the genome or on 11q, the site of AIP and MEN1. CONCLUSION Analysis of 18 cases of intraosseous hibernoma, to our knowledge, the largest series to date, revealed that these tumours are most often detected in the spine and pelvis of older adults. Tumours were generally small, sclerotic and frequently found incidentally and can raise concern for metastasis. Whether or not these tumours are related to soft tissue hibernomas is uncertain.
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Affiliation(s)
- Chiraag N Gangahar
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Carina A Dehner
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - David P Wang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Behrang Amini
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Travis Hillen
- Musculoskeletal Section, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Christopher O'Conor
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kathleen Byrnes
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Bogdan A Czerniak
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julia A Bridge
- Propath, Dallas, TX, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Molly C Schroeder
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Jack W Jennings
- Musculoskeletal Section, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Wei-Lien Wang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John S A Chrisinger
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
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Jennings JW. Pulsed Radiofrequency: An Additional Tool in the Armamentarium for More Effective and Durable Treatment of Sciatica. Radiology 2023; 307:e230161. [PMID: 36975824 DOI: 10.1148/radiol.230161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Jack W Jennings
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; and Siteman Cancer Center, St Louis, Mo
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Tomasian A, Cazzato RL, Sharma K, Gangi A, Jennings JW. Benign Bone Tumors: State of the Art in Minimally Invasive Percutaneous Interventions. Radiographics 2023; 43:e220041. [PMID: 36563097 DOI: 10.1148/rg.220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Painful benign bone tumors most commonly affect pediatric patients and young adults. They may be associated with skeletal-related events such as intractable pain, pathologic fracture, neurologic deficit as a consequence of nerve or spinal cord compression, as well as growth disturbance. Consequently, they often result in diminished activity and adversely affect quality of life. There have been substantial recent advances in percutaneous minimally invasive image-guided interventions for treatment of painful benign bone tumors including thermal ablation (radiofrequency ablation, cryoablation, microwave ablation, laser photocoagulation, and high-intensity focused US ablation), chemical (alcohol) ablation, cementoplasty, and intralesional injections. The safety, efficacy, and durability of such interventions have been established in the recent literature and as such, the role of musculoskeletal interventional radiologists in the care of patients with benign bone lesions has substantially expanded. The treatment goal of minimally invasive musculoskeletal interventions in patients with benign bone tumors is to achieve definitive cure. The authors detail the most recent advances and available armamentarium in minimally invasive image-guided percutaneous interventions with curative intent for the management of benign bone tumors. © RSNA, 2022.
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Affiliation(s)
- Anderanik Tomasian
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Roberto Luigi Cazzato
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Karun Sharma
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Afshin Gangi
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Jack W Jennings
- From the Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 (A.T.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (R.L.C., A.G.); Department of Radiology, Children's National Hospital, Washington, DC (K.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
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Tomasian A, Filippiadis DK, Tutton S, Deschamps F, Cazzato RL, Prologo JD, Kelekis A, Levy J, Gangi A, Garnon J, Jennings JW. Comprehensive Palliative Musculoskeletal Interventional Radiology Care for Patients with Cancer. Radiographics 2023; 43:e229014. [PMID: 36490212 DOI: 10.1148/rg.229014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tomasian A, Filippiadis DK, Tutton S, Deschamps F, Cazzato RL, Prologo JD, Kelekis A, Levy J, Gangi A, Garnon J, Jennings JW. Comprehensive Palliative Musculoskeletal Interventional Radiology Care for Patients with Cancer. Radiographics 2022; 42:1654-1669. [DOI: 10.1148/rg.220009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dehner CA, Maloney N, Amini B, Jennings JW, McDonald DJ, Wang WL, Chrisinger JSA. Dedifferentiated chondrosarcoma with minimal or small dedifferentiated component. Mod Pathol 2022; 35:922-928. [PMID: 35115636 DOI: 10.1038/s41379-022-01008-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/09/2022]
Abstract
Dedifferentiated chondrosarcoma (DDCS) is an aggressive bone sarcoma characterized by low-intermediate grade cartilage component with abrupt transition to a high-grade non-chondrosarcomatous component. Generally, the dedifferentiated (DD) component is large. However, rare cases have minimal (<1 cm) or small (1-2 cm) areas of DD. We describe the clinicopathologic features of such tumors and evaluate the prognostic significance of this finding compared to cases with large DD (>2 cm). Available slides were re-reviewed for assessment of histologic features. The medical record was reviewed for imaging studies and clinical characteristics. Thirty-five cases were included. Six patients had minimal DD, four had small DD and 25 had large DD. None of the minimal DD showed definitive imaging evidence of DD. Two minimal DD (33%) locally recurred and 2 (33%) developed distant metastases. None of the small DD cases showed definitive imaging evidence of DD. None of the small DD locally recurred and at least 1 (25%) developed distant metastases. There was no significant difference in age, gender, pelvic site, tumor size >8 cm, tumor necrosis or undifferentiated pleomorphic sarcoma-like morphology between minimal or small DD compared to large DD, though osteosarcomatous differentiation was significantly more common in large DD. There was no significant difference in overall survival between minimal or small DD compared to large DD (p = 0.81 and p = 0.17, respectively), or in progression-free survival (p = 0.47 and 0.29, respectively), or metastasis-free survival (p = 0.06 and 0.62, respectively). DDCS with minimal or small DD show similar demographic distribution, anatomic localization and histologic features to large DD. DD in these cases is unlikely to be detected on imaging. Furthermore, at least a subset of these tumors is extremely aggressive despite the limited extent of DD. This highlights the need for thorough gross and histologic examination and sampling.
