Spine Cryoablation: A Multimodality Image-Guided Approach for Tumors Adjacent to Major Neural Elements

We report percutaneous cryoablation of spine tumors in 7 consecutive patients (5 men, 2 women [mean age, 47 years; range, 17-68 years]) by using intraprocedural image monitoring of ice ball margins to protect adjacent neural elements. Complete tumor ablation was achieved in all patients without neurologic complication. Pain relief was achieved in 4 of 5 (80%) patients; the patient with persistent pain was later found to have enlarging metastases at other sites.

Solid and papillary epithelial neoplasm of the pancreas: MR imaging findings

We present the magnetic resonance imaging (MRI) findings in a young patient with histological proven solid and papillary epithelial neoplasm of the pancreas. Although the appearance of this tumor at MRI can be useful in making a correct preoperative diagnosis, only few cases describing its MRI features have been reported in the radiological literature.

MR imaging-guided percutaneous cryotherapy of liver tumors: initial experience

PURPOSE

To describe the cryoablation of liver tumors by using a percutaneous approach and intraprocedural magnetic resonance (MR) imaging monitoring and to assess the feasibility and safety of the procedure.

MATERIALS AND METHODS

Fifteen hepatic tumors (mean diameter, 2.9 cm) in 12 patients were treated (18 total cryoablations). Fourteen were metastases and one was a hemangioma; all were proved at biopsy. By using a 0.5-T open MR imaging system, cryoneedles were placed and lesions ablated by using real-time monitoring. Clinical signs and symptoms were assessed and laboratory tests performed. Intraprocedural depictions of iceballs were compared with contrast material-enhanced MR imaging-based estimates of cryonecrosis that were obtained 24 hours after cryoablation.

RESULTS

MR imaging-guided percutaneous cryotherapy resulted in no serious complications and no clinically important changes in serum liver enzymes or creatinine or myoglobin levels. Intraprocedural MR imaging demonstrated iceballs as sharply marginated regions of signal loss that expanded and engulfed tumors. The maximal iceball size was 4.9 x 2.2 x 2.2 cm with the use of one cryoneedle and 6.0 x 5.6 x 4.9 cm with three cryoneedles. Intraprocedural iceball depictions correlated well with postprocedural cryonecrosis estimates.

CONCLUSION

MR imaging-guided percutaneous cryotherapy of liver tumors is feasible and safe. MR imaging can be used to estimate cryotherapy effects and guide therapy intraprocedurally.

Transperineal magnetic resonance image guided prostate biopsy

PURPOSE

We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy.

MATERIALS AND METHODS

Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a single core from each MRI defined lesion. The patient had previously undergone proctocolectomy for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful.

RESULTS

The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 + 3 = 6 adenocarcinoma was confirmed in 15% and 25% of the 2 cores obtained from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient.

CONCLUSIONS

Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.

Patient and personnel exposure during CT fluoroscopy-guided interventional procedures

PURPOSE

To estimate patient dose and personnel exposure from phantom measurements during computed tomographic (CT) fluoroscopy, to use the estimates to provide users with dose information, and to recommend methods to reduce exposure.

MATERIALS AND METHODS

Surface dose was estimated on a CT dosimetric phantom by using thermoluminescent dosimetric (TLD) and CT pencil chamber measurements. Scatter exposure was estimated from scattered radiation measured at distances of 10 cm to 1 m from the phantom. Scatter exposures measured with and without placement of a lead drape on the phantom surface adjacent to the scanning plane were compared.

RESULTS

Phantom surface dose rates ranged from 2.3 to 10. 4 mGy/sec. Scattered exposure rates for a commonly used CT fluoroscopic technique (120 kVp, 50 mA, 10-mm section thickness) were 27 and 1.2 microGy/sec at 10 cm and 1 m, respectively, from the phantom. Lead drapes reduced the scattered exposure by approximately 71% and 14% at distances of 10 and 60 cm from the scanning plane, respectively.

CONCLUSION

High exposures to patients and personnel may occur during CT fluoroscopy-guided interventions. Radiation exposure to patients and personnel may be reduced by modifying CT scanning techniques and by limiting fluoroscopic time. In addition, scatter exposure to personnel may be substantially reduced by placing a lead drape adjacent to the scanning plane.

CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure

PURPOSE

To evaluate the benefits of computed tomographic (CT) fluoroscopy-guided interventions and assess radiation exposures incurred with CT fluoroscopy.

MATERIALS AND METHODS

A 6-month period of use of CT fluoroscopy to guide abdominal biopsy procedures and catheter drainage was analyzed. Efficacy measures and needle placement and procedure room times were compared with those of the preceding 6 months during which conventional CT was used. CT fluoroscopic times and estimated radiation exposures were compared for two CT fluoroscopic methods.

RESULTS

The sensitivity and negative predictive values for biopsy procedures and the success rate for needle aspiration or catheter drainages for CT fluoroscopy--98%, 86%, and 100%, respectively--were not significantly different from those for conventional CT--95%, 80%, and 97%, respectively. Room time was not reduced significantly, but mean needle placement time for CT fluoroscopy (29 minutes; n = 95) was significantly lower than that for conventional CT (36 minutes; n = 93; P < .005). The mean patient dose index was 74 cGy. Limiting CT fluoroscopy to scanning the needle tip rather than scanning the entire needle pass significantly reduced the dose to the patient and the operator.

CONCLUSION

Although CT fluoroscopy is a useful targeting technique, significant radiation exposures may result. Therefore, radiologists need to be aware of different methods of CT fluoroscopic guidance and the factors that contribute to radiation exposure.