Review of craniofacial pain syndromes involving the greater occipital nerve: relevant anatomy, clinical findings, and interventional management.

Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9 months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.

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.

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture.

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients' quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

Erratum to: Greater occipital nerve infiltration under MR guidance: Feasibility study and preliminary results.

The original version of this article, published on 12 July 2017, unfortunately contained mistakes. The following corrections have therefore been made in the original.

Greater occipital nerve infiltration under MR guidance: Feasibility study and preliminary results.

OBJECTIVE: To assess the feasibility of greater occipital nerve (GON) intermediate site infiltration with MRI guidance. METHODS: Eleven consecutive patients suffering from chronic refractory cranio-facial pain who underwent 16 GON infiltrations were included in this prospective study. All of the procedures were performed on an outpatient basis in the research facility of our institution, with a 1.5 T scanner. The fatty space between inferior obliquus and semispinalis muscles at C1-C2 level was defined as the target. Technical success was defined as the ability to accurately inject the products at the target, assessed by post-procedure axial and sagittal proton density-weighted sequences. Clinical success was defined as a 50% pain decrease at 1 month. RESULTS: Technical success was 100%. GON was depicted in 6/11 cases on planning MRI sequences. Mean duration of procedure was 22.5 min (range 16-41). Clinical success was obtained in 7/11 included patients (63.6%) with a mean self-reported improvement of 78%. CONCLUSION: Interventional MR-guidance for GON infiltration is a feasible technique offering similar results to an already established effective procedure. It may appear as a useful tool in specific populations, such as young patients and repeat infiltrations, and should be considered in these settings. KEY POINTS: • MR guidance for GON infiltration is a feasible technique. • Preliminary results are in agreement with other guidance modalities. • MR guidance may be seen as a useful tool in specific populations. • Specific populations include young patients and repeat infiltrations. • Target patients may also include patients with potentionally previously reported complications (torticollis).

Greater occipital nerve cryoneurolysis in the management of intractable occipital neuralgia.

OBJECTIVE: To assess technical feasibility of cryoneurolysis of the greater occipital nerve in the management of occipital neuralgia. METHODS: Six patients suffering from unilateral refractory greater occipital neuralgia and who underwent 7 GON cryoneurolysis were assessed between October 2015 and January 2017. All procedures were performed under CT guidance and local anesthesia. A planning CT was performed with contrast enhancement to plan needle target and identify surrounding major vascular structures. A 12G coaxial needle (Inomed) was then inserted and targeted the first bend of the GON under and lateral to the obliquus capitis inferior muscle. A 2.0mm cryoprobe was then inserted in the coaxial and sensitive stimulation at 100Hz was performed. One to three freezing cycles were performed in one session. RESULTS: Technical feasibility was 100% as cryoneurolysis could be performed in all 7 cases with accurate sensitive nerve stimulation prior to freezing cycle. One patient benefited from a second session after failure of the first session. More than 50% pain reduction was achieved at day 7 in all cases, and 5 of 6 cases at one and three months follow-up. CONCLUSION: Cryoneurolysis of the GON in the management of refractory GON neuralgia is feasible. Initial results are promising as 5/7 cases benefited from a 3-month pain alleviation period.

Prospective 1-year follow-up pilot study of CT-guided microwave ablation in the treatment of bone and soft-tissue malignant tumours.