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Affiliation(s)
- Carina A Dehner
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nolan Maloney
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Behrang Amini
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack W Jennings
- Musculoskeletal Section, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Douglas J McDonald
- Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Wei-Lien Wang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John S A Chrisinger
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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Zavras AG, Schoenfeld AJ, Patt JC, Munim MA, Goodwin CR, Goodwin ML, Lo SFL, Redmond KJ, Tobert DG, Shin JH, Ferrone ML, Laufer I, Saifi C, Buchowski JM, Jennings JW, Ozturk AK, Huang-Wright C, Mesfin A, Steyn C, Hsu W, Soliman HM, Krishnaney AA, Sciubba DM, Schwab JH, Colman MW. Attitudes and trends in the use of radiolucent spinal implants: A survey of the North American Spine Society section of spinal oncology. North American Spine Society Journal (NASSJ) 2022; 10:100105. [PMID: 35368717 PMCID: PMC8967730 DOI: 10.1016/j.xnsj.2022.100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
Background In spinal oncology, titanium implants pose several challenges including artifact on advanced imaging and therapeutic radiation perturbation. To mitigate these effects, there has been increased interest in radiolucent carbon fiber (CF) and CF-reinforced polyetheretherketone (CFR-PEEK) implants as an alternative for spinal reconstruction. This study surveyed the members of the North American Spine Society (NASS) section of Spinal Oncology to query their perspectives regarding the clinical utility, current practice patterns, and recommended future directions of radiolucent spinal implants. Methods In February 2021, an anonymous survey was administered to the physicians of the NASS section of Spinal Oncology. Participation in the survey was optional. The survey contained 38 items including demographic questions as well as multiple-choice, yes/no questions, Likert rating scales, and short free-text responses pertaining to the “clinical concept”, “efficacy”, “problems/complications”, “practice pattern”, and “future directions” of radiolucent spinal implants. Results Fifteen responses were received (71.4% response rate). Six of the participants (40%) were neurosurgeons, eight (53.3%) were orthopedic surgeons, and one was a spinal radiation oncologist. Overall, there were mixed opinions among the specialists. While several believed that radiolucent spinal implants provide substantial benefits for the detection of disease recurrence and radiation therapy options, others remained less convinced. Ongoing concerns included high costs, low availability, limited cervical and percutaneous options, and suboptimal screw and rod designs. As such, participants estimated that they currently utilize these implants for 27.3% of anterior and 14.7% of all posterior reconstructions after tumor resection. Conclusion A survey of the NASS section of Spinal Oncology found a lack of consensus with regards to the imaging and radiation benefits, and several ongoing concerns about currently available options. Therefore, routine utilization of these implants for anterior and posterior spinal reconstructions remains low. Future investigations are warranted to practically validate these devices’ theoretical risks and benefits.
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Jennings JW. The Safety and Potential Harm of Intraarticular Steroid Injections: The Debate Continues. Radiology 2022; 304:370-371. [PMID: 35536140 DOI: 10.1148/radiol.220700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jack W Jennings
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; and Siteman Cancer Center, St Louis, Mo
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19
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Tomasian A, Jennings JW. Interventional Palliation of Painful Extraspinal Musculoskeletal Metastases. Semin Intervent Radiol 2022; 39:176-183. [PMID: 35781996 DOI: 10.1055/s-0042-1745787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The musculoskeletal system is commonly involved by metastases, and skeletal-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a result of nerve compression often adversely affect patient's quality of life. There have been substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions for the management of patients with musculoskeletal metastases including thermal ablations, cementation with or without osseous reinforcement via implants, osteosynthesis, neurolysis, and palliative injections which are progressively incorporated in clinical practice. These interventions are performed, in conjunction with or supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesics, to achieve durable pain palliation, local tumor control, or cure. This article reviews minimally invasive percutaneous image-guided musculoskeletal oncologic interventions for the management of patients with extraspinal musculoskeletal metastases.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of California Irvine, Orange, California
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, Missouri
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20
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Tomasian A, Jennings JW. Spine Microwave Ablation: Safety and Efficacy for Treatment of Vertebral Metastases. AJNR Am J Neuroradiol 2022; 43:E9-E10. [PMID: 35241417 PMCID: PMC8910790 DOI: 10.3174/ajnr.a7439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A. Tomasian
- Department of Radiological SciencesUniversity of CaliforniaIrvine, California
| | - J W Jennings
- Mallinckrodt Institute of RadiologyWashington UniversitySaint Louis, Missouri
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Cazzato RL, Jennings JW, Autrusseau PA, De Marini P, Auloge P, Tomasian A, Garnon J, Gangi A. Percutaneous image-guided cryoablation of spinal metastases: over 10-year experience in two academic centers. Eur Radiol 2022; 32:4137-4146. [PMID: 35028752 DOI: 10.1007/s00330-021-08477-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To report on safety and clinical effectiveness of cryoablation for the treatment of spinal metastases (SM) in patients needing pain palliation or local tumor control (LTC). METHODS All consecutive patients with SM who underwent cryoablation from May 2008 to September 2020 in two academic centers were retrospectively identified and included in the present analysis. Patient characteristics, goal of treatment (curative/palliative), SM characteristics, procedural details, and clinical outcomes (pain relief; local tumor control [LTC]) were analyzed. RESULTS There were 74 patients (35 women; median age 61 years) accounting for 105 SM. Additional cementoplasty was used for 76 SM (76/105; 72.4%). There were 9 complications (out of 105 SM [8.5%]; 2 major and 7 minor) in 8 patients. Among the 64 (64/74; 86.5%) patients with painful SM, the mean Numerical Pain Rating Scale dropped from 6.8 ± 2.2 (range, 0-10) at the baseline to 4.1 ± 2.4 (range, 0-9; p < 0.0001) at 24 h, 2.5 ± 2.6 (range, 0-9; p < 0.0001) at 1 month, and 2.4 ± 2.5 (range, 0-9; p < 0.0001) at the last available follow-up (mean 14.7 ± 19.6 months; median 6). Thirty-four patients (34/64; 53.1%) were completely pain-free at the last follow-up. At mean 25.9 ± 21.2 months (median 16.5) of follow-up, LTC was achieved in 23/28 (82.1%) SM in 21 patients undergoing cryoablation with curative intent. CONCLUSION Cryoablation of SM, often performed in combination with vertebral augmentation, is safe, achieves fast and sustained pain relief, and provides high rates of LTC at mean 2-year follow-up. KEY POINTS •Cryoablation of spinal metastases is safe. •Cryoablation of spinal metastases allows rapid and sustained pain relief. •The mean 2-year rate of local tumor control after cryoablation of spinal metastases is 82.1%.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France. .,Medical Oncology, Institut de Cancérologie Strasbourg Europe, 17, Rue Albert Calmette, 67200, Strasbourg, France.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO, 63110, USA
