Percutaneous strategies for the management of pulmonary parenchymal, chest wall, and pleural metastases.

OBJECTIVE: The purposes of this article are to review the indications for and technical aspects of various percutaneous strategies available for the treatment of intrathoracic metastases involving the parenchyma, pleura, and chest wall and to describe the relative merits of one of these strategies over another to determine the best approach to use. CONCLUSION: The thorax is a common site of metastatic disease with frequent involvement of the lungs, pleura, and osseous structures. A variety of interventional procedures and techniques are available for treatment and for palliative care of patients with this disease. Imaging-guided interventions include thermal ablation of metastatic disease of the lungs and pleura, catheter placement and sclerosis of malignant pleural effusions, and palliative pain management for osseous and soft-tissue metastases.

Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts.

PURPOSE: To assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPSs), in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Retrospective database review of patients with pre-existing TIPS undergoing RF ablation of HCC was conducted over a 159-month period ending in November 2013. TIPS patency pre- and post-RF ablation was assessed by ultrasound, angiography, and/or contrast-enhanced CT or MRI. Patient demographics and immediate post-RF ablation outcomes and complications were also reviewed. RESULTS: 19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients, respectively. Eleven patients (58 %) ultimately underwent liver transplantation. Immediate technical success was seen in all ablation sessions without residual tumor enhancement (100 %). No patients (0 %) suffered liver failure within 1 month of ablation. Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88 %). Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100 %) at immediate post-ablation imaging and in 21/22 (95 %) at last follow-up (1 patient was incidentally noted to have occlusion 31 months later). No immediate complications were observed. CONCLUSION: Ablation efficacy was similar to the cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation.