Non-enhanced MR angiography of renal arteries: comparison with contrast-enhanced MR angiography.

BACKGROUND: The main causes of renal artery stenosis (RAS) are atherosclerosis and fibromuscular dysplasia. Despite contrast-enhanced magnetic resonance angiography (CE-MRA) being a safe and reliable method for diagnosis of RAS especially in young individuals, recently it has been possible to adopt innovative technologies that do not require paramagnetic contrast agents. PURPOSE: To assess the accuracy of steady-state free-precession (SSFP) non-contrast-enhanced magnetic resonance angiography (NC-MRA) by using a 1.5 T MR scanner for the detection of renal artery stenosis, in comparison with breath-hold CE-MRA as the reference standard. MATERIAL AND METHODS: Sixty-three patients (33 men, 30 women) with suspected renovascular hypertension (RVHT) were examined by a 1.5T MR scanner; NC-MRA with an electrocardiography (ECG)-gated SSFP sequence was performed in 58.7% (37/63) of patients; in 41.3% (26/63) of patients a respiratory trigger was used in addition to cardiac gating. CE-MRA, with a three-dimensional gradient echo (3D-GRE) T1-weighted sequence, was performed in all patients within the same session. Maximum intensity projection (MIP) image quality, number of renal arteries, and the presence of stenosis were assessed by two observers (independently for NC-MRA and together for CE-MRA). The agreement between NC-MRA and CE-MRA as well as the inter-observer reproducibility were calculated with Bland-Altman plots. RESULTS: MIP image quality was considered better for NC-MRA. NC-MRA identified 143 of 144 (99.3%) arteries detected by CE-MRA (an accessory artery was not identified). Fourteen stenoses were detected by CE-MRA (11 atherosclerotic, 3 dysplastic) with four of 14 (28.5%) significant stenosis. Bland-Altman plot demonstrated an excellent concordance between NC-MRA and CE-MRA; particularly, the reader A evaluated correctly all investigated arteries, while over-estimation of two stenoses occurred for reader B. Regarding NC-MRA, inter-observer agreement was excellent. CONCLUSION: NC-MRA is a valid alternative to CE-MRA for the assessment of renal arteries.

Removable vena cava filter: single-centre experience with a single device.

PURPOSE: The aim of our study was to evaluate the safety of retrieving both short- and long-term permanent/ retrievable ALN vena cava filters (VCF). MATERIALS AND METHODS: From 2002 to 2010, 201 permanent/retrievable VCF were percutaneously placed in 201 patients (age range, 18-80 years). Sixty-seven were placed through the jugular vein, 61 through the brachial vein and 63 through the femoral vein. In 109 patients, the VCF was placed for absolute indications, in 77 for relative indications, and in 15 for temporary filtration. Follow-up was carried out with colour Doppler ultrasound (CDUS) and abdominal X-ray at 3 and 12 months, then annually. Indications for removal included: lack of contraindications to anticoagulant therapy, absence of pulmonary embolism and iliocaval venous patency. All candidates for VCF removal underwent computed tomography angiography (CTA). RESULTS: VCF placement with correct position (tilting up to 15°) was achieved in 99.01% of cases. In two (0.99%) cases, tilting >15° was present. Haematomas, which resolved spontaneously, occurred in only eight jugular access sites. A total of 26 of 201 VCF were removed, with 96.16% technical success. The removal procedure failed in one case only. In seven cases, a double approach through the right jugular and femoral veins was necessary. VCF was removed 6 months after deployment in 11 patients, 12 months in eight, 24 months in four after 36 months in three (range, 180-1,155 days.) There were no periprocedural complications. Of the 26 removed VCF, 21 were infrarenal and five suprarenal. Of the 15 VCF placed for temporary use, 12 were removed; the remaining three not removed owing to persistence of the neoplastic thrombus after nephrectomy for kidney cancer. Of the 186 VCF placed for permanent use, with absolute and relative indications, 14 were removed (4/109 and 10/77, respectively). Only one showed thrombi occluding the cranial end. CONCLUSIONS: VCF removal is certainly more difficult than placement. Technical failure of the removal procedure is directly proportional to the VCF tilt, and the VCF is as yet unable to ensure absolute removal safety, with the result that failure may occasionally occur. The morphological and structural features of permanent/retrievable VCF allow for unlimited time from placement to removal, documented to be up to 3 years after placement.

Radiofrequency ablation for single lung tumours not suitable for surgery: seven years' experience.