| | - Pierre-Alexis Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Anderanik Tomasian
- Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA, 90033, USA
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, Strand London, London, WC2R 2LS, UK
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22
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Tomasian A, Jennings JW. Bone marrow aspiration and biopsy: techniques and practice implications. Skeletal Radiol 2022; 51:81-88. [PMID: 34398308 DOI: 10.1007/s00256-021-03882-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 02/02/2023]
Abstract
Bone marrow aspiration and biopsy (BMAB) is a valuable diagnostic procedure commonly performed for evaluation of a wide spectrum of diseases including hematologic abnormalities, nonhematologic malignancies, metabolic abnormalities, and tumor treatment response such as chemotherapy and bone marrow transplantation, hematologic tumor staging, and suspected infection in patients with fever of unknown origin. This minimally invasive intervention offers excellent safety profile and a high diagnostic yield. Radiologists should be familiar with clinical implications of BMAB for patient care and be able to implement various technical armamentarium available to achieve a safe intervention while maximizing procedure yield.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd, St. Louis, MO, 63110, USA
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Abstract
Bone is the third most common site involved by cancer metastases, and skeleton-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a consequence of nerve or spinal cord compression often affect patients' functional independence and quality of life unfavorably. The annual medical-economic burden related to bone metastases is a substantial component of the total direct medical cost estimated by the National Institutes of Health. There have been substantial recent advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions for the management of patients with osseous metastatic disease. These advances include thermal ablation, cementation with or without osseous reinforcement with implants, osteosynthesis, thermal and chemical neurolyses, and palliative injections, which are progressively incorporated into the management paradigm for such patients. These interventions are performed in conjunction with or are supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesic agents to achieve durable pain palliation, local tumor control, or cure, and they provide a robust armamentarium for interventional radiologists to achieve safe and effective treatment in a multidisciplinary setting. In addition, these procedures are shifting the patient management paradigm in modern-era practice. The authors detail the state of the art in minimally invasive percutaneous image-guided musculoskeletal oncologic interventions and the role of radiologists in managing patients with skeletal metastases. ©RSNA, 2021.
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Affiliation(s)
- Anderanik Tomasian
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
| | - Jack W Jennings
- From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.)
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Yahanda AT, Moore E, Ray WZ, Pennicooke B, Jennings JW, Molina CA. First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance. Neurosurg Focus 2021; 51:E10. [PMID: 34333484 DOI: 10.3171/2021.5.focus21217] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Augmented reality (AR) is an emerging technology that has great potential for guiding the safe and accurate placement of spinal hardware, including percutaneous pedicle screws. The goal of this study was to assess the accuracy of 63 percutaneous pedicle screws placed at a single institution using an AR head-mounted display (ARHMD) system. METHODS Retrospective analyses were performed for 9 patients who underwent thoracic and/or lumbar percutaneous pedicle screw placement guided by ARHMD technology. Clinical accuracy was assessed via the Gertzbein-Robbins scale by the authors and by an independent musculoskeletal radiologist. Thoracic pedicle subanalysis was also performed to assess screw accuracy based on pedicle morphology. RESULTS Nine patients received thoracic or lumbar AR-guided percutaneous pedicle screws. The mean age at the time of surgery was 71.9 ± 11.5 years and the mean number of screws per patient was 7. Indications for surgery were spinal tumors (n = 4, 44.4%), degenerative disease (n = 3, 33.3%), spinal deformity (n = 1, 11.1%), and a combination of deformity and infection (n = 1, 11.1%). Presenting symptoms were most commonly low-back pain (n = 7, 77.8%) and lower-extremity weakness (n = 5, 55.6%), followed by radicular lower-extremity pain, loss of lower-extremity sensation, or incontinence/urinary retention (n = 3 each, 33.3%). In all, 63 screws were placed (32 thoracic, 31 lumbar). The accuracy for these screws was 100% overall; all screws were Gertzbein-Robbins grade A or B (96.8% grade A, 3.2% grade B). This accuracy was achieved in the thoracic spine regardless of pedicle cancellous bone morphology. CONCLUSIONS AR-guided surgery demonstrated a 100% accuracy rate for the insertion of 63 percutaneous pedicle screws in 9 patients (100% rate of Gertzbein-Robbins grade A or B screw placement). Using an ARHMS system for the placement of percutaneous pedicle screws showed promise, but further validation using a larger cohort of patients across multiple surgeons and institutions will help to determine the true accuracy enabled by this technology.
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Affiliation(s)
| | - Emelia Moore
- 2Wayne State University School of Medicine, Detroit, Michigan
| | | | | | - Jack W Jennings
- 3Radiology, Washington University School of Medicine in St. Louis, Missouri; and
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Kurup AN, Jennings JW, Tutton S, Tam AL, Kelekis A, Wood BJ, Dupuy DE, Napoli A, Park SS, Robinson SI, Rose PS, Soulen MC, White SB, Callstrom MR. Musculoskeletal Oncologic Interventions: Proceedings from the Society of Interventional Radiology and Society of Interventional Oncology Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1089.e1-1089.e9. [PMID: 34210477 DOI: 10.1016/j.jvir.2021.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/05/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
Musculoskeletal interventions are increasingly used with palliative and curative intent in the multidisciplinary treatment of oncology patients with bone and soft-tissue tumors. There is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients. Therefore, the Society of Interventional Radiology Foundation and the Society of Interventional Oncology collaborated to convene a research consensus panel to prioritize a research agenda addressing the gaps in the current evidence. This article summarizes the panel's proceedings and recommendations for future basic science and clinical investigation to chart the course for interventional oncology within the musculoskeletal system. Key questions that emerged addressed the effectiveness of ablation within specific patient populations, the effect of combination of ablation with radiotherapy and/or immunotherapy, and the potential of standardization of techniques, including modeling and monitoring, to improve the consistency and predictability of treatment outcomes.
