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Ultrasound-guided percutaneous liver biopsy (UG-PLB) is a commonly performed procedure for the diagnosis and monitoring of various liver diseases. The objective of this article is to present the most important information relating to UG-PLB from the perspective of interventional radiologists in a clear and concise fashion, referencing the most influential papers in current literature. This paper gives a brief overview of the history of the procedure and its conception, as well as the most common indications, contraindications, complications, and a technical overview of the most common techniques and equipment that are used by UG-PLB operators.
Assuntos
Biópsia Guiada por Imagem , Hepatopatias , Fígado , Ultrassonografia de Intervenção , Humanos , Ultrassonografia de Intervenção/métodos , Biópsia Guiada por Imagem/métodos , Fígado/patologia , Fígado/diagnóstico por imagem , Hepatopatias/patologia , Hepatopatias/diagnóstico por imagemRESUMO
PURPOSE: To describe the feasibility and technique of percutaneous image-guided combined treatment of bone cyst (BC) using cryoablation and bone graft substitute injection. MATERIALS AND METHODS: Between July 2019 and January 2022, six consecutive patients (ages between 16 and 33 years) with symptomatic BC in pelvic and lower extremity bones underwent percutaneous image-guided combined treatment using cryoablation and bone graft substitute. To induce bone mineralization as early as possible, the cyst cavity was filled with bone graft substitute. Technical success of the procedure was evaluated, and clinical success was defined as satisfactory clinical symptom relief using visual analogue scale (VAS). Radiologic success was defined as early BC remineralization on radiographic studies. Detailed demographic data with lesion location, size, time to and degree of BC mineralization, complications, clinical outcomes, and radiological follow-up were retrospectively assessed. RESULTS: Technical success was 100% achieved in all patients. BC mineralization was observed in all patients, with a median time to reach 80% mineralization at 6 months, with one patient reaching 80% at 5 months and another reaching 100% at 3 months. A significant drop in VAS was observed in all patients, reflecting significant pain relief. There were no major complications. The median follow-up period was 31.5 months, with a minimum follow-up of 5 months and a maximum follow-up of 3 years. CONCLUSION: Percutaneous image-guided combined treatment with cryoablation and bone graft substitute for symptomatic BC is technically feasible and was safe in this limited series.
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Cistos Ósseos , Criocirurgia , Humanos , Adolescente , Adulto Jovem , Adulto , Resultado do Tratamento , Estudos Retrospectivos , Criocirurgia/métodos , Estudos de ViabilidadeRESUMO
Backgroun: Full-thickness rotator cuff tear is common in the older population. The incidence of traumatic deltoid tears post-surgery is well addressed. However, non-traumatic spontaneous injury is not well recognized despite a few case reports and previous studies. The aim of the study is to determine the incidence and association of deltoid tear among patients with non-traumatic full-thickness rotator cuff tear using shoulder magnetic resonance imaging. Methods: A retrospective cross-sectional study was conducted of 271 shoulders magnetic resonance imaging examinations with full-thickness rotator cuff tear between 2012 and 2022. The analyzed variables were full-thickness rotator cuff tear size, tear grading (small, medium, large, and massive), muscle fatty degeneration, and deltoid tear. Acromio-humeral interval was also recorded and analyzed on the anteroposterior projection of shoulder radiographs. Results: The incidence of deltoid tear was 7% (19 cases), encountered in eleven females (6.4%) and eight males (8%) with a mean age of 65 years. Deltoid tears were located on the right side in fifteen patients (9.4%) and on the left side in four patients (3.6%). The Man-Whitney U test indicated a significant association between deltoid tears and full-thickness rotator cuff tear, P < 0.001. The deltoid tear was more notably associated with large and massive full-thickness rotator cuff tear (16.7% and 42.3%, respectively), P < 0.001. Acromio-humeral interval showed a significant difference between the deltoid and non-deltoid cases, P = 0.045. Conclusion: The incidence and association of deltoid tears with full-thickness rotator cuff tear with no prior surgical intervention or traumatic insults were considered significant, with a positive impact of large and massive tear size and association of muscle fatty degeneration. This association is statistically significant and should be adequately evaluated by the radiologist.
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OBJECTIVES: To determine the prevalence and demographic data regarding incidentally encountered elastofibroma dorsi (EFD) in the Saudi population-based on chest CT (computed tomography) scans. METHODS: This retrospective study was carried out on 4,435 chest CT examinations that were collected between January 2014 and December 2016 in Riyadh, Saudi Arabia. One musculoskeletal radiologist who was unaware of the patients' clinical presentations or reasons for CT study reviewed the 4,435 chest CTs prospectively, searching for soft tissue tumors in the subscapular region. RESULTS: Elastofibroma dorsi was incidentally confirmed via CT scan in 36 of the 4,435 patients, including 8 males and 28 females, with a mean age of 76.6 years, yielding a prevalence of 0.8%. Elastofibroma dorsi was more common in females, with a 3.3-fold higher prevalence (77.8%) as compared to males (22.2%); however, this difference was not statistically significant (p>0.05). Twenty-five (69.44%) patients had unilateral EFD and 11 (30.56%) had bilateral EFD. Right-sided EFD was encountered in 60% of females and 50% of males. Furthermore, there was no statistically significant correlation between the size of EFD and the patient's gender or age (p>0.05). CONCLUSION: Elastofibroma dorsi is a rare but uncommon incidental finding on routine chest CT examination encountered in 0.8% of elderly Saudi patients.