PURPOSE: This study was done to review recurrence patterns in patients with lung cancer (primary or secondary) treated with percutaneous image-guided radiofrequency (RF) ablation. MATERIALS AND METHODS: From January 2003 to August 2010, 32 patients (24 with primary non-small-cell lung cancer and eight with metastases) with single lung cancer were treated with RF ablation. Post-treatment imaging results were available for each patient. Follow-up was performed using computed tomography (CT) scans at 1, 3, 6, 12, 18 and 24 months after the procedure and annually thereafter. Patterns of recurrence were classified as local, intrapulmonary, nodal, mixed and distant. We evaluated overall survival after RF ablation and the factors associated with recurrence. RESULTS: Seventeen (53.1%) patients showed no evidence of recurrence at follow-up imaging (range 12-72 months; mean, 32.5 months). Recurrence was seen in 15 (46.9 %) patients (range 6-36 months; mean 14.8 months). Local recurrence (40%) after RF ablation was the most frequent. Median disease-free survival was 20 months. Sex, tumour location, tumour size and tumour stage were not associated with a risk of recurrence. Patient age was related to the risk of recurrence (p<0.05). CONCLUSIONS: Local recurrence is the most common pattern in our series. A more aggressive initial RF ablation might offer improvement in outcomes, but this hypothesis needs to be confirmed by larger studies involving a larger number of patients.

Suprarenal inferior vena cava filter implantation.

PURPOSE: This study evaluated the feasibility, safety, and efficacy of the suprarenal implantation of a retrievable filter in patients with renal cell carcinoma (RCC) and renal vein thrombosis (RVT) [extending or not extending to the inferior vena cava (IVC)] undergoing surgery. MATERIALS AND METHODS: Between March 2005 and May 2010, 13 patients (eight men and five women; mean age 67.08 years, range 38-95) with RCC and RVT associated or not with IVC thrombosis underwent implantation of a retrievable suprarenal IVC filter. All patients underwent computed tomography angiography (CTA), which documented RVT and in some cases its extension to the IVC. The level of IVC involvement by the neoplastic thrombus was evaluated on the basis of the Oto classification. Cavography was performed before and after filter implantation. Surgical resection of RCC was performed in all patients. A CTA scan was performed 1 week before filter removal. RESULTS: The procedure had 100% feasibility. All filters were correctly deployed in the suprarenal tract of the IVC. There was no evidence of peri-or postprocedural complications. All patients were monitored for clinical symptoms of pulmonary embolism (PE). There was no evidence of PE in the 30 days after the procedure. All suprarenal IVC filters were removed from 30 to 60 days after surgery. CONCLUSIONS: Implantation of a temporary suprarenal IVC filter is an additional and feasible procedure that can prevent immediate and perioperative PE.

Initial experience with percutaneous biopsies of bone lesions using XperGuide cone-beam CT (CBCT): technical note.

PURPOSE: This paper describes our preliminary experience with percutaneous bone biopsy under XperGuide conebeam computed tomography (CBCT) guidance. MATERIALS AND METHODS: Seventeen patients (11 men and 6 women; mean age 57.8; range 17-81) with 17 bone lesions underwent biopsy with XperGuide CBCT (Philips Medical System, Best, The Netherlands). The mean diameter of the lesions was 2.32 cm (range 1-8 cm). Technical success (defined as the correct positioning of the needle within the lesion), diagnostic accuracy, sensitivity and specificity were evaluated. Complication rate was also recorded. RESULTS: The technical success rate was 100%. In 15 patients, a sample of adequate material for histopathological analysis to yield a definitive diagnosis was obtained; in two patients, the sample was inadequate for a definitive diagnosis. In one of these two cases, the lesion was closely followed up for 1 year, during which it remained stable in size, and as a result, it was considered a false positive; the other was considered a false negative. Diagnostic accuracy, sensitivity and specificity were 94.12%, 90.91% and 100%, respectively. No major complications were recorded; only one patient had slight bleeding, with a consequent small haematoma, which reabsorbed in about 15 days. CONCLUSIONS: Bone biopsy under XperGuide CBCT guidance can be considered accurate as a result of the combination of real-time needle orientation and spatial resolution of CT fluoroscopy. Moreover, our results are encouraging in terms of complication rate, diagnostic accuracy, sensitivity, specificity and reduction of CT workload.

Percutaneous cholecystostomy as the sole treatment in critically ill and elderly patients.