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Affiliation(s)
- Anil Nicholas Kurup
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Jack W Jennings
- Division of Diagnostic Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alda L Tam
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexis Kelekis
- Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bradford J Wood
- Department of Interventional Radiology, National Cancer Institute, Bethesda, Maryland
| | - Damian E Dupuy
- Department of Interventional Radiology, Cape Cod Hospital, Hyannis, Massachusetts
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Sean S Park
- Radiation Oncology, Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester, MN 55905
| | - Steven I Robinson
- Medical Oncology, Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester, MN 55905
| | - Peter S Rose
- Orthopedic Surgery, Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester, MN 55905
| | - Michael C Soulen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah B White
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew R Callstrom
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN
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Stensby JD, Long JR, Hillen TJ, Jennings JW. Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients. Skeletal Radiol 2021; 50:915-920. [PMID: 33011873 DOI: 10.1007/s00256-020-03623-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the safety of fluoroscopically guided drill-assisted bone marrow aspirate and biopsy in severely thrombocytopenic patients. MATERIALS AND METHODS The study was approved by the IRB with waiver of informed consent. Retrospective review of 111 bone marrow aspirate and biopsies (BMAB) performed in 94 patients who received a CT scan which included the pelvis and biopsy site within the 7 days following the BMAB. The 94 patients were subdivided based on their platelet count: severe thrombocytopenia (< 20 platelets × 109/L), thrombocytopenia (20-50 platelets × 109/L), and control (> 50 platelets × 109/L). The procedure report was reviewed for sedation time, aspirate volume, and aggregate size of core biopsy specimens. The electronic medical record was reviewed for specimen adequacy; pathologic diagnosis; body mass index; pre- and post-procedure labs including platelet count, hemoglobin (HGB), hematocrit (HCT), prothrombin time (PT), and international normalized ratio (INR) levels; post-procedural transfusion; and complications including mortality at 30 and 90 days. CT scans were independently reviewed by 2 fellowship-trained radiologists for the presence of post-procedural hemorrhage. RESULTS There was no significant difference in CT-identified post-procedural hematoma, or change in the hemoglobin and hematocrit levels pre- and post-procedure between the three groups. There was no significant difference in complication rate or all-cause mortality. There was a significant difference in transfusion at 30 days with thrombocytopenic and severely thrombocytopenic patients more likely to receive transfusion within the 30 days post-procedure. CONCLUSION Fluoroscopically guided BMAB can be safely performed in patients with severe thrombocytopenia.
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Affiliation(s)
- J D Stensby
- Department of Radiology, University of Missouri, 1 Hospital Dr., Columbia, MO, 65203, USA.
| | - J R Long
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - T J Hillen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - J W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
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Cazzato RL, Bellone T, Scardapane M, De Marini P, Autrusseau PA, Auloge P, Garnon J, Jennings JW, Gangi A. Vertebral augmentation reduces the 12-month mortality and morbidity in patients with osteoporotic vertebral compression fractures. Eur Radiol 2021; 31:8246-8255. [PMID: 33899142 DOI: 10.1007/s00330-021-07985-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/26/2021] [Accepted: 04/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the 12-month all-cause mortality and morbidity in patients with osteoporotic vertebral compression fractures (OVCFs) undergoing vertebroplasty/balloon kyphoplasty (VP/BKP) versus non-surgical management (NSM). METHODS Following a Medline and EMBASE search for English language articles published from 2010 to 2019, 19 studies reporting on mortality and morbidity after VP/BKP in patients with OVCFs were selected. The 12-month timeline was set due to the largest amount of data availability at such time interval. Estimates for each study were reported as odds ratios (OR) along with 95% confidence intervals (CI) and p values. Fixed or random-effects meta-analyses were performed. All tests were based on a two-sided significance level of 0.05. RESULTS Pooled OR across 5 studies favored VP/BKP over NSM in terms of 12-month all-cause mortality (OR: 0.81 [95% CI: 0.46-1.42]; p = .46). Pooled OR across 11 studies favored VP/BKP over NSM in terms of 12-month all-cause morbidity (OR: 0.64 [95% CI: 0.31-1.30]; p = .25). Sub-analysis of data dealing with 12-month infective morbidity from any origin confirmed the benefit of VP/BKP over NSM (OR: 0.23 [95% CI, 0.02-2.54]; p = .23). CONCLUSION Compared to NSM, VP/BKP reduces the 12-month risk of all-cause mortality and morbidity by 19% and 36%, respectively. Moreover, VP/BKP reduces by 77% the 12-month risk of infection from any origin. KEY POINTS • Compared to non-surgical management, vertebral augmentation reduces the 12-month risk of all-cause mortality by 19% and all-cause morbidity by 36%. • Vertebral augmentation reduces the 12-month risk of infection morbidity from any origin by 77%.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.
| | | | | | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre-Alexis Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Jennings JW, Prologo JD, Garnon J, Gangi A, Buy X, Palussière J, Kurup AN, Callstrom M, Genshaft S, Abtin F, Huang AJ, Iannuccilli J, Pilleul F, Mastier C, Littrup PJ, de Baère T, Deschamps F. Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study. Radiol Imaging Cancer 2021; 3:e200101. [PMID: 33817650 PMCID: PMC8011449 DOI: 10.1148/rycan.2021200101] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/19/2020] [Accepted: 12/04/2020] [Indexed: 04/21/2023]
Abstract
PURPOSE To assess the clinical effectiveness of cryoablation for palliation of painful bone metastases. MATERIALS AND METHODS MOTION (Multicenter Study of Cryoablation for Palliation of Painful Bone Metastases) (ClinicalTrials.gov NCT02511678) was a multicenter, prospective, single-arm study of adults with metastatic bone disease who were not candidates for or had not benefited from standard therapy, that took place from February 2016 to March 2018. At baseline, participants rated their pain using the Brief Pain Inventory-Short Form (reference range from 0 to 10 points); those with moderate to severe pain, who had at least one metastatic candidate tumor for ablation, were included. The primary effectiveness endpoint was change in pain score from baseline to week 8. Participants were followed for 24 weeks after treatment. Statistical analyses included descriptive statistics and logistic regression to evaluate changes in pain score over the postprocedure follow-up period. RESULTS A total of 66 participants (mean age, 60.8 years ± 14.3 [standard deviation]; 35 [53.0%] men) were enrolled and received cryoablation; 65 completed follow-up. Mean change in pain score from baseline to week 8 was -2.61 points (95% CI: -3.45, -1.78). Mean pain scores improved by 2 points at week 1 and reached clinically meaningful levels (more than a 2-point decrease) after week 8; scores continued to improve throughout follow-up. Quality of life improved, opioid doses were stabilized, and functional status was maintained over 6 months. Serious adverse events occurred in three participants. CONCLUSION Cryoablation of metastatic bone tumors provided rapid and durable pain palliation, improved quality of life, and offered an alternative to opioids for pain control.Keywords: Ablation Techniques, Metastases, Pain Management, Radiation Therapy/OncologySupplemental material is available for this article.© RSNA, 2021.