PURPOSE: The aims of this work were to assess the feasibility, efficacy, short-term outcome and safety of microwave ablation (MWA) in the treatment of malignant musculoskeletal tumours. MATERIALS AND METHODS: Sixteen bone and soft-tissue malignant tumours were prospectively included and were treated by CT-guided MWA. The percentage and size of necrosis of the lesions were measured by contrast-enhanced MRI before the procedure and after 1, 3, 6 and 12 months. mRECIST criteria were used to assess tumour response. Procedural success was defined as ≥80 % necrosis. Patient pain (as assessed using a numeric visual scale (NVS)) and side effects were noted. RESULTS: Six osteolytic metastases, five osteoblastic metastases and five soft tissue sarcomas were treated. At 1 month, 40 % were treated completely, the percentage of necrosis was 85 ± 30.4 %, and the success rate was 80 %. At 3, 6 and 12 months the success rate was 80 %, 76.9 % and 63.6 %, respectively. At 12 months, four lesions (36.3 %) still had no recurrence. Mean NVS during the procedure was 3.5 ± 2.8. One patient had transitory sciatica without neurological deficit that was treated medically. CONCLUSION: CT-guided MWA of bone and soft-tissue malignant tumours is efficient, well tolerated and has good short-term anti-cancer effects. KEY POINTS: • CT-guided MWA is efficient in treating musculoskeletal malignant tumours. • This prospective pilot study showed MWA induces high percentages of tumour necrosis. • MWA has good short-term anti-cancer effects. • MWA has healing potential when lesions can be completely necrosed. • CT-guided MWA under equimolar mixture of oxygen-nitrous oxide inhalation is well tolerated.

Feasibility of Real-Time Intraprocedural Temperature Control during Bone Metastasis Thermal Microwave Ablation: A Bicentric Retrospective Study.

PURPOSE: To evaluate feasibility of using a thermocouple for temperature monitoring during microwave (MW) ablation of metastatic bone disease. MATERIALS AND METHODS: This retrospective study comprised 16 patients (8 men with mean age 63 y and 8 women with mean age 59 y) with 18 bone metastases treated with MW ablation using a thermocouple between March 2012 and October 2015. The mean maximum tumor size was 29.5 mm. MW ablation power was set between 15 W and 40 W and applied for 1-6 minutes. Thermocouple placements were as follows: epidural space (n = 7 cases), nerve roots (n = 9 cases), pleura (n = 1), and pericardium (n = 1). The procedure was considered technically successful when the MW and the thermocouple probes were accurately placed and thermoablation was initiated. Clinical success was defined as a 50% visual analog scale score decrease at 1 month as assessed by the operators. RESULTS: Mean MW ablation time was 4.3 minutes with a mean energy of 30 W. Procedural success was 100%. In 16 cases with neural structure monitoring, temperature did not increase > 43°C. In 8 cases, MW ablation had to be discontinued because of temperature reaching 42°C. Efficacy of the procedure in regard to pain was achieved in 17 of 18 ablation sessions at 1 month. CONCLUSIONS: Use of a thermocouple during bone MW ablation is a feasible technique and may be a potentially useful tool to help avoid nontarget ablation surrounding tumors.

Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas.

PURPOSE: The aims of this work were to assess the feasibility and efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OOs). MATERIALS AND METHODS: Thirteen consecutive patients (range 11-31 years old) presenting with OO were prospectively included and treated by CT-guided MWA. Power and duration of MWA were both recorded. The patient's pain was assessed using a numeric pain rating scale (NRS), and side effects were recorded during procedures, after 1 day, 7 days and 1 month. The nidus vascularization and the volume of necrosis induced by MWA were assessed using contrast-enhanced MRI. Success was defined as the complete relief of the patient's pain 1 month after the first procedure, associated with necrosis of the nidus on follow-up MRI. RESULTS: The success rate was up to 92.3% (12/13). At 1 day, 7 days and 1 month, the median NRSs were respectively 5 [interquartile range (IQR) 2-5], 0 (IQR 0-1) and 0 (IQR 0-0). Side effects observed were one partial and self-resolving lesion of a sensory branch of the radial nerve and two skin burns. The median power of the MWA used was 60 W (IQR 50-60) with a 1.5-min duration (IQR 1-2), leading to MWA-induced necrosis measuring on average 23 × 15 × 16 mm. CONCLUSION: CT-guided MWA of OO has a success rate that appears to be almost similar to that of laser or radiofrequency ablation, but care must be taken to prevent nerve or skin lesions.

A simplified CT-guided approach for greater occipital nerve infiltration in the management of occipital neuralgia.