PURPOSE: This study was done to investigate the effectiveness and clinical outcome of percutaneous cholecystostomy (PC) of treating acute cholecystitis in critical ill and elderly patients. MATERIALS AND METHODS: In the last 3 years, PC was performed on 30 elderly and critically ill patients (17 men, 13 women; mean age 78.6, range 57-97 years) with acute cholecystitis and comorbid diseases. RESULTS: Technical success was 30/30 (100%). Clinical effectiveness was 30/30 (100%), with statistically significant reductions in while blood cell (WBC) count, C-reactive protein (CRP) and fever. Mean WBC upon admission (19.87×10(3)±1.61×10(3) /µl), axillary temperature (38.2±0.11 °C), and CRP (248.7±4.76 mg/l) values were significantly decreased in the 72 h following PC [12.9×10(3) ± 1.05×10(3)/µl (p≤0.0001), 37 ± 0.04 °C (p≤0.0001), 113.5 ± 3 mg/l (p≤0.0001), respectively]. Clinical and ultrasonographic (US) signs of acute cholecystitis decreased in all patients. There were no major complications or procedure-related deaths, and the morbidity rate was low (3/30; 10%). CONCLUSIONS: PC appears to be a fast, easy and effective treatment for the acute phase of cholecystitis in elderly and critically ill patients. Procedure-related morbidity and mortality rates are very low compared with surgery. Conservative treatment for patients who are not eligible for surgery is acceptable.

Upper urinary tract biopsy: an old device for a new approach.

PURPOSE: The authors sought to evaluate the feasibility, diagnostic accuracy and safety of urological biopsy performed using a flexible alligator forceps. MATERIALS AND METHODS: Twenty-seven patients with suspected urothelial malignancy underwent retrograde biopsy using a 7-F biopsy forceps (Cordis, Miami, FL, USA). Mild sedation was guaranteed by an anaesthesiologist. The final diagnosis was confirmed by cytohistological data and subsequently by pathology findings at surgery. Lesions with benign histopathology were closely monitored for at least 12 months. RESULTS: The technical success rate was 92.6%. The high diagnostic accuracy was related to the positive correspondence between histological outcomes and surgical results or follow-up observations. As regards sample site, the procedure was less successful in calyceal lesions than in lesions located in the upper urinary tract, with a technical success of 71.43%. Twenty patients had asymptomatic haematuria in the early hours after the procedure; ten of them had mild dysuria. No one require medication, and no major complications occurred. CONCLUSIONS: Urological forceps biopsy is a safe and easy procedure. It provides a relatively high level of accuracy in the diagnosis of lesions of the upper urinary tract.

Complications of microwave and radiofrequency lung ablation: personal experience and review of the literature.

PURPOSE: Complications correlated with percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of lung tumours were retrospectively reviewed to compare them with data from the literature and to assess risk factors related with the procedures. MATERIALS AND METHODS: From January 2003 to January 2009, 29 patients (36 lung lesions) were treated with RFA; from January 2007 to January 2009, 16 patients (17 lung lesions) were treated with MWA. Complications recorded at our institution are reported following the Society of Interventional Radiology guidelines. A systematic review of the literature was performed. RESULTS: Any major complication of RFA or MWA was recorded. In agreement with the literature, pneumothorax was the most frequent complication, even though the incidence in our series was lower than reported in the literature (3.5% vs. 4.3-18%). Other complications of RFA were pleural effusion and subcutaneous emphysema. No massive haemorrhages, haemoptysis, abscesses, pneumonia, infections or tumour seeding were recorded in our series. The most common complication of MWA was pneumothorax (25% vs. 39% reported in the literature). Pleural effusion was a common reaction, but therapeutic drainage was never required. CONCLUSIONS: Pneumothorax is the most common complication of both techniques. RFA and MWA are both excellent choices in terms of safety and tolerance.

Ultrasound-guided thermal radiofrequency ablation (RFA) as an adjunct to systemic chemotherapy for breast cancer liver metastases.

PURPOSE: The aim of this study was to evaluate the effectiveness of radiofrequency thermal ablation (RFA) of liver metastases from breast cancer and its impact on survival. MATERIALS AND METHODS: Thirteen female patients (age range 36-82 years; median 54.5 years) underwent RFA for the treatment of 21 liver metastases from breast cancer. The procedures were performed under ultrasound (US) guidance using an RF 2000 or RF 3000 generator system and Le Veen monopolar needle electrodes. Follow-up was carried out by computed tomography (CT) after 1, 3, 6 and 12 months. RESULTS: Technical success was 100%. No major or minor complications occurred at the end of the procedure. In our series, 7/21 lesions in 7/13 patients increased in size at 7, 18, 19 and 38 months. This resulted in a mean disease-free interval of 16.6 months. Mean overall survival after RFA was 10.9 months. CONCLUSIONS: RFA appears to be a useful adjunct to systemic chemotherapy and/or hormone therapy in the locoregional treatment of hepatic metastases from breast cancer. RFA may also be a less invasive alternative to surgery in the locoregional treatment of liver metastases from breast cancer.