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Abstract
Bone marrow aspiration and biopsy is a valuable procedure commonly utilized for evaluation of hematologic abnormalities, nonhematologic malignancies, metabolic abnormalities, tumor treatment response, and suspected infection in patients with fever of unknown origin. Imaging guidance with computed tomography (CT) is commonly utilized to improve safety and effectiveness of the procedure. Considering progressively increasing volume of complex CT-guided procedures as well as diagnostic CT imaging in most practices potentially resulting in limited availability of CT, a technique for fluoroscopy-guided bone marrow aspiration and biopsy is described with focus on advantages, which could be beneficial to most busy practices in modern era radiology.
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Affiliation(s)
| | | | - Jack W Jennings
- Mallinckrodt Institute of Radiology, St.Louis, Missouri, USA
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Tomasian A, Madaelil TP, Wallace AN, Wiesner E, Jennings JW. Percutaneous thermal ablation alone or in combination with cementoplasty for renal cell carcinoma osseous metastases: Pain palliation and local tumour control. J Med Imaging Radiat Oncol 2021; 64:96-103. [PMID: 32043316 DOI: 10.1111/1754-9485.12991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/29/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION To evaluate the safety and efficacy of minimally invasive percutaneous thermal ablation alone or in combination with cementoplasty for pain palliation and local tumour control of renal cell carcinoma osseous metastases. METHODS Imaging-guided thermal ablation was performed in 59 renal cell carcinoma osseous metastatic tumours in 23 patients (concomitant cementoplasty in 43 tumours) selected following multidisciplinary consultations to achieve local tumour control and pain palliation (75%, 44/59) or pain palliation alone (25%, 15/59) in this retrospective study. Tumour characteristics, procedural details and complications were documented. Pain palliation was assessed using pre- and post-procedural Numeric Rating Scale scores at 1-week, 1-month, 3-month and 6-month time intervals. Pre- and post-procedural cross-sectional imaging was reviewed to assess local tumour control rates at 3-month, 6-month, and 12-month post-treatment time intervals. RESULTS All procedures were technically successful and performed as pre-operatively planned. The median pre- and post-procedural Numeric Rating Scale scores were 8.0 and 3.0 (at all time intervals), respectively (P < 0.001). Local tumour control rates were 100% (40/40), 100% (36/36) and 85% (28/33) at ≥3 months, ≥6 months and ≥12 months post-procedural time intervals, respectively. There was 1 minor complication (1.7%, 1/59). CONCLUSIONS Percutaneous thermal ablation alone or in combination with cementoplasty is safe and effective for pain palliation and local tumour control of renal cell carcinoma osseous metastases.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Thomas P Madaelil
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Adam N Wallace
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Elizabeth Wiesner
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
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Tomasian A, Jennings JW. Vertebral Hemangioma: Percutaneous Minimally Invasive Image-Guided Radiofrequency Ablation. J Vasc Interv Radiol 2020; 31:1949-1952.e1. [PMID: 33129438 DOI: 10.1016/j.jvir.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Anderanik Tomasian
- University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033
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Bryson WN, Fischer EJ, Jennings JW, Hillen TJ, Friedman MV, Baker JC. Three-Column Classification System for Tibial Plateau Fractures: What the Orthopedic Surgeon Wants to Know. Radiographics 2020; 41:144-155. [PMID: 33275542 DOI: 10.1148/rg.2021200106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Recent orthopedic surgical literature emphasizes a three-column approach to understand and guide the treatment of tibial plateau fractures. This three-column classification system published in 2010 relies on preoperative CT images to depict injuries to the medial, lateral, and posterior columns of the tibial plateau and improves surgical outcomes in complex tibial plateau fractures with coronal fracture planes and posterior plateau fracture fragments requiring dorsal plating. Tibial plateau fracture classification systems traditionally used by radiologists and orthopedic surgeons, including the Schatzker and the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) classification systems, rely on findings at anteroposterior radiography and lack the terminology to accurately characterize fractures in the coronal plane involving the posterior tibial plateau. Incorporating elements from the contemporary three-column classification system into radiology reports will enhance radiologists' descriptions of these injuries. It is essential for radiologists to understand the role of clinical assessment and the pertinent imaging findings taken into consideration by orthopedic surgeons in their management of these injuries. This understanding includes familiarity with injury patterns and how they relate to mechanism of injury, patient demographics, and underlying pertinent comorbidities. Evaluating findings on initial radiographs is the basis of tibial plateau fracture diagnosis. Additional information provided by preoperative cross-sectional imaging, including two-dimensional and three-dimensional CT and MRI in specific circumstances, aids in the identification of specific soft-tissue injuries and fracture morphologies that influence surgical management. These specific fracture morphologies and soft-tissue injuries should be identified and communicated to orthopedic surgeons for optimal patient management. Online DICOM image stacks are available for this article. ©RSNA, 2020.
