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Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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OBJECTIVES: The purpose of this report is to describe the effect of computed tomography-guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. METHODS: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. RESULTS: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. CONCLUSION: Computed tomography-guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.
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Dolor en Cáncer/cirugía , Criocirugía/métodos , Dolor Intratable/cirugía , Cuidados Paliativos/métodos , Neoplasias Pélvicas/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Alta del Paciente , Estudios Retrospectivos , Factores SocioeconómicosRESUMEN
PURPOSE: We aimed to investigate the effect of the time interval from the clinical presentation of a thrombosed dialysis access graft to intervention on procedure success. MATERIALS AND METHODS: Records from two academic institutions for patients who underwent percutaneous thrombectomy of occluded surgical hemodialysis graft access sites in interventional radiology from 2006 to 2011 were reviewed retrospectively. The following data were recorded: gender, age, time and date of the initial request for a thrombectomy and the procedure, age of the surgical access, angiographic outcome, and clinical outcome (successful or unsuccessful postinterventional dialysis). Univariate and multivariate logistic regression were used to evaluate whether the time to intervention significantly affected the study endpoint. RESULTS: In total, 268 percutaneous thrombectomies were performed in 139 patients. Of these 224 (83.5%) were categorized as successful and 44 (16.4%) as unsuccessful. The time to intervention was 19.9±30.1 vs. 22±35 hours for successful and unsuccessful procedures, respectively. The difference between the two was not significant, and there were also no significant differences in covariate distributions between successful and unsuccessful outcomes. CONCLUSION: During the first 72 hours following clinical presentation of a thrombosed dialysis access graft, time to intervention may be considered independent of procedure outcome.
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Diálisis Renal , Trombectomía/métodos , Trombosis/cirugía , Tiempo de Tratamiento , Dispositivos de Acceso Vascular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trombosis/etiología , Dispositivos de Acceso Vascular/efectos adversosRESUMEN
PURPOSE: Plasma-mediated radiofrequency ablation (coblation) creates a cavity for directed polymethylmethacrylate deposition through molecular dissociation, providing a safe and efficacious cementoplasty for patients with high-risk, painful vertebral body metastatic disease. The purpose of this study was to retrospectively review and report details regarding the feasibility, safety, and efficacy of coblation and cementoplasty for treating painful advanced vertebral body metastatic disease. MATERIALS AND METHODS: Fifteen patients with painful metastatic vertebral body fractures with a posterior cortical defect and/or epidural tumor extension underwent percutaneous coblation and cementoplasty. Each patient's medical record was reviewed for technical success, imaging outcome, complications, and palliative effect. RESULTS: Of the 15 cases, 14 were completed successfully. Postprocedure imaging studies demonstrated adequate cement deposition within the targeted vertebral body without cement extravasation or fracture progression during the 1-3 months follow-up period. Pain relief was achieved in all patients, and no neurological damage was reported (mean follow-up, 141.1 ± 132.5 days). CONCLUSION: Percutaneous image-guided coblation-mediated cavity creation prior to vertebroplasty allows for safe, efficacious cement deposition in patients with metastatic foci. Future studies prospectively comparing this procedure with other standard-of-care regimens are warranted.
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Ablación por Catéter/métodos , Cementoplastia , Fracturas por Compresión/cirugía , Fracturas de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Fluoroscopía , Fracturas por Compresión/etiología , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Dolor/cirugía , Radiografía Intervencional , Estudios Retrospectivos , Fracturas de la Columna Vertebral/etiología , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/cirugíaRESUMEN
OBJECTIVE: We sought to compare the clinical outcomes of patients in whom pulmonary embolism (PE) has been ruled out with single-detector CT versus MDCT, given the improved visualization of subsegmental clots with the latter and the recent increase in use of CT for evaluation of PE. SUBJECTS AND METHODS: Two cohorts of patients undergoing CT for suspected PE with either single-detector CT (3-mm collimation and pitch of 1.7) or MDCT (2-mm collimation and pitch of 1) scanners were prospectively observed and compared using predefined criteria for evidence of subsequent thromboembolic disease during the 6 months after the acquisition of their initial scan. RESULTS: Ninety-eight patients were scanned using a single-detector CT scanner. Of these, none had evidence of subsequent PE or deep venous thrombosis (DVT), and six (6.1%) died of unrelated causes. Of the 100 patients scanned using an MDCT scanner, one (1.0%) had a subsequent nonfatal PE 2 months after the initial scanning, one (1.0%) had DVT 1 month after the initial scanning, and eight (8.0%) died of unrelated causes. No significant difference was found in either the probability of subsequent thromboembolic events (chi(2) = 0.3183, degrees of freedom [df] = 1, p = 1) or frequency of unrelated deaths (chi(2) = 0.2655, df = 1, p = 0.7829) between patients scanned using single-detector CT or MDCT protocols. CONCLUSION: Our results show that patients with suspected acute PE and negative CT results have acceptable clinical outcomes in the absence of anticoagulation treatment up to 6 months after acquisition of their initial scan. Furthermore, we found that the increased visualization of smaller, more peripheral arteries afforded by multislice technology did not affect clinical outcome.
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Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Anticoagulantes/uso terapéutico , Distribución de Chi-Cuadrado , Medios de Contraste , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Yohexol , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Embolia Pulmonar/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Embolia Grasa/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Biopsia , Líquido del Lavado Bronquioalveolar/citología , Embolia Grasa/patología , Femenino , Humanos , Alveolos Pulmonares/patología , Embolia Pulmonar/patologíaRESUMEN
The purpose of this study is to retrospectively examine the patterns of diagnostic modality utilization in the setting of suspected acute pulmonary embolism (PE) by physicians in the emergency department (ED) of a major academic tertiary care center. All patients (n=180) with a hospital discharge diagnosis of PE that were admitted through the ED during 1997 to 1999 were included. Overall test frequency and distribution, ancillary testing used when the initial ventilation-perfusion (V/Q) scan or spiral computed tomography (sCT) angiogram was nondiagnostic, concordance of V/Q and sCT, and sensitivities of D-dimer assays, arterial blood gas analysis, and deep venous imaging were assessed. There was a wide discrepancy in practice, most pronounced when first-line radiological studies were nondiagnostic. There was a poor correlation of PE detection between sCT and V/Q. D-dimer assay, arterial blood gas analysis, and deep venous imaging are insensitive tests for PE, and "gold standard" pulmonary angiography is rarely used.