Comparison between MRI with spin-echo echo-planar diffusion-weighted sequence (DWI) and histology in the diagnosis of soft-tissue tumours.

PURPOSE: Our aim was to assess the usefulness of magnetic resonance imaging (MRI) with spin-echo echo-planar diffusion-weighted sequences (SE-EPI-DWI) in the study of primary and secondary soft-tissue tumours by correlating the results of imaging and histology. MATERIAL AND METHODS: We retrospectively studied 23 patients (14 men, 9 women; age range 25-87 years) affected by soft-tissue lesions. The MRI study was performed with baseline and contrast-enhanced SE-T1, proton density/T2-weighted (PD/T2), fat-saturated (FATSAT) DP/T2 and single-shot SE-EPI-DWI (b value 50-400- 800s/mm2) sequences. RESULTS: We identified 7/23 benign lesions (three myxoid, four nonmyxoid) and 16/23 malignant tumours (four myxoid, 12 nonmyxoid) with a mean diameter between 21 mm and 20 cm. Qualitative analysis of DWI showed persistence of high signal intensity for increasing b-values in all malignant tumours. Quantitative DWI analysis of the apparent diffusion coefficient (ADC) maps showed a statistical difference between benign and malignant lesions. CONCLUSIONS: In our experience, DWI with qualitative and quantitative analysis correlated well with histology.

Recurrence of intracardiac large B-cell non-Hodgkin's lymphoma (NHL) encasing and nearly obliterating the right coronary artery: a case report.

Among malignant tumors of the heart, primary malignant lymphomas are unusual and they are typically non-Hodgkin's B-cell cancers. A 73-year-old man affected by non-Hodgkin lymphoma (NHL) treated with four cycle of chemotherapy and radiotherapy was admitted to the Emergency Department for chest pain. Echocardiography showed a mass inside the right ventricle obstructing blood outflow in the pulmonary artery. The ECG-gated angio-multidetector computed tomography (MDCT) examination confirmed a solid mass in the right ventricle encasing the proximal-middle tract of the right coronary artery (RCA); RCA stenosis was confirmed by coronary angiography. After trans-thoracic CT-guided biopsy the mass was characterized as a recurrence of NHL and the patient started a new cycle of chemotherapy. After 15 days a MDCT exam showed both mass reduction and absence of RCA significant stenosis. MDCT imaging allows an accurate assessment of tumour extension and it represents an useful guide during biopsy procedures, necessary for a precise histological characterization of neoplasms.

Microwave ablation therapy for treating primary and secondary lung tumours: technical note.

PURPOSE: The purpose of our study was to retrospectively evaluate the feasibility, safety and effectiveness of microwave ablation (MWA) in nine patients with unresectable lung tumour. MATERIALS AND METHODS: Ten lesions were treated in ten ablation sessions in nine patients. The treatments were performed with a microwave generator with 45 W and 915 MHz connected to a 14.5-gauge antenna for 10 min. Antenna placement was performed with computed tomography (CT) fluoroscopy guidance or XperGuide. All patients underwent CT follow-up at 1, 3 and 6 months from the procedure. RESULTS: Technical success was obtained in all cases; mortality at 30 days was 0%. CONCLUSIONS: This study shows that in selected patients, MWA is a valid alternative to other ablative techniques. Further studies are required to demonstrate the short- and long-term effects of this technique and to make a comparison with other available ablation systems, especially with radiofrequency.

Hybrid treatment of isolated aortic arch aneurysms.