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Affiliation(s)
- Wesley N Bryson
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Eric J Fischer
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jack W Jennings
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Travis J Hillen
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael V Friedman
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jonathan C Baker
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Adogwa O, Rubio DR, Buchowski JM, D'Souza A, Shlykov MA, Jennings JW. Spine-specific skeletal related events and mortality in non-small cell lung cancer patients: a single-institution analysis. J Neurosurg Spine 2020; 36:125-132. [PMID: 33254136 DOI: 10.3171/2020.7.spine20829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The population prevalence of non-small cell lung cancer (NSCLC) continues to increase; however, data are limited regarding the incidence rate of skeletal related events (SREs) (i.e., surgery to the spinal column, radiation to the spinal column, radiofrequency ablation, kyphoplasty/vertebroplasty, spinal cord compression, or pathological vertebral body fractures) and their impact on overall mortality. In this study, the authors sought to estimate the incidence rates of SREs in NSCLC patients and to quantify their impact on overall mortality. METHODS This was a single-institution retrospective study of patients diagnosed with NSCLC between 2002 and 2014. The incidence rates for bone metastasis and subsequent SREs (per 1000 person-years) by time since lung cancer diagnosis were calculated and analyses were stratified separately for each histological type. Incidence rates for mortality at 1, 2, and 3 years from diagnosis stratified by the presence of SREs were also calculated. Kaplan-Meier survival curves were constructed to describe crude survival ratios in patients with spine metastasis and SREs and those with spine metastasis but without SREs. These curves were used to estimate the 1- and 2-year survival rates for each cohort. RESULTS We identified 320 patients with incident NSCLC (median follow-up 9.5 months). The mean ± SD age was 60.65 ± 11.26 years; 94.48% of patients were smokers and 60.12% had a family history of cancer. The majority of first-time SREs were pathological vertebral body compression fractures (77.00%), followed by radiation (35%), surgery (14%), and spinal cord compression (13.04%). Mortality rates were highest in NSCLC patients with spine metastasis who had at least 1 SRE. Stratifying by histological subtype, the incidence rate of mortality in patients with SRE was highest in the large cell cohort, 7.42 per 1000 person-years (95% CI 3.09-17.84 per 1000 person-years); followed by the squamous cell cohort, 2.49 per 1000 person-years (95% CI 1.87-3.32 per 1000 person-years); and lowest in the adenocarcinoma cohort, 1.68 per 1000 person-years (95% CI 1.46-1.94 per 1000 person-years). Surgery for decompression of neural structures and stabilization of the spinal column was required in 6% of patients. CONCLUSIONS SREs in NSCLC patients with bone metastasis are associated with an increased incidence rate of mortality.
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Affiliation(s)
| | | | | | | | | | - Jack W Jennings
- 2Radiology, Washington University School of Medicine, St. Louis, Missouri
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Tomasian A, Hillen TJ, Jennings JW. Unifocal Langerhans cell histiocytosis of bone: percutaneous navigational bipolar radiofrequency ablation for curative treatment. Clin Imaging 2020; 72:55-57. [PMID: 33217670 DOI: 10.1016/j.clinimag.2020.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/26/2020] [Accepted: 11/13/2020] [Indexed: 10/23/2022]
Abstract
In this report, the initial clinical experience of authors is described on the novel application of a navigational bipolar radiofrequency ablation electrode system for curative treatment of a painful unifocal Langerhans cell histiocytosis involving the supra-acetabular iliac bone. The technical success and safety of the radiofrequency ablation procedure to achieve cure suggests that this intervention may be utilized in clinical practice as a viable and minimally invasive alternative option, for management of unifocal Langerhans cell histiocytosis.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
| | - Travis J Hillen
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd, St. Louis, MO 63110, USA.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd, St. Louis, MO 63110, USA.
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Abstract
This article provides a step-by-step guide for minimally invasive percutaneous image-guided thermal ablation for treatment of vertebral metastases. Such interventions have proved safe and effective in management of selected patients with spinal metastases primarily to achieve pain palliation and local tumor control. Particular attention to patient selection guidelines, details of procedure techniques, thermal protection, adequacy of treatment, recognition and management of potential complications, and post-ablation imaging are essential for improved patient outcomes.
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Rudra S, Lauman MK, Stowe H, Henke LE, Wallace AN, Roach MC, Huang J, Tsien CI, Bradley JD, Santiago P, Buchowski JM, Jennings JW, Robinson CG. Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference. Global Spine J 2020; 10:888-895. [PMID: 32905719 PMCID: PMC7485068 DOI: 10.1177/2192568219882649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion-based strategies for utilizing radiation therapy, interventional radiology procedures, and surgery to treat 5 types of spine metastases: asymptomatic spinal metastases, uncomplicated spinal metastases, stable vertebral compression fractures (VCF), unstable VCF, and metastatic epidural spinal cord compression (MESCC). Evaluation of this set of algorithms in a clinical setting is lacking. The authors aimed to identify rate of treatment adherence to the Working Group Algorithms and, subsequently, update these algorithms based on actual patient management decisions made at a single-institution, multidisciplinary, spine tumor conference. METHODS Patients with metastatic spine disease from primary non-hematologic malignancies discussed at an institutional spine tumor conference from 2013 to 2016 were evaluated. Rates of Working Group Algorithms adherence were calculated for each type of metastasis. Based on the reasons for algorithm nonadherence, and patient outcomes in such cases, updated Working Group Algorithms recommendations were proposed. RESULTS In total, 154 eligible patients with 171 spine metastases were evaluated. Rates of algorithm adherence were as follows: asymptomatic (67%), uncomplicated (73%), stable VCF (20%), unstable VCF (32%), and MESCC (41%). The most common deviation from the Working Group Algorithms was surgery for MESCC despite poor prognostic factors, but this treatment strategy was supported based on median survival surpassing 6 months in these patients. CONCLUSIONS Adherence to the Working Group Algorithm was lowest for MESCC and VCF patients, but many nonadherent treatments were supported by patient survival outcomes. We proposed updates to the Working Group Algorithm based on these findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Clifford G. Robinson
- Washington University, St Louis, MO, USA,Clifford G. Robinson, Department of Radiation Oncology, Washington University School of Medicine, 660 South Euclid Ave, Campus Box #8224, St Louis, MO 63110, USA. Portions of this work were presented as an oral presentation at the American Radium Society meeting in May 2018 in Orlando, FL
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Hillen TJ, Baker JC, Long JR, Friedman MV, Jennings JW. Percutaneous CT-Guided Core Needle Biopsies of Head and Neck Masses: Technique, Histopathologic Yield, and Safety at a Single Academic Institution. AJNR Am J Neuroradiol 2020; 41:2117-2122. [PMID: 32943422 DOI: 10.3174/ajnr.a6784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CT-guided head and neck biopsies can be challenging due to the anatomy and adjacent critical structures but can often obviate the need for open biopsy. A few studies and review articles have described approaches to biopsy in the head and neck. This retrospective study evaluated technical considerations, histopathologic yield, and safety in CT-guided head and neck core needle biopsies. MATERIALS AND METHODS A retrospective review of head and neck biopsies performed from January 2013 through December 2019 was conducted. Clinical diagnosis and indication, patient demographics, mass location and size, biopsy needle type, technical approach, dose-length product, sedation details, complications, diagnostic histopathologic yield, and the use of iodinated contrast were recorded for each case. RESULTS A total of 27 CT-guided head and neck core needle biopsies were performed in 26 patients. The diagnostic sample rate was 100% (27/27). A concordant histopathologic diagnosis was obtained in 93% (25/27) of cases. There was a single complication of core needle biopsy, a small asymptomatic superficial hematoma. CONCLUSIONS Percutaneous CT-guided biopsy of deep masses in the head and neck is safe and effective with careful biopsy planning and has a high diagnostic yield that can obviate the need for open biopsy.