OBJECTIVES: To evaluate the efficacy of a simplified CT-guided greater occipital nerve (GON) infiltration approach in the management of occipital neuralgia (ON). METHODS: Local IRB approval was obtained and written informed consent was waived. Thirty three patients suffering from severe refractory ON who underwent a total of 37 CT-guided GON infiltrations were included between 2012 and 2014. GON infiltration was performed at the first bend of the GON, between the inferior obliqus capitis and semispinalis capitis muscles with local anaesthetics and cortivazol. Pain was evaluated via VAS scores. Clinical success was defined by pain relief greater than or equal to 50 % lasting for at least 3 months. RESULTS: The pre-procedure mean pain score was 8/10. Patients suffered from left GON neuralgia in 13 cases, right GON neuralgia in 16 cases and bilateral GON neuralgia in 4 cases. The clinical success rate was 86 %. In case of clinical success, the mean pain relief duration following the procedure was 9.16 months. CONCLUSIONS: Simplified CT-guided infiltration appears to be effective in managing refractory ON. With this technique, infiltration of the GON appears to be faster, technically easier and, therefore, safer compared with other previously described techniques. KEY POINTS: • Occipital neuralgia is a very painful and debilitating condition • GON infiltrations have been successful in the treatment of occipital neuralgia • This simplified technique presents a high efficacy rate with long-lasting pain relief • This infiltration technique does not require contrast media injection for pre-planning • GON infiltration at the first bend appears easier and safer.

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.

Microwave thermal ablation of spinal metastatic bone tumors.

PURPOSE: To assess feasibility, safety, and efficacy of microwave ablation of spinal metastatic bone tumors. MATERIALS AND METHODS: Retrospective study of 17 patients with 20 spinal metastatic tumors treated with microwave ablation under computed tomographic guidance between March 2011 and August 2013 was performed. Ablations were performed under local anesthesia and nitrous oxide ventilation. Lesions were lumbar (n = 10), sacral (n = 7), and thoracic (n = 3) in location. Primary neoplastic sites were lung (n = 9), prostate (n = 4), kidney (n = 6), and uterus (n = 1). Adjunct cementoplasty was performed in nine cases, and a temperature-monitoring device was used in four cases. Procedure effectiveness was evaluated by visual analog scale (VAS) during a 6-month follow-up. Patient medical records were reviewed, and demographic and clinical data, tumor characteristics, and information on pain were assessed. RESULTS: Mean ablation time was 4.4 minutes ± 2.7 (range, 1-8 min), with an average of 3.8 cycles per ablation at 60 W (range, 30-70 W). The preprocedure mean VAS score was 7.4 ± 1.2 (range, 6-9). Pain relief was achieved in all but one patient. Follow-up VAS scores were as follows: day 0, 1.3 ± 1.8 (P < .001); day 7, 1.6 ± 1.7 (P < .001); month 1, 1.9 ± 1.6 (P < .001); month 3, 2.2 ± 1.5 (P < .001); and month 6, 2.3 ± 1.4 (P < .01). No complications were noted. CONCLUSIONS: Microwave ablation appears to be feasible, safe, and an effective treatment of painful refractory spinal metastases and may be considered as a potential alternative percutaneous technique in the management of spinal metastases.

Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain.

INTRODUCTION: The sphenopalatine ganglion (SPN) has been proven to be involved in various types of facial pain syndromes. Management of these cranio-facial pain syndromes can be challenging, and existing specific treatments are sometimes inefficient and may fail. The purpose of this study is to describe and evaluate alcohol SPN in the management of cranio-facial pain. METHODS: Forty-two patients suffering from refractory facial pain who underwent 58 consecutive SPN were included in this study between 2000 and 2013. Patients were divided into three groups: group "cluster headache" (CH), group "persistent idiopathic facial pain" (PFIP), and group "Other". Pain was assessed using Visual Analogue Scale scores (measured immediately before and after procedure and at regular intervals following the procedure). Alcohol SPN was considered to be effective when pain relief was equal to or greater than 50 % and lasting for at least 1 month. All procedures were realized ambulatory under CT guidance and consisted of an injection of 1 ml of absolute alcohol. RESULTS: Overall efficacy rate of alcohol SPN was 67.2 %, with mean pain relief duration of 10.3 months. Procedure was graded either not painful or tolerable by patients in 64.2 %. Analysis showed a higher efficacy rate in the groups CH (76.5 %) and PFIP (85.7 %) compared to the group Other (40 %). No difference was found between groups regarding the recurrence rate. CONCLUSION: Alcohol SPN under CT guidance appears as a safe and effective treatment of refractory facial pain, especially in cases of cluster headache and persistent idiopathic facial pain.