PURPOSE: This study sought to assess the feasibility and effectiveness of hybrid treatment of isolated aortic arch aneurysms. MATERIALS AND METHODS: Between December 2000 and December 2006, we selected 14 patients affected by 14 isolated aortic arch aneurysms. All patients had involvement of the left subclavian artery, four of the innominate artery and four of the left carotid artery. All patients underwent intentional exclusion of the left subclavian artery and placement of a straight graft; four patients underwent supra-aortic vessel transposition and four underwent carotid-carotid bypass in one case combined with carotid-subclavian bypass. The procedures were planned with multislice computed tomography (MSCT), in some cases associated with virtual endoscopy. The follow-up was performed with MSCT angiography at 1, 3, 6 and 12 months and yearly thereafter. RESULTS: Immediate technical success was achieved in 100% of cases. There were four ischaemic attacks (three transient ischaemic attacks and one stroke). During follow-up (range 12-48, average 21 months), we observed two type-I endoleaks that were treated by endograft extension, in one case associated with supra-aortic vessel transposition, and two type-II endoleaks that were treated with embolisation. CONCLUSIONS: Hybrid treatment for aortic arch aneurysms is feasible and provides good short-term results, although it requires accurate planning. Further studies are needed to verify the long-term results.

Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience.

PURPOSE: The treatment of pain in bone metastases is currently multidisciplinary. Among the various therapies, local radiotherapy is the gold standard for pain palliation from single metastasis, even though the maximum benefit is obtained between 12 and 20 weeks from initiation. In carefully selected patients, several ablation therapies achieve this objective in 4 weeks. The purpose of this study was to assess the technical success, effectiveness and possible complications of percutaneous ablation therapies in patients with symptomatic bone metastases. MATERIALS AND METHODS: From November 2003 to May 2008, ten ablation treatments were performed in ten patients with acute pain from metastatic bone lesions. Patient selection and choice of the most appropriate ablation treatment was made based on lesion characteristics. Three patients were treated with radiofrequency, one with plasma-mediated radiofrequency, two with plasma-mediated radiofrequency and cementoplasty, three with radiofrequency and cementoplasty and one with microwave. RESULTS: Assessments were based not only on imaging but also on the visual analogue scale (VAS) score for determining pain and on changes in morphine-equivalent doses. In both cases, 3-month follow-up showed a statistically significant reduction of pain. In no case did local complications occur either during or after treatment. Only one patient treated with radiofrequency (1/9, 11%) developed low-grade fever and general malaise during the 6 days following the procedure, compatible with a post-radiofrequency syndrome, which was treated with acetaminophen (paracetamol) only and resolved on day 7. CONCLUSIONS: Percutaneous ablation therapies represent a safe and valuable alternative for treating localised pain from single bone metastasis, providing rapid (4-week) relief of symptoms and a significant reduction in morphine doses. This contributes to improving the quality of life of patients with metastatic disease.

Image-guided percutaneous treatment of abdominal-pelvic abscesses: a 5-year experience.

PURPOSE: This study was undertaken to evaluate the efficacy of image-guided percutaneous drainage in treating abdominal and pelvic abscesses. MATERIALS AND METHODS: From August 2001 to August 2006, 95 patients (49 men and 46 women; mean age 61 years, range 25-92) with 107 abscesses underwent image-guided percutaneous drainage. Thirty-one abscesses were retroperitoneal (9 peripancreatic, 17 perirenal, 5 pararenal), 37 intraperitoneal (2 in communication with the small bowel), 8 intrahepatic (2 in communication with the extrahepatic biliary system and 2 with the intrahepatic biliary system), 4 perisplenic and 27 pelvic (4 in communication with the large bowel). Seventy-one of 107 procedures were performed with ultrasonographic (US) guidance and 36/107 with computed tomography (CT) guidance. All procedures were carried out with 8-to 14-Fr pigtail drainage catheters. RESULTS: Immediate technical success was achieved in 107/107 fluid collections. No major complications occurred. In 98/107 abscesses, we obtained progressive shrinkage of the collection (>50%) with consequent clinical success. In 9/107 cases, percutaneous drainage was unable to resolve the fluid collection. There were 12 cases of catheter displacement and six of obstruction. CONCLUSIONS: Percutaneous drainage is feasible and effective in treating abdominal and pelvic abscesses. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

Imaging-guided percutaneous radiofrequency ablation of adrenal metastases: preliminary results at a single institution with a single device.

The aim of this study was to show the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of adrenal metastases (AM). Seven imaging-guided percutaneous RFA treatments were performed in six patients (two men and four women; mean age, 67.2 years; range, 55-74 years) with six AM who were referred to our institution from 2003 to 2006. One patient was treated twice for recurrence after first treatment. The average diameter of the treated AM was 29 mm (range, 15-40 mm). In all patients, the diagnosis was obtained with CT current protocols in use at our institution and confirmed by pathology with an image-guided biopsy. No major complications occurred. In one patient shortly after initiation of the procedure, severe hypertension was noted; another patient developed post-RFA syndrome. In five of six lesions, there was no residual enhancement of the treated tumor. In one patient CT examination showed areas of residual enhancement of the tumor after treatment. Our preliminary results suggest that imaging-guided percutaneous RFA is effective for local control of AM, without major complications and with a low morbidity rate related to the procedure. Long-term follow-up will need to be performed and appropriate patient selection criteria will need to be determined in future randomized trials.