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Affiliation(s)
- T J Hillen
- Mallinckrodt Institute of Radiology (T.J.H., J.C.B., M.V.F, J.W.J.), Musculoskeletal Section, Washington University School of Medicine, St. Louis, Missouri
| | | | - J R Long
- Musculoskeletal Radiology (J.R.L.), Mayo Clinic Arizona, Phoenix, Arizona
| | - M V Friedman
- Mallinckrodt Institute of Radiology (T.J.H., J.C.B., M.V.F, J.W.J.), Musculoskeletal Section, Washington University School of Medicine, St. Louis, Missouri
| | - J W Jennings
- Mallinckrodt Institute of Radiology (T.J.H., J.C.B., M.V.F, J.W.J.), Musculoskeletal Section, Washington University School of Medicine, St. Louis, Missouri
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Garnon J, Jennings JW, Meylheuc L, Auloge P, Weiss J, Koch G, Caudrelier J, Cazzato RL, Bayle B, Gangi A. Biomechanics of the Osseous Pelvis and Its Implication for Consolidative Treatments in Interventional Oncology. Cardiovasc Intervent Radiol 2020; 43:1589-1599. [DOI: 10.1007/s00270-020-02624-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022]
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Garnon J, Jennings JW. Percutaneous Consolidation for Extraspinal Osteolytic Lesions: To Cementoplasty and Beyond. J Vasc Interv Radiol 2020; 31:659-660. [PMID: 32200944 DOI: 10.1016/j.jvir.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 01/20/2023] Open
Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1 place de l'hôpital, 67096 Strasbourg, France.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Long JR, Verhey JT, Sensakovic WF, Flug JA, Stensby JD, Hillen TJ, Jennings JW. Digital Subtraction Air Arthrography: An Innovative Technique for Needle Tip Location Confirmation. Curr Probl Diagn Radiol 2020; 50:485-488. [PMID: 32507654 DOI: 10.1067/j.cpradiol.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE This article describes an innovative technique to confirm needle tip positioning using digital subtraction fluoroscopy and air within a targeted joint. MATERIALS AND METHODS Digital subtraction fluoroscopy with air was utilized to confirm intra-articular needle tip position in 12 joints over a 14-month period at a single institution. Procedural details were recorded for each joint including: joint location, fluoroscopy time, patient age, patient body mass index, and change in subjective pain rating following the injection. Shoulder and hip phantoms were utilized to compare radiation dose differences between fluoroscopy with digital subtraction technique and fluoroscopy without digital subtraction technique. RESULTS All of the 12 injections were technically successful with air clearly visualized within each targeted joint and subjective pain ratings either did not change or decreased following the injection. Patient age ranged from 51 to 87 years old and body mass index values ranged from 19.2 to 37.1 kg/m2. Fluoroscopy times ranged from 11.1 to 32.9 seconds. There were no complications during or immediately following the injections. The addition of digital subtraction technique increased the skin dose at the shoulder by approximately 2.6 times and at the hip by approximately 2.2 times. Likewise, the cumulative dose at the shoulder increased by approximately 2.7 times and at the hip by 2.0 times. CONCLUSION Fluoroscopic digital subtraction air arthrography is a valuable option for needle tip confirmation when using air as a contrast agent. This novel combination of established fluoroscopic techniques can be incorporated into most clinical practices.
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Affiliation(s)
| | | | | | | | | | - Travis J Hillen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
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Long JR, Stensby JD, Wiesner EL, Bryson WN, Hillen TJ, Jennings JW. Efficacy and safety of bone marrow aspiration and biopsy using fluoroscopic guidance and a drill-powered needle: clinical experience from 775 cases. Eur Radiol 2020; 30:5964-5970. [PMID: 32518988 DOI: 10.1007/s00330-020-06987-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of performing a fluoroscopically guided bone marrow aspiration and biopsy (BMAB) using a drill-powered needle in a large patient population. METHODS This retrospective study received institutional review board approval with a waiver of patient informed consent. We identified all BMAB procedures from August 2012 through December 2016 performed at our institution using fluoroscopic guidance and a drill-powered needle. Clinical diagnosis, patient age, patient gender, biopsy site, biopsy needle gauge, bone marrow aspirate volume, bone marrow core biopsy length, patient platelet count, conscious sedation details, complications, and diagnostic adequacy were investigated for each case and summarized. RESULTS A total of 775 BMAB procedures were performed and analyzed. These were performed in 436 female patients and 339 male patients ranging in age between 16 and 91 years (average age of 53 years). Samples obtained from the procedures in our series were diagnostic in 95.0% of cases. The complication rate for our series was 0.3%. CONCLUSIONS The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy is a safe and efficacious procedure. KEY POINTS • Fluoroscopy can be utilized for imaging guidance during bone marrow aspiration and biopsy. • The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy has a high diagnostic yield. • The procedure has an excellent patient safety profile.