Transfontanellar contrast enhanced ultrasound in infants: initial experience.

BACKGROUND AND PURPOSE: Transfontanellar contrast enhanced ultrasound (TCEUS) in infants with neurological diseases has not been previously reported. Thus, the objective of our study was to describe the imaging findings of transfontanellar contrast enhanced ultrasound (TCEUS) performed in various neurological conditions in infants and to compare the findings with non-enhanced transfontanellar ultrasound (TFUS) and MRI. METHODS: Local institutional review board approval was obtained and, because of the need to catheterize children for contrast media administration, written informed consent of parents was obtained prior to all performed TCEUS. Twelve infants who underwent 12 TCEUS were included in this study from June 2009 to June 2012. Second generation contrast material was used (Bracco). TCEUS imaging findings were compared with those of conventional transfontanellar ultrasound in each case and with MRI. RESULTS: In 10 out of the 12 performed examinations, TCEUS showed abnormalities which were not depicted on non-enhanced TFUS. Accurate diagnosis of TCEUS compared with MRI was found in 10 out of 12 initial TCEUS. No adverse events during or immediately after contrast media injection occurred. CONCLUSION: TCEUS appears to be a potential bedside accessible non-ionizing alternative imaging modality in the assessment of neonatal brain injury. It provides additional information when compared to non-enhanced transfontanellar US, especially in the field of brain perfusion assessment. Moreover, the information provided seems to be accurate when compared with those of MRI.

CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb.

OBJECTIVE: To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb. METHODS: Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was ≥50 %, lasting for at least 2 years. RESULTS: Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76. CONCLUSION: CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade. KEY POINTS: • Complex regional pain syndrome is painful, disabling and often refractory to treatment. • Sixty-seven percent of patients had lasting pain relief (2 years) after radiofrequency neurolysis. • Retrospective study showed a significantly higher success rate for radiofrequency neurolysis. • CT guidance is mandatory for a successful and safe procedure.

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.

Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography.

OBJECTIVE: The purpose of this study is to assess the elastic and anisotropic properties of normal calcaneal tendon in vivo by transient shear wave elastography (SWE). MATERIALS AND METHODS: This study was approved by our institutional ethics committee. Eighty healthy subjects over 18 years of age were prospectively included. Data on the patients' height, weight, sporting activities, and take-off foot were assessed. The thickness, width, and cross-sectional area of the calcaneal tendons were measured. The shear wave propagation velocity (Vmean) was measured by three radiologists on axial and sagittal SWE images at four different degrees of ankle flexion, enabling to calculate elasticity modulus (Emean), and relative anisotropy coefficient (A) values. RESULTS: In complete plantar flexion, Vmean was 6.8 ± 1.4 m.s(-1) and 5.1 ± 0.8 m.s(-1), respectively, on the sagittal and axial SWE image, resulting in an elastographic anisotropy A of 0.24 ± 0.16. The best interobserver correlation coefficient of Emean and Vmean was 0.43 and 0.46, respectively, in the sagittal SWE for complete plantar flexion. Vmean and Emean significantly increase when the tendon is stretched by ankle dorsiflexion. The maximal values in sagittal SWE were Vmean = 16.1 ± 0.7 m.s(-1), Emean = 779.5 ± 57.1kPa and A = 0.63 ± 0.07. CONCLUSIONS: SWE allows the elastic properties of the calcaneal tendon to be evaluated quantitatively in vivo, but interobserver reproducibility is questionable. It confirms the tendinous elastographic anisotropy and stiffness augmentation of stretched tendon.

