Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient's Experience and Pain Outcome.

Background and objectives: To assess the pain relief of bipolar RFA combined or not with vertebroplasty in patients with painful vertebral metastases and to evaluate the feasibility and tolerance of the RFA procedure performed under local anesthesia. Materials and Methods: 25 patients (18 men, 7 women, mean age: 60.X y.o) with refractory painful vertebral metastasis were consecutively included between 2012 and 2019. A total of 29 radiofrequency ablation (RFA) procedures were performed under CT guidance, local anesthesia and nitrous oxide inhalation, including 16 procedures combined with vertebroplasty for bone consolidation purposes. Pain efficacy was clinically evaluated using the visual analogue scale (VAS) at day 1, 1 month, 3 months, 6 months and 12 months, and the tolerance of the procedure was evaluated. Results: Procedure tolerance was graded as either not painful or tolerable in 97% of cases. Follow-up postprocedure mean VAS score decrease was 74% at day 1: 6.6 (p < 0.001), 79% at 1 month: 6.6 (p < 0.001), 79% at 3 months: 6.5 (p < 0.001), 77% at 6 months, and 79% at 12 months: 6.6 (p < 0.001). Conclusions: Bipolar RFA, with or without combined vertebroplasty, appears to be an effective and reliable technique for the treatment of refractory vertebral metastases in patients in the palliative care setting. It is a feasible procedure under local anesthesia which is well tolerated by patients therefore allowing to broaden the indications of such procedures. Field of study: interventional radiology.

Prostate cancer diagnosis: Efficacy of a simple electromagnetic MRI-TRUS fusion method to target biopsies.

OBJECTIVE: To assess that transrectal ultrasound guidance (TRUS) targeted biopsies (TB) aimed with an easy to use electronic real-time fusion registration device have a higher rate of prostate cancer (PC) detection than standard biopsies (SB). MATERIAL AND METHODS: This prospective study included 130 patients referred for TRUS biopsies after suspicious MRI. They underwent 16-core SB and 2 to 3 cores in each MRI suspicious area, using a fusion software. We noted SB and TB positivity for PC and Gleason score (GS). We used the McNemar test to compare SB and TB, with a statistical significance p<0.05. RESULTS: Among 130 patients, 68.5% had PC. Additional time due to the fusion registration was 3.3 min. One hundred fifteen patients (88.4%) had pathological findings on the histological analysis (prostate cancer n=89, others n=26). TB diagnosed PC in 75 patients with negative SB. Positivity rate for PC was significantly higher for TB than SB (p=0.03). Among highly suspicious MRI lesions, detection rate of histological abnormalities using SB and TB was 96% with 79.7% of PC. Most PC that TB diagnosed alone were clinically significant (86.3%). CONCLUSION: TRUS biopsies performed with a simple MRI and US electronic fusion is an unrestrainedly method to increase PC diagnosis.

DWI in the Etiologic Diagnosis of Excretory Upper Urinary Tract Lesions: Can It Help in Differentiating Benign From Malignant Tumors? A Retrospective Study of 98 Patients.

OBJECTIVE: The objective of this study was to evaluate the diagnostic performance of high-field DWI in distinguishing benign from malignant lesions of the upper urinary tract (UUT). MATERIALS AND METHODS: Ninety-eight patients who underwent 3-T DWI (b = 1000 s/mm(2)) for assessment of a UUT lesion were retrospectively included in the study. Data on the size, location, and mean apparent diffusion coefficient (ADC) value of the lesions were collected and correlated with the final diagnosis. ROC curve analysis was used to determine the best threshold value of the mean ADC for characterization of the lesions. RESULTS: A total of 66 carcinomas and 33 benign lesions were identified. The mean (± SD) ADC value was statistically significantly lower for the malignant lesions than for the benign lesions (0.984 ± 0.048 vs 1.536 ± 0.067 × 10(-3) mm(2)/s; p = 0.000007). For characterization of malignant lesions, the best cutoff ADC value on the ROC curve was found to be less than or equal to 0.996 10(-3) mm(2)/s. On the basis of this value, the sensitivity and specificity of 3-T DWI for the identification of malignant UUT lesions were 78.3% and 95.5%, respectively, with a positive predictive value of 94.7% and a negative predictive value of 80.8% (p = 0.0001). The thickness of the smallest lesion was 3 mm. The mean ADC value of high-grade tumors was not statistically significantly lower than that of low-grade tumors. The best cutoff value for predicting benignancy was greater than or equal to 1.100 × 10(-3) mm(2)/s with sensitivity of 90.9%, specificity of 82.6%, positive predictive value of 83.3%, and negative predictive value of 90.5%. CONCLUSION: The ADC measurement is a useful additional parameter in the differentiation of benign from malignant UUT lesions.

Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome.

OBJECTIVE: Objectives were to study the MRI appearance of the repaired distal biceps tendon (DBT), anatomically reinserted, and to search for a correlation between tendon measurements and functional results. MATERIALS AND METHODS: Twenty-five patients (mean age, 49 ± 4.9 years old) who benefited from 3-T MRI follow-up of the elbow after surgical reinsertion of the DBT were retrospectively included and compared to a control group (n = 25; mean age, 48 ± 10 years old). MRI was performed during the month of clinical follow-up and on average 22 months after surgery. Delayed complications (secondary avulsion, new rupture), intratendinous osteoma, tendinous signal on T1-weighted (T1w) and fat-suppressed proton density-weighted (FS-PDw) images as well as DBT measurements were recorded. The maximum isometric elbow flexion strength (MEFS) and range of motion of the elbow were assessed. RESULTS: Repaired DBT demonstrated a heterogeneous but normally fibrillar structure. Its low T1w signal was less pronounced than that of normal tendons, and the FS-PDW image signal was similar to that of T1w images. MRI detected seven osteomas (Se = 53 % vs. plain radiography), one textiloma and one secondary avulsion. Repaired DBT measurements were significantly correlated with MEFS (dominant arm R2: 0.38; nondominant arm R2: 0.54); this correlation involved the insertion surface (Δ = -75.7 mm(2), p = 0.046), transverse diameter (Δ = -2.6 mm, p = 0.018), anteroposterior diameter at the level of the radial head (Δ = -3.9 mm, p = 0.001) and DBT cross-sectional area (Δ = -50.2 mm(2), p = 0.003). CONCLUSION: The quality of functional outcome after anatomical elbow rehabilitation of DBT correlates with the extent of tendinous hypertrophy during the healing process.

Treatment of painful extraspinal bone metastases with percutaneous bipolar radiofrequency under local anesthesia: feasibility and efficacy in twenty-eight cases.

PURPOSE: To retrospectively assess the feasibility and efficacy of bipolar radiofrequency ablation (RFA) of extraspinal osseous neoplasms performed under local anesthesia. METHODS AND MATERIALS: Twenty-eight patients (21 males, 7 females; mean age, 61.2 years) underwent RFA under local anesthesia between 2005 and 2012. All included patients suffered from painful osseous metastases refractory to previous medication; all presented with end-stage neoplasms. RFA was performed under computed tomography (CT) guidance with bipolar radiofrequency probes. All procedures were performed under local anesthesia (lidocaine-ropivacaine) and nitrous oxide ventilation. Intravenous injection of paracetamol was performed throughout the procedure with or without intravenous injection of nalbuphin. Tolerance of procedure was recorded. Pain efficacy was evaluated on visual anologue scale (VAS) scores at day 7, 1 month, and at 6 months after the procedure. RESULTS: Technical success rate was 100%. The procedure was considered not painful in 4 cases and tolerable in 20 cases. Average procedural time was 23.1 minutes. Mean VAS score prior to RFA was 8.1/10. Significant decrease of pain was noted at day 7 (3.3/10, p<0.001, n=27), 1 month (3.8/10, p<0.001, n=27), and 6 months (4.5/10, p<0.001, n=13). No complications were noted. CONCLUSION: Bipolar RFA of osseous metastases is a safe and effective treatment for refractory bone metastases. Its feasibility under local anesthesia should broaden the indications.

Analgesic effects of microwave ablation of bone and soft tissue tumors under local anesthesia.

OBJECTIVE: To assess the feasibility and efficacy of microwave ablation (MWA) of painful refractory bone and soft tissue tumors performed under local anesthesia. STUDY DESIGN: A retrospective study between 2011 and 2013. SETTING: A single center, Academic Interventional Pain Management Unit. SUBJECTS: Fifteen patients with 25 refractory painful bone (N = 19) or soft tissue (N = 6) tumors treated with MWA were consecutively included. METHOD: Local Institutional Review Board approval was obtained, and written informed consent was waived. Lesions included spinal (N = 3), sacral (N = 4), and extraspinal (N = 18) locations. Pain was measured on a visual analog scale (VAS) from 0 to 10 before and immediately after procedure, at 1 week, and on a monthly basis following procedure. MWA procedures were always performed under computed tomography guidance and local anesthesia along with nitrous oxide inhalation. RESULTS: Mean ablation time was 4.09 minutes (range 1-11) with an average of 4.2 cycles with a mean ablation power of 60 W. Preprocedure mean VAS score was 7.2 ± 0.97 (range 6-9). Follow-up postprocedure VAS scores were as follows: day 0: 1.64 ± 1.86, day 7: 1.82 ± 1.79, month 1: 2.05 ± 2.03 (14/15 patients), month 3: 2.13 ± 1.81, month 6: 2.36 ± 2.17; and were statistically significant (P < 0.001). Mean pain relief was 5.5 months. CONCLUSION: MWA is feasible, safe, and effective in the management of painful refractory bone and soft tissue tumors. It may therefore be considered as a potential alternative to existing percutaneous ablation techniques in the management of bone and soft tissue tumors.