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Affiliation(s)
- Jeremiah R Long
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - J Derek Stensby
- University of Missouri, One Hospital Drive, Columbia, MO, 65212, USA
| | - Elizabeth L Wiesner
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - Wesley N Bryson
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - Travis J Hillen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA
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Abstract
This article details an approach for evaluation as well as minimally invasive percutaneous treatment of spinal metastases focusing on thermal ablation and most recent advances. Safe and effective management of certain subgroups of patients with spinal metastases can be achieved by minimally invasive percutaneous thermal ablation with or without vertebral augmentation. Adjunctive palliative treatment options such as epidural or neuroforaminal corticosteroid and long-acting anesthetic injections may also be performed in patients who have nerve and radicular pain including those who are not candidates for thermal ablation. Thermal protection strategies should be implemented to minimize the risk of neural thermal injury.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, Los Angeles, California
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
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Affiliation(s)
- Jack W Jennings
- From the Mallinckrodt Institute of Radiology and Siteman Cancer Center, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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Tomasian A, Jennings JW. Percutaneous minimally invasive thermal ablation for management of osseous metastases: recent advances. Int J Hyperthermia 2019; 36:3-12. [DOI: 10.1080/02656736.2019.1613573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Jack W. Jennings
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, MO, USA
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Naeem M, Maluf H, Baker JC, Jennings JW. Primary osseous sacral neuroblastoma in an adult. Skeletal Radiol 2019; 48:985-988. [PMID: 30269206 DOI: 10.1007/s00256-018-3081-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 02/02/2023]
Abstract
Neoplasms of the sacrum are rare. Given the non-specific imaging findings in sacral lesions, the imaging-based differential diagnosis is always difficult. This case is about an adult with primary sacral neuroblastoma and we have discussed imaging and histopathological findings of this rare tumor.
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Affiliation(s)
- Muhammad Naeem
- Musculoskeletal Imaging and Interventions Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Horacio Maluf
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan C Baker
- Musculoskeletal Imaging and Interventions Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jack W Jennings
- Musculoskeletal Imaging and Interventions Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA. .,Division of Musculoskeletal Imaging and Interventions, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus box 8131, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA.
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Affiliation(s)
- Jack W. Jennings
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, Siteman Cancer Center, 510 S Kingshighway Blvd, St Louis, MO 63110
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Wallace AN, Robinson CG, Meyer J, Tran ND, Gangi A, Callstrom MR, Chao ST, Van Tine BA, Morris JM, Bruel BM, Long J, Timmerman RD, Buchowski JM, Jennings JW. The Metastatic Spine Disease Multidisciplinary Working Group Algorithms. Oncologist 2019; 24:424. [PMID: 30867318 PMCID: PMC6519761 DOI: 10.1634/theoncologist.2015-0085err] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tomasian A, Hillen TJ, Jennings JW. Percutaneous CT-Guided Skull Biopsy: Feasibility, Safety, and Diagnostic Yield. AJNR Am J Neuroradiol 2019; 40:309-312. [PMID: 30655252 DOI: 10.3174/ajnr.a5949] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/08/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Although percutaneous musculoskeletal biopsies are routinely performed in the axial and appendicular skeleton, there are no published data on the systematic evaluation of the feasibility, safety, and diagnostic accuracy of percutaneous skull biopsy. In certain clinical encounters such as patients with primary skull tumors or patients with known cancer and isolated skull lesions suspected of calvarial metastasis or synchronous primary tumor, percutaneous skull biopsy may be considered a viable option. The purpose of this study was to evaluate the feasibility, safety profile, and diagnostic yield of percutaneous CT-guided skull biopsy. MATERIALS AND METHODS Percutaneous CT-guided skull biopsy was performed in 14 patients. Patient demographics, cancer history, indication for initial imaging, imaging technique of diagnosis, skull tumor anatomic location, and final histologic diagnosis were documented. Preprocedural imaging of each skull lesion was reviewed to determine tumor size and characteristics. Procedural notes were reviewed to determine the total conscious sedation time or anesthesia time, type of biopsy needle, and the number and length of obtained core specimens. Procedure-related complications were also documented according to the Society of Interventional Radiology classification. RESULTS All CT-guided percutaneous skull biopsy procedures were performed as preoperatively planned and were technically successful. Procedures were performed with the patient under conscious sedation in 93% (13/14) of cases. Definitive histologic diagnosis was achieved in 86% (12/14) of cases. There were no acute or delayed procedure-related complications. CONCLUSIONS The results of this retrospective initial study suggest that percutaneous CT-guided skull biopsy is feasible with an excellent safety profile, affords a high diagnostic yield for histologic characterization, and may obviate more invasive open skull biopsies.
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Affiliation(s)
- A Tomasian
- From the Department of Radiology (A.T.), University of Southern California, Los Angeles, California
| | - T J Hillen
- Mallinckrodt Institute of Radiology (T.J.H., J.W.J.), St. Louis, Missouri
| | - J W Jennings
- Mallinckrodt Institute of Radiology (T.J.H., J.W.J.), St. Louis, Missouri
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Tomasian A, Jennings JW. Percutaneous Radiofrequency Ablation of Spinal Osteoid Osteomas Using a Targeted Navigational Bipolar Electrode System. AJNR Am J Neuroradiol 2018; 39:2385-2388. [PMID: 30361430 DOI: 10.3174/ajnr.a5831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/24/2018] [Indexed: 11/07/2022]
Abstract
Safe and effective percutaneous CT-guided radiofrequency ablation of spinal osteoid osteomas can be performed using a targeted navigational bipolar electrode system. Articulating bipolar electrodes with built-in thermocouples along an electrode shaft and variable generator wattage settings allow optimal nidus access, particularly in challenging locations; provide precise real-time monitoring of ablation zone volume and geometry; and minimize the risk of undesired thermal injury.
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Affiliation(s)
- A Tomasian
- From the Department of Radiology (A.T.), University of Southern California, Los Angeles, California
| | - J W Jennings
- Mallinckrodt Institute of Radiology (J.W.J.), St. Louis, Missouri
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