Hepatic radiofrequency under CT-fluoroscopy guidance.

PURPOSE: This study was done to assess the effectiveness and advantages of computed tomography (CT) fluoroscopy as a guide for locating and treating lesions that are not amenable to ultrasound (US) guidance, and to evaluate the CT signs of immediate technical success and the short-term results. MATERIALS AND METHODS: Over the past year, we selected 14 patients (four women and ten men; mean age 73, range 61-83 years) out of 103 candidates for hepatic radiofrequency ablation (RFA). The 14 lesions comprised seven residual tumours after combined embolisation and US-guided RFA of a large hepatocellular carcinoma (HCC), which were indistinguishable from necrosis or surrounding healthy parenchyma; two HCC nodules in locations that were inaccessible by US; five metastases (two from renal carcinoma, two from colorectal adenocarcinoma and one from lung carcinoma), of which one could not be distinguished from the surrounding healthy parenchyma on US and four were inaccessible by US. Lesion diameters were between 1.4 and 3.5 cm. The procedures were performed in the CT room with anaesthesiological assistance using a coaxial LeVeen needle electrode (14 gauge, 2-to 4-cm array diameter). Immediate technical success was evaluated by multidetector CT (MDCT), and follow-up was carried out with MDCT at 3 and 6 months and yearly thereafter. RESULTS: Immediate technical success was obtained in 13/14 patients; one case required further placement of the electrode due to incomplete ablation of a hypervascular lesion. In 2/3 metastatic lesions with portal vein supply, there were no recurrences at 3 and 6 months; in 1/3, we observed disease progression, with the appearance of additional nodules at 6 months. The two metastases with arterial supply showed no signs of recurrence at 3 months; one case developed a recurrence along the ablation margin, with the appearance of satellite nodules at 6 months. In two HCC nodules, there was immediate technical success and no recurrence at 3 and 6 months. Of the seven residual tumours of HCC, all treated with immediate technical success, we observed disease progression, with the appearance of satellite nodules at 3 months in one case, at 6 months in another and at 12 months in another; 3/7 patients were free of disease at 12-month follow-up; 1/7 died 5 months later due to causes unrelated to the procedure. CONCLUSIONS: CT fluoroscopy is overcoming the limitations of CT in locating and treating lesions with different hepatic vascularisation and those unamenable to US; furthermore, it reduces the length of the procedure, thanks to the faster and more accurate placement of the needle electrode. MDCT proved to be a reliable method in the assessment of immediate and short-term results of RFA.

Combined treatment of ablative therapy with percutaneous radiofrequency and cementoplasty of a symptomatic metastatic lesion of the acetabulum.

We report the case of a symptomatic metastatic lesion of the acetabulum from colon adenocarcinoma in an 82-year-old woman patient treated by a combined approach of thermal ablation with percutaneous radiofrequency and cementoplasty. We obtained an immediate technical success with a good control of pain without any complications at a 6-month clinical follow-up.

Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours: one centre experience and review of published works.

The aim of this study was to evaluate prospectively post-radiofrequency ablation (RFA) syndrome and to determine its effect on the quality of life in the 15 days after percutaneous RFA treatment. We carried out an internal review board-approved prospective study of the delayed symptoms that occurred after 71 consecutive RFA sessions in 53 patients (12 women and 41 men; age range 45-83 years; mean age 71.6 years) with 45 primary liver tumours, 34 liver metastases, 3 renal cell carcinoma (RCC), 2 residual lesions from RCC after nephrectomy and 1 pancreatic metastases from RCC. Postablation symptoms occurred in 17 of 53 (32%) patients. Six of 17 patients developed low-grade fever (from 37.5 to 38.5 degrees C). Other symptoms included delayed pain (9/17), nausea (7/17), vomiting (3/17), malaise (3/17) and myalgia (1). Postablation syndrome is a common phenomenon after RFA of solid abdominal tumours. Not only in our study but also in the previous ones the occurrence is observed in approximately one-third patients. Patients should be informed that these symptoms are self-limiting after RFA and most patients should be able to resume near-complete preprocedural levels of activity within 10 days after the procedure.