Radiofrequency neurolysis in the management of inguinal neuralgia: preliminary study.

PURPOSE: To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency (RF) neurolysis (RFN) in the management of refractory inguinal neuralgia. MATERIALS AND METHODS: Local institutional review board approval was obtained and written informed consent was waived. Twelve patients 26-75 years of age with chronic (>6 months) inguinal pain refractory to specific medication were included between 2005 and 2011. Data on patient demographics, clinical history, and pain management history were retrospectively assessed. Pain was measured on a visual analog scale (VAS) from 0 to 10 before and immediately after the procedure and at 1, 3, 6, 9 and 12 months. Diagnosis was always confirmed by a positive nerve block test result. Ambulatory CT-guided RF was the rule. RESULTS: Sixteen RFN procedures were performed. Pain was present for an average of 3.2 years (range: 2-8 years) prior to initial RFN. Mean VAS score before the procedure was 7.75 of 10. Immediate pain relief of 100% was achieved in all patients. Pain reduction at 1-, 3-, 6-, 9-, and 12-month follow-up was statistically significant. Important pain reduction (≥80%) was obtained in 75% of RFN procedures at 6-month follow-up and in 50% of cases at 12 months. The mean duration of pain relief was 11.8 months after RFN, with a maximum average pain reduction of 84.5%. No complications were noted during or after the procedure. CONCLUSION: RFN with CT guidance is an effective technique in the management of refractory inguinal pain with lasting satisfactory pain reduction; it may be considered as an alternative treatment to surgery. These results should be confirmed in a controlled trial with a larger series of patients.

Patient's Selection and Evaluation for Bone Stabilization.

Bone stabilization procedures performed by Interventional Radiologists have significantly increased in the past ten years with a wide variety of techniques available ranging from cementoplasty to complex combined treatment associating thermoablation, cementoplasty and fixation. Many available manuscripts and reviews focus on the technical aspects, feasibility and outcomes of these procedures. However, not every procedure is suitable for every patient, and therefore selecting a patient for a specific procedure represents the first necessary step to a successful procedure. This review will describe every step of the selection process which the Interventional Radiologists is confronted with prior to performing a consolidation procedure in the setting of bone cancer. Defining the clinical setting is mandatory and includes assessing the patient's clinical status, cancer stage, level of pain and disability will help define the objective of the procedure: curative, palliative intent. A thorough imaging assessment is also mandatory, as it will define the type of consolidation (cementoplasty or fixation) which will be performed depending on the anatomical location and size of the lesion, the type of stresses at stake (compression or shear) and it will help plan the needle pathway and assess for possible complications. The process of selecting a patient for a specific procedure should be performed by the Interventional Radiologist but should be validated in a multidisciplinary approach. Moreover, the objective of a procedure, including the expected outcome and possible adverse events and complications should clearly be explained to the patient.

Feasibility study of 3-T MR imaging of the skin.

The purpose of this study was to assess the quality of 3-T magnetic resonance (MR) imaging of the skin, to describe skin anatomy at 3 T and to discuss future prospects of skin MRI. A 7-cm single-element surface receiver coil was developed for our 3-T MRI system. Thin sections were obtained with a three-dimensional FIESTA acquisition sequence and a spin-echo T1-weighted sequence (SET1). Prospective analysis was performed twice by two radiologists independently. Thirty-six healthy volunteers were included and underwent MRI on the face and the calf. Image quality was assessed regarding visibility of skin layers and quantification of artefacts. High field strength MR enables imaging of the skin with a high spatial in-plane resolution (87-180 microm), the total examination lasting 15-20 min. Image quality was excellent for the calf (mean SET1 quality = 96%) with a high intra- and interobserver correlation (SET1 kappa coefficient concerning visibility of epidermis, dermis and hypodermis > or = 0.84). Motion artefacts resulted in a small loss of quality and reproducibility for the face. In conclusion, 3-T MR allows high spatial resolution imaging of the skin and can potentially provide an accurate noninvasive means of analysing the skin.