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Fibroma , Neoplasias de Tecidos Moles , Idoso , Feminino , Fibroma/diagnóstico por imagem , Fibroma/epidemiologia , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/epidemiologia , Centros de Atenção Terciária , Tomografia Computadorizada por Raios XRESUMO
Atypical intra-articular osteoid osteoma can be difficult to diagnose and challenging to treat. We report a case of a right acetabular subchondral intra-articular osteoid osteoma in a young male patient which was initially diagnosed as femoroacetabular impingement due to its atypical clinical and radiological presentations. After fully working up the patient the lesion was successfully treated with percutaneous CT-guided low-power bipolar radiofrequency ablation using several per procedural articular cartilage thermal protective measures including intra-articular thermocouple, and continuous per procedural joint space cooling with Dextrose 5% solution. A precise RFA electrode placement, using the No-touch technique, and applying different passive and active thermal protective measures were helpful in avoiding collateral damage of the hip joint articular cartilages. atypical intra-articular osteoid osteomas necessitate pertinent correlation between the clinical and radiological presentations. As far as intra-articular or subchondral nidus ablation is concerned, thermal protective measures should be considered.
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Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.
Assuntos
Neoplasias Ósseas/terapia , Oncologia/tendências , Neoplasias Musculares/terapia , Antineoplásicos/administração & dosagem , Dor do Câncer/terapia , Terapia Combinada/métodos , Criocirurgia/métodos , Eletroporação/métodos , Potenciais Evocados , Feminino , Fluoroscopia/métodos , Previsões , Fraturas Ósseas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Doença Iatrogênica/prevenção & controle , Lipossomos/administração & dosagem , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Micro-Ondas/uso terapêutico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Ablação por Radiofrequência/métodos , Terapia por Radiofrequência/métodos , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendências , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodosRESUMO
OBJECTIVE: To review our initial experience in acetabular cartilage protection from thermal injury with temperature monitoring during percutaneous image-guided tumor thermal ablation. MATERIALS AND METHODS: Between June 2015 and December 2016, three consecutive oncologic patients (mean age 58 years; range 48-67 years) with acetabular bone metastasis underwent percutaneous image-guided thermal ablation procedures along with hip joint cartilage thermal monitoring. Due to the close proximity of the metastatic lesion to the acetabular articular cartilage, a thermosensor device was placed under CT and fluoroscopic guidance near the acetabular roof and next to the ablation zone in order to monitor the local temperature around the articular cartilage. Stand-alone thermal ablation (n = 1) and combined thermal ablation with cementoplasty (n = 2) were performed to optimize local palliation or disease control. Clinical and radiological outcomes at follow-up were assessed. RESULTS: Three acetabular metastatic lesions were treated with thermal ablation, and temperature monitoring of the acetabular articular cartilage was conducted during the ablation procedure. Mean size of lesions was 1.6 cm (range 1.5-2 cm). Technical success was achieved in all cases (100%) without any immediate complications. No hip cartilage damage occurred clinically and radiologically. Good palliation and local disease control were achieved in two cases, and in the other case, there was local recurrence and distant progression of hip metastatic disease after 7 months of follow-up. CONCLUSION: Temperature monitoring of the articular cartilage during percutaneous image-guided thermal ablation appears technically feasible with good short-term efficacy in a complex patient subset. Further studies are warranted to confirm these promising initial results.
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Técnicas de Ablação/métodos , Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Cartilagem Articular , Monitorização Fisiológica/métodos , Recidiva Local de Neoplasia/cirurgia , Tratamentos com Preservação do Órgão/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Temperatura , Resultado do TratamentoRESUMO
AIM: To present a new blunt-tip coaxial needle (SoftGuard) applied to access "hard-to-reach" targets undergoing percutaneous image-guided biopsy or drainage. MATERIALS AND METHODS: All consecutive patients presenting between August and December 2016 with "hard-to-reach" (<10 mm from a critical nearby structure such as vessels, nerves, bowel or adjacent parenchymal organs) solid lesions requiring biopsy (group A) or abscesses requiring drainage for sepsis (group B) were prospectively included. The individual features of each patient and lesion as well as technical and clinical data were collected and analysed. RESULTS: Twenty-six patients (18 males, 8 females, mean age 59.81 ± 17.53 years) were enrolled in group A and nine (6 males, 3 females, mean age 58.33 ± 13.8 years) in group B. Technical success was achieved in 92.3% of cases from group A and 100% of cases from group B. Five (19.2%) minor complications were noted in group A (four small self-limiting pneumothoraces and one small self-limiting peri-pancreatic haematoma). There were no complications in group B. Histological results in group A accounted for 95% sensitivity, 100% specificity and 95.2% diagnostic accuracy. In group B, mean post-operative C-reactive protein was 41 ± 48.3 mg/L in comparison with 155 ± 117.5 mg/L at baseline (P = 0.004). CONCLUSIONS: The SoftGuard blunt-tip needle is a safe and effective tool when applied as a coaxial working cannula for percutaneous biopsy or drainage of "hard-to-reach" targets.
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Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Biópsia Guiada por Imagem/instrumentação , Agulhas , Neoplasias/diagnóstico por imagem , Neoplasias/cirurgia , Paracentese/instrumentação , Radiografia Intervencionista/instrumentação , Cirurgia Assistida por Computador/instrumentação , Adulto , Idoso , Proteína C-Reativa/metabolismo , Desenho de Equipamento , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Tomografia Computadorizada por Raios XRESUMO
This study aims to discuss MRI-guided cryoablation (CA) of in-transit (IT) metastases from melanoma and to retrospectively present our preliminary experience in such a specific field. Three female patients (mean age 55.6 years; range 39-64) were included, and eight IT metastases (mean size 12.4 ± 6.5 mm, range: 5-25) were treated in three different sessions. Technical success was 100%; and mean procedural time 129.3 ± 103 min. (range 42-243). Primary local tumour control was 100% at 1-, 6- and 12-month follow-up; and 87.5% at 18-month follow-up. Two complications were recorded (one minor and one major). MRI-guided CA is a novel therapy, which may be included in the armamentarium of local therapies of IT metastases.
Assuntos
Criocirurgia/métodos , Metástase Linfática/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Melanoma/secundário , Melanoma/cirurgia , Neoplasias Cutâneas/secundário , Neoplasias Cutâneas/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Feminino , Humanos , Metástase Linfática/patologia , Masculino , Melanoma/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Tela Subcutânea/diagnóstico por imagem , Tela Subcutânea/cirurgiaRESUMO
Osteoporotic fractures of the sacrum usually involve the sacral ala and can be managed with percutaneous cementoplasty if conservative therapy failed to achieve bone consolidation. On the other hand, isolated transverse fractures of the lowest sacrum are more rare, with little literature focusing on their management in the osteoporotic population. If pseudoarthrosis occurs in this location, sacroplasty is not an optimal therapeutic option because of the poor biomechanical resistance of cement to multi-directional stresses. Hence, we report two cases of chronic unhealed transverse fractures of the lowest sacrum successfully managed with percutaneous image-guided screw fixation augmented with cement injection. At last follow-up available, both patients experienced complete pain relief, without evidences of failure of the osteosynthesis on CT-scan controls.
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Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Fraturas por Osteoporose/cirurgia , Sacro/lesões , Fraturas da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Vertebroplastia/métodos , Idoso de 80 Anos ou mais , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagemRESUMO
We report a case of painful and disabling anterior acetabular bone metastasis treated with bipolar radiofrequency ablation and cementoplasty. Due to the high risk of complications related to the proximity of the femoral neurovascular structures with a direct approach, we successfully performed a retrograde transpubic approach under combined CT and fluoroscopic guidance. In the present report, we describe this approach detailing its indications, advantages, and the technical tips to achieve a safe and satisfactory procedure.
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Sarcoidosis is a multisystem granulomatous disease of unknown cause that commonly involves the spleen. Sarcoid can produce either homogeneous splenomegaly or multiple splenic nodules. Although other organ system involvement usually occurs, this is not invariable. Herein, we report on the clinical, histological, and radiological features-including sonography and MRI-of an isolated splenic sarcoidosis that mimicked neoplastic disease in a 37-year-old female. Knowledge of this atypical sonographic presentation may prevent unnecessary splenectomy.
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Sarcoidose/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Esplênicas/diagnóstico , UltrassonografiaRESUMO
"Wandering liver" describes an excessive mobility of the liver caused by abnormalities of hepatic fixation that could lead to hepatic pedicle torsion or bowel obstruction. It is considered a rare entity, but because of the evolution in medical imaging techniques, this unusual condition is being identified more often. We report 2 cases presenting with chronic vague abdominal pain, diagnosed by abdominal ultrasonography and the use of cine-magnetic resonance imaging sequences with dynamic maneuvers. We tried to correlate our ultrasound and magnetic resonance imaging findings to peroperative findings and insist on the usefulness of dynamic maneuvers when confronted with atypical symptoms and a normal abdominal ultrasound